2019-2020 Annual Report

Issue 04, August 2020

University of Miami Miller School of Medicine

20 Years of Service

Mitchell Wolfson Sr. Department of Community Service (DOCS) Annual Report 2019-2020

Table of Contents

Our Organization

P#6

DOCS Clinics

P # 18

DOCS Health Fairs

P # 28

Regional Medical Campus DOCS

P # 38

Community Health Leadership Conference

P # 46

National Health Leadership Consortium

P # 50

Emergency Preparedness and COVID-19

P # 52

Behind the Scenes

P # 54

Future of DOCS

P # 66

Contact Information

P # 70

A Thank You, from DOCS On behalf of our Wolfson DOCS family, we want to extend our heartfelt gratitude to all those who made this year possible - from our philanthropic donors whose generosity allows us to accomplish our goals to our hardworking students and physicians who donate countless hours to serving our patients, DOCS is built on a foundation of true dedication to serving the community.

This dedication is particularly important in the face of the current COVID-19 pandemic.

While the pandemic has certainly affected all of our lives, the challenges experienced by the medically underserved are more heightened than ever, and the Wolfson DOCS program has worked diligently over the last few months to adapt to these uncertain times. From modulating our student clinics to Telehealth where possible, to partnering with the Florida Department of Health and Miami Poison Control Center to answer the COVID-19 Hotline calls, Wolfson DOCS has remained committed to serving our patients as safely as possible.

This year marks the 20th Anniversary of the Mitchell Wolfson Sr. DOCS program creation. Though the Miller school has hosted community health fairs since the 1970s, it was 20 years ago that the various medical student groups running these fairs decided to join forces and create the “Department of Community Service.� Such a collaboration of efforts allowed the DOCS program and its health fairs and clinics to flourish under one umbrella organization for the last 20 years.

The anniversary 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. In this report, we aim to provide some more reflections from DOCS students and physicians from the past 20 years.

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.

We would also like to thank the numerous other donors whose gifts have assisted us to carry out our mission this year. In particular, we were honored to be selected by the Select Project Fund as the winners of the Citizen’s Board Grant with which we were able to purchase new medical equipment for osteoporosis screening at our health fairs.

Lastly, we profoundly 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 for donating their time and efforts to support our students at every single health fair.

As we look to the future, we acknowledge that there is much uncertainty in how this pandemic will affect the logistics of a program like ours. Though we anticipate that our delivery of care in 2020-2021 may be somewhat different than it has been for the last 20 years, we know that the Wolfson DOCS program will work to adapt to the needs and safety of our patients and remain committed to serving our community.

Sincerely,

Sarah Sukkar and Kyle Sutherland DOCS Executive Directors 2019-2020

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/

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

DOCS Turns 20 in 2020 2000

Then & Now

2020

Our History 20 Years of Community Service Since the inception of the first health fair in Big Pine Key in 1971, the students of the University of Miami Miller School of Medicine have made access to care for the medically underserved a top priority. In academic year 2000-2001, the health fairs formalized into DOCS, a student-run, non-profit organization endorsed by the medical school under the direction of Dr. Mark T. O’Connell. As DOCS gained recognition, a generous donation was received in 2006, endowing the service organization as the Mitchell Wolfson Sr. Department of Community Service.

In the 2019-2020 academic year, DOCS brought screening and educational services through its health fairs and clinics to over 2,000 patients thanks to the volunteer efforts of over 500 medical students and 250 physicians. Currently, DOCS holds 10 annual health fairs in underserved areas in Miami-Dade, Monroe, and Broward counties to screen for the most prevalent health problems in our community, including: hypertension, diabetes, dyslipidemia, obesity, vision and hearing loss, glaucoma, osteoporosis, fall risk, oral health, dementia, depression, HIV, and Hepatitis C, as well as colon, breast, cervical, and skin cancers. In addition, DOCS works closely with community partners to increase awareness about local resources through mini-health fairs and exhibitions.

DOCS also operates 4 free student-run clinics that provide treatment in both primary care and specialized services through the Center for Haitian Studies Clinic, the IDEA Needle Exchange Clinic, San Juan Bosco Clinic, and the Caridad Center Clinic. Using a referral system from our health fairs to free and reducedcost clinics, we are able to provide continuity of care and follow-up services by acting as a portal of entry into the healthcare system for at-risk patients.

Alumna Feature: Josefina Farra, MD Dr. Farra is a board-certified in General Surgery with a specialization in Endocrine Surgery. She completed both her residency and fellowship at the University of Miami/Jackson Memorial Hospital program. She is currently faculty within the DeWitt Daughtry Family Department of Surgery as an Assisant Professor of Surgery within the Division of Endocrine Surgery and an Associate Program Director for the UM Fellowship in Endocrine Surgery. Dr. Farra is a graduate of the University of Miami Miller School of Medicine, Class of 2009. She was Executive Director of the DOCS Program from 2008-2009.

What is your current area of practice?

My practice consists of benign and malignant diseases of the thyroid, parathyroid, and adrenal glands as well as multiple endocrine neoplasia (MEN) syndromes. I have expertise in thyroid surgery, minimally invasive parathyroid surgery, and laparoscopic adrenalectomy.

Can you tell us about your involvement in DOCS as a medical student? How has DOCS evolved since your time as executive director?

My involvement with DOCS began in my first year of medical school with me being a station manager for the health fairs, in my second year I was the Director of the Marathon Health Fair, in my third year I was one of the 2 Directors of DOCS, and in my fourth I was Executive Director. During my four years we expanded DOCS by adding health fairs as well as the second weekly clinic. We also expanded the yearly budget by securing additional funding from the Wolfson Foundation. Since my time it has continued to evolve and expand even further, I am so proud of the work of the students.

What role do you feel DOCS has played in the community over the last 20 years?

DOCS has been extremely important for the south Florida community. It has provided consistent and dependable access to health care for the underserved populations in south Florida. Many patients depend on the care they receive at the clinics and/or health fairs as their sole source of healthcare and screening.

How did DOCS impact your professional career?

My experiences with DOCS taught me a great deal about leadership in healthcare. As physicians we are the leader of the care teams which is an important responsibility. There are many different dynamics which we need to be able to juggle and navigate and I feel my many roles within DOCS during medical school helped prepare me for this. It also taught me about obstacles patients have with access to care which impacts their health leading to later stage diagnoses for many health issues. It is important to recognize this and understand our roles as physicians in advocating for our patients.

What role do you feel DOCS plays in medical education? As well as for residents & attendings?

DOCS is an incredible learning experience for medical students as it allows them to interact with patients and take ownership of their care. Because it is a student run organization, the medical students are able to feel what it is like to be the providers for the patients. This is key to the learning. It gives students the opportunity to practice their bedside manner and clinical skills. Additionally, it teaches them about underserved medical communities and the importance of advocating for them. It’s a wonderful experience for residents and attendings to teach students as well as give back to the community.

