Customizing the Clinical Trunk: How I Engaged with Underserved Communities During My Clinical Clerkships
From the moment I decided to apply to medical school, I knew that I was interested in working with underserved populations. As someone from a low-income background myself and from working with many underserved populations through volunteering and working in Chicago where I did undergrad, I saw the immense need for dedicated healthcare providers in these communities.
When interviewing at Michigan, I looked for the opportunities to work with these communities, as I did in all of my medical school interviews, and remember students discussing various ways they worked with diverse and underserved populations. From opportunities such as volunteering at the Student-Run Free Clinic or completing my emergency medicine rotation in Detroit during the Branches, I was excited about the various options Michigan gave to create a path in medical school that aligned with my passions. Despite this excitement, I was also worried that a core of my clinical learning, the clinical trunk or M2 year, would lack the opportunity to work with underserved populations as most of the clinical year is completed at the University of Michigan Hospital. While the University of Michigan sees patients from all over the state and even the country, it is no secret that a lot of patients in the Ann Arbor area are more affluent than surrounding cities and have access to excellent health care that not everyone in the country is afforded. I knew that I would receive a great education, but would I be able to help the underserved like I wanted to? It turns out the answer is yes.
One of my first clinical clerkships was Family Medicine where I worked at the Ypsilanti Health Center. Ypsilanti is a town just southeast of Ann Arbor and is home to some of the best food I’ve found in the area (check out Lan City and La Torre, you won’t regret it). I chose this location not only for the food, but also to begin to see patients from populations I eventually wanted to work with in my career. During this month, I worked with patients who could not afford medication to control their diabetes, who didn’t want to go to the emergency room despite our suggestion due to the associated cost, who was in the process of getting deported and had to leave their entire family behind, and many others with circumstances and experiences that were novel to my medical career. I found that many of my appointments weren’t simply focused on diagnosing a condition and coming up with a plan to fix this medical problem, but rather having to discuss their life circumstances and put their health in the context of their overall life in order to come up with viable options that I might not have ever thought about with patients not in their position.
In addition to working in Ypsilanti, the Family Medicine clerkship also offers excursion days where you can work at various clinics or sites for a day to see different aspects of family medicine. These experiences ranged from doing home visits to working in a sports medicine clinic, but the one that interested me was the Corner Health Center, which is a clinic that provides free services to patients aged 12-25 that range from general health care, obstetric and newborn care, mental health, support services, and more. While I only spent one morning working at this clinic, I was excited to be able to participate in an organization that provided such necessary services and was working to improve the overall health of young people.
The last experience I had during my clinical year working with populations outside of Ann Arbor was during my outpatient month of Internal Medicine. During this month, students are typically assigned to specialty and general internal medicine clinics that they work at once a week; however, there is an option for students that are interested to request to work at a clinic that primarily works with underserved populations. As you can probably guess by now, I requested to work at one of these clinics and was assigned to Hamilton Community Health Network in Flint, MI. Hamilton Community Health Network is a Federally Qualified Health Center (FQHC), which means they receive money from the government to cover health care-associated costs for those who cannot pay and also see lots of patients with government insurance, such as Medicare and Medicaid. Their mission is to provide care for low-income patients, regardless of their insurance or ability to pay. In addition to general health care, the clinic I worked in included in- office dentistry, pharmacy, x-ray, blood labs, and subspecialty services from the University of Michigan such as urology and ob/gyn that saw patients weekly. Many of the patients I saw were unable to drive themselves or afford public transportation and needed to utilize transportation from their insurance to come to the office. With physical and/or financial restrictions, it was important for them to be able to see the doctor, get their labs, and pick up their prescription all in the same day at the same place or else they would not be able to. I saw how seemingly small things such as coming to a return appointment, which normally I would suggest to a patient without hesitation, were major barriers to the health care these patients received. This experience allowed me to see everything we take for granted in a well-resourced health care system and gave me experience working in an environment where all aspects of the patient’s life must be considered.
Reflecting on my clinical year, I am grateful for the opportunities I was given to work with populations that I care so much about. These experiences were among the most impactful I have had this year and have taught me important lessons that will make me a better doctor. While not everyone has the same experiences as me, I saw that you are able to tailor your clinical year to your interests and can see patients from different backgrounds than those at Michigan Medicine. As I enter the Branches, I am excited to continue to incorporate these experiences into my medical school career, and I have already scheduled a month to return to the Corner Health Center for an adolescent medicine rotation! While the Branches are a great place to explore your interests and passions, know that the clinical trunk has lots of flexibility and many unique opportunities to work with patients from many backgrounds.
Kyle Wickham is a rising third-year medical student at the University of Michigan Medical School. He is interested in pediatric primary care and improving health disparities in underserved youth. Outside of medical school, you can find him with his cat Bao, riding his bike, or watching RuPaul’s Drag Race.