Table 1.

Problems Contributing to Clinic Inefficiency, and Proposed Interventions

	Interventions
Problems with time management and communication
Patients were roomed late after arrival.	All students were instructed to arrive at the clinic at least 30 minutes before the clinic start time in order to review the patient's chart. Second-year students were instructed to review the patient's chart a day in advance of the patient's visit.
	A board member was designated to notify the student-providers of their patient's arrival in order to decrease the time spent in the waiting room.
Student-providers' responsibilities were split into 9 teams without proper communication and recognition of duties, which increased patient wait time.	Each team was instructed to record the time in and out of the patient room.
	Student-care team members adopted the role of measuring vital signs (from student-providers) in order to decrease the wait time between vital signs measurement and the start of history taking.
	Student-providers were instructed to provide student-educators with an “education form” to communicate patient education needs more effectively.
	Student-providers were instructed to provide student-pharmacists with a “medication form” to communicate needed medications more effectively.
Patients were waiting for the overbooked attending physician to discuss the patient's medical management and discharge plan.	The number of patients seen by each physician was decreased from 3 or 4 to 2 or 3 patients.
	The number of physicians participating at each clinic was increased to improve physician availability for each patient.
	Physicians' schedules were confirmed at least 2 months before their clinic date to decrease the number of physician cancellations.
	The pool of supervising student-providers was increased by integrating the internal/family medicine third-year clerkship students into the clinic, thereby increasing the number of patients seen per clinic.
	Periodic surveys were sent to third- and fourth-year students to determine their availability and decrease cancellation frequency.
	A single physician faculty advisor was designated to monitor and manage laboratory results, alongside the student-providers responsible for each patient, to decrease the workload outside of clinic for the other volunteer attending physicians.
Problems with clinic resources
Students providing care were slow in processing their duties due to the lack of readily available information.	Student-educators were trained on lifestyle education using a free interactive website.
	A written guide for applying to Prescription Assistance Program (PAP) was developed to decrease the wait time between prescribing the medicine and completing the form.
	Student-pharmacists were instructed to verify the PAP medications at the beginning of each clinic in order to decrease wait time for medications dispensed by the PAP.
	An EMR user guide was created and distributed to student-providers (as a self-learning module and printed resource) in order to decrease time spent documenting in the patient chart.
	The number of student-informaticists was increased from 2 to 4 per clinic in order to decrease documentation time.
Problems with assessing clinic performance
No baseline data were available for use to improve the quality and efficiency of patient care in the clinic.	A research committee was created and met periodically with the purpose of designing research studies to evaluate patient satisfaction and educational benefits for the volunteers.
	All clinic board members were instructed to collect, track, and analyze their own data (time of appointments, number of patients, patients receiving education, physician-to-patient ratios, etc.)

In February 2015, overall clinic performance was analyzed and a needs assessment was performed. These interventions were implemented over the next 2 months. The analysis compared outcomes from March 2014 to February 2015 with data from March 2015 to February 2016.
EMR, electronic medical record; PAP, Prescription Assistance Program.