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Promise Clinic Volunteer Manual 2013-2014 Funder
“It is very expensive to give bad medical care to
poor people in a rich country” – Paul Farmer
General Information What makes us unique?
The Promise Clinic is a student-run organization that aims to provide
free primary care to the clients of Elijah’s Promise Soup Kitchen in New
Brunswick, NJ. Our patients are uninsured and many are afflicted with
chronic conditions.
The Promise Clinic is built upon a continuity of care model, where
student doctor teams are assigned a patient and and are responsible for the
management of the patient’s primary care. We also have an Urgent Care
component to serve our community with acute issues.
Under close supervision of volunteer attending physicians, medical
students are committed to providing an encompassing range of care for our
patients.
Our goals are aligned to the
core missions of RWJMS:
Through Promise Clinic,
the uninsured and under-served
communities of New Brunswick,
NJ have access to primary
health care that they could not
otherwise receive. The clinic also
serves as an opportunity for
early clinical exposure for
medical students in their preclinical years. We provide both
patient and peer education, as
students in their clinical years
teach pre-clinical students the
basics of the physical exam and
management of chronic and
acute health conditions. We also
collect data on the
characteristics of our patient
population and use this research
to optimize our service and care.
Our facilities are
graciously loaned to us every
week on Thursday evenings
from the Eric B. Chandler
Health Center. What care do we provide?
The Promise Clinic provides basic
health maintenance screenings by
monitoring blood pressure and blood
sugar levels. We also provide
prescription medications, basic
laboratory blood work, and vaccinations,
all free of charge to patients.
We offer psychiatric care on site
for non-emergent cases with the
assistance of volunteer Psychiatry
resident physicians from Robert Wood
Johnson University Hospital. We also
assist qualifying patients in applying for
Charity Care so that they may meet
Specialty Care needs such as Optometry,
Podiatry, Endocrinology, Cardiology, etc.
General Information Important Contacts
Faculty Advisors
Dr. Karen Lin, Faculty Advisor for Promise Clinic
Dr. Eric Jahn, Senior Associated Dean for Community Health
Susan Giordano, HIPHOP Program Coordinatory
Clinic Directors
Phoebe Askie
Veronica Demtchouk
Nitesh V. Patel
Paawan Punjabi
Email: askiepe@umdnj.edu
Email: demtchve@umdnj.edu
Email: patel236@umdnj.edu
Email: punjabpv@umdnj.edu
Clinic Address
Eric B Chandler Health Center
277 George St.
New Brunswick NJ 08901
Clinic Phone
(201)-452-6067
[For use by Patients to schedule
appointments and contact the clinic]
Mailing Address
The Promise Clinic
RWJMS Student Run Healthcare Clinic
Robert Wood Johnson Medical School
675 Hoes Lane, Room N-100 & N-101A
Piscataway, NJ 08854-5635
The Patients We Serve & Services We Provide
Our patients are referred from Elijah’s Promise Soup Kitchen in New
Brunswick, NJ.
We provide the following services
•  Primary medical care for adults, including management of chronic
conditions, acute illnesses, preventative medicine and social support.
•  Vaccinations
•  Patient Assistance Programs (PAP) for prescriptions
•  Basic laboratory services including EKGs
•  Referrals to specific specialty care services
•  Psychiatry consults c/o UMDNJ-RWJ Psychiatry Residents
Before You Volunteer: Background Statement of Need
In the United States, it has been estimated that 671,000 adults are homeless
in a given week, and an estimated 2.3 million adults are homeless over the
course of a year. When children are included, these numbers increase to
842,000 and 3.5 million, respectively.
In January 2004, as part of a course in their curriculum, a group of students
at Robert Wood Johnson Medical School (RWJMS) conducted a survey to
determine the level of health care access for the clients of Elijah's Promise, a
soup kitchen in downtown New Brunswick. The survey revealed substantial
limitations to health care access, as well as the need for a consistent source of
care. This is the premise on which the Promise Clinic began.
Relationship with Elijah’s Promise Soup Kitchen
In partnership with Elijah's Promise, The Promise Clinic runs a weekly
evening clinic, where teams of medical students from all 4 years supervised
by physician preceptors serve selected clients of Elijah’s Promise.
Clinic Structure
In partnership with Elijah's Promise, The Promise Clinic runs a weekly
evening clinic, where teams of medical students from all 4 years supervised
by physician preceptors serve selected clients of Elijah’s Promise.
