Almost overnight, the COVID-19 pandemic transformed how health care in the U.S. was delivered. The shift to telehealth was a blessing to millions, but some patients lacked the necessary technology—even a telephone—and were suddenly deprived of their access to a physician. Students at University of California, Davis, School of Medicine (UC Davis) took note and developed a workaround at their student-run clinics.

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Content related to health systems science—an understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery—has become more frequent on the United States Medical Licensing Examination (USMLE). The National Board of Medical Examiners includes the topics in its USMLE Content Outline and offers a dedicated health systems science subject examination.

To help medical students, the AMA Accelerating Change in Medical Education Consortium has collaborated with the “InsideTheBoards” podcast to create a health systems science (HSS) podcast series. Each episode of the HSS series offers on-the-go learning by breaking down practice exam questions with expert guests.

A recent episode features a conversation with Tonya Fancher, MD, MPH, associate dean of workforce innovation and community engagement, and Mustafa Shakir, a second-year medical student, both at UC Davis. Besides answering hypothetical test questions on the subject of social determinants of health, they shared a real-world example of helping patients whose socioeconomic circumstances threaten their health during the pandemic.

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Like most U.S. medical schools, UC Davis has student-run clinics for uninsured, undocumented and low-income patients who have no other access to nonemergent health care. They shut down to in-person visits in March in response to the COVID-19 pandemic, and while they quickly transitioned to a telemedicine model, students and faculty saw that many patients lacked the means to connect online or by phone.

But even if all of their patients had had Zoom or an equivalent, they would have still faced a steep challenge.

“If you go to a regular provider right now and the provider suspects something, instead of them making the decision right then and there, they end up sending you for imaging because they have access to that,” Shakir said. That of course is impossible to do on Zoom.

“How do we get around those two problems?” he said. “How do we get to see patients who don't have access to care or who need a physical evaluation, while limiting the spread of COVID—keeping our patients safe and keeping our students safe?”

“We decided that we were going to open one centralized clinic to see patients in person and have all the other 12 student-run clinics still operate on a telemedicine capacity and send patients that they deemed necessary to see physically to that centralized clinic for physical evaluation,” Shakir said. “Having one centralized location would allow us to consolidate PPE.”

The move also enabled the team to consolidate its medical student workforce.

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“It's really hard to implement a safety protocol in 12 locations and make sure everyone's following it, compared to implementing a safety protocol in one location,” he said.

Shakir and Dr. Fancher also discussed how they customized their clinics to serve different populations, including those who have specific needs.

“They're very exciting projects because they help the medical students get clinical experience, and they help the populations of the communities around us,” Shakir said.

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