2020-2021 DOCS Annual Report

UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE

Mitchell Wolfson Sr. Department of Community Service Annual Report 2020-2021

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Table of Contents Thank you from DOCS Our Mission Message from the Dean Our Year in Numbers Health Fair Screenings Intern Feature: Dr. Stephanie Lee Clinics Alumna Feature: Dr. Geeta Nayyar Health Fairs Resident Feature: Dr. Dijo Joseph Community Partner Feature: Pastor Gustavo Diaz Regional Medical Campus Emergency Preparedness Community Health Leadership Conference National Health Leadership Consortium Research and Quality Improvement Medical Student Feature: Alessandra Della Porta & Tara Tardino Longitudinal Access/Patient Navigation Alumna Feature: Dr. Sabrina Taldone Medical Informatics Interprofessional Education DOCS Executive Board

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4 6 7 8 10 12 14 18 20 32 34 36 39 40 41 42 44 46 48 50 51 53

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Thank you from DOCS This year has been unlike any other in DOCS history. The ever-changing landscape of the COVID-19 pandemic forced us to be innovative and adapt our infrastructure to continue to serve the medically underserved of South Florida. Without the support of our philanthropic donors, our hardworking students, and our volunteer physicians, this year would not have been possible. At the core of its mission is DOCS’ commitment to providing quality healthcare to the underserved in our community. Despite the challenges of this year, our volunteers remained committed to this mission. On behalf of the Wolfson DOCS family, we extend our heartfelt gratitude to everyone who remained steadfast in caring for our communities.

Over the past year, the medically underserved in our community have faced remarkable difficulties and the need for quality healthcare has been greater than ever before. We had the added challenge of ensuring the health and safety of not only our patients but also the volunteers necessary to operate our clinics and health fairs. The COVID-19 pandemic forced us to adapt and make changes to our existing protocols to ensure the safety of both our patients and volunteers. Our volunteers and fellow student leaders rose to the challenge and created innovative ways to continue the DOCS mission.

The COVID-19 pandemic forced us to call on our volunteers to restructure many of our existing projects and also assist us with projects typically outside the realm of the Wolfson DOCS program. For example, we created new protocols to limit the number of volunteers in each of our weekly clinics, created screening protocols for patients, and utilized telehealth when possible. We created a new appointment-system to replace our usual walk-in style health fairs and were successful in hosting 6 smaller-scale health fairs throughout the year. Our student volunteers were also instrumental in the distribution of the COVID-19 vaccine, working with Jackson Health System leadership at vaccination sites in early 2021.

The unprecedented year has prompted us to reflect on how much the Wolfson DOCS program has changed our lives as students and future physicians; we personally feel so grateful for the unparalleled experiences that DOCS has given us in the realms of leadership, mentorship, and friendship.

We want to express our gratitude for the incredible generosity of the Mitchell Wolfson Sr. Foundation.

Their commitment to the sustainability of the DOCS program allows us to deliver consistent care to the patients in our community while also training the next generation of physician leaders to foster a lifelong commitment to serving the needs of underserved patients.

Lastly, we profusely thank our DOCS faculty advisor, Dr. Amar R. Deshpande, and RMC DOCS faculty advisor, Dr. Julia Belkowitz, for their constant guidance of our program and dedication to its success.

We also thank our DOCS Manager and “Mom,” Raysa Christodoulou, whose daily support and assistance to our students cannot be overstated. Finally, we thank the Medical Parents Association. Although we missed them greatly at our health fairs this year due to COVID-19 limitations, their support for our students remained.

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While the delivery of care in 2020-2021 was different than it has been for the prior 20 years of our history, we are so proud that our student leaders and volunteers rose to the challenge and created ways to continue the Wolfson DOCS mission. We look forward to the continuing evolution of the program as our community continues to adapt to the COVID-19 pandemic.

Sincerely,

Sophia Pines

Alexa Turpin

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Our Mission DOCS is dedicated to providing preventive, primary, and subspecialty healthcare to the medically underserved populations in South Florida in collaboration with medical students, physicians, and allied health students and professionals at the University of Miami Miller School of Medicine through:

Leadership:

Fostering students’ leadership abilities among peers, patients, and the community

Training:

Providing formal training and practical experience, allowing students to hone essential clinical skills

Education:

Realizing the importance of not only educating ourselves but also our patients and the communities in which we live

For more information please visit us online at: https://umdocs.mededu.miami.edu/ http://udocs.med.miami.edu/ https://www.facebook.com/UMDOCS

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A Message from the Dean

“The DOCS program represents one of the Miller School’s most fundamental and essential missions: service to our community. Our students and faculty bring medical care to neighborhoods whose residents often have no other way of getting this care. The patients’ gratitude and their hope for good health in the future are an inspiration to all of us. It is a privilege to be the dean of a medical school whose students are so committed to providing help to every member of our community who needs it.”

Henri R. Ford, MD, MHA Dean and Chief Academic Officer University of Miami Miller School of Medicine

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Our Year in

682

UM Faculty Hours

8

535

Resident Physician Hours

218

Medical Student Volunteers

n Numbers

374

Patients seen at Health Fairs

505

Patients seen in Clinics 9

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Bl o

Number of Patients Served

2020-2021 2020-2021 Health

400

350

150

100

50

0

374 361

300

250

200

238 21

147 124

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at e

h Fair Screenings Screenings

16 223 223 243 164

93

56 60 2 29

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Intern Feature: Stephanie Lee, MD What is your current involvement with DOCS? What initially made you interested in becoming involved?

For the past year, I have been one of the resident volunteers at the Final Doctor Evaluation (FDE) Station at the DOCS Health Fairs. At this station, I work with medical students trained as patient navigators to review with patients the results of their health assessments from the various stations. We also answer questions about the impact of these results on patients’ future health, and we work together to get patients connected to primary care providers and crucial sub-specialty follow ups that they would have otherwise struggled to obtain or never seen at all.