Continuity of
Care Team
Urgent Care
Team
Each new patient is
paired with a team of
medical students from
all levels of training.
The assigned studentdoctor team will be
responsible for the
patient’s care
throughout the
patient’s stay with the
clinic, ensuring
continuity that is
characteristic of
primary care.
The Urgent Care
team sees patients
who are new to clinic
and have not yet been
assigned a Continuity
team. This team sees
patients with more
acute issues. With the
changing landscape of
American health care,
the Urgent Care
model will become
crucial to our clinic
structure.
Walk-In Team
Each continuity of
care team will be
assigned one date
during the year to
serve as walk-in
team. This team sees
any continuity of care
patient who elects to
walk in on a date
where their regular
team is not scheduled
to come into clinic.
Often, medication
refills are handled
this way.
Promise Clinic Steering Committee The Promise Clinic operates with the assistance of
the steering committee, which is made up of
various subcommittees.
Student Directors
Paawan Punjabi
Veronica Demtchouk
Nitesh Patel
Pheobe Askie
Patient Recruitment
Rachit Vakil
Stephanie Oh
Usha Rao
Michael Serzan
Sophia Sequeira
Luming Li
Chris Jakubowski
Elizabeth Shteyn
Carolyn Na
Sakina Attar
Carolyn Junior
Education
Pharmacy
Bryan Botti
Laura Parente
Afua Takyi
Hannah Simon
Bahareh Shanehsaz
Mark Huang
Sanaa Somalya
Katherine Fu
Angela Rugino
Azad Hirpara
Managers
Finance
Sana Ahmad
Andrew Orr
Jeff Williams
James Yoon
Specialty Care
Stephanie Peters
Aman Shah
Rachel Rosenblum
Helen Mac
Alyssa Schochet
Laboratory
Angel Lee
Derek Rudge
Bekah Gensure
Jenna Presto
Laura Pierce
Public Health
Lisa Gabor
Tina Goodwin
David Silvergeld
Andrea Poon
Suzanne Elshafey
Anousheh Shafa
Quality Improvement
Vidya Puthenpura
Hannah Xu
Timothy Dempsey
Jennifer Reese
Alina Bayer
Lesley Portugal
Chase Hulderman
Stephanie Michelle
Transition Committee
Phoebe Askie
Bekah Gensure
Sophia Sequeira
Lindsay Volk
Timothy Dempsey
Stephanie Oh
Sana Ahmad
Chase Hulderman
Kristin Bonello
Phone Coordinator
Hannah Janoowalla
Pallabi Guha
Thomas Golden
Kerly Guerrero
Schedulers
Kristin Bonello
Ramya Krishnan
Gloria Gerber
M1 Representatives
Sanjay Jumani
Kiersten Frenchu
Christine Tolias
Jimmy Lin
Interpreter
German Bayas
Clinic Policies Role of a Student Doctor
Care is delivered using a team approach. Each patient will be paired with a
group of four or more student doctors, each from various years in medical
school. The student doctor team will work with the patient to come up with
an assessment and plan, and the team will present the patient’s case to the
attending physician. The attending physician will then see the patient to
confirm the assessment and prescribe medication, if necessary. The student
doctor teams will help the patient navigate any social services, further
specialty care, or inpatient services.
Attendance Policy
Serving as a Promise Clinic Student Doctor requires a four (4) year
commitment to your assigned patient(s). In order to maximize the continuity
experience of the clinic, attendance by all team members at every visit is
required. Excused absences will be given according to the circumstances
below:
•  M1: the Thursday night before an exam, the summer months preceding
second year, confirmed illness, and any absence excused by the Student
Affairs office.
•  M2: the Thursday night before an exam, the months of May and June
preceding third year, confirmed illness, and any absence excused by the
Student Affairs office.
•  M3: confirmed illness, and any absence excused by the Student Affairs
office.
•  M4: confirmed illness, and any absence excused by the Student Affairs
office. Due to the unique nature of rotations during fourth year, the
attendance committee will give latitude to students who have
demonstrated commitment to their patients for such events as away
rotations and residency interviews.
The attendance policy will consist of the following:
Any student who accumulates three absences (excused or unexcused) will
have their specific attendance situation reviewed by the education committee.
The committee will weigh the student’s contribution to his/her team and the
detrimental effect of his/her absences to determine appropriate action, if it
should be required.