Health Fairs Health Fairs

» Crockett Foundation’s Back to School Event 8.03.19 » Commissioner Edmonson’s Back to School Event 8.10.19 » South Dade Health Fair 09.28.19 » Little Haiti Health Fair 10.26.19 » Hialeah Health Fair 11.23.19 » Liberty City Health Fair 12.14.19 » Jack & Jill Health Fair 01.11.20 » Florida Keys Health Fair 02.01.20 » West Kendall Health Fair 02.22.20 » Light of the World Health Fair Cancelled due COVID-19

Clinics

» Caridad Center Clinic » Center for Haitian Studies DOCS Night Clinic » IDEA Clinic » San Juan Bosco Clinic

Our Year in Numbers

» 2350+ physician hours volunteered » 500+ medical students volunteered

» 1600+ patients seen at health fairs » 400+ patients seen at clinics

*All DOCS Clinics & Health Fairs were suspended in March 2020 due to the COVID-19 Pandemic

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Clinics

CeNter FOr HaitiaN stUDies (CHs) DOCs NiGHt CliNiC Since its grand opening in February 2019, this DOCS clinic has:

◊ Provided care to 131 patients ◊ Hosted 32 primary care nights ◊ Held 6 clinic nights dedicated to women’s health needs

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 aimed 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 also offer obstetric and gynecological services on the first Monday of every month.

We have been able to provide our patients with primary care and health screenings, routine laboratory evaluations, valuable patient education and counseling, as well as establishing their care at Jackson should they need to see specialists for more complex health issues.

The partnership between CHS and DOCS has led to increased access of 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 131 patients with the help of numerous volunteer physicians, medical students, and 8 clinic staff during our 32 primary care nights and 6 women’s health nights. We are very grateful for our patients who allow us to serve them and would like to thank Dr. Pierre, Dr. Metellus, Gina, and Sonide for their support in making this clinic a reality.

CHS DOCS Night Clinic Staff celebrate their one year anniversary with both student & physician volunteers.

The CHS Night Clinic Staff shares the research they have done on the impact of opening the new clinic.

Dayana Perez, first-year medical student & assistant patient education coordinator, makes clinic appointments at Liberty City Health Fair.

CHS Night Clinic Staff pictured here with student volunteers and physician volunteer, Dr. Sabrina Taldone.

iNFeCtiOUs Disease eliMiNatiON aCt (iDea) WOUND Care CliNiC aND NeeDle eXCHaNGe 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 address ing 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-ofcare 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 sec ondary to chronic use of injectable drugs. Our physician volunteers educate both students and patients not only in the principles of harm reduction and methods to encourage historically marginalized patient populations to access healthcare, but also in the execution of necessary procedures such as abscess care and prevention. 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 also developed and presented two successful lunchand-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 Narcan and lived experiences of people who inject drugs. These sessions were well received, and future programming is planned.

This past June, 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. We would like to thank Dr. Hansel Tookes, Dr. David Forrest, and the entire IDEA Exchange Staff for their support and guidance.

A participant in the IDEA Needle Exchange disposes of his used syringes prior to getting clean ones.

DOCS IDEA Clinic Staff, made up of first-year medical students, pictured here with IDEA Founder Dr. Hansel Tookes and IDEA Exchange Staff members.

Ainhoa Norindr, first-year medical student, and a member of the DOCS IDEA Clinic Staff pictured here providing a participant in the needle exchange with important supplies.

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, pulmonol ogy, 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 speciality 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 im prove in the past year through various new initiatives. In order to decrease patient wait times and maximize quality of care, we shifted from a first-come first-serve system to a scheduled appointment system with patients scheduled in phased time slots throughout the evening. We also created maximum limits on patients seen per evening and aimed to do this responsibly by referring all patients with an active Jackson card to Jackson Memorial Hospital instead of to our weekly night clinic so that we could focus our resources on those patients who have no other access to specialty care. We also updated our protocols to have an SJB student clinic staff member in each patient room as part of the healthcare team during encounters, which proved to greatly improve the flow and efficiency of each night. Lastly, we were able to obtain educational videos on a variety of specialty-specific conditions that we began streaming on the TVs in the waiting room for patients each Tuesday night.

In the 34 clinic nights held this academic year, DOCS SJB Clinic had a total of 244 patient visits with 101 physician volunteers and 585 student volunteers. We are very grateful for our patients who al low us to serve them and would also like to thank Berta Cabrera, Luz Gallardo, Marta Villalta, our doctors, and our student volunteers who give their time and energy to make this clinic such a success.

SAN JUAN BOSCO CLINIC

DOCS

Mitchell Wolfson Sr. Department of Community Service

The first-year SJB Clinic Staff is photographed here outside of SJB Clinic.

The first- and second-year SJB Clinic Staff celebrate the end of the second-year’s tenure at SJB and the beginning of the first years’ transition to clinic staff.

The second-year clinic staff celebrates SJB Logistics Coordinator Elijah Newfo’s birthday at clinic.

Medical Student Feature: Daniela Cosio & Megan Nocita Class of 2022 Tell us about yourselves– what year are you in medical school? What program are you in?

Both of us are in our second year of the MD/MPH program! We are both passionate about helping underserved communities and have both worked in the past in helping Hispanic communities gain access to health care and health services.

What are your current roles in DOCS? Can you elaborate the responsibilities of your positions? Can you tell us a little about the structure of the clinics and why our weekly clinics are so vital to the communities that we serve?

From October 2018 to February 2020, Daniela served as the DOCS SJB Clinic Project Manager and Megan served as DOCS SJB Clinic Professional Liaison. In addition to attending each weekly clinic night and acting as translators for student groups and doctors, Megan spent much time each week recruiting physicians, organizing their Department of Health approval, coordinating their availability to volunteer with us, and managing their access to the clinic’s electronic medical records. Meanwhile, Daniela oversaw each clinic night, managed the flow of student groups and doctors, explained roles and responsibilities, and coordinated with clinic nurses, doctors, and staff members as to scheduling, follow-up, and medication prescribing.

Without DOCS and the various free clinics it runs, many patients would go without much needed care for serious and treatable conditions. Throughout our time with DOCS SJB Clinic, we have seen deadly complications of severe asthma and diabetes prevented, psychiatric disorders treated, debilitating joint pain reduced, and even cancers diagnosed.

Why were you interested in becoming involved in DOCS and specifically in the SJB clinic?

Daniela: Having been born and raised in Miami and coming from a Hispanic family myself, I’ve always felt passionately about bettering access to healthcare for underserved populations, especially Hispanic communities. It’s one of the factors that led to my interest in a joint MD/MPH degree. And while I have always made participation in community service projects a priority both throughout high school and in college, participation in DOCS, especially at the San Juan Bosco Clinic, now gave me the unique opportunity to put my past experience and my newfound medical skills to work for a community close to my heart in my own backyard. It was a perfect fit!