I actually first heard about DOCS when I was a medical student in Oklahoma. I was one of the delegates for my medical school to the American Association of Medical Colleges’ Organization of Student Representatives and every year I remember the University of Miami submitted several research projects highlighting many of their community outreach efforts at the medical student level through DOCS. Prior to applying for residency, I also presented a poster at DOCS’ 2019 annual conference and was able to see firsthand this student body’s dedication towards serving those with barriers to healthcare access. Seeing how pervasive the spirit of service was even in the medical school curriculum helped influence my decision to rank University of Miami/Jackson Health System’s Med-Peds program as my #1 choice. So it was only natural that I jumped at the chance to volunteer with DOCS this year as a resident!

Is there a similar program where you went to medical school?

Yes, there is a student organization called the University of Oklahoma Community Health Alliance (OUCHA). I was the president of the organization during my 3rd and 4th year of medical school. It’s organized very differently from DOCS in that instead of several health fairs spread throughout the local area, our volunteerism and community outreach efforts were focused on collaborating with 14 different local, free to low cost healthcare clinics. In addition, OUCHA hosted health fairs for the Oklahoma City Public School System (where children were taught about healthy lifestyle habits), Stop the Bleed courses for the community, a statewide conference about bridging the access gap in healthcare, and several other fundraisers and workshops throughout the year. The main goal of both organizations though is the same: to teach medical students how to extend care to underserved populations and promote the passion of giving back to the communities that we serve.

What impact do you see that DOCS has on the communities we serve?

I think taking care of our own health is something that is very difficult for the average person to do, even when they are healthy. I love volunteering with DOCS because the efforts made through the health fairs give our patients ownership and awareness of their own health status, sometimes for the first time! We can go a long time in our life without seeing a doctor because life gets in the way (working long hours, busy home life, prioritizing our family or friends over ourselves) but DOCS being accessible to so many communities helps remind people that when they’re ready to take the first steps to live a healthier life, someone will be there to help them get started on the right road.

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What does DOCS offer to interns and residents?

As a Med-Peds resident, I often work in the hospital where I see both children and adults with their families in the worst moments of their life. At that time, I hear so many people start to regret not prioritizing their health sooner and I sometimes even have to deliver bad news that the patients may never regain their previous functional status. DOCS is a reminder that there are still patients out there that are not as sick yet and are very motivated to seek help for their health concerns. It’s a nice refresher from my usual daily work routine!

How has your involvement in DOCS impacted your current practice of medicine?

The cool thing about DOCS is that I get to see a population of patients that sometimes never make it into the clinic I work in for one reason or another. I have learned so many valuable lessons including how access to medications goes beyond just the ability to afford it and reliable transportation sometimes requires monumental sacrifices for an entire family. Oftentimes it’s either the patients or medical students who help to teach me these lessons every fair.

What role does DOCS have on medical education? Why is it important for medical students to participate?

Learning medicine is truly something that is done through service and repeated experience. I strongly believe that my current foundation of knowledge today was built through the patients that I saw during my training, not just in my medical school curriculum but also through volunteerism. DOCS is beneficial in that medical students can be exposed to direct patient care quite early in their educational careers and also understand the impact that their knowledge and time can have on a large population of people. In addition, I have heard multiple times while serving with DOCS how much the community is uplifted by the fact that a young generation of future doctors will take time out of their busy schedules to volunteer to talk to them.

What were your favorite experiences this year while volunteering with DOCS? I did not know anyone in Miami, other than the people I met in my residency, prior to moving here. Volunteering with DOCS has given me a chance to get to know some amazing medical student leaders (who I now get excited to work with when they rotate with me on Internal Medicine or Pediatrics), become closer to some of my Internal Medicine and Family Medicine co-residents, and get to really know the cultures and people who live in Southern Florida!

How has your experience at health fairs changed during the COVID-19 pandemic?

In previous health fairs I’ve worked at, I’ve always felt like there was a giant swarm of people who come in sporadically throughout the day. DOCS leadership has come up with a clever organization for the people who come to the fair to follow a steady flow throughout the day to respect physical distancing guidelines. It has given more time to really focus on each individual patient who comes to the FDE station and allows more time to delve into health topics with medical students.

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Clinics

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San Juan Bosco Clinic The DOCS San Juan Bosco (SJB) Clinic is a student-run, free clinic that operates every Tuesday night and rotates through seven different medical specialties: cardiology, psychiatry, neurology, pulmonology, rheumatology/musculoskeletal, gastroenterology, and urology. Our patient population consists of individuals who do not have insurance and are at or below 200% of the federal poverty level.

We offer laboratory and diagnostic testing at no cost to patients, help obtaining a Jackson discount card for those patients who need advanced specialty care or procedures, a patient assistance program that gives patients low-cost access to expensive medications, and referrals to various outside resources including physical therapy, psychotherapy, colonoscopy/endoscopy, and sleep studies.

Our student-run night clinic has continued to grow and improve through various new initiatives. In order to decrease patient wait times and maximize quality of care, we have implemented a scheduled appointment system with patients scheduled in phased time slots throughout the evening. We also limited the number of patients seen per evening, focusing our resources on patients with no other access to specialty care and referring patients who were eligible to Jackson Memorial Hospital. We also updated our protocols to have an SJB student clinic staff member assigned to each patient room as part of the healthcare team during encounters, which proved to greatly improve the flow and efficiency of each night.

SJB staff has worked diligently and safely to continue to provide quality patient care throughout the COVID-19 pandemic. To limit patient exposure and risk, we implemented COVID-19 questionnaires and temperature checks completed outside the clinic. We were flexible in maintaining half of our staff members in person while the other half worked off-site, limiting patient flow in accordance with COVID capacity requirements, and utilizing proper protective equipment throughout clinic nights. We are very grateful for our patients who allow us to serve them and would also like to thank Berta Cabrera, Luz Gallardo, our doctors, and our student volunteers who give their time and energy to make this clinic such a success.

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clinic nights

172 patients seen

71

physician volunteers

385

student volunteers

SAN JUAN BOSCO CLINIC

DOCS

Mitchell Wolfson Sr. Department of Community Service

Center for Haitian Studies Clinic

117 65

visits completed

patients seen

The creation of the Center for Haitian Studies (CHS) DOCS Night Clinic was inspired by the desire to expand healthcare access to the Little Haiti area of Miami. We have a strong relationship with the Little Haiti community in partnership with the Center for Haitian Studies, a beacon in Little Haiti for both health and social needs of the community. The Center of Haitian Studies is also the site of the annual DOCS Little Haiti Health Fair, which further strengthens our relationship with the community. Through this clinic, we aim to create more continuity for the patients seen at the DOCS health fairs each year.

