COVID-19 Pandemic Frames Medical Students’ Family Medicine Externship Experience

September 8, 2020—Each summer, a medical student member of Michigan Academy of Family Physicians is selected to participate in an externship to gain first-hand experience of what it’s like to be a family doctor. Thanks in part to two matching grants from AAFP Foundation, Family Medicine Foundation of Michigan (FMFM)—MAFP’s philanthropic arm dedicated to advancing family medicine—was able to grant externship awards to two students in summer 2020. Under the mentorship of seasoned family physicians, both students gained valuable insight into direct patient care amidst the COVID-19 pandemic and strengthened their commitment to family medicine.   

“Once again, Family Medicine Foundation of Michigan’s summer externship program proved to be highly successful in providing students with opportunities to ‘try on’ family medicine and explore its breadth, depth, and hallmark physician-patient relationship building,” said the organization’s president, Mary Marshall, MD, RN, FAAFP.

Expanding Access to Care for Uninsured Patients

Ameen Suhrawardy, now in his second year at Oakland University William Beaumont School of Medicine, spent the month of July working under the mentorship of Sariea Alsmoudi, MD. Dr. Alsmoudi practices family medicine at Premier Medicine, a source of primary and urgent care in Dearborn, Livonia, and Hamtramck.

With the goal of expanding access to care for uninsured patients, the team at Premier Medicine launched a pilot prior to the COVID-19 pandemic, to integrate a free clinic model within its main primary care site in Hamtramck.

As the number of COVID-19 cases continued to increase in southeast Michigan in the spring, it became quickly apparent that patients in Hamtramck, as well as at the clinic’s other two sites in Dearborn and Livonia, desperately needed support. Many have been directly impacted by the virus, lost medical insurance due to the economic fallout, are experiencing stress or trauma, or have had a disruption in their care.

This was the backdrop of Ameen’s externship. In addition to being involved in direct patient care and practice management responsibilities, he helped establish a network of primary care physicians and other specialists through Premier Medicine’s integrated free clinic model.

“Our initial focus was on creating enough time where our physicians may see the patients face-to-face. However, with COVID-19, we saw a need to also implement a telemedicine approach to provide quick access for patients and a safe environment for our providers,” said Dr. Alsmoudi.

He credits Ameen as instrumental in brainstorming, developing, and expanding the integrated free clinic model, as well as propelling the team to overcome the challenges it faced while “going live” during the pandemic.

Recognizing how important consistent primary care is for prevention and whole-person care, “our plan is to allocate a specific clinician in one of our offices every day to dedicate time to seeing uninsured patients through telemedicine,” explained Ameen. Patients needing follow-up care, testing, or procedures are scheduled for in-person visits at the main family medicine clinic in Hamtramck.

“The benefit of integrating the free clinic within our larger practice is that we give uninsured patients the same access to the providers, the care, and the electronic medical record we have set up and optimized for our main primary care practice.”

Shortly after rolling out the services in Dearborn and Livonia, Ameen worked on applying for federal funding to purchase COVID-19 testing kits. His successful application enabled Premier Medicine to offer COVID-19 tests for over 150 patients free of charge.

Through establishing the infrastructure for the integrated free clinic and applying for funding, Ameen feels he built a solid understanding of the inner workings of every aspect of a private family medicine practice, from clinical decision-making, to billing, to administration. Plus, it allowed him to apply the foundational sciences he has learned thus far in his medical training.

“He and I enjoyed seeing patients together, going through their cases and delving into history taking, physical exam findings, and various diagnoses and treatments. He was very close to our patients, and they enjoyed his participation and certainly appreciated his help,” said Dr. Alsmoudi.

Ameen characterizes his externship with Dr. Alsmoudi and the Premiere Medical team as ideally timed between his first and second years of medical school.

“Seeing real-life presentations of clinical diseases and conditions is the best way to fully connect and understand illnesses,” he shared. “I got to see the work of family physicians in the outpatient setting on a day-to-day basis. I learned from their history-taking strategies, clinical decision making, patient relationship building, and from their own career trajectories out of medical school. I observed how family physicians manage long-term chronic conditions and integrate lifestyle and holistic solutions into their treatment. I participated in clinical management alongside physicians, reviewing patient history, medications, consult notes, lab results, and much more.”

Comprehensive Inpatient and Outpatient Experience

From evaluating suspected COVID-19-positive patients, to providing prenatal care, to caring for transgender and homeless individuals and beyond, Eli Benchell Eisman, PhD experienced the range and depth of the family medicine specialty during his one-month externship in the heart of Detroit.

This was exactly what he was looking for, he said, reflecting on his application for Family Medicine Foundation of Michigan’s annual summer hands-on immersion opportunity.

“My hope was to explore the full breadth of how the specialty can be realized, while gaining a deeper appreciation of barriers to accessing and providing culturally-sensitive care for historically underserved and economically disadvantaged patients.”

Eli’s end goal: Construct a strong foundation for future humanitarian work as a family physician in vulnerable communities domestically and abroad.

Richard Bryce, DO—program director at Henry Ford Family Medicine Residency, chief medical officer at Community Health & Social Services Center (CHASS), a federally qualified health center, faculty advisor at Detroit Street Care, and clinical professor at Michigan State University College of Osteopathic Medicine—was Eli’s choice of mentor for his externship.

“Eli exemplifies the virtue to assist the poor, the sick, the weak, and the downtrodden. He showed true compassion for our patients, understanding that many are facing poverty, food insecurity, violence, homelessness, and other social determinants of health,” said Dr. Bryce of Eli’s care delivery in outpatient and inpatient settings.

A fourth-year medical student at Michigan State University College of Osteopathic Medicine, Eli was inspired to attend medical school while conducting post-doctoral ethnopharmaceutical field research in Ghana. In this capacity, he was able to offer a direct intervention for the treatment of Buruli ulcers and he was exposed to the potency of the caregiver-receiver relationship.

Eli said he began his externship with a preconception of modern family medicine based on experiences gained shadowing physicians while applying to medical school and during clinical rotations.  He left the externship with skills for better listening to his patients while retaining compassionate objectivity and understanding that what is in the purview of the family physician is limited only by what an individual provider feels they are competent and capable of performing.

More specifically, Eli said he learned to implement patient-centered communication strategies for navigating factors such as race, ethnicity, gender, socioeconomics, substance use history, housing status, immigration status, and language barriers. He found these approaches key for “more empathetically effectuating optimal health-decision making in my patients and implementing low-cost, high-value interventions aimed at halting disease progression, targeting prevention, and promoting wellness.”

As he enters his final year of medical school, Eli’s sights are more strongly set on pursuing family medicine residency than before, crediting the Family Medicine Foundation of Michigan / AAFP Foundation externship with reaffirming his commitment to the specialty.

“The externship taught me to understand that when I see a patient, regardless of the setting, that what I am getting is just a snapshot of what’s going on in their life. That by taking the time to meet someone where they are in that moment, and offer holistic and contextualized care, that’s when we can see real healing,” said Eli.