Megan: Community service was the most formative part of my undergraduate career and the primary factor in my decision to pursue an MD/MPH. During my first summer in Miami, I volunteered at SJB and fell in love! In past volunteer experiences, I was disappointed by the failure of free medical care to meet the standards of care I would want for myself and my family. The continuity of care provided by SJB’s day clinic, the variety of specialty services provided by UM’s faculty, and the administrative oversight provided by a dedicated student staff made SJB different. I was thrilled to become part of a team that holds the highest possible expectations for the care of a community that often does not receive the support they need and deserve.

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? Daniela: The first two years of medical school can be extremely challenging and can feel mainly academically focused.

Participating in DOCS gave me the opportunity to link everything I was learning back to real patients. I could see the good we were doing in actual people’s lives and that helped me to remember why we are each working so hard. Not to mention, applying what I had learned to actual situations helped cement the information and augmented my learning.

Megan: When I began medical school, I was stressed about how I would choose a specialty. I assumed that decision would provide clarity in everything else. I still don’t know what kind of physician I want to be, but DOCS has reminded me that the “why” is sometimes more important than the “what.” DOCS allows students to learn from service-minded physicians and incredibly diverse patient populations as they gain knowledge in both clinical medicine and the social determinants that often determine the health outcomes of our patients. I want to be a physician who integrates clinical medicine with a commitment to improving the structures and policies that impact my patients’ wellbeing, and the time I’ve spent with DOCS has strengthened that passion. I feel a sense of clarity knowing that regardless of specialty, my career will be centered on this activism and service.

What lessons and skills that you have learned from DOCS do you hope to carry with you in your future career while caring for patients?

Daniela: The biggest lesson I have learned from my time at the DOCS SJB clinic is how to approach patients with empathy and compassion. When running a clinic, details and logistics begin to rule and one can become frustrated when patients, doctors, or students don’t make it on time or when the night becomes delayed. But then I would realize that said patient didn’t have transportation or couldn’t take time off from work or was caring for an ill parent; that that doctor who was running late had been called back in to work to perform a life-saving transplant; that that student who cancelled at the last minute was dealing with a family emergency- and I’d be reminded that not only as a doctor but as anyone in a leadership position, we have to remember to maintain empathy and compassion always.

Megan: I agree with everything Daniela has said, but I’ll add two more points. First, I believe working with a population that does not share my first language has been pivotal in my development as a future physician. While I consider myself proficient in Spanish, I have to actively listen in order to gather important details and undertones of my conversations with patients. I know the chaos of clinical settings can be distracting, but my time at SJB has reminded me of the value of active listening and complete presence. It was a privilege to learn these patients’ stories, and I look forward to being a listening ear for my patients in the future. Finally, it’s easy to become isolated while studying medicine, but my DOCS experience taught me to lean on and be inspired by my classmates. Daniela, Elie, Lara, Claudia, Veronica, and Brad were the greatest team I’ve been part of, and they’ll be friends for life.

Health Fairs

Crockett Foundation’s Back to School Event Mini Health Fair Blanche Ely High School

This was our third year participating in the Crockett Foundation’s Back to School Extravaganza in Pompano Beach. We offered screening services including blood pressure checks, point-of-care glucose and cholesterol screening, and pediatric education resources. A special appearance was made by Mr. Crockett, pictured in blue.

Commissioner Edmonson’s Back to School Event Mini Health Fair Olinda Park

This was our third year participating in the District 3 Commissioner Audrey Edmonson’s Annual Back to School Fun Day/ Health and Information Fair in Overtown. We offered services including vision and glaucoma screening, blood pressure checks, point-of-care glucose and cholesterol screening, and pediatric education resources at this health fair. A special appearance was made by Commissioner Edmonson herself, pictured in purple.

South Dade Health Fair Branches South Florida

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.

Little Haiti Health Fair Center for Haitian Studies

The Little Haiti Health Fair is hosted at the Center for Haitian Studies, a non-profit organization that works with local members of the large Haitian community living in Miami. The ability to partner with and serve the Haitian community makes this fair a unique and exciting experience for DOCS students and physicians.

Additionally, this year our Little Haiti Health Fair team assisted with the advertisement of our new initiative of the DOCS Center for Haitian Studies Clinic.

Hialeah Health Fair Jose Marti MAST Academy

The Hialeah Health Fair provides screening services to the medically underserved communities in the Hialeah community. This population comprises a diverse mix of underserved communities who do not have health insurance nor access to quality medical care. We partnered with the Jose Marti MAST Academy as the new location of the health fair and aimed to encourage patient attendance at our new site through community partnerships with local organizations and churches.

Liberty City Health Fair Holmes Elementary

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.

This is why we provide each family with a fresh bag of fruits and vegetables.

Jack & Jill Health Fair Salvation Army of Ft. Lauderdale

The Jack and Jill Health Fair is held in Broward County in partnership with the Jack and Jill Children’s Center, which provides childcare and parenting classes to underserved populations in Ft. Lauderdale. This year, we also had the opportunity to work with the Salvation Army of Fort Lauderdale, both expanding our network of community partnership and also the patient population that we were able to serve. Our diverse patient population spanned from locals in the Ft. Lauderdale area to underserved community groups in Pompano Beach.

Florida Keys Health Fair: Marathon Site Marathon Middle High School

The Marathon Health Fair saw an increase in patients this year and with our community partner, AHEC, we were able to provide healthcare services to an area that is still recovering from the effects of Hurricane Irma.

Florida Keys Health Fair: Big Pine Key Site Big Pine United Methodist Church

The Big Pine Key Health Fair is the oldest DOCS health fair, operating since 1971. For over 40 years, our program has provided screening services and medical care to the Keys’ various populations. Volunteers from the local community assist in our fair, many of whom have worked with us for more than 40 years. They provide unique insight into how far these fairs have progressed and helped us serve this community.

Florida Keys Health Fair: Key West Site Key West High School

Key West is the largest site in our Florida Keys Health Fairs. Thanks to our community partners AHEC and Key West High School, we are able to provide annual care to a patient population in a medically underserved area with an aging population. We plan to partner with local providers to make year-round healthcare more accessible for our patients.

West Kendall Health Fair Capilla Del Rey

The West Kendall Health Fair provides healthcare screening services to a community that primarily consists of Hispanic immigrants. This was our second year partnering with Capilla Del Rey, a church that is located in the heart of West Kendall. We were able to further strengthen our relationship with the church and the local community.

