Boundary crossing in medical education: The Sayre Health Center

Poor, minority populations receive suboptimal health care services. Many of these patients do not benefit from sustained interaction and communication with physicians. Research shows that this lack of focus on interaction and attention to issues of difference in patient race, class, and culture are partially rooted in the medical school educational experience. Documentation of non-traditional programs that advance a different socialization experience for medical students as they interact with patients in underserved communities, however, is limited. The health clinic at Sayre High School in West Philadelphia provides medical services to community residents. The Sayre Health Center (SHC) also presents an opportunity for select University of Pennsylvania medical students to work with patients in their urban neighborhoods; requiring the students to navigate boundaries of race and class that medical school programs often ignore. This qualitative case study uncovers the attitudes that exist and changes that occur for medical students throughout the course of this experience. The study positioned the complexity of transactions between Penn students and SHC patients in the context of Penn medical training. Through initial and exit interviews of participating clerkship students at the onset and conclusion of their rotations, this study brought to life medical students\u27 views of community patients as well as the impact of the clerkship on these perspectives. The study showed participants viewed the SHC rotation as a uniquely beneficial component of their medical training. The experience expanded their views of community patients and the challenges they face. Medical students recognized intra-group variation, and the distinct cultural norms of community patients. Participants understood the strong connection between individual and community barriers to behavioral change, and gained new appreciation for the role that doctors could play in improving patient health. Medical students experienced profound changes as a result of the four-week clerkship at Sayre Health Clinic. This finding suggests the importance of such community experiences in all medical school curricula. This work can potentially assist medical faculty and professional developers as they address the salient issues raised by these findings in their own training programs, and in their practice of medicine