Factors associated with enhancing medical students training include ample and varied patient contacts, an active, “hands-on” approach, delegating patient care responsibilities to students (1, 2), and altruism (3). Toward these ends, medical students have seized the initiative by establishing student-run health clinics in at least 52% of medical school programs across the country (4). A majority of student-run health clinics are located within homeless shelters, targeting populations with unmet needs (4, 5). Psychiatry interventions are well suited for targeting unmet needs within the homeless population (6, 7). Responding to their need for a training experience and to unmet needs of homeless persons, Creighton University medical students have opened the student-run Magis Psychiatry Clinic in an Omaha, Nebraska, homeless shelter.

The student-run Magis Psychiatry Clinic was opened in February 2007, branching from its parent, the student-run Magis Acute Care Clinic, founded in October 2004, by Creighton University medical students. It has a student-elected board overseeing fundraising, clinic operations, and community involvement. The Magis Acute Care Clinic has greatly expanded since its inception, to include the addition of a psychiatry clinic. A psychiatry clinic was developed to address unmet mental health needs of homeless individuals—needs that are substantial and beyond the scope of the acute-care clinic. Rates vary in the literature, but a major urban homeless population yielded a chronic mental illness rate of 25% and a substance-use disorder rate of 71% (8). Also, the Magis Psychiatry Clinic has partnered with Creighton’s third-year psychiatry clerkship, making it a unique outpatient training experience for medical students. We describe the psychiatry clinic’s general make-up and present a satisfaction survey of medical students who participated.

The Magis Psychiatry Clinic operates in an Omaha, NE, homeless shelter. Funding sources are from private donors, and the clinic is complete with three exam rooms, a laboratory space, and a waiting area. The Psychiatry clinic is open twice a month, on Saturdays, and operates primarily by appointment. “Walk-ins” seeking psychiatric treatment are triaged by severity and seen accordingly. The Magis Psychiatry Clinic is completely free; this includes prescribed medications.

Working closely with the Visiting Nurse Association (VNA) of Omaha, referrals are made through an outreach nurse visiting Omaha-area shelters. A screening process assesses the need for psychiatric treatment and refers on to the Magis Psychiatry Clinic. Liaison with nursing outreach is an invaluable service to ensure that referrals are consistent with an ambulatory setting and provide follow-up care between visits. Once the patient is evaluated, a diagnosis and initial treatment plan are established with an eye toward eventually referring individuals beyond the Magis Psychiatry Clinic to Omaha Community Mental Health Services. The Magis Psychiatry Clinic functions as an urgent point of service entry for the community mental health service programs of Omaha. However, because of long waiting lists and various other complications, patients may be seen at the Magis Psychiatry Clinic for anywhere from 2 weeks to 1 year.

Volunteers

The Magis Psychiatry Clinic is staffed strictly by volunteers. Two volunteer psychiatrists on Creighton University’s faculty provide services at every clinic date. Since the clinic fulfills an outpatient activity for third-year medical students who are rotating through their psychiatry clerkship, they are also present. First- and/or second-year medical students observe by shadowing third-year students who participate in patient-care responsibilities. The clinic convenes every 2 weeks, so a given student participates in one clinic throughout his or her third-year clerkship rotation. The average number of patients evaluated by a student is 5, with 2-to-3 third-year students per clinic. Staffing by two psychiatrists and a pharmacy faculty member enables flexibility with seeing larger number of patients per clinic date if it is necessary. Interprofessional interaction has proven beneficial within other student-run clinics (9). Pharmacy team members at the Magis Psychiatry Clinic include a pharmacy faculty member who specializes in mental health pharmacotherapy and several pharmacy students. This pharmacy team is essential for efficiently and accurately dispensing medications while also helping to educate patients about potential side effects. Finally, a clinic manager, who is both a medical student and Magis Board member, attends to administrative needs and patient satisfaction issues.

Clinic Protocol

A list of patients provided by the VNA before each clinic includes names and a brief history of each patient scheduled. Typically, 20–25 patients are seen per clinic date. Free transportation is provided for those patients who have no means of travel. A third-year medical student plus a first- or second-year medical student are assigned to each patient encounter. After a complete psychiatric history is conducted, the third-year student presents the patient to the staff psychiatrist. A diagnosis and treatment plan are formulated, using a team approach. Team members see patients a second time, with the staff psychiatrist present. Patients go on to meet with pharmacy team members, reviewing potential side effects of medications and reinforcing directions for proper administration. The Magis Psychiatry Clinic has a formulary of medications on site, and generic prescribing is used as often as it makes sense to do so. Another option is to write prescriptions whereby patients avoid personal expense through accessing a Magis Clinic expense account available at a selected pharmacy. Between visits, patients are monitored by VNA nursing outreach, who may contact staff psychiatry when needed for troubleshooting patient complaints.

Funding

The Magis Clinic does not receive any monetary support from Creighton University. Students on the Magis Board dedicate much time and effort to fundraising. Two major fundraising events held annually include a golf tournament and wine-tasting event with a silent auction. Fundraising is generally well supported by the Creighton community, enabling resources to purchase clinic supplies. The Magis Clinic also submits applications for private grants. Grants from private organizations and endowment funds cover expenses associated with technology equipment and medication. Creighton University alumni and private donors also contribute generously to the clinic.

Creighton University’s third-year psychiatry clerkship offers a variety of experiences. Students are required to do an inpatient experience (either adult or child/adolescent), outpatient (Magis Psychiatry Clinic or child/adolescent), and a psychiatric specialty (consultation, geriatric, or addiction psychiatry). The Magis Psychiatry clinic is a valuable outpatient rotation for student involvement simply because the clinic affords timely access of psychiatry services to a homeless population. A sense of accomplishment is thus experienced by medical students no matter what their individual role may be in the student-run enterprise.

After obtaining approval from Creighton’s IRB, a survey was conducted in order to assess medical student satisfaction with the Magis Psychiatry Clinic as a training site. The survey was administered once after student participation. The survey was closed-ended, but included a choice of ‘No Opinion.’ A percentage of favorable opinions is tallied as a reflection of medical students’ satisfaction and is shown in table format (Table 1). Results of the survey are largely favorable, indicating students’ widespread acceptance of their rotation through the Magis Psychiatry Clinic.

The student-run Magis Psychiatry Clinic is a blend of medical-student training and access to psychiatry services for the homeless population. The free psychiatric clinic is student-run, independently raising funds from grants, private donations, and fundraising events. Partnering with the psychiatry third-year clerkship, medical-student participants are largely satisfied with their training experience as well as the clinic’s commitment to service in general.