Light of the World Health Fair Cancelled due to COVID-19

The Light of the World Health Fair is run in collaboration with Light of the World Health Clinic in Ft. Lauderdale. Each year, the clinic hosts a Health Expo that connects nearly 500 attendees to many health and social services throughout South Florida, hosting 40-60 vendors each year. There was a planned expansion this year to incorporate more stations in collaboration with DOCS, including HIV/HCV testing, skin cancer screening, and head and neck screening. Unfortunately, this year’s Health Expo was cancelled due to the COVID-19 pandemic, but we hope to follow-through on our expansion efforts and increase our collaboration with the UM Internal Medicine residency program at Holy Cross.

Intern Feature: Lamere Buchanan, MD Dr. Buchanan is currently a first-year Family Medicine resident at Jackson Memorial Hospital. He is a graduate of Howard University of Medicine Class of 2019. He is a volunteer physician with DOCS, working at numerous of our health fairs around South Florida.

What is your current involvement with DOCS? What initially made you interested in becoming involved with DOCS? I currently serve as a resident volunteer with DOCS serving at various health fairs that they hold throughout the year. I became interested in DOCS after hearing about their awesome monthly community service commitment. I have a strong passion for community medicine, and serving the community through DOCS felt like the perfect opportunity.

Community service is an excellent way to empower our community through education, but it is also a great opportunity for medical students to learn. I believe that together, these skills help DOCS volunteers become better physicians.

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

There are no programs quite like DOCS in Washington, D.C. There were plenty of opportunities to get involved in the community, and I experienced a few through my Family Medicine Interest Group. However, DOCS has established itself through its rich history of serving via their health fairs throughout Miami-Dade County. When going into these communities, you realize how grateful the community members are for DOCS and how large of a role DOCS plays in their yearly health maintenance.

What impacts do you see DOCS have in regards to the communities we serve?

DOCS’ presence and consistent service opportunities allow community members to receive health screenings on an annual basis. Many of these individuals are unable to receive regular, preventative health maintenance due to various socioeconomic reasons. DOCS has really built trusting relationships with the community. I believe this trust comes from DOCS’ volunteers showing up year after year, excited and ready to commit to help they community in as many ways possible.

What does DOCS offer to other interns & residents?

DOCS offers resident physicians the opportunity to get to know the patient population we serve at Jackson/UM, but outside of the walls of the hospitals and clinics. It gives us a small glimpse into our patients’ communities and some of the factors that influence their behaviors and decisions. It also gives residents the opportunity to build rapport with our patients by showing them that we are willing to meet the patients in their communities.

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

DOCS has allowed me to see the different social factors affecting the populations of people I care for on a daily basis in our community health clinic. As someone from out of state, immersion in the communities of my patients is extremely valuable, providing me with needs assessments of their communities and insight on how to navigate improving their overall health care.

What role does DOCS have on medical education? Why is it important for medical students to participate in DOCS? DOCS provides medical students with plenty of learning opportunities and direct 1-on-1 time with residents and attending physicians. Students have opportunities to gain a new perspective on medicine. The program also leaves a lasting impression on medical providers, one that is not often found inside the walls of a hospital or clinic.

What were some of your favorite experiences this year while volunteering with DOCS? My favorite experience was volunteering in Key West. The people of Key West that we served were so much fun and had great attitudes for what we were doing in their community. They were so thankful to have us volunteering in the various Keys. Also, all of the volunteers were lodging in the same hotel which allowed for us to get to know one another outside of volunteering and spend some time getting to know the beautiful city.

Regional Campus (RM

l Medical MC) Projects

Brazilian Community Center

The Brazilian Community Center (Centro Comunitário Brasileiro, or CCB) is an organization based in Pompano Beach that offers support services to the community in the areas of: education, legal assistance, business development/networking, political representation, public safety, and health & wellness. The CCB organizes events, has active social media outreach, and broadcasts its own Portuguese-language radio station. This past year, our goal was to establish and explore the relationship between DOCS and this new community partner. We connected the DOCS Jack & Jill Health Fair leaders to the CCB, resulting in a successful health fair with more Brazilian participants and volunteer translators, and a stronger relationship between our institutions.

At the Jack & Jill Health Fair, we conducted an interactive community survey of health topics that participants would like to learn more about and also discussed community health needs with volunteers and leaders of the CCB. We will also supplied the CCB with a local resource binder to assist the volunteer front desk managers in directing community members who walk into the office with concerns about health. In the upcoming year, goals include establishing more regular communication with CCB leadership, further assessing the community’s health needs, creating initiatives through in-person events, radio, or social media to address the community’s specific areas of health needs, and coordinating with the DOCS RMC Healthcare Access Director to annually update the CCB health resource binder.

Caridad Center

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.

Guatemalan-Mayan Center

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

DOCS also utilized Photovoice techniques to assess the impact of these health literacy classes on the community, and preliminary results were shared at the Society for Student-Run Free Clinics in March 2020. The GMC won a grant from Philanthropy Tank this year that has allowed them to host a back-to-school event and a Thanksgiving event and purchase video equipment that enables the non-profit to broadcast information to the community in the main indigenous languages.

Healthcare Access

The RMC DOCS Healthcare Access Project aims to educate students regarding the health insurance and healthcare resources 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 2019, we represented HCSEF at a community back to school fair at the Physician Family Pharmacy Clinic in Lake Worth, where we interacted with over one hundred families. We advised parents on health insurance options for their children through Florida KidCare and handed out bilingual flyers on health insurance and health literacy workshops. Two students became trained and certified to assist in Florida KidCare enrollment and assisted HCSEF in making phone calls to community members after the fair.

We updated and expanded the GIS resource map created last year for Palm Beach and Broward Counties, which details free and reduced clinics and other healthcare resources. We also updated the healthcare resource white coat pocket cards for Palm Beach County and created new cards for Broward County. These resources were distributed to RMC medical students and shared with residents at our rotation sites as well as students at the main Miami campus to personalize counseling on healthcare resources for patients in these counties. In March 2020, we presented our work on the healthcare resource pocket cards and the GIS resource map and their utilization by medical students at the Society of Student-Run Free Clinics (SSRFC) Conference in Orlando, FL.

RMC Scholarly Work

The RMC DOCS team presented three posters at the Society of Student-Run Free Clinics Conference at UCF in Orlando, FL on March 7th, 2020: Ultization Analysis of ArcGIS and Public Health Resouce Cards to Increase Community Resource Referrals Among Medical Students, presented by Abby Pelletier; Using Photovoice to Assess the Successes and Challenges of Health Literacy Classes at a Local Guatemalan-Mayan Center, presented by Rebecca Lynch; and Utilizing Point-of-Care Ultrasound as a Diagnostic Tool for People who Inject Drugs to Support Early Diagnoses and Timely Treatment of Soft Tissue Infections, presented by Hardik Patel.

