This issue of the Center for Humanism newsletter celebrates 10 years of the Cooper Rowan Clinic.

The Cooper Rowan Clinic -- or "student clinic," as it's known throughout the CMSRU community -- is one of the most amazing things about being a student at Cooper.

It's student-run, it's free for all patients, and it changes the lives of all who step through its doors.

Below, you'll find reflections from members of the Cooper Rowan Clinic community on what they've learned being a part of this very special place.

The Cooper Rowan Clinic has been an integral part of the curriculum since CMSRU welcomed its first class of students in 2012. As attendings and subsequent directors, it has been an absolute privilege to be a part of such a meaningful establishment which has provided positive experiences for patients and students who rotate through the clinic.

The idea of a student clinic that could provide free continuity primary care seemed like a pipe dream, at first. What started as a once-a-week clinic with 50 first year students has now evolved into a 4-day-a-week clinic with over 300 CMSRU students working together to provide primary care services to over 600 patients per year.

As the clinic grew, we came to understand the multiple unique factors which impacted our patients’ overall health and access to care. Student driven initiatives, such as care coordination, were born and have evolved over the years to include resources for transportation, mental health, housing -- amongst many others.

We have cared for patients that have remained in our clinic for 10 years, and some that have come to us transiently when they have lost their job and insurance. Patients who had not been able to access a doctor in years were now able to receive free medications, labs, imaging and specialty care within the Cooper health system.

As directors of this clinic, it has also been amazing to witness the relationships and trust formed between patients and their student providers. Students have stood in the room with their patients while they undergo surgery, offering a sense of comfort from afar.They’ve gone with them to the specialist's office, sat by their side and consoled them during a difficult diagnosis.

These same patients are brought to tears when they hear their M3 student provider is moving on to fourth year and will no longer be with them.

But these patients will not be left alone. Thanks to near peer learning, they will continue to be followed by their M2 and M1 providers as they progress through their educational journey and the care will continue onwards for years to come.

To improve the quality of healthcare, the field of medicine has been incorporating new technology, such as robotic surgeries and artificial intelligence. Many people cannot ever reach this type of advanced healthcare because of social inequality. As a medical student in Camden, I often witness social determinants of health such as economic instability, cultural and language barriers, poor health literacy, and other social constructs like age profoundly limiting access to the healthcare system. These factors affect people’s quality of life, morbidity, and mortality and further perpetuate health inequity.

Since the start of my medical education, I have put effort into increasing health equity by being deeply involved in Cooper Rowan Clinic, especially with Cooper’s Care Coordination. Cooper’s Care Coordination connects patients with free local resources to meet their social needs. Based on patients’ self-reported social needs, we provide resources in transportation, shelter, food, and careers.

Even during the pandemic, my effort was extended to updating our resource database weekly and providing the most updated resources to patients as many organizations constantly modified their services and hours. This way, I wanted to minimize any hindrance patients may face to reaching the health care system during the worldwide struggle.

In the hindsight, being involved in Cooper’s Care Coordination helped not only our patients at Cooper Rowan Clinic, but also myself, especially during the pandemic. As soon as everything was shut down due to the pandemic, I felt as if my life as a medical student came to a halt. No social interaction. No more encounters with my patients at CRC. That was when Cooper’s Care Coordination served as a lifeline for me. I was struggling with social isolation and worthlessness, because I felt I couldn't do anything for my family, friends, and community.

Although we cannot say we overcame the pandemic completely, I can say that we were able to get through this hardship together as one, big community. Being a part of the Cooper Rowan Clinic was a huge part of that, for me.

Teaching is like zesting citrus. Tiny specks, folded into something, making it better. It can be done carefully, or carelessly. If you add zest to something that’s too hot you’ll evaporate, oxidize, or hydrolyze the volatile hydrocarbons that embody zest. Add too much and the result can be bitter; too little is as good as none at all. If you scrape the peel against the rasp in the same direction over and over, you will develop tiny little tracks between the tiny little blades. You may miss the peel and pilfer the pith!

The transition from student to student-teacher is tough. Like zesting a lemon, one can teach with or without attention to detail. When I started managing my team of student doctors as a third year “team captain” in the Cooper-Rowan Clinic, I wanted to craft an experience that would allow my colleagues’ intellectual curiosity and compassion to bloom, not burn.