Dress Code
Student doctors must dress in a Business Casual scheme and their White
Coats. Women must wear a blouse with slacks or an appropriate-length
skirt, or a professional dress with closed toed shoes. Men must wear slacks,
a button-down shirt, tie, and professionals shoes.
Student doctors must also bring their stethoscopes and a pen.
Clinic Policies Staffing Policy
On each clinic night the clinic will be staffed by: a student director, a
scheduling coordinator, a pharmacy coordinator, (a) attending physician(s),
an M1 Representative, a Lab coordinator, a Specialty Care coordinator,
and Student Doctor Teams
Student teams will be assigned their first date with a new patient, and can
schedule subsequent follow-ups. Reminders are sent on Sunday night prior
to appointment. Urgent Care teams have specific dates where they are the
walk-in team, and they will also be reminded via email regarding these
dates.
Confidentiality
The UMDNJ-RWJMS policy on Confidentiality is described in the Code of
Professional Conduct and is adapted from the AAMC’s Recommendations
and Guidelines for the Students of the Organization of Student
Representatives. It states the following:
The Patient’s right to confidentiality of his or her medical record is a
fundamental tenet of medical care. The discussion of the problems or
diagnoses of an identified (or potentially identifiable) patient by
professional staff or medical students in public places (for example in
elevators or in cafeterias) violates patient confidentiality and is unethical.
Under no circumstances can any medical record be removed from the
institution, nor is photocopying of the record permitted. For presentations
or rounds, students are permitted to extract information but not copy
wholesale parts of the chart.
All Promise Clinic patient charts will be kept in a separate filing
cabinet in Eric B. Chandler, which will be locked when the clinic is not in
session. Under no circumstances may a chart be removed from the clinic. It
is essential that all students maintain the confidentiality guidelines
outlined in the University’s Code of Professional Conduct and in the
HIPAA (Health Insurance Portability and Accountability Act) guidelines.
For more information about HIPAA guidelines, please see the following
website: http://www2.umdnj.edu/hipaaweb/index.htm
Clinic Policies Patient Phone Communication Policy
A student will be managing patient phone calls. The scheduled oncall hours will be from 5-9 pm daily, during which time the cell phone will
be on and patients should expect their call to be answered. If a patient
leaves a message at any time, the call will be returned as soon as possible
after 5 PM or at earliest convenience for the patient.
Information from each patient contact will be sent in an e-mail to
the student doctor team and PC steering committee, which includes the
following information:
Name, Date of call, Chief Complaint/Patient
Question, and if an appointment is scheduled the appointment date and
time will also be included.
Phone coordinators will make reminder phone calls to patients who
have an appointment the upcoming Thursday on Monday or Tuesday
night. For any patients who are unable to be reached personally, follow-up
phone calls will be tried on Wednesday.
Any phone calls between the patient and the student doctor team must be
recorded in EMR.
Interpretation Services Policy
We have tried to include one Spanish speaker on each student doctor team,
although this was not always possible. However, translators will often be
available at the clinic. Be aware of the appropriate protocol that one puts
in use when utilizing a medical interpreter
Electronic Medical Records (EMR)
EMR is maintained on a RWJMS secure server. EMR is a central hub, where
patients are scheduled for visits, clinic encounters are documented, and
patient healthcare is. Safeguards have been put in place to ensure patient
confidentiality of sensitive patient health information. EMR can be accessed
at: http://rwjmsweb.rwjms.rutgers.edu/PromiseClinic. To access the
websites, users must have a RWJMS Core account and be approved by
Promise Clinic Student Directors.
Standard Clinic Visit Remember your ABCs
Before your patient arrives
 Arrive to clinic 5:15-5:30
 Discuss the patient history with your team
Admit the Patient
A
 Bring your Patient to the Intake Room and take vitals
 Move to the exam room and complete HPI/ROS
 Write your time of entry on the Post-It on the door
 Complete the Physical Exam
 Compete any labs, if necessary.
Bring to Presentation
B
 Sign up on the Presentation Board
 While you wait, complete your note in EMR
 Present your patient to the attending
 Bring the attending to the room to visit the patient
 Create any prescriptions, if necessary
 Make any charity/specialty care referrals, if necessary
Close the Visit
C
 Finish the note in EMR and have the attending sign off
 Print your note and add it to the patient file
 Counsel your patient, if necessary.
 Schedule your patient for the next appointment
 Deliver your summary and Superbill to the scheduler
 Wrap-up discussion with your team
Things to remember:
•  Arrive 15-30 minutes early
•  Bring your white coat, stethoscope, other relevant
medical equipment, RWJMS ID
•  Do not park in the Eric B. Chandler Parking Lot.