In addition, student members of RMC DOCS, Jaclyn Perreault and Hardik Patel, led an interactive, trilingual survey of participants at the Jack & Jill Health Fair on “health topics that I would like to learn more about.� Participants wrote & drew responses on post-it notes for this collaborative community poster. These topics will be used to help inform future events with RMC DOCS partners such as the Brazilian Community Center.

Community Health Leadership Conference The fourth annual DOCS Community Health Leadership Conference (CHLC) was held on December 12th-14th, 2019. We had 124 participants from 21 medical school throughout the country in attendance, making this the largest DOCS Conference to date. We hosted over 75 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 Dr. Roderick King, Senior Associate Dean for Diversity, Inclusion, and Community Engagement, as our Keynote Speaker. The DOCS Patient Navigation Care Coordinators led a workshop on how to improve the longitudinal access to care for patients seen at student-run health clinics and health fairs. We also offered conference participants an opportunity to volunteer at the Liberty City Health Fair and get a behind-the-scenes perspective on the logistics of health fair planning.

We are very proud of our success over the past 4 years and are hoping we can continue improving the conference to become the premier national event for leaders at studentrun health initiatives to share, collaborate, and improve the services they provide to their patients.

Awards Gala Highlights First Place in Oral Presentation: University of Iowa Carver College of Medicine: “The Transition from Reactive to Preventative Care” First Place in Poster Presentation Eastern Virgina Medical School: “Clínica Comunitaria Esperanza: Frequency of Categorical Diagnoses among Patients of the Student-Run Free Clinic for Uninsured, Spanish-Speaking Residents of Hampton Roads, VA”

Resident Feature: Joshua Kronenfeld, MD Dr. Kronenfeld is currently a third year General Surgery resident and postdoctoral research fellow in Surgical Oncology at the University of Miam/Jackson Memorial Hospital. He is a graduate of the University of Miami Miller School of Medicine, Class of 2017. As a student, he worked as part of the Big Pine Key Health Fair team, a Co-Director on the DOCS Executive Board, and in his senior year as the Executive Director of DOCS Programs. As a resident, Dr. Kronenfeld has attended multiple health fairs as a volunteer physician and works with students caring for patients at the DOCS IDEA Clinic.

What were some of the impacts DOCS had on you as a medical student, and how did it shape your current practice of medicine?​ As a medical student, DOCS helped me understand how to be a leader.

I learned how to work with my peers and lead them to a common goal.

I also learned about the large disparities seen in patients in surrounding communities with regard to access to healthcare. Many of the patients we serve live just a few miles from our campus but have very different challenges that they face each day. It helped impact my decision to remain in Miami for my residency training. DOCS also helped shape me into a hard-working and compassionate physician, dedicated to caring for all of my patients, including those of vulnerable sociodemographics.

What are some of your best memories involving DOCS? ​ I have made lasting friendships with my fellow medical students, as well as students from other classes. I very much enjoyed working closely with medical school faculty to execute the incredible mission of DOCS, forging partnerships with many physicians I continue to work with as a resident. I also loved attending the various health fairs and clinics, working with community partners to bring care to those without access. The appreciation of the patients after these events made all the hard work worth it. Finally, I made lasting friendships with some of the patients and their families who attend the fairs each year, and I look forward to seeing them year after year.

What role do you think DOCS has in medical education, and why should medical students participate at DOCS events? ​DOCS is an incredible opportunity for students to get out in their community and practice medicine. Supervised by physicians, students are able to utilize the skills obtained in the classroom on real patients. As junior medical students, it is important to take a break from classroom learning and work with patients, kindling the passion for patient care we all have when entering medical school. For senior medical students, it is an opportunity to learn from and connect with patients from our diverse community. These senior students, soon to graduate, also learn how to lead and teach junior students at the fairs, skills that will be important throughout their careers as physicians.

What does volunteering with DOCS offer to other residents? ​As a resident, the DOCS health fairs and clinics offer another opportunity to engage with our communities and help its citizens. We care for these patients every day in the hospital for acute medical issues, but it is nice to have the opportunity to engage with these patients in health screening settings where we have the opportunity to counsel and guide patients to healthier lifestyles. This also gives us the time to mentor and teach medical students interested in particular specialties. The fairs and clinics allow for the students and residents to spend long periods of time together, fostering lasting partnerships.

As Executive Director, you supervised the planning for the inaugural UM DOCS Community Health Leadership Conference (CHLC). What was the original idea behind the CHLC, and how has CHLC developed over time to fit that idea? ​ The conference actually existed before I took over as executive director, but it had a slightly different form.

Originally, the conference was called “Disseminating the Model” (DTM) and was designed to invite medical students to attend a health fair and learn from our work. We brought them to the Florida Keys Health Fair and detailed our implementation strategy for a fair. At these early conferences, we had break-out sessions where students from other medical schools would share their own experiences, but we did not have formal sessions for this. We soon realized, however, that many other medical schools had amazing programs of their own for delivery of care to underserved populations. The CHLC emerged as a way for sharing of ideas and collaboration across the country for like-minded students interested in helping their communities. We transitioned from a program where we share our own ideas to a program now where we have built a network working together to improve care delivery to underserved patients. Each year, we learn from our attendees and build on our program. Many of our conference attendees have also implemented new strategies and programs at their medical schools, based on what has been discussed at this conference.

How does the CHLC fit the mission of DOCS? The DOCS mission is to care for and provide services to underserved patients in our South Florida community.

The CHLC helps to build on this mission by expanding our reach to the entire country. We collaborate with students and faculty at medical schools across the nation to execute this mission.

What benefits does a conference like CHLC have for medical students at the University of Miami? ​ The CHLC provides a forum for collaborative learning and discussion across medical schools. It allows for our students to learn about teamwork and implementation strategies for change. It is also often one of the first professional conferences attended by our students. This gives them an opportunity to refine their networking and presentation skills - skills that will be important throughout their careers.

For students from other medical schools, what does this conference offer?​ For students of other medical schools, the conference offers many of the same benefits as students from our institution receive. Students have the opportunity to engage with our students and faculty leaders, learning how we have implemented our health fairs and clinics. As a large community service organization, we have much to share with these students. They too learn how to network, present, and foster long-term partnerships with our students. As future colleagues in the medical field, these friendships are important for collaboration throughout their careers.

National Health Leadership Consortium Disseminating the Model

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: Âť 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 with other schools on how we were updating our procedures as well as a protocol for communicating with local health systems.

Âť NHLC is actively advising a group of interested students at the newly founded Nova College of Medicine in how to start a free health fair and clinic in the setting of a new medical school.

NHLC aims to help Nova College of Medicine 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 by Spring 2021.

» National Clinics Collaborative (NCC): NHLC has begun to expand the Florida Clinics Collaborative 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.