To set a tone, I started every clinic email with, “our healing circle re-commences!” In a healing circle, everyone participates—altogether—in everyone else’s restoration. I wanted to set the tone: we are the healers, and our success is collective. I hoped to convince everyone to invest themselves in our clinic, and therefore our patients and each other. I requested that, before leaving clinic, every team check if the other teams needed help seeing patients. I wanted to imbed solidarity and kinship as key elements of workflow. We are a community whose responsibility is at least as much to each other as to our patients, i.e. check on your people.

Before each clinic, I set goals with my small group, composed of one first and one second year. One month, a goal I shared with my brilliant first year was that I would interject less during her patient conversations. I was surprised to hear that actually, I could offer more support. Teaching is a feedback loop. I encouraged other groups to set goals for themselves too, and I shared resources for building their andragogy. Scholarship describing effective andragogy is becoming robust and user-friendly, and I hope that my peers and I will employ its advice.

As I consider my transition to residency, I’m excited to continue learning to be an effective teacher, working with students to procure the right environment within which to bloom.

Names and identifying details have been changed to protect patient privacy.

I have the honor of working in the Cooper Rowan Clinic and have done so for many years, in fact, two days each week. Certain experiences defy words and must be felt – the CRC is one of those. It is an entity that gives constantly: to the many patients seen there, to the countless students who play a large role in running it and caring for the patients, and to the faculty who embrace their role as teacher. The countless hours of those who oversee the CRC, the pharmacy team, the quiet and unwavering financial support of Cooper University Hospital and Cooper Medical School of Rowan University have created and nourished the CRC, and through it touch the lives of so many in need.

My role allows me to see a first-year student on their first day in the CRC, wearing their bright and pressed new white coats. They begin as nervous and unskilled and turn into third year students who have grown into teachers, mentors, and skilled diagnosticians with wonderful bedside and interpersonal skills. At the end of the M3 year they turn the care of their patient, many of whom they have guided through the past three years to their M2 teammate as the M1 sees what lies ahead for them. As a faculty member in our clinical course, FMP, I get to see the CRC as the showcase of what is taught and see the patients as the ultimate beneficiaries of the curriculum at CMSRU. Priceless.

May has been a CRC patient since the day I started. She is bigger than life, in her early 60s and has a loud voice with an island accent that makes everyone smile. She loves the student team and knows everyone’s name and takes the time to find out how their life is going! I have seen her many times as luck would have it since her student team has been on one of my days there. The faculty get to know these patients and that is the key: each patient gets the extra time and effort of a team of three students along with the experience and knowledge of board- certified physicians. These patients do not have insurance, live in Camden, and would not have free access to such care elsewhere.

May asked if I was there on this particular day and wanted me to come and say hello and to give me a gift. I walked in and May was May and had me laughing in no time. She reached into a bag and pulled out a piece of art she had created for me. It was a torn-out page from a crayon coloring book brightly brought to life by May. It was protected by a clear plastic cover – no frame. The pride in her face was immediately met by a blush in mine and a hug from me. What May gave me that day is priceless.

I remember my first day at Cooper Rowan Clinic as if it were yesterday.

I sat in the small exam room waiting for the arrival of our first patient. Imposter syndrome slowly began to creep in from all angles and filled me with doubt. What if I forget to introduce myself? What if I forget to ask the patient their name? There is no way I am capable of caring for this patient.

The thoughts began to race with no end in sight. Until my colleagues turned to me and said, "Samantha, the patient is here. Do you want to go get them from the waiting room?" There was no turning back now.

When my patient responded to their name in the waiting room, I was greeted with a warm familiar smile that eased my doubt.

I always saw my background as a disadvantage, because adversity is often associated with first-generation college graduates or Latinx medical students. But for the first time, being a first-generation Latina in Cooper Rowan Clinic was a strength of mine. The majority of the uninsured population at our clinic is Hispanic and Spanish speaking, which was a pleasant surprise. I never anticipated caring for a Hispanic population of this magnitude.

Working with CRC patients allows me to celebrate my cultural identity in ways I have never anticipated. As a Latina, I relate to our patients on many levels, allowing me to form everlasting bonds with them. I also enjoy the opportunity working with the patients at CRC provides me to educate my peers on caring for Hispanic patients and other underserved populations. The combination of these two aspects significantly impacts the patient's experience and long-term outcomes, which is why I take great pride in being part of the process.

Although most of my CRC experiences are positive, some are more challenging than others. The biggest challenge I face is feeling limited in the ways I can help patients, especially as a member of Care Coordination. I know CRC and Care Coordination already provide many resources, but it's difficult when we can't offer them a particular service. I tend to struggle with over-offering my help when limitations like these arise.