The CHS DOCS Night Clinic is held every Monday night, offering primary care. In October 2019, we expanded to offer gynecologic services on the first Monday of every month. In November 2020, we began offering gastrointestinal services and sigmoidoscopies. We have been able to provide our patients with primary care and health screenings, routine laboratory evaluations, and valuable patient education and counseling, as well as establishing their care at Jackson should they need to see specialists for more complex health issues.

CENTER FOR HAITIAN STUDIES

DOCS NIGHT CLINIC 16

The partnership between CHS and DOCS has led to increased access to care for those in the Little Haiti community who are otherwise unable to access the day clinic. We have been working with community partners at local events to increase community awareness of the services we provide at our new clinic. Since our grand opening on February 11, 2019, we have seen hundreds of patients with the help of numerous volunteer physicians, medical students, and 8 clinic staff during our primary care, women’s health, and GI nights. We are very grateful for our patients who allow us to serve them and would like to thank Dr. Pierre, Dr. Metellus, Gina Marie Augustin, and Sonide Cherisier for their support in making this clinic a reality.

IDEA Clinic The DOCS IDEA Clinic stemmed from a partnership with the IDEA Needle Exchange Program, the first legal syringe exchange program in Florida. The goals of the DOCS IDEA clinic include addressing patient healthcare needs in a timely and comprehensive manner, working with patients to increase their trust in the healthcare system, and providing important educational opportunities for medical students regarding harm reduction. In addition to offering general primary care services and free point-of-care HIV and Hepatitis C testing, student volunteers at our clinic work with surgeons, dermatologists, and emergency medicine physicians to treat skin infections and abscesses that often occur secondary to chronic use of injectable drugs. Our physician volunteers educate both students and patients not only in the principles of harm reduction and wound care and prevention but also in methods to encourage historically marginalized patient populations to access healthcare. Through these efforts, we have been able to reach a variety of patients with primary care and wound care needs in the Overtown Community.

Additionally, the DOCS IDEA Clinic staff have also developed and presented successful lunch-and-learn sessions for UM medical students. The first session focused on the way language and stigma impact care for people who inject drugs, while the second, in conjunction with the AMA student section, focused on the use of naloxone and lived experiences of people who inject drugs. These sessions were well received and future programming is planned.

In June 2019, Governor Ron DeSantis signed the 2019 IDEA Act, to expand the Miami-Dade pilot needle exchange program statewide. In collaboration with the DOCS National Health Leadership Consortium, the DOCS IDEA Clinic staff is now providing ongoing support to students at other Florida medical schools looking to expand our clinic model. This year, we have also implemented a grant that allows patients to access buprenorphine free-of-charge to aid in their recovery from opioid use disorder. We would like to thank Dr. Hansel Tookes, Dr. David Forrest, and the entire IDEA Exchange Staff for their support and guidance.

268 patients seen

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Alumna Feature: Geeta Nayyar, MD, MBA As a nationally recognized leader in healthcare information technology, a physician executive, public speaker, and author, Dr. Geeta Nayyar loves sharing her unique perspectives that bridge clinical medicine, business, communications, and digital health. She currently serves as General Manager of Healthcare and Life Sciences and Executive Medical Director for Salesforce.

As a specialist in rheumatology, Dr. Nayyar maintains a voluntary appointment with the University of Miami and serves on the University of Miami Medical School Alumni Association Board. She has held several positions in media and with professional societies, including as a medical contributor for CNN and as a member of the Health Information and Management Systems Society (HIMSS) board of directors.

What is your current area of practice?

Internal Medicine & Rheumatology Can you tell us about your involvement in DOCS? I am a regular attending precepting/mentoring medical students and seeing patients.

How has DOCS impacted your professional career?

DOCS has been one of the most rewarding experiences of my professional career. The energy, enthusiasm, and thirst for knowledge of the medical students, along with their passion for making an impact in our local communities is infectious. During such a historic time in medicine, it has been so inspiring to work alongside such bright and passionate future physicians. I’m so proud to be a UM Alumna. I also serve on the UM medical school alumni board, so when I am able to see first-hand the work we do impacting medical students, it is that much more rewarding to pay it forward for the next generation of physicians.

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Miami Herald article co-authored by Dr. Nayyar, Dr. Taldone, and MS2 Pranusha Atuluru

What role do you feel DOCS plays in medical education?

DOCS is clearly a core part of the medical education that the UM medical students benefit from. It is real world application of the complex pathophysiology that medical students come to higher education for. DOCS is where the books meet real life. It also empowers our medical students to understand social determinants of health and that many forces outside of medicine ultimately affect health outcomes. It teaches them the importance of incorporating this into bedside manner and management recommendations.

What impact has DOCS had on the medically underserved communities of South Florida?

In my experience we provide primary care for so many of the underserved that have nowhere else to go, whether it is questions about getting vaccinated or managing everyday diabetes and hypertension. It’s clear to me that this community needs both a doctor and an advocate; our students help with both.

How has your experience changed during the COVID-19 pandemic?

I think the work we do at DOCS has become that much more important, all while ensuring safety for staff and students first. I am impressed by our ability to adapt and our patients’ ability to adapt. Embracing telemedicine, new protocols, and shift management has been a great part of the learning, but also understanding how to scale the patient/physician experience through technology has been phenomenal to be a part of and inspiring as we think about the future of medicine and our supply/demand issues for top talented doctors and nurses.

Dr. Nayyar with medical students at CHS clinic

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Health Fairs

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Little Haiti Health Fair Center for Haitian Studies Nov 14 2020

The Little Haiti Health Fair (LHHF) is hosted at the Center for Haitian Studies, a non-profit organization that works with local memers of the large Haitian community living in Miami. The ability to partner with and serve the Haitain community makes this fair a unique and exciting experience for DOCS students and physicians. The Little Health Fair was our first smaller scale, socially-distanced health fair held during the COVID-19 pandemic.

