The Dermatology Clinic at the Downtown Emergency Service Center (DESC)
Through participation in the dermatology clinic, medical, nursing, and physician assistant students learn and practice a set of clinical and interviewing skills, as well as become familiar with the special health challenges of homelessness, including limited access to health care, mental health services, and basic amenities such as water and toilet facilities. Student coordinators and student care providers attend annual seminars taught by Amanda Kost, MD, MEd and other physicians on topics relating directly to unique disparities in Seattle’s homeless population. Since 1994, the Dermatology Clinic has provided dermatology care very other Wednesday evening at the Downtown Emergency Service Center (DESC), a shelter for more than 200 adult men and women. Dermatological problems are common in the homeless community, but often go untreated in the presence of more serious medical and social concerns. Approximately ten student coordinators share leadership responsibility, scheduling students and attending physicians, ensuring that supplies are stocked and supervising each clinic session. Care is delivered by two medical student teams, each consisting of a pre-clinical medical student (first or second year) and a clinical (third or fourth year) medical. The teams are precepted by a volunteer attending physician. This program helps students appreciate and learn the complex, tacit skills and knowledge essential in family medicine and many other specialties. Effective diagnosis and treatment requires sophisticated cognitive skills, particularly in the care of underserved and vulnerable patients with multiple comorbidities in communities of special need. CHAP helps future health care providers master skills essential for meeting the challenges of building patient investment, setting priorities, engaging patients in behavior change. Expert practitioners like our preceptors use tacit knowledge and skills that are not often apparent to learners.
Note: As of 2019, the Dermatology Clinic at DESC is on hold while students complete an updated Community Needs Assessment.
Foot Care Clinics
Medical, nursing, and physician assistant students who participate in CHAP Foot Care Clinics develop a toolkit of clinical and health promotion skills for working with community members experiencing homelessness, for whom quality foot care can be a potential life-saver. Students attend a two-hour seminar by Amanda Kost, MD, MEd, and Josephine Ensign, DrPH, which teaches students principles of diabetic pathophysiology and foot care management, in addition to health education techniques and strategies for encouraging positive health behaviors by diabetic and non-diabetic patients. During clinics for individuals affected by homelessness, students work one-on-one with clients to provide foot examinations and foot care while gaining skills in relevant health education and promotion. Current sites for this project include Mary’s Place Shelters, Downtown Emergency Service Center, and Chief Seattle Club, a space for urban Native Americans in Seattle.
Teeth & Toes Clinic
Students who participate in CHAP Teeth & Toes Clinics develop a toolkit of both clinical and health promotion skills for working with community members experiencing homelessness, as well as an opportunity for interprofessional education. Teeth & Toes is a partnership with the School of Dentistry, School of Nursing, and MEDEX NW (physician assistant training program) to provide patients with both a foot and oral exam. Clinics are usually held on holidays (Mondays) when students are out of class and can provide services during the day. Community partners currently include Mary’s Place shelters in Seattle and King County, and Chief Seattle Club, a space for urban Native Americans.