You must use street parking to save the few
available parking lot spots for the patients
•  Enter through the front door, show your badge to
the security guard, and proceed to the back of the
waiting area
•  Collect your patient’s file and review it with your
team in the break room
Student Doctor Responsibilities During the M1 and M2 years, your goal is to perfect skills associated with
the intake and physical exam. This correlates with skills that you are
learning in PCM. Utilize the guidance of your M3/M4 to help you develop as
a student-doctor.
M1 Responsibilities
Objective: Learn about your patient and general clinic procedures
Semester 1
•  Observe the patient encounters
•  Learn to take vitals
•  Familiarize yourself with EMR
•  Read prior EMR notes
•  Attend teaching sessions
Semester 2
•  Take vitals at each appointment
•  Learn/Practice Physical Exam
•  Deliver summary to scheduler
•  Participate in the composition of
the EMR note
•  Attend teaching sessions
M2 Responsibilities
Objective: Learn how to assess patients and manage patient care
Semester 1
•  Perform Physical Exam with
assistance of M3/M4
•  Teach M1 to take vitals
•  Start writing the EMR note
•  Set up follow up appointment &
deliver summary to scheduler
•  Attend teaching sessions
Semester 2
•  Start presenting with assistance of
M3/M4
•  Teach M1 Physical Exam Skills
•  Write more notes with approval of
M3/M4
•  Start presenting to Attending
•  Attend teaching sessions
•  Practice SOAP writing skills
Student Doctor Responsibilities As a M3/M4, you serve as the Team Leaders. This means that you are the
primary physician for your patient. This allows you to demonstrate
leadership skills to M1/M2s. The commitment that you show to your
patients will serve as an example for students in their initial stages of
training. M3/M4s are expected to teach M1/M2s basic physical diagnosis
skills and clinical pearls as they arise during clinic visits. M3s are
expected to lead patient visits and present to the attending with the
guidance of M4s. Discussion regarding patient diagnosis and management
is greatly encouraged among student doctor teams, as the Promise Clinic
environment can greatly prepare M4s for residencies.
M3 Responsibilities
Objective: Learn to coordinate care for your patient and lead a team of student
doctors
•  Coordinate care for the patient according to national health guidelines
•  Present case and write notes
•  Make and explain action plan to team
•  Complete superbill, medication order sheet and other paperwork is
complete
•  Teach M1/M2 Physical Exam Skills
•  Draw labs with guidance of M4/Lab
M4 Responsibilities
Objective: Guide the M1, M2, and M3 in their care of patients
•  Ensure correct measurement of vitals by M1
•  Ensure/confirm physical exam by M2
•  Correct/confirm note in EMR by M3
•  Discuss prognosis and treatment with your team
•  Assist team in presenting to the attending
Patient Flow Process
Admit the
Patient
(35 Minutes)
Once the patient has
arrived, a scheduler
will notify your team.
Greet the patient in the
waiting area.
Bring the patient into
the Vitals Intake
Room. The M1/M2
shall take the vitals
and the M3/M4 shall
record them in EMR.
Work together to create
a differential diagnosis
and management plan.
Record all findings
in EMR.
Update the patient’s
contact information.
Conduct a H&P. M3/
M4 should teach M1/
M2 key points.
Move the patient to an
exam room and write
the time you enter on
the Post-It attached to
your door. Ascertain
the chief complaint.
Bring to
Presentation
(10-15 Minutes)
Sign up on the white
board to see the
physician preceptor.
Present the patient
with the attending in
the attending office.
Discuss your
assessment and plan.
Close the visit
(25 Minutes)
Once the attending has
confirmed the
diagnosis, arrange for
any labs, prescriptions,
referrals or social
services.
Accompany the
attending as s/he sees
the patient.
Ensure that all patient
questions have been
addressed. Counsel
your patient, if
necessary.
If your patient needs a
Public Health referral,
search for the
appropriate resource in
the Public Health box.
One of the team
members should
accompany the patient
and make a follow-up
appointment with the
scheduler. Give him/
her an reminder card
Conclude the visit with
your team. Make sure
all teaching points are
discussed.
Complete your note in
EMR, have the
physician electronically
sign it, and print a
hard copy for your
patient’s file.
Deliver your Superbill
and summary to the
scheduler on duty.