Volume 13

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Title: Addressing Barriers to Visit Attendance and Improving Patient Communication for Gynecologic Specialty Care at Fourth Street Clinic
Authors: Marina Kern, Emma Singleton, Jennifer Kaiser MD
Date: 1/27/2025
Abstract: The monthly Gynecology Clinic at Fourth Street Clinic (4SC) sees approximately one-third of scheduled patients. 4SC serves individuals experiencing homelessness, a population facing unique challenges in clinic communication, visit attendance, and follow-up care. To address this gap in care, a text/telephone reminder system and a patient survey regarding reminder efficacy, communication preferences, and barriers to care (e.g., transportation, safety, childcare) were launched. Based on survey feedback, reminders will be modified, and feasible clinic adjustments will be made to best suit patient needs. Piloting this project among a subset of 4SC gynecology patients will inform communication practices on a larger scale. The project received UUH IRB and 4SC Board QI project approval. The reminder protocol was implemented in phases: months 1–6 used text reminders, months 6–12 used text and call reminders, and months 12-onward will implement a revised reminder system. Patient surveys were collected to assess communication preferences and barriers to care, and the impact of reminders on attendance was analyzed. Preliminary analysis of patient attendance over the previous 12 months revealed that of 43 patients reminded by text only, 24 attended their visit (56%), while out of 47 patients reminded by text and call, 21 showed (44%). The resulting Chi-Squared value of 0.29 (p<0.05) indicated no significant difference between text-only and text-plus-call groups. Future work will focus on retrieving historical clinic data to compare current attendance with attendance prior to the reminder system, estimated at 33%. Recent in-clinic patient surveys provided insight into barriers to attendance. Preliminary responses indicate that factors beyond forgetting appointments and reminder modality (text vs. call) contribute to missed visits. Many patients reported changed or out-of-service phone numbers, which may hinder reminder efficacy. However, all respondents reported ease of scheduling and that clinic timing (Monday evenings) is not an issue. Full survey results are expected to further clarify the barriers patients face.

Copyright: Academy of Health Sciences Educators ©2025

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Title: Impact of Monthly Orthopedic Clinic at Fourth Street Clinic
Authors: Nate Behrens, Tanner Heaton
Date: 1/27/2025
Abstract: The Fourth Street Clinic is a free clinic dedicated to addressing health disparities among underserved populations. Orthopedic conditions are prevalent in these communities due to manual labor, delayed care, and limited access to specialty services. The monthly orthopedic clinic, led by medical students and supervised by orthopedic surgeons, aims to provide free, high-quality musculoskeletal care. Objectives include improving patient mobility, reducing pain, and fostering medical education for future providers in community settings. Patients were referred by Fourth Street Clinic primary care providers for orthopedic evaluation. Each clinic session included triage, evaluation, and treatment planning. Medical students conducted initial evaluations, presented findings to supervising orthopedic surgeons, and participated in patient education. Data on patient demographics, presenting complaints, and interventions were recorded. Patients received follow-up care as needed through the clinic or referral networks. Over six months, the clinic served 26 patients, addressing conditions such as chronic joint pain (50%), acute musculoskeletal injuries (43%), and deformity management (7%). Interventions included intra-articular injections (33%), physical therapy referrals (10%), and surgical consultation arrangements (5%). Approximately one half of patients had follow-up visits and among these, concerns regarding the initial complaint resolved for the vast majority (85%). Students reported enhanced diagnostic skills and a greater understanding of barriers to specialty care in underserved populations.  The orthopedic clinic demonstrates the impact of specialty care integration in free clinics. By addressing musculoskeletal conditions, the program improves patients’ quality of life and builds capacity among medical trainees. Future directions include expanding clinic capacity, assessing long-term patient outcomes, and fostering interprofessional collaborations to enhance service delivery.