» IDEA Clinic Expansion: After contact established at the annual DOCS Community Health Leadership Conference, 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.

Emergency Preparedness » The Emergency Preparedness Response Team organizes hands-on training for medical students in preparation for a variety of emergency situations. This year’s events included:

1. Miami Poison Control: Drugs of Abuse Presentation 2. Active Shooter Response Training 3. Tactical Emergency Casualty Care Training

» The Emergency Preparedness (EP) team continued its mission of patient education at DOCS health fairs through the EP Station. At this station, patients learned about handsonly CPR, received information about firearm safety and safe gun ownership, and worked with student volunteers to develop individualized hurricane preparedness plans. A new addition to the station this year was a collaboration with the American Red Cross Sound the Alarm program, which offers free installation of smoke detectors in patients’ homes. » The new Emergency Preparedness Hurricane Response Team created the infrastructure to allow medical students to work in our hospitals and other local healthcare settings in the event of a hurricane.

COVID-19 Response

» Florida Department of Health COVID Hotline: through partnership with Miami Poison Control, our DOCS Emergency Preparedness team led the charge on efforts to cover the COVID Hotline. DOCS Emergency Preparedness staff served as shift supervisors and recruited medical students to serve in shifts every day from 8am to 11pm during the height of the COVID pandemic in South Florida. » SPARK-C Project: through partnership with Dr. Erin Kobetz, DOCS volunteered its efforts to assist in the Surveillance Program Assessing Risk and Knowledge of Coronavirus (SPARK-C) research project that randomly selects Miami-Dade residents to receive serologic testing for COVID-19 in order to determine community prevalence.

Students have been trained on data capture and operating telecom from home, performing numerous shifts per week to register, consent, and schedule Miami-Dade residents for their serologic testing. » ContraCOVID: our DOCS National Health Leadership Consortium collaborated with other medical schools and ContraCOVID, a student-run group that identified social needs of underserved patients. Subsequently, our NHLC team created a comprehensive document to collate the services and laws in place for Miami-Dade residents during the pandemic. We worked with our community partners as well as our DOCS Patient Navigation team and DOCS Clinics to distribute the document widely to our patients. » Telehealth: the DOCS IDEA Clinic converted its operations to telehealth in order to provide its vulnerable patients with continued care during the pandemic. Medical students volunteered via telehealth and acted as team leads to coordinate patient and physician schedules, take patient histories, and present the information to the physicians.

The staff of our other clinics worked with their community partners and the Florida Clinics Collaborative to consider the feasibility of telehealth at their respective sites.

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.

Patients Meeting Criteria for Patient Navigation at each Health Fair

58

60 46

50

35

40 30 20

23

27

23

21

WK HF

F FKH

F JJH

F LCH

HH F

LLH

0

F

10 SDH F

Longitudinal Access

Patient Navigation

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 the patient followup. We believe it has significantly improved our ability to handle patient volume and decreased 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.

Patients with a Patient Navigator who Attended an Appointment

20

20 15

11 1 HF

F

JJH F

3

WK

4 LCH F

HH F

3 LLH F

0

5 SDH F

5

FKH

10

Resident Feature: Douglas (“Chip”) Timmons, MD Dr. Timmons is currently a third-year resident in Obstetrics & Gynecology. He is a graduate of the University of Miami Miller School of Medicine, Class of 2017. As a resident, Dr. Timmons has attended multiple health fairs as a volunteer physician, volunteered as a judge at our Community Health Leadership Conference, and provided access to longitudinal gynecological care to high-risk patients identified at the Women’s Health Station.

What were your roles in DOCS throughout medical school?

I participated in multiple DOCS health fairs in various positions.

How have you been involved in DOCS as a resident?

I have helped to coordinate expedited follow up for any gynecologic complaint or problem encountered at DOCS health fairs. Specifically, I have assisted in expediting financial aid and colposcopy appointments following abnormal Pap smears.

As a resident in Ob/Gyn, why do you feel compelled to offer patients with positive Pap smears the opportunity to easily access colposcopies through JMH? How were you able to leverage your role as a resident to provide this important service to our DOCS patients?

Cervical cancer screening is one of the most important aspects of well-woman care. This is especially important in Miami-Dade county where we have some of the highest cervical cancer rates in the entire country. When abnormalities are detected early through adequate screening, cervical cancer can largely be prevented through timely excisional procedures. Working at the county hospital, many times we are the only option for many patients, and this remains true with many of the patients seen at DOCS health fairs. Providing access to care is something I am passionate about and was a large aspect of my training in the MD/MPH program at the University of Miami. Being a resident allowed be to know the inner working of the Jackson system and help patients navigate a system that can at times be daunting to make sure their care was as expedited as possible. The entire Ob/Gyn residency department is fully in support of the DOCS program with excellent leadership in our chairman Dr. Paidas. The collaboration with DOCS and the department of Ob/Gyn is exciting and we hope it will continue to grow in the future!

DOCS in the Media

For more of DOCS in the media, please visit: https://www.lefloridien.com/the-25th-annual-little-haiti-health-fair-a-resounding-success/ https://www.youtube.com/watch?v=65EMJv30Fto&feature=youtu.be https://www.youtube.com/watch?v=ZGeDxI2i_uE&feature=youtu.be https://wsvn.com/news/local/broward/hundreds-take-part-in-jack-jill-health-fair-in-fort-lauderdale/

High-Risk Patient Navigation The High-Risk Patient Navigation Team is a new initiative of DOCS that provides personalized and in-depth assistance to those patients qualifying under our highest-risk criteria: positive SEPTIN-9 colorectal cancer screening test, positive Hepatitis C test, positive HIV test, abnormal Pap smear results, and any other cancer suspicion detected at the health fairs. This group of dedicated medical student patient navigators receive 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 at the same time fostering strong rapport between navigators and patients.

Statistics from this year’s High-Risk Patient Navigation Team Number of Patients followed by the High-Risk Patient Navigation Team

677

Number of High-Risk Patients who have completed Follow-Up

169

Number of High-Risk Patients in the Follow-up Process

339

The Medical Informatics Team included an easily accesible table for volunteers to reference during the Final Doctor Evaluation station about the high-risk inclusion criteria.

After evaluating the results from each station, the student volunteer is then asked to assign patients to a risk-stratification group to ensure they are assigned to the appopriate team of patient navigators. Branching Logic was used to populate the risk stratification groups.

Resident Feature: Stephanie Ioannou, MD Dr. Ioannou is currently a second year Internal Medicine resident and was selected as a Chief Resident for the Department of Medicine for the 2021-2022 academic year. She is a graduate of the University of Miami Miller School of Medicine, Class of 2018. As a student, she worked as the Women’s Health Station Manager, a Co-Director on the DOCS Executive Board, and in her senior year as the Executive Director. Dr. Ioannou has attended multiple health fairs as a volunteer physician in her years as a resident.