We followed COVID-19 safety precautions by pre-registering all patients, implementing unidirectional patient flow during the fair, involving translators remotely via Zoom, and limiting capacity of patients and student volunteers. The rest of the health fairs held during the pandemic were modeled after the intial protocol developed for LHHF.

LITTLE HAITI HEALTH FAIR

DOCS

Mitchell Wolfson Sr. Department of Community Service

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West Kendall Health Fair Capilla del Rey Jan 16 2021

The West Kendall Health Fair provides healthcare screening services to a community that primarily consists of Hispanic immigrants. This was our third year partnering with Capilla Del Rey, a church that is located in the heart of West Kendall.

Despite the challenges faced because of the COVID-19 pandemic, we were able to hold a successful health fair and further strengthen our relationship with the church and the local community.

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Florida Keys Health Fair

Marathon Middle High School Jan 30 2021

This year marked the 50th annual health fair that DOCS has hosted in the Florida Keys. The Marathon Health Fair was able to provide health care to almost 100 patients in a safe and effective way by utilizing the support of our community partners and flexibility of physician volunteers.

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Liberty City Health Fair Belafonte Tacolcy Center Feb 20 2021

Liberty City is a community that truly represents the culture and history of Miami.

Though just a few miles away from our medical campus, the healthcare challenges that this community faces continue to be evident. Through the Liberty City Health Fair, we aim to address these medical concerns by providing on-site care and resources to community clinics. Liberty City is known to be in a food desert where access to healthy fruits and vegetables is difficult for families. We provide each family with a fresh bag of fruits and vegetables to help the community stay healthy. Through our annual fairs, we work to connect this spirited community with health awareness and education.

LIBERTY CITY HEALTH FAIR 28

DOCS

Mitchell Wolfson Sr. Department of Community Service

South Dade Health Fair

Branches United Methodist Church March 13 2021

The South Dade Health Fair aims to provide medical care to uninsured, low-income, and migrant worker families in the Florida City and Homestead areas. This year, we reached out to local community organizations and farms to engage those populations who may otherwise lack access to routine health screenings.

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Fort Lauderdale Health Fair New Hope Baptist Church May 8 2021

This year’s Fort Lauderdale Health Fair was held in Broward County in partnership with the YMCA of South Florida, which provides community engagement and health navigation resources to the Fort Lauderdale population. We also had the opportunity to work with the New Hope Baptist Church of Fort Lauderdale, where we hosted the fair. These partnerships expanded our network of community outreach and the patient population that we were able to serve. Our diverse patient population spanned from locals in the Fort Lauderdale area to underserved community groups in Pompano Beach.

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Resident Feature: Dijo Joseph, MD What is your current involvement with DOCS? What initially made you interested in becoming involved?

I had the opportunity to be a resident physician volunteer at the DOCS health fairs. I was heavily involved in a similar health fair in my medical school and always appreciated the residents coming out to assist so I jumped at the opportunity when I had a chance.

Is there a similar program where you went to medical school?

I went to medical school at FSU and we had a similar program that had just started when I was a first year medical student. It was in its infancy and we had a lot of challenges on how to best serve the community but it was an incredibly fulfilling experience with a lot of learning, community outreach, and grass roots drive.

What impact do you see that DOCS has on the communities we serve?

It promotes overall health awareness and literacy. It provides people with resources that they may have not known existed prior to exposure to these health fairs. As physicians, >50% of our job is to be good teachers to our patients. Any opportunity to reinforce that education for our patients is time well spent and I think DOCS health fairs accomplish that well.

What does DOCS offer to interns and residents?

It’s a fantastic opportunity to teach and a reminder of how far I’ve come in my medical education. Sometimes we forget what it was like to be a medical student and how challenging it can be. To be on the other side as a resident now, being able teach and watch the dots connect in a low pressure environment is really enjoyable.

How has your involvement in DOCS impacted your current practice of medicine?

It’s reinforced the importance of health education with my patients. Finding ways to educate patients in simple and sometimes creative ways can sometimes be more impactful than prescribing a new medication.

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What role does DOCS have on medical education? Why is it important for medical students to participate?

Any opportunity for clinical exposure is always time well spent. Medicine is never clear cut and sometimes you have to work with what you have. These health fairs are a great opportunity to practice those skills of meeting patients where they are at and working with them from there.

How has your experience at health fairs changed during the COVID-19 pandemic?

I don’t know that it has impacted it much from my perspective, at the end of the day I’m there to assist in the education of patients and medical students any way I can.

“We had a patient who was experiencing classic anginal symptoms that were becoming progressive. Because of the DOCS health fair we were able to identify this patient and get him plugged into Jackson where he was found to have a myocardial infarction and was treated appropriately. The DOCS health fair changed the trajectory of this man’s life. This became a fantastic opportunity to teach medical students of how to identify alarm symptoms in chest pain as well.”

- Dr. Dijo Joseph

Dr. Joseph with medical students at Men’s Health Station

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Community Partner Feature: Pastor Gustavo Diaz What is your current professional role? Please tell us a little bit about Capilla del Rey. I am the administrative pastor at Capilla del Rey. I manage the day-to-day operations of the church in order for our senior pastor to have time to devote to prayer, scripture and ministering to our congregation. At Capilla del Rey we always tell people that we are a church for the whole family and we live by that. Our children’s, youth’s, men’s, and women’s ministries all work in tandem to minister to the family as a unit. We strive to bring families closer together by bringing them closer to Christ as we minister to their individual needs.

As pastors, preachers, and Sunday school teachers, we are trained to minister to our community’s spiritual and emotional needs, but we realize that our community also has physical needs.

As we strive to make people spiritually healthy, we also want them to be physically healthy. That is why we are so happy to partner with UM every year for the health fair. The service UM provides for our community is so important. Every year we hear from people that they had never been to a dermatologist, gotten screened for cancer, or spoken to a mental health professional until they got that care at the UM health fair. One would think that because we are in Kendall, everyone is affluent and well taken care of, but the truth is that the need in our community is great. Right up until the COVID-19 pandemic we hosted a cafeteria for elderly folk. One hundred elderly people coming here everyday to socialize and eat lunch. For many of them that was their only healthy meal of the day. For others it was the only time they ever got to leave their house or even speak to anyone outside their household.

How was your experience as the key community partner for the West Kendall Health Fair?