Copyright: Academy of Health Sciences Educators ©2025

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Title: Promoting Skin Protection through Dermatology Outreach Booths at Community Health Fairs
Authors: Annabelle Huntsman, Justin Lyon, Adriene Pavek, Bethany K. H. Lewis, MD, MPH
Date: 1/27/2025
Abstract: Skin cancer is the most common cancer in the United States, with basal cell carcinoma being the most prevalent, followed by squamous cell carcinoma and melanoma. Among these, melanoma has the highest potential for metastasis. Utah consistently ranks among the states with the highest incidence of melanoma, driven by its elevated UV index, the popularity of outdoor recreational activities, and genetic predispositions prevalent in the population. Despite these challenges, skin cancer is largely preventable through consistent sun protection and regular skin cancer screenings. Since May 2024, two dermatology booths have been hosted at community health fairs held at the Rose Park Clinic. These booths provided free sunscreen, skincare products, stickers, educational pamphlets on sun safety, information about student-led dermatology clinics, and resources for skin cancer screenings at these free clinics. The number of attendees engaging with the booth and the volume of sunscreen distributed were tracked. Plans are in place to continue hosting the dermatology booth at the clinic’s biannual health fairs to expand community outreach. During the first fair, hosted in May 2024, 125 guests visited the booth, received free sunscreen, and learned about sun protection and available clinic services. At the second fair, hosted in October 2024, 75 attendees engaged with the booth. The dermatology booth strives to emphasize the importance of preventive dermatologic healthcare through direct community engagement. By distributing free sunscreen and products, providing educational resources, and fostering connections with local clinics, meaningful steps have been taken to empower community members to prioritize skin health. The goal is to offer tangible resources to the community to enhance awareness and uptake of preventive measures, ultimately reducing the burden of skin cancer in underserved populations in Utah.

Copyright: Academy of Health Sciences Educators ©2025

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Title: Medical Language Interpreter Training for Student-Led Clinic
Authors: Aileen A. MacLachlan, Kerri Shaffer, Boris Tirado, Boyd Richards
Date: 1/27/2025
Abstract: With the increasing need for medical language interpreters and limited resources at volunteer clinics, many rely on community volunteer interpreters. However, affordable and accessible interpreter training is largely unavailable, creating gaps in the quality of medical language interpretation. This project addresses the need for cost-effective training by designing a free, online interpreter training course specifically tailored for student-led clinics (SLCs) and adaptable for other underserved volunteer clinics. Medical language interpretation is a vital aspect of quality care and is frequently required in SLCs. Inadequate interpretation has been linked to misdiagnoses and even fatal outcomes, highlighting the critical need for skilled interpreters. To address this, our training course consists of asynchronous, web-based modules requiring approximately three hours to complete. The content focuses on the application of the NCIHC Standards of Practice and includes a synchronous final assessment conducted either in person or via Zoom. The course was evaluated using a retrospective pre-post survey sent to 20 volunteers who completed the training, with 15 responses collected. Participants rated their confidence in applying interpretation-specific skills, comfort in providing medical interpretation, and understanding of NCIHC standards before and after the course. Results demonstrated a doubling in the number of participants reporting the highest levels of confidence, comfort, and understanding post-training (p=0.01). All respondents reported high levels of satisfaction and perceived benefit. Our findings affirm that modest, asynchronous training can significantly enhance the confidence, comfort, and understanding of volunteer interpreters. By extending this training model to other student- led clinics, we aim to improve care for non-English-speaking patients while maintaining low costs, requiring only trainees’ time and the final assessment. This initiative reflects our commitment to providing equitable healthcare access and addressing systemic barriers in medical interpretation.