Nonetheless, all my experiences working with the population of CRC have been memorable. I envision pursuing primary care in an area like Camden to provide quality healthcare in underserved communities. Additionally, I hope to do clinical research specific to the Hispanic population to provide data that more accurately reflects the Hispanic population. Lastly, I anticipate involvement in admissions and diversity in an academic setting. I believe in diversifying the medical field to accurately reflect the society we care for and to bridge gaps in healthcare.

Cooper Rowan Clinic provides patients with free medications, blood pressure cuffs, and blood glucose meters. The pharmacy serves approximately 8 to 10 patients and dispenses an average of 20-30 prescriptions every clinic day. During regular clinic hours, there are always two pharmacists on duty at the clinic. One is responsible for filling and the other for verifying the prescription. During the academic year, there are pharmacy students from different years. The pharmacy students help the medical students collect medication history, conduct medication reconciliation, and educate patients. Additionally, pharmacy students help obtain certain expensive branded medications for patients through patient assistance programs (PAPs).

Running a small pharmacy with a limited budget comes with its challenges. Firstly, Cooper Rowan clinic only carries a small formulary with a few generic medications. We are required to formulate recommendations based on these limitations. If it is not within the clinic formulary, the pharmacy can try to obtain certain brand-name medications through patient assistance programs. Secondly, we are limited in the use of technology. In the clinic, we have to manually fill and write all our labels, log our inventory, and count large quantities of medications. However, most large pharmacies have all or most of these processes automated. The automation allows them to reduce waste, improve productivity, reduce waste, and shift pharmacy focus from dispensing to patient care activities.

Despite these challenges, working in Cooper Rowan Clinic has been one of the most rewarding experiences in pharmacy school. When I first moved to the States and my family did not have insurance, my dad relied on a similar state-run program for his hypertension and diabetes care. I am grateful to be able to pay it forward and be a part of a program that provides care to the underinsured population. The program offers additional benefits for pharmacy students. Firstly, it helps develop interprofessional collaboration. In the clinic, pharmacy and medical students work together to interview and formulate a recommendation for the patients. The collaborative practice allows us to acknowledge each individual's vital role in the patient care process. Secondly, the clinic has helped me learn and consider social determinants of health in patient care. All our patients have varying degrees of literacy, beliefs, and financial and social support. We keep these social determinants in mind when making recommendations for our patients because it drastically impacts the effect of our intervention. Finally, most of the preceptors in the clinic are academic practitioners. As a student, this provides us with opportunities for mentorships and research.

After graduation, I would like to enroll in a residency in Health-System Pharmacy Administration and Leadership (HSPAL). Through the program, I want to learn and gain the skills required to make healthcare more practical and efficient for the uninsured population. Cooper Rowan Clinic has taught me that there is a lot that can be done and is a good start for those interested in making a change.

As a brand new M3, excited to finally be in the hospital, I wanted to help the medical team I was assigned to as much as I could. This often came in the form of communicating with pharmacists about medications, social workers regarding discharge, and behavioral therapists when our patients were disheartened. Thankfully, I was well prepared for the task after working as part of an interprofessional team of students at the Cooper Rowan Student Clinic. I was able to work closely with pharmacy, physical therapy, and social work students in similar stages of training as myself to serve our patients more comprehensively.

Early on in my medical education I was told an analogy of a physician’s toolbox. Throughout my education and experience I would add tools, both physical and mental, that would help me diagnose, treat, and counsel patients. However, like any tool, I must learn how to use it correctly. This was the major challenge while working as an interprofessional team at the Cooper Rowan Clinic. I knew my job as a student doctor but didn’t know enough about the role of the other professional students to use them for my patient’s best interest. This required me to humbly apologize for my ignorance and ask my team members about their professions, often outside of the designated clinic time. Interacting with and learning from the different professional students was a highlight while working at the Cooper Rowan Student Clinic. I have always enjoyed the challenge posed by a medical career to be a lifelong learner and working with my interprofessional team was the perfect opportunity to practice.

I plan to go into Otolaryngology – Head and Neck Surgery and the skills and experience gained from working with my interprofessional team will help me be more successful in my future career. Otolaryngologist frequently work with interdisciplinary cancer teams, audiologists, speech and language pathologists, and everyone involved with a patient’s hospital stay such as pharmacists, nurses, social workers, and psychologists. Working with the interdisciplinary teams in the Cooper Rowan Student clinic was not only fun but extremely valuable in teaching me how to increase my physician toolbox to better serve my patients.