We love hosting the West Kendall Health Fair. We have hosted the fair for three years now and it has been a wonderful experience. The students that organize the event are kind, understanding of our limitations, and so hard working that it is honestly a joy to work with them. We are forever grateful to Dr. Andres Lopez, a member of our church and UM Miller School of Medicine graduate who is the person that originally contacted us about hosting the West Kendall Health Fair.

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The team leaders every year have been exceptional. Dr. Nicole Cruz who directed the fair in 2019, Rick Lin in 2020 and Ankit Shah in 2021. Their attention to detail, preparedness, and ability to lead their team made all the difference. Their energy and enthusiasm were unending. Their passion and positive attitude were contagious. Everything was run by us to make sure we were comfortable with what would be happening. Great care was taken at all times to protect our property. Clear goals were set, schedules were met, and the fairs ran great.

But having said all that, I must add that the greatest joy was from seeing all the good done for the community. Every year we hear dozens of testimonies about how the fair impacted patients’ lives; some going as far as saying that the fair saved their lives. A member of our church had been experiencing discomfort and dizziness and found out at the fair that his blood sugar was high. He was able to get treatment and bring his sugar levels under control. A woman in our church had been feeling pain in her bones. The bone density scanner showed bone loss. She took this to her primary care physician and is getting treatment. There are dozens of stories like this that I know of. I can only imagine how many more that I do not know of. For us, partnering with UM for the health fair has been an enormous blessing. One we hope to continue.

How has DOCS impacted the West Kendall community? Why do you think it’s important for students to get involved with the community?

After the health fair, some of the top comments I hear from people are “UM cares” or “the students care” or “the doctors care.” People appreciate the effort, and they are grateful for it. The health fair does not just help people get medical attention; it uplifts their faith. Because it lets them know that they are not forgotten and that someone cares enough to reach out to them. The DOCS program comes into West Kendall and spreads all that kindness. You are having a deeper impact in the lives of hundreds of people. I know because I get to speak to them afterwards and hear their stories.

“Being a pastor is my great privilege. And in a way, I believe, it is like being a doctor. I tend to people in need and help heal their hurt. But sometimes it feels like I live in a bubble. I am constantly surrounded by friends, family, and fellow church members who share my same ideals and faith. Therefore, every so often, I have to step outside of that bubble and go meet the rest of the community. The ones that do not come to me, but nonetheless need my help. That is another way in which doctors and pastors are similar. There are some people who will make it to the hospital or to the clinic. But there are a whole host of people who, for one reason or another, will not make there. They suffer in silence until someone comes to them to help.”

- Pastor Gustavo Diaz

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Regional Medical Campus Projects

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Caridad Clinic Caridad Center in Boynton Beach is the largest free clinic in South Florida; it provides healthcare to uninsured and low-income patients. DOCS partners with Caridad Center in order for UM faculty and students to provide free primary care appointments to Caridad Center patients on select Saturdays.

During the COVID-19 pandemic, our team worked with Caridad Center to convert these clinics into a virtual setting through transition to a telehealth platform.

Guatemalan Maya Center (GMC) The Guatemalan Maya Center (GMC) is a non-profit community organization located in Palm Beach County that serves the Guatemalan Maya immigrant population in South Florida. In past years, DOCS has held health literacy workshops focusing on community education topics such as diabetes, physical activity, nutrition, and healthcare utilization, along with a simultaneous pediatric program complementing the adult curriculum to engage the children and encourage families to come together.

With the COVID-19 pandemic, the GMC team was not able to host these classes, as gatherings were prohibited, and access to technology for virtual classes within this community was limited. Early in the pandemic we focused our efforts on disseminating information on COVID-19 prevention and the importance of vaccination. We compiled information from the CDC on both the virus and the vaccines and produced flyers for the community that were translated into Spanish as well as various Mayan languages. Regarding other health concerns of the community, we also partnered with Aids to Victims of Domestic Abuse (AVDA) on a project to quantify the prevalence of intimate partner violence within the community, a concern brought to our attention by GMC staff. With the information collected, we plan to assist the GMC in applying for a grant for a social worker to address these concerns. As the year comes to a close, and with the lifting of some COVID-19 restrictions, we have recently been able to organize a community resource fair at the GMC with the aim of connecting families to free or low-cost health resources available to them.

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Healthcare Access The RMC DOCS Healthcare Access Project aims to educate and empower students regarding the health insurance and healthcare resource options in Palm Beach and Broward Counties, as well as provide students with public health volunteer opportunities in partnership with the Health Council of Southeast Florida (HCSEF). In August 2020, DOCS represented HCSEF at a community back-to-school fair at the Edna West Runner Center in Jupiter, where we interacted with over one hundred families. We provided back-to-school supplies for their children and distributed bilingual flyers on health insurance and health literacy workshops.

The major initiative of the Healthcare Access team this year was to digitize the “white coat pocket cards” developed in previous years for Palm Beach and Broward County. We converted the pocket cards into a curated, up-to-date webpage on the DOCS website, adding hyperlinks and scrollable maps as pertinent. We then created a dynamic scannable QR code which connects to this page and designed a sticker bearing this QR code, which is being distributed to incoming RMC medical students to attach to their hospital badges. We also updated and expanded the GIS resource map, which details free and reduced clinics and other healthcare resources. Plans are currently underway to expand the QR code health resource sticker initiative to include distribution of stickers to residents at our RMC rotation sites as well as inclusion of the main Miami campus in the initiative, with a separate list of resources for Miami-Dade County.

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Emergency Preparedness The Emergency Preparedness Response Team organizes hands-on training for medical students and volunteers at monthly health fairs in the greater South Florida area to prepare our community for a variety of emergency situations.

Given the challenges this year with in person events, we were unable to organize our annual mass casualty, active shooter, and “Stop the Bleed” events. However, we were able to uphold a core tenet of our group and engage in an active response to the COVID-19 pandemic and then vaccination efforts through a partnership with the Poison Control Center and Florida Department of Health. We look forward to continuing our work with the COVID-19 response and the opportunity to have an active role in an ongoing emergency affecting our campus and community.