What did DOCS mean to you as a medical student?

Being involved with DOCS was without a doubt one of the most fulfilling parts of my medical education, and I continue to be involved as a DOCS resident liaison and volunteer at health fairs.

As an Executive Director of DOCS, you were heavily invested in the follow-up of our highest risk patients being tested for Septin-9. Can you tell us about the Septin-9 test and why it’s so important for patients to have proper follow up? What role did you play to ensure this happened?

The mSEPT9 DNA blood test is a novel blood-based screening tool for colorectal cancer (CRC). It’s particularly appealing in our health fair population due to its ease of collection in patients who otherwise face financial and social barriers to traditional forms of CRC screening (most commonly FIT and colonoscopy). Since its inception at the last fair of the 2016-2017 academic year, we have noticed a profound improvement in screening rates compared to prior years when we provided only FIT, which were infrequently returned.

The shortcoming of all non-invasive CRC screening tests is the necessity for follow-up with colonoscopy when positive in order to evaluate for any pre-malignant or malignant lesions. When we implemented the mSEPT9 testing, we also enhanced the patient navigation arm of DOCS in order to prevent patients from being lost to follow-up. Connecting patients to follow-up has proven to be challenging in the communities we serve, yet DOCS has come a long way in developing more robust mechanisms to arrange colonoscopies for these patients.

Patient Feature: Julia Maynard How did you first hear about the South Dade Health Fair?

A community flyer in Florida City.

How do you feel about your experience at the South Dade Health Fair?

I feel great about my experience, so much so that I recommended the Health Fair to everyone!

Can you speak a little about your experience communicating with our Patient Navigators after the health fair?

After the South Dade Health Fair in November 2017 I was told I had a positive Septin-9 test; the students were able to arrange a primary care visit and worked on scheduling a colonoscopy.

Unfortunately, I was then I told I did not need a colonoscopy after a negative stool test, but luckily the students sent me another reminder about the colonoscopy.

In March of 2018 I received a call from Stephanie [Ioannou] asking me if I received the testing needed to follow-up on the Septin-9 test. When I told her no, she scheduld a colonoscopy for me at Jackson, where a polyp was removed. I am so happy that Stephanie took it into her own hands to make sure I had the proper care for my condition. If it had not been for Stephanie and the DOCS Health Fairs I would have gone my whole life without knowing that I have a pre-malignant condition.

Why do you think DOCS is so important to the South Dade community?

A lot of people in the South Dade community are not aware that they have health prolems and the DOCS Health Fair affords those in the community the opportunity to get screened to ensure that they are healthy. The voluteers at the health fair made me feel very comfortable, they asked me a lot of important questions regarding my health and I felt very comfortable sharing with them.Many people’s lives have been positively affected the same way as mine by the work of DOCS. I hope that DOCS and Stephanie continue to do great work in my community.

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 speciality specific society screening guidelines.

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 flagged through the use of the branching logic function. Piping and branching logic functions were utilized to indicate whether patient health screening results were “normal” or “abnormal” at each screening station. After patients were counseled by physicians at the Final Doctor Evaluation station, they were assigned a patient navigator based on risk from A (lowest risk) through D (highest risk), ensuring those with most urgent findings receive appropriate post-fair navigation efforts.

Medical Student Feature: Kevin Davis Kevin Davis is currently a second year MD/PhD student at the University of Miami Miller School of Medicine. He has been one of the Project Managers overseeing the Medical Informatics team for the last two years.

Can you elaborate on your responsibilities and the importance of Medical Informatics in DOCS? Generally, the responsibilities of an informatics project manager is to maintain and improve REDCap surveys in collaboration with station managers. We ensure that questions are associated with appropriate variable naming and data management, and we ensure the surveys have a logical flow that adhere to an intuitive design and address risk criteria. Additionally, we run statistical analysis upon requests for project and station managers. As another minor role, I also help update and improve the DOCS website.

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? There are plenty of reasons to get involved in DOCS, and those reasons can vary depending on your role.

Generally, it’s great to put actual experience to the classroom material we learn. DOCS consists of a lot of moving parts, and being a part of that highlights how a clinic might run, or what it might require.

What lessons and skills that you have learned from DOCS do you hope to carry with you in your future career while caring for patients?

While many roles in DOCS may allow medical students to gain clinical and patient experience, working with the medical informatics team has certainly shaped my future perspective on how physicians work with EHR systems. The idea that some physicians find working with EHRs frustrating is what drove me to look into the medical informatics team to learn a little bit more about how EHRs function. While REDCap is more of a survey tool rather than a health record system, working with medical informatics and DOCS has reinforced my understanding that EHRs can be an incredible tool. For me personally, I hope to take this experience and continue to focus on how EHR systems, and technology in general, can and should benefit physicians in a way that makes what they do efficient, allowing them to focus on the patient and enjoy their work.

Interprofessional Education The role of Interprofessional Education (IPE) at DOCS health fairs and clinics is to foster partnerships between DOCS and interprofessional healthcare practioners, 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.

This year, the IPE team enhanced our physical therapy screening program by establishing a direct referral program so that patients seen at the health fairs and deemed as high fall risk or in need of further assessment could be seen at the free student-run UM Physical Therapy LAGO Clinic.

The team also recently redesigned the DOCS health fair patient education booklets to not only include areas for data entry from screening stations but also to provide information about many common conditions like hypertension and diabetes and to educate patients on lifestyle modifications like nutrition.

Research & Quality Improvement

Âť REDCap Analysis: REDCap is a secure web application that the DOCS MedIT team has used to build and maintain a database to serve as an electronic health record for health fairs. The database contains a wide variety of information, from patient demographics to station-specific health results, and it gives us the ability to garner insights to the current impact DOCS health fairs have on our patients and to improve upon the services we provide at future health fairs. In prior years, we divided the potential data analysis into 3 categories: demographics/healthcare access, health statistics and trends, and health fair processes. The first category provides us with a granular view of our patient population and how it changes over years, the health access barriers patients may face, and the reasons patients attend health fairs. Last year, we focused on the first category and analyzed demographic and healthcare access data for health fairs, and our analyses contributed to fair planning this year.

This year we continued to analyze the trends to inform better patient recruitment and follow-up.

Âť DOCS Medical Education Training Video Series: The DOCS Medical Education Training Video Series was created in order to standardize and improve student training for health fairs and clinics. We developed comprehensive modules to supplement the in-person training sessions.

The modules consist of an introductory video that educates students on the purpose of the screening station and current USPSTF guidelines, a practical section that delineates how to perform station-specific tasks, and additional content as needed. Each module ends with a 5-question competency assessment. The purpose of this training series is to enhance volunteer preparedness by having a standardized presentation of material to improve volunteers’ awareness of screening guidelines, to improve flow on the day of the health fair, and to improve efficiency of student training. As of this year, more than 20 modules have been developed and implemented.

