Building a Bridge for Patient Care

Medical students and Albert Schweitzer fellows Stephanie Kiser and Laura Cone are passionate about North Carolina, their home state. By developing an educational program and clinic for individuals with chronic diseases, they're doing what they've always wanted to do - give back to North Carolinians.

Building a Bridge for Patient Care click to enlarge Laura Cone (left) and Stephanie Kiser

by Hannah Crain - hannah.crain@unchealth.unc.edu

“The UNC School of Medicine serves the people of North Carolina,” says fourth-year medical student Stephanie Kiser, an Albert Schweitzer fellow who plans to specialize in internal medicine and pediatrics. “That’s the mission, and that's what I want to do as a doctor.”

Classmate and Schweitzer fellow partner Laura Cone believes the training she's received will help her put the School of Medicine mission into practice.

“What makes UNC unique is its excellent primary care program along with its strength in specialties,” Cone says. “I cannot say enough about the training I’ve received. I’ve learned so much and I’m excited to use my skills.”

Growing up on opposite sides of the state – Kiser from Shelby, Cone from Jacksonville – the students share a desire to serve North Carolina’s underserved. Together, as first-year students, they volunteered at the Student Health Action Coalition (SHAC). Then, between their third and fourth years, as they were pursuing their Masters in Public Health from the Gillings Global School of Public Health, they developed an idea for a student-run clinic -- the idea would become their Schweitzer fellow project. It’s not uncommon in North Carolina for underserved patients with chronic diseases to wait three to six months, sometimes longer, to be seen by a primary care physician. The clinic they proposed starting would allow medical students to treat patients until they were able to be seen by a community provider or primary care physician.

Earlier this year, after months of development, the students launched Bridge-to-Care. Today, Bridge-to-Care treats patients from underserved populations who have chronic diseases and conditions such as diabetes and high blood pressure. Part of the clinic’s mission is to educate patients about their disease. Comprising students from each of the health affairs schools, Bridge-to-Care has a curriculum in which students meet with groups of patients to teach them about how to care for themselves at home. The curriculum involves activities such as goal-setting, reviewing efforts to reach goals, teaching nutritional information, and discussing guidelines for how to take care of the disease.

“The UNC School of Medicine serves the people of North Carolina,” says fourth-year medical student Stephanie Kiser, an Albert Schweitzer fellow who plans to specialize in internal medicine and pediatrics. “That’s the mission, and that is what I want to do as a doctor.”

As Schweitzer fellows, Kiser and Cone must address root causes of health disparities in communities that lack resources by developing service projects. They feel that the School of Medicine’s existing organizational opportunities helped them conceive of and implement their project.

“We were really fortunate in that SHAC already existed,” says Kiser. “We’ve learned that it’s difficult to start a clinic even when building off of existing infrastructure. We can’t imagine what it would be like without clinics like SHAC to work with.”

In the process of designing the program, Kiser and Cone went through a community needs assessment with SHAC leadership.

“We gathered input from many different faculty and staff members at UNC,” says Cone. “Then we set up a number of meetings to talk about what we could do and what the needs are.”

Kiser and Cone expanded the clinic slowly and eventually recruited six medical students to help see the patients and coordinate and schedule clinical appointments.

Charles Semelka volunteered with Bridge-to-Care between his first and second years of medical school. “I learned a lot from Stephanie and Laura in terms of how to listen to patients, and allowing them to voice their problems,” says Semelka. “They were good role models as I gained experience counseling patients on lifestyle changes and motivating them to take charge of their own health….It’s been a really great experience to learn these clinical skills. I feel like it’s given me a head start on my second year.”

While Kiser and Cone have seen positive results from their clinic, they have also encountered road blocks along the way.

“The biggest challenge we're facing right now is finding resources,” Kiser says. “Having resources for medications and for any education that we provide is essential. We use medical tools such as blood pressure cuffs and glucose monitors. These materials are very expensive and that makes it difficult to provide every patient with their own devices.”

Bridge-to-Care has given Kiser and Cone memories they will carry throughout their careers as doctors. One patient’s story in particular exemplifies the positive results of the clinic. Ten years ago, one of their patients had been diagnosed with diabetes. Although she was taking her medication regularly, she was not receiving treatment or seeing her physician. Eventually, her condition became uncontrollable and she found herself in the ED. After she was released from the hospital, she was introduced to Bridge-to-Care. Within four months, she was able to take complete control of her diabetes, and get back to a healthy weight. In addition to her improved physical health condition, she returned to work and doubled her production rate.

“To see her become healthy again and overcome her struggles from her disease was special to me because I hadn’t seen that as a medical student,” says Kiser. “She has told me that she couldn’t have done it without our clinic.”

For future doctors like Kiser and Cone, helping patients become happy and healthy makes them aspire to provide exceptional patient care in short amounts of time.

“We’ve now seen these patients for up to six months, so I’ve had time to build relationships with them, see how their lives have changed, and look at how we’ve helped them through their journeys,” says Cone. “It motivates me to continue.”

The hard-working effort and passion for medical care have impressed faculty.

“Laura and Stephanie are fantastic role models for future physicians,” says their project advisor, Dr. Anthony Viera, Director of the Health Care & Prevention Public Health Leadership Program and Distinguished Associate Professor of Family Medicine. “They are passionate about caring for underserved populations, and they surely will be leaders in improving the health of the communities they serve.”