Copyright: Academy of Health Sciences Educators ©2025

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Title: Language Matters: Integrating Community Voices to Validate the University of Utah Quick Language Guide
Authors: Jazmine Abril, Jacob Knight, Tiffany Ho MD, MPH, Paloma Cariello, Rawad Farhat MD, MSPH, Jessica Jones
Date: 1/27/2025
Abstract: Stigmatizing language can significantly reduce patient-provider trust and lead to decreased healthcare utilization and negative outcomes. Using respectful, identity-affirming language is essential to creating a welcoming environment, but a disconnect between academic guidelines and clinical practice persists. Limited literature exists on how diverse communities prefer to be addressed, highlighting a gap in medical education and practice. To address this, a concise language guide was created to educate medical learners on appropriate terminology in patient care settings. The objective of this study was to incorporate both academic research and the perspectives of diverse patient communities to improve the guide. To incorporate community views, focus groups were conducted with community health workers (CHWs), who are trained advocates with close ties to the community. The CHWs represented various medically underserved communities, and 20 CHWs employed by the institution were invited to attend one of three focus groups. Two researchers led 1-hour groups using a semi-structured question guide. The sessions were audio recorded and transcribed, and data was coded using Dedoose software for qualitative content analysis. Results were organized into two themes: suggestions for quality improvement purposes and tensions between academia and the community. Sub-themes included terms used by academics that are stigmatizing to community members, terms used by the community that are stigmatizing to academics, and medical information considered confusing or controversial. Findings emphasized the need to consider differences in language used by academics and community members to avoid misunderstandings. Feedback from focus group discussions is currently being incorporated to revise the language guide. A significant insight revealed that discrepancies in the language utilized by academics and community members may lead to misunderstandings or conflicts. Broadly, the data support the utility of the Quick Language Guide, which ultimately has the potential to improve the awareness, knowledge, and use of inclusive language among medical learners and instructors.

Copyright: Academy of Health Sciences Educators ©2025

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Title: Cultivating Cultural Humility and Advocacy: An Online Module on Health Equity for Medical Students at the University of Utah Spencer Fox Eccles School of Medicine
Authors: Jacob Knight, Karishma Shah MD, PhD, Jenna Weber MD, PhD, Jenna Murray MD, PhD, Silvia Soule, Eve Larkin, Adam Gaudin, Bita Tristani-Firouzi, Rawad Farhat MD, MSPH, May Shaban
Date: 1/27/2025
Abstract: The objective of this project is to develop an accessible tool for medical students to enrich their knowledge and better meet the needs of tribal, rural, and medically underserved communities. The University of Utah Spencer Fox Eccles School of Medicine (SFESOM) serves all people and communities of Utah and the Intermountain West by intentionally supporting and improving individual and community health. This mission is achieved through equitable patient care, education, and research. To support this mission, a student-led clinic initiative was launched, requiring all medical students to serve in five community clinics as part of their education. Additionally, the Tribal, Rural, and Underserved Education (TRUE) program and the Rural, Urban Underserved, and Tribal Education (RUUTE) initiatives are designed to equip future healthcare providers with the skills necessary to serve in underserved areas. However, these opportunities are not available to all 500 medical students enrolled at SFESOM. It is evident that the training provided in student-led clinics could be complemented by an elective online module focusing on research and cultural humility skills to further align with the school’s mission. To better understand the educational needs of the medical students, a group of 10 fellows—3 MD/PhD candidates and 7 medical students ranging from second- to fourth-year— affiliated with the Office of Academic Culture and Community met weekly or biweekly. Their goal was to assess gaps in the current curriculum and develop a detailed outline for new modules. These modules address topics such as cultural humility and the health challenges faced by rural and tribal communities. To ensure the professional development of the online modules, partnerships were established with domain experts in online curriculum design. The creation of these online modules requires a stepwise process with input from a multidisciplinary team. A prototype of the online module will be presented at the symposium.