Our team was able to continue our efforts at DOCS health fairs, which included providing information about firearm safety and safe gun ownership, accidental overdose and accidental poisoning, hurricane preparedness, and home fire prevention. A new addition to the station this year was providing information on COIVD-19 vaccine distribution information.

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Community Health Leadership Conference Jan 23 2021

The fifth annual DOCS Community Health Leadership Conference (CHLC) was held virtually on Gather.Town, on January 23rd, 2021. We had 150 participants from 21 medical schools throughout the country in attendance, making this the largest DOCS conference to date. We displayed over 70 unique posters on community health initiatives at student-run free clinics, health fairs, and healthcare service organizations across the United States.

This year, we had the pleasure of hearing from our Keynote Speaker, Infectious Disease physician Dr. David Serota, who spoke about the impact of COVID-19 on underserved communities throughout South Floria. The virtual format on Gather.Town featured poster sessions, presentation conferences, social rooms, and even a beach allowing participants to engage with each other in real time.

We are very proud of our success over the past 5 years and are hoping we can continue improving the conference to become the premier national event for leaders at student-run health initiatives to share, collaborate, and improve the services they provide to their patients.

Awards Gala Highlights

First Place Poster Presentation: UT Southwestern “Developing A Student-led Patient Navigator Program for Individuals Experience Homelessness” Second Place Poster Presentation: Northeast Ohio Medical University “A Survey Analysis of Telehealth across to Geriatric Patients During Covid-19” Third Place Poster Presentation: Northeast Ohio Medical University “Development And Implementation Of Virtual Patient Education Training For Pharmacy And Medical Students At A Student Run Free Clinic”

Interactive Poster Session on Gather.Town

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National Health Leadership Consortium The DOCS National Health Leadership Consortium (NHLC) aims to be a national springboard for discussion and collaboration among medical students seeking to serve their communities, in addition to aiding students in creating and realizing meaningful community health initiatives at their own institutions. The initiative continues to evolve with the goal of involving more students, organizations, and institutions nationally. Our information-sharing model has already had several successes, including:

Florida Clinics Collaborative (FCC): In partnership with the University of Florida, DOCS NHLC

formed a Florida Clinics Collaboration that includes the medical schools from across Florida. We have assisted other Florida medical schools with a variety of endeavors, including assisting Florida International University medical school in setting up REDCap to use as their electronic medical record system for health fairs, sharing the details of the UM DOCS upperclassmen clinical elective structure with University of Central Florida, and sharing online training modules and standard operating procedures with all other Florida schools who are looking to implement Intimate Partner Violence training into their free clinics. Lastly, during the COVID pandemic, we disseminated DOCS protocols to other schools that showed how we were updating our procedures and communicating with local health systems.

NHLC is actively advising a group of interested students at the new Nova College of Allopathic Medicine in how to start a free health fair and clinic in the setting of a new medical school. NHLC aims to help Nova identify a health fair site and scope of services in a way that is sustainable for a newly founded organization and establish their inaugural health fair.

National Clinics Collaborative (NCC): NHLC has begun to expand the Florida Clinics Collabora-

tive Model to other states and regions around the country. NHLC aims to disseminate the DOCS model by creating a “starter-kit” for how to start a clinic and/or a health fair using the DOCS structure as a guideline.

NHLC has partnered with UF to create a survey to assess clinic and health fair demographics that will be disseminated nationally to assess needs for clinic and health fair services. In this endeavor, the establishment of NCC has been successful in connecting clinic collaboratives in almost every state and creating an organization in which clinics from across the nation can learn from each other in improving patient care for their respective populations.

IDEA Clinic Expansion: After meeting at the annual DOCS Community Health Leadership Confer-

ence, medical students at University of Central Florida (UCF), University of Florida (UF), and University of South Florida (USF) all expressed interest in establishing their own needle exchange clinic modeled after the IDEA Needle Exchange. NHLC facilitated meetings between the UCF and UF student groups and Dr. Hansel Tookes, founder of the Miami IDEA Clinic, to help them navigate the current political landscape and engage key community leaders. NHLC has also connected with students in Texas, California, Arizona, and New York who are interested in collaborating on needle exchange programs.

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Research and Quality Improvement (RQI) DOCS has a very rich and vulnerable patient population and a unique structure in terms of the services we provide and our elaborate student network. Research and quality improvement (RQI) projects are an important part of the sustainability and continued growth of DOCS. These projects allow us to evaluate our current processes and implement quality improvement projects and new initiatives that will help in our ultimate goal of improving the quality of care we provide. We provide so many valuable services, but without having a systematic way of analyzing the purpose or outcomes of those services it is hard to evaluate the impact of our work. RQI is an avenue through which we can actively reflect on our standard of care. We strive to improve our ability to connect patients to the health care system and train medical students in various aspects of physicianship. Our major projects this year include:

DOCS Social Needs Resources Navigation:

Adequate medical care is intrinsically tied to understanding and addressing social determinants of health, and DOCS has always been dedicated to reducing these barriers. Volunteers worked this year to identify domains of social needs that are barriers to health. For 5 of our health fairs this year, they created lists of resources that address specific domains of social needs that patients may have difficulties accessing, such as housing, food security, and access to childcare.

Future steps for this project include compiling these resources into a database that can be iteratively reviewed and updated. Our DOCS clinics are currently developing an active intake and screening process for longitudinally connecting patients to resources.

Patient Education Modules:

Our patient education modules were developed this year as an initiative to maintain connections with our patient populations virtually during the ongoing COVID-19 pandemic. Over the past year, the DOCS health fairs and clinics were unable to serve the traditional volumes of patients that are seen in a typical year. In addition, some DOCS student volunteers missed out on vital opportunities to learn about counseling patients on common medical conditions due to physical distancing constraints at our health fairs and clinics. Video modules were created in conjunction with health fair station managers who identified the most common conditions and questions from patients who attended their stations in the past. Station Managers then guided a team of student volunteers in developing visual guides and scripts that would address key questions and concerns that patients may have with regard to their health, with evidence-based medicine guiding their recommendations. RQI team members then created videos and ensured that they were culturally representative of our target patient populations, included easily understood terminology and avoided medical jargon, and were translated into our other predominantly spoken languages such as Spanish and Creole. Thus far, 6 educational videos have been produced and are shared on our Facebook page to maintain connections with our patient population.