Future Initiatives » Street Medicine: In the upcoming academic year, UM will be starting its own branch of the StreetMedicine Institute Student Coalition in collaboration with UM Wolfson DOCS. Street Medicine is a global organization focused on providing much needed health care directly to people experiencing homelessness. The organization provides resources to communities and medical professionals so that they are confident and capable of providing care for these vulnerable populations. Our goal of a DOCS chapter is to help those living on the streets of Miami-Dade get access to care without the barriers and stigma that people experiencing homelessness may face when trying to utilize the healthcare system » DOCS Violence Prevention Project: In collaboration with the Miller student organizations Students Against Domestic Violence (STAND) and Code Rise, DOCS is working to provide our students with formalized training in Intimate Partner Violence (IPV) and Human Trafficking screening tools. With this training, students identify possible cases of violence at our health fairs and clinics; they then report back to supervising physicians and safely provide the patients with necessary resources and possible next steps. » Incorporating formal Social Needs Assessments into Health Fairs and Clinics: As an organization, we want to provide patient-centered measures to ensure that we are helping our communities with all social determinants of health, including housing, employment, food insecurity, or feeling safe within their home and communities. We will be training students with the PREPARE Assessment Tool to identify these factors and provide valuable, free resources to patients within their respective communities.

In addition, DOCS Staff will undergo training through the Caring with Compassion Modules provided by the American College of Physicians, which focuses on the working knowledge and special needs of homeless, uninsured, and underserved populations. » Telemedicine: Building on resources from the Florida Clinics Collaboration in response to the ongoing COVID pandemic, DOCS will aim to deploy more telemedicine opportunities for our clinic patients in the future. Volunteer students and physicians will be able to address the concerns of our patients remotely, if they have access to an internet connection or a smart device. In the future, we will explore the possibility of having this as a standing option at our clinics for patients who are unable to leave their home due to medical concerns or lack of access to a form of transportation.

DOCS in 20 Years...Imagined In honor of our 20th anniversary, we asked our Executive Board what they hope DOCS will look like in 20 years: here’s what they had to say...

“In 20 years I hope we have a new generation of students that are still as committed to DOCS and are striving to make it the best it can be. I hope every one of our patients gets connected to the care they need and that we don’t have anyone slipping through the cracks. I also hope every future Miller student has the chance to experience Keys Weekend!”

-Sophia Pines, Class of 2021

“In 20 years, I hope the entire mission of DOCS will be dedicated to helping patients navigate the health system, rather than providing screening services, because we will be living in a country with universal healthcare. If that is not possible, I hope we have a surgery clinic.”

-Alexa Turpin, Class of 2021

“In 20 years I see DOCS continuing to be a pioneer for other student-run community service programs across the country (& world!) not only by expanding access to our health fairs & clinics, but also through its further developed patient navigation system that will connect patients with the community providers they both deserve and need.”

-Nicole Cruz, Class of 2021

“20 years from now, I hope to see a new set of health fairs in new locations throughout South Florida. This would mean that we’ve done our jobs in the communities we’ve been in for the past 20 years by connecting people into the health care system, and we can focus our efforts on helping other communities in need. “ -Carly Misztal, Class of 2022

“I hope that in 20 years DOCS continues to meet nearly all USPTF screening guidelines and begins to integrate vendors that are able to offer patients medication on site so that patients can acquire immediate treatment.”

-Robert Peaden, Class of 2021

“I hope DOCS continues to change. To not only be responsive but proactive. To balance thinking critically with directly hearing from the communities we serve to provide what the populations need.”

-Madeline Cohen, Class of 2021 “I hope that in 20 years DOCS continues to serve the community in the most meaningful way possible to its residents. It would be amazing to see the DOCS screening, clinical, and patient navigation services grow such that every single at-risk patient has a way to get connected longitudinally to the health care system - to the point that a program like DOCS wouldn’t even need to exist! But as long as there are medically underserved individuals in the community who need help accessing care, I hope that DOCS can expand its services to address their ever-evolving needs in the medical as well as social domains of their wellbeing.”

-Sarah Sukkar, Class of 2020

DOCS Executive Board

From left to right: Jessica Hunter, Alexa Turpin, Steven Canon Brodar, John Wiltshir Sophia Pines, Rober Not

re, Nizar Osmani, Anise Crane, Kyle Sutherland, Sarah Sukkar, Raysa Christodoulou (DOCS Manager), rt Peaden, Nicole Cruz, & Carly Misztal Pictured: Camille Scott

Contact Information DOCS Faculty DOCS Faculty Advisor DOCS RMC Faculty Advisor DOCS Manager

Amar R. Deshpande, M.D. adeshpande@med.miami.edu Julia L. Belkowitz, M.D. jbelkowitz2@med.miami.edu Raysa Christodoulou rchristodoulou@med.miami.edu

DOCS Executive Board Executive Director Executive Director Co-Director Co-Director Co-Director Interprofessional Education Director Logistics Director Longitudinal Access Director Medical Informatics Director Medical Informatics Director Public Relations Director Research & Quality Improvement Director Training Director

Sarah Sukkar Kyle Sutherland Madeline Cohen Nicole Cruz Camille Scott Sophia Pines Carly Misztal John Wiltshire Jessica Hunter Nizar Osmani Alexa Turpin Steven Canon Brodar Robert Peaden

s.sukkar@med.miami.edu kjs132@med.miami.edu mac504@med.miami.edu nmc113@miami.edu c.scott@med.miami.edu sophiapines@med.miami.edu cmisztal@med.miami.edu j.wiltshire@med.miami.edu jah381@miami.edu n.osmani@umiami.edu agt41@miami.edu brodar@med.miami.edu rpeaden@med.miami.edu

DOCS Regional Medical Campus Executive Board RMC Director Brazilian Community Center Director Director of Clinics Guatemalan Mayan Center Director Healthcare Access Director Light of the World Senior Project Manager Light of the World Project Manager RMC Research & Quality Improvement Director

Anise Crane Jaclyn Perreault Madeleine Hindenlang Rebecca Lynch Abigail Pelletier Nicole Lin Gautam Shrivastava Kumar Patel

axc1476@med.miami.edu jcp208@miami.edu mvh32@miami.edu rml161@miami.edu a.pelletier@med.miami.edu lin.nicole@med.miami.edu gas135@miami.edu hardik.p.patel@med.miami.edu

A final goodbye...

in the era of COVID-19 DOCS Executive Board members bid farewell to the graduating fourth year medical students Anise Crane, Camille Scott, Sarah Sukkar, and Kyle Sutherland, during the final executive meeting hosted over Zoom.

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