Copyright: Academy of Health Sciences Educators ©2025

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Title: Enhancing Early Detection: A Community-Based Skin Cancer Screening Initiative at the Fourth Street Clinic
Authors: Justin Lyon, Addy Kirkham, Adriene Pavek, Bethany K. H. Lewis MD, PhD
Date: 1/27/2025
Abstract: Non-melanoma skin cancers (NMSC), including basal and squamous cell carcinoma, are the most commonly diagnosed cancers in the United States, with approximately 5.4 million cases diagnosed annually. The rising prevalence of skin cancer over the past two decades may be attributed to increased surveillance, greater sun exposure, and longer patient lifespans. While NMSCs are rarely life-threatening due to their low metastatic potential and high curability rates, individuals experiencing homelessness have been shown to have a delayed time to diagnosis, increasing their risk for poor prognostic factors. Current dermatologic literature underscores the importance of annual skin cancer surveillance for high-risk populations to enable early detection and reduce melanoma- related mortality. In response to this growing need, the Fourth Street Clinic (4SC) in Salt Lake City, UT, partnered with the American Academy of Dermatology (AAD) to provide annual skin cancer screenings for this underserved population. Patients were scheduled for screenings through phone calls and walk-in requests. Awareness of the event was spread through local health fairs, flyers, and word of mouth. Staffing included volunteer-based medical students from the Spencer Fox Eccles School of Medicine (SFESOM), current dermatology residents (PGY2-4), and attending dermatology faculty. Each patient was triaged and completed a demographic form provided by the AAD prior to their screening. Dermatology residents and attending physicians conducted free skin cancer screenings, biopsying suspicious lesions when found, with results shared within 10-14 days along with treatment recommendations. Thirty-nine patients were scheduled for screening, with 20 free skin cancer screenings provided. Two biopsies were performed, both showing benign findings with no further treatment needed. The average age of screened patients was 51.5 years, with 35% of patients being Spanish speaking. Additionally, this event provided a first-time learning experience for five medical students. The Fourth Street Clinic’s annual skin cancer screening provides a model for overcoming healthcare access barriers faced by individuals experiencing homelessness. Expanding these services through continued partnerships with the AAD could potentially detect skin cancers earlier, thereby improving patient outcomes and reducing skin cancer-related morbidity. Further efforts are needed to enhance awareness of these screenings.

Copyright: Academy of Health Sciences Educators ©2025

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Title: Community Health Workers (CHWS) Partnering with Medical Students to Promote Experiential Service Learning in a Student Led Clinic
Authors: Wesley Allen, Karishma Shah, Jazmine Abril, Sonia Sehgal, Silvia Soule, Sonja Raaum MD, Kamaile Tripp, Princess Bombyck CHW, Kristine Snyder, Rawad Farhat MD, MSPH
Date: 1/27/2025
Abstract: Community Health Workers (CHWs) are public health professionals who share life experiences with the communities they serve and specialize in addressing the specific Social Determinants of Health (SDOH) for their populations. Despite their vital contributions, their role remains underrecognized and underutilized within the University of Utah Health System. While SDOH curricula are common in medical education, effective teaching methods remain unclear. Experiential service learning has proven to be an effective strategy in helping students understand the profound impact of SDOH on patients’ lives. Partnering CHWs with medical students in a clinical environment has the potential to enhance education on SDOH. To increase awareness of CHWs’ roles, two MD/PhD students created an online awareness video, sponsored by Utah AHEC. Sixty-two first-year medical students (MS1s) were assigned to work one half-day per week in a student-led clinic (SLC), where a full-time CHW, employed using HRSA funds, was present. Students paired with CHWs conducted SDOH screenings to identify patients’ social, medical, and physical needs and collaborated to address gaps using health system and community resources. To evaluate the effectiveness of students’ experiential learning with the CHW, surveys were distributed to all 62 students, and a focus group with 12 MS1s was conducted to identify qualitative themes. Results showed that 98% of students reported that CHWs enhanced their ability to advocate for patients, recognize available resources, and understand SDOH. Additionally, 60% noted a “significantly value-added” impact of the CHW in each category. Focus group findings aligned with survey results, highlighting improved understanding of SDOH, community resources, and stronger connections to patients and the community when working alongside CHWs. Incorporating CHWs into SLCs effectively educates medical students about SDOH through experiential learning. Students reported a significant positive impact on their knowledge and skills, suggesting that this model enhances both education and patient care. Future research will focus on evaluating patient outcomes to further assess the program’s effectiveness.