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Collection of Patient Education Modules on YouTube

created by Health Fair Station Managers, MS1 volunteers, and RQI representatives

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Medical Student Feature: Alessandra Della Porta & Tara Tardino

What is your current role in DOCS? What responsibilities does your role entail?

Alessandra: My current role is DOCS is the Emergency Preparedness (EP) Senior Advisor. In this role, I work alongside the project manager, station manager, and team to advance the two aims of our project. First, we aim to better prepare members of our community for everyday emergencies through DOCS health fairs, where we disseminate information about various environmental, medical, and social emergencies. Second, we aim to better prepare the University of Miami student body to respond to emergencies, specifically with respect to mass casualty events, such as active shooter training and hemorrhage control.

Tara: I currently serve as DOCS Emergency Preparedness Team Project Manager. I lead the effort in organizing community emergency response projects as well as organizing emergency preparedness trainings/educational programming for medical students.

Can you tell us more about the structure of EP and how your team mobilized to effectively respond to the COVID-19 pandemic? What challenges did you face?

Alessandra: While the EP team has a rather small core group of leaders and members, we were able to accomplish a successful response to the COVID-19 pandemic. Very early on last March we were contacted by the Poison Control Center (PCC) and Department of Health to assist with the creation of a hotline for disseminating information to community members. Our relationship with the PCC is something that we have fostered for the last several years and we feel incredibly blessed to have access to their resources on our campus. Over the course of the spring and through the early summer, we initiated and maintained a 24/7 hotline to ensure that whoever needed the information could access it. We owe our success to the hundreds of student volunteers who worked tirelessly to staff the hotline with EP. Since that time, we have continued to work on projects both for the PCC and the university to continue educating ourselves and Miami-Dade residents.

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Tara: In January of 2020, I served as Assistant Coordinator for DOCS EP with the goal of creating a connection between the PCC and DOCS. I was starting my MPH field experience at the PCC when I took on this DOCS position and planned to facilitate a partnership with the center in which students could come and listen in on calls to the center (from providers and the public) and learn how to manage acute poisonings. Things turned upside down when the COVID-19 crisis began, and although I plan to develop this poison educational opportunity for students moving forward, our team was able to mobilize to address the COVID-19 pandemic instead. On March 9th, 2020, Dr. Weisman, Director of the Center, requested help from the DOCS Emergency Preparedness Team in staffing the hotline. In under 24 hours, our team recruited 48 medical student volunteers to come to the center for training, and within one week over 100 medical students had signed up to volunteer with the hotline. Since the hotline went live over a year ago, more than 200 medical students have volunteered at the hotline, totaling over 1500 volunteer hours (equivalent to 62 full days!!) in community service. As the vaccine rollout began, students were able to respond to calls regarding distribution as well as reports of vaccine adverse events. We offered leadership opportunities to students by way of staffing the volunteer effort and teaching other students on how to respond to calls. We were able to provide a one-of-a-kind learning opportunity for students on how to respond to a pandemic, keep up with ever-changing CDC and Department of Health guidance, as well as how to extend that knowledge to the greater Florida community.

How has your involvement in DOCS impacted your medical school career? Why do you think it is important for medical students to participate in DOCS? Alessandra: My time with DOCS EP has been truly phenomenal. I have been given a wonderful opportunity to grow my leadership and professional development skills, while serving my community over the last three years.

I believe one of the very special things about the University of Miami is the infrastructure for volunteerism in our communities. No matter what your interest, or desired future specialty, there is a way to become involved in DOCS that will allow you to explore you interest while learning the core principles of caring for patients from underserved communities.

Tara: Participating in DOCS provides the opportunity for students to put the knowledge and skills learned in the classroom into action. Through DOCS, students are able to use their toolkit to make real, impactful change in their community.

What lessons and skills have you learned from DOCS that you hope to carry with you in your future career?

Alessandra: As a future emergency medicine physician, my time in DOCS EP has allowed me to interface with communities outside of the traditional context that I will be confined to in the future. To see and discuss emergency prevention with patients, in their own communities where these emergencies occur, has fostered my interest in social emergency medicine. My time in DOCS has prepared me to acknowledge the social context in which patients live and work and the impact on their lives far before they ever reach the steps of the emergency department.

Tara: How to work in a team to respond to real world crisis situations is something I will never forget from the COVID-19 hotline experience.

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Patient Navigation We train about 60 students to serve as patient navigators each year to provide longitudinal follow-up for patients after each fair. Patient navigators follow patients who meet certain “high-risk” criteria for three months in order to assist them with acquiring health insurance and appointments with physicians at either Jackson Memorial Hospital or local free or low-cost clinics throughout South Florida. The goal of this project is to ensure that patients who attend our fairs are accessing the healthcare system throughout the year, so they can receive the necessary long-term medical care. Additionally, this year we are training navigators to assist these local clinics in getting patients insurance and improve inter-organizational healthcare access.

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Community Health Resources (CHR) Throughout this past year, the CHR station has undergone significant updates to our database of community health resources and clinics. Our updates included researching and adding further details about available clinic services, options for financial assistance, information on policies towards acceptance of undocumented patients, as well as the translation of our database into Spanish.

Beginning in December, we overhauled our health fair workflow by implementing a standardized CHR form for patients. The new form helps us provide a reproducible, organized, and personalized list of relevant clinics and health resource information for patient follow-up. We believe it has significantly improved our ability to handle patient volume and decrease wait times.

We also developed a new REDCap tab to simplify finding patient information and searching for relevant resources on ArcGIS. Together with Patient Navigation data, the new tab will allow us to measure the performance of our station.

High-Risk Patient Navigation The High-Risk Patient Navigation Team is another initiative of DOCS that provides personalized and in-depth assistance to those patients qualifying under our highest-risk criteria: positive colorectal cancer screening test, positive Hepatitis C test, positive HIV test, abnormal Pap smear, and any other cancer suspicion detected at the health fairs.

This group of dedicated medical student patient navigators received hours of training on navigating the complexities of the healthcare system, registering patients for government health insurance programs, overcoming the socioeconomic barriers to healthcare access encountered by the local patient population, and understanding the various resources that provide affordable health care services to uninsured and undocumented patients throughout the tri-county area.