Copyright: Academy of Health Sciences Educators ©2025

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Title: Addressing Nutritional Deficiencies at the South Main Clinic through collaboration with Better Being Co.
Author: Joselyn Slobodow
Date: 1/27/2025
Abstract: The South Main Clinic provides healthcare services to the local community, with the majority of its patients identifying as Hispanic. These patients demonstrate an increased prevalence of food insecurity and chronic disease. To address such food insecurities, the clinic has worked with local food banks to provide donations directly to patients during their clinical visits when requested. However, these donations primarily consist of dried grains and canned foods, lacking fresh produce and the vital nutrition associated with it. This project aims to understand and address nutritional deficiencies among the Hispanic population. A comprehensive literature review evaluated the prevalence of nutritional deficiencies among underserved Hispanic populations. To address identified nutritional deficiency gaps, a partnership was established with Better Being, a company specializing in nutritional supplements. The collaboration entailed explaining the needs of the South Main Clinic community and providing a tailored supplement list to address those needs effectively. Literature demonstrates that food insecurity is associated with higher rates of anemia and micronutrient deficiencies, including vitamin A and iron. Additionally, Hispanic populations exhibit increased rates of vitamin D deficiency, with toddlers being particularly affected by iron deficiency. Further, Hispanic pregnant women have demonstrated lower rates of prenatal supplementation and knowledge of the importance of prenatal vitamins for fetal development. Using this knowledge, the South Main Clinic community health worker and medical student communicated the community’s needs directly with the Better Being outreach team to ensure donations would be tailored to these specific needs. By request, the company donated 100 units each of vitamin D, iron, calcium, prenatal vitamins, and children’s multivitamins. The literature review conducted prior to the donation request allowed for an informed decision to best serve the community’s needs. Future efforts should focus on expanding such partnerships and increasing patients’ education to improve their overall health outcomes.

Copyright: Academy of Health Sciences Educators ©2025

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Title: Mass Confusion: A Liquid Cancer’s Solid Disguise
Authors: Bailey Kelson, Michal Niwinski
Date: 1/27/2025
Abstract: A 58-year-old man with acute onset dyspnea and leg edema was admitted through the ED when evaluation revealed elevated BNP, leukocytosis, troponin elevation, and interstitial edema. A provisional diagnosis of NSTEMI resulting from acute-on-chronic HFpEF was made. Methods: Echocardiogram revealed no regional wall motion abnormality but did show diastolic dysfunction with apical sparing suggestive of cardiac amyloidosis, prompting a PYP scan that returned negative for TTR amyloid. Management of HFpEF was initiated, and urine and serum protein electrophoresis were requested. Interestingly, leukocytosis increased despite NSTEMI resolution; the development of vomiting and abdominal pain prompted an abdominopelvic CT after which the patient electively discharged home. Results: The radiologist’s report later noted numerous mesenteric solid masses concerning for malignant lymphadenopathy. On outpatient follow-up, repeat CT to identify the optimal biopsy site revealed that the mesenteric nodules had surprisingly decreased in size and intensity. This prompted reinterpretation as resolving hemorrhagic foci from amyloid angiopathy. Urine electrophoresis returned showing monoclonal gammopathy, and bone marrow biopsy confirmed the diagnosis of multiple myeloma. After discussing prognosis and treatment options, the patient elected for comfort care. Conclusion: This case illustrates the importance of recognizing AL amyloid-associated disease, including amyloid angiopathy, as possible manifestations of multiple myeloma. Amyloid angiopathy can occur via vascular fragility and multiple mechanisms that disrupt primary and secondary hemostasis. AL amyloid may also present with nephrotic-range proteinuria, macroglossia, hepatomegaly, peripheral neuropathy, or purpura. Here, the unifying diagnosis was delayed by a spurious CT finding of lymphadenopathy, which is not characteristic of multiple myeloma; this distracted from echocardiographic evidence of an amyloid-producing disease. Additionally, while cardiac technetium scans are invaluable for the non-invasive detection of transthyretin amyloidosis, they are insensitive in detecting amyloid of other compositions and must be combined with monoclonal protein studies to confidently rule out amyloidosis. Recognizing the connection between plasma cell dyscrasias and amyloidosis is critical to the timely identification of potentially malignant underlying mechanisms of amyloidosis. By drawing attention to the heterogeneity of this illness’ presentation, we hope to spare similarly presenting patients the time spent contemplating the presence of “solid tumors” and move them more quickly toward a hematologic malignancy work-up. Additional Context: This patient was unable to be reached once his CT results had raised concern for malignancy. His outpatient workup would have been significantly delayed had he not been part of Rose Park’s pilot program bridging patients from inpatient to outpatient. Had we not met him prior to his unexpectedly early discharge, he would have been lost to follow-up.

Copyright: Academy of Health Sciences Educators ©2025