Upon receipt of a screening test or exam result, patients are contacted via phone by their patient navigator who will follow them until achieving a navigation end goal. After the initial contact, patients are sent a personalized healthcare access plan which includes an explanation of their test or exam results and an outline of all the necessary steps to attain their navigation end goal. Weekly follow-up calls encourage progress towards care while fostering strong rapport between navigators and patients.

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Alumna Feature: Sabrina Taldone, MD, MBA Dr. Taldone is a triple ‘Cane, having earned her undergraduate, MD, and MBA degrees at the University of Miami.

She completed her internal medicine residency at Jackson Memorial Hospital and served as Chief Resident in the 2018-2019 academic year. Dr. Taldone is now an Assistant Professor at the University of Miami Miller School of Medicine, serving as a director of the Medicine as a Profession course for medical students and one of the Associate Program Directors of the Internal Medicine Residency Program.

What is your current area of practice?

General Internal Medicine Can you tell us about your involvement in DOCS? I volunteer at the Center for Haitian Studies (CHS) clinic on Monday nights and at Health Fairs, usually in the Final Doctor Evaluation (FDE) station.

How has DOCS evolved since your time as a medical student?

One of the excellent aspects of the DOCS organization’s model is that there is a system in place for best practices knowledge to be transferred from outgoing student leadership to incoming student leadership. I have been most impressed by DOCS’ focus on connecting patients to longitudinal care through their Longitudinal Health Access Team (“patient navigation”) at Health Fairs. Furthermore, the CHS student-run clinic didn’t even exist until a few years ago. I enjoy seeing innovative, determined students work together to bring about positive, sustainable changes in the DOCS organization.

How has DOCS impacted your professional career?

First and foremost, my experiences with DOCS opened my eyes to see that for so many members of the South Florida communities, our U.S. health care system falls short, leading to adverse health outcomes. The complex relationships between private, public, and government entities at a macro level had such a significant impact on the patient that I saw in front of me in a clinic or at a health fair. I wanted to become a part of the solution. This was one of the reasons I decided to pursue the MBA program. Currently, I serve as the Internal Medicine Medical Director for Population Health, where I work with an interdisciplinary team. DOCS taught me that teamwork makes the dream work!

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What role do you feel DOCS plays in medical education?

DOCS provides volunteer services to community members. Nevertheless, some of the best teachers are the patients we aim to serve. These patients help MS1 and MS2 students hone their empathy and communication skills, and they also provide a way for students to get to know more about the South Florida communities through their patients’ stories. Students in DOCS learn leadership skills, like time management and conflict resolution. Depending on what the leadership role is, students learn a variety of skills complementary to medicine, like public relations with community members, or even IT. Diverse student interests help students to realize how they can collaborate to create positive change.

How has your experience at clinics and/or health fairs changed during the COVID-19 pandemic?

My experiences at clinics and health fairs have always been fulfilling. DOCS’ student leadership at CHS and health fairs have helped make the transition as smooth as possible. I am in awe of the resilience the student leaders exhibited in adapting to the COVID-19 changes; their passion for their patients is inspiring. At the CHS student-run clinic, they had to reduce the number of patients the students would see per night due to COVID precautions. Also, I saw more mental health illness (depression, anxiety) with my patients at CHS after the COVID-19 pandemic started in the U.S.

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Medical Informatics Starting in 2016, DOCS has used Research Electronic Data Capture (REDCap), a HIPAA secure online database often used for research, as an electronic medical record (EMR) system for our community health fairs. Utilizing a custom built branching logic, DOCS created a user-friendly system that provides patients a unique record number to assist in tracking their information longitudinally across different years, assists with real-time data collecting during each health fair, and ensures a standardized screening process based on US Preventive Services Task Force guidelines and other specialty-specific screening guidelines.

This year, an online pre-registration survey and process was implemented allowing us to manage size and flow of the fairs as part of our safety measures in response to COVID-19.

We also used REDCap for more seamless integration with the DOCS patient navigation program. As data is inputted in real time at each station, patients who have been identified as high risk are automatically flagged through the use of the branching logic function. After patients were counseled by physicians at the Final Doctor Evaluation station, they were automatically assigned a patient navigator risk score, A (highest risk) through D (lowest risk), ensuring those with most urgent findings receive appropriate post-fair navigation efforts.

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Interprofessional Education The role of Interprofessional Education (IPE) at DOCS health fairs and clinics is to foster partnerships between DOCS and interprofessional healthcare practitioners, community exhibitors, and graduate students from the University, including students in the Nursing School and the Department of Physical Therapy. This provides great opportunities for learning and for mentorship for our students and gives us opportunities for one-on-one interaction with leading interprofessional faculty at our University. DOCS IPE also engages the youth of Miami including high school and undergraduate students who serve as interpreters at our health fairs and clinics.

Faculty and student volunteers from the Department of Physical Therapy

In light of the COVID-19 pandemic, the IPE team created a virtual interpreter system through Zoom, allowing volunteers and patients to speak face-to-face with an interpreter using a smartphone. This limited physical exposure and gave more opportunities for interpreters to volunteer for health fairs. Later in the year, we used a hybrid model of in-person and virtual interpreters to maximize accessibility and safety.

We are continuing to foster better relationships with the departments at the University of Miami. We are reaching more physicians using a fast and reliable sign-up system through Microsoft Teams and are working more closely with attending physicians. Unfortunately, COVID-19 limited our number of volunteers and exposure to these departments in general, but we hope to be more integrated in their education and community service in the upcoming year.

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DOCS Executive Board 2020 - 2021 Co-Executive Directors: Alexa Turpin & Sophia Pines RMC Director: Abigail Pelletier Co-Directors: Billy Scola, Rick Lin, Mary Muffly, Veronica Nuñez Logistics Director: Annika Patel Training Director: Brandon Anderson Research & Quality Improvement Director: Sirisha Gaddipati Medical Informatics Director: Jessica Hunter Public Relations Director: Sameeha Rau Interprofessional Education Director: James Bao Longitudinal Access Director: Andrew Masciarella Faculty Advisor: Amar R. Deshpande, MD DOCS Manager: Raysa Christodoulou

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