IMAGINE a student-run health clinic for Toronto’s underserved

Every Saturday morning, U of T students from across healthcare professions  volunteer to offer drop-in services to people in Toronto who are underserved or homeless – no ID or provincial health card required.  With the support and guidance of volunteer clinical preceptors, students from the faculties of nursing, pharmacy, medicine, social work, and physiotherapy provide care to patients with acute needs like wound care, medication management, chronic condition assessment, and harm reduction. Patients are able to access this full suite of interprofessional care to have their immediate needs met and often come away with a care plan complete with referrals to other services.

The clinic is called IMAGINE -- a bright-sounding acronym drawn from the lengthier Interprofessional Medical and Allied Groups for Improving Neighbourhood Environments – and has been operating in the Queen West neighbourhood in downtown Toronto since 2010.

“The unmet need was eye-opening”

“The goal is to provide accessible healthcare to anyone who is unable to access the regular system,” says Mishaal Arshad, a recent graduate from the Leslie Dan Faculty of Pharmacy, University of Toronto, and former co-director of the IMAGINE clinic. Arshad, who worked in the clinic in various roles over four years while studying for her Doctor of Pharmacy Degree, was surprised at the volume and  variety of patients that came in for care – people from many different walks of life who, for one reason or another, could not access the care they needed.

“It was surprising to see how many people don’t have access to healthcare. You would think the healthcare system should be providing care for everyone, but the fact remains that we get about ten patients every Saturday, and the clinic has been running for nearly ten years,” she says. “That’s a significant number of people we’ve been able to serve. The unmet need was very eye-opening for me,” she says.

The hands-on interprofessional experience was also invaluable. “It was incredible to see how different clinicians can work together. There’s so much overlap in our professions and so many more resources to access when we work together. The quality of care we were able to provide was so much better than if it was just one profession operating the clinic,” says Arshad who also worked as the clinic flow manager, overseeing the flow of patients throughout clinic hours.

Starting at 10 a.m. patients can register for care in a boardroom above the clinical space. The group then gathers and discusses which professional area should take the lead based on the patient’s needs – nursing and social work, for example, for a patient who is homeless and needs a wound to be treated and patched.  The preceptors, (U of T faculty members and licensed healthcare professionals), review the care plan created by the students who then return to the patient to provide care. In addition to the students who provide care and manage the clinic, there is also a group responsible for visiting local shelters to “get the word out”.

Led by students

Collaboration across health disciplines was central to the vision of the original founders of the clinic, initially co-led by students from the Faculty of Pharmacy and Faculty of Medicine.

Getting the clinic off the ground was a significant amount of work, says Marie Rocchi associate professor, teaching stream at U of T’s Leslie Dan Faculty of Pharmacy and one of the original faculty advisors who helped launch the project. “The idea was born out of a small group of students. They had a clear vision and they made it happen with a lot of grace and intellect, despite the inevitable setbacks and challenges,” she says.

Teaching the art and science of healthcare

Even in the early stages, the IMAGINE team wanted to avoid duplicating the good clinical work that was already happening through existing community-based services. Focusing on the educational component of the clinic and how this collaborative format helps shape healthcare providers upstream, makes the program unique.

“Yes, we are ultimately focused on improving patient health, but we also want to find as many ways as possible to humanize the healthcare experience for patients,” says Dr. Fok-Han Leung, associate professor with U of T Medicine’s Department of Family and Community Medicine and long-time volunteer preceptor at the clinic.  “To me this is what the art and science of healthcare is all about – how do we take the science and connect it to the human person? It is this kind of setting that allows us to guide our students in that journey, and to really show how they can make a difference and how they can work together at this very foundational time in their careers,” says Dr. Leung, who is also a family physician at St. Michael’s Hospital in Toronto.

Time to scale up

As the IMAGINE clinic nears it’s ten year anniversary, Mishaal Arshad and a small group of U of T alumni who contributed to the clinic have taken on the challenge of scaling up this work and expanding the reach of IMAGINE. With help from Dr. Leung, this group was awarded a Communities of Interest grant from the Canadian Medical Association (CMA) in 2018 to build on and expand the work of the IMAGINE clinic. In addition to supporting clinics in other cities where universities and other institutions provide healthcare education, the goal is to create a platform and network of resources to enable collaboration and knowledge sharing to ease the burden on individual care providers and promote sustainable change in the health system.

“As students we fell in love with what we were doing through this “club” and it propelled us into this larger vision of a not-for-profit organization that could help set up clinics like this in other areas of the country,” says Arshad. “Our blue sky vision is that we will help breakdown barriers to healthcare across Canada while also providing high-quality student learning experiences.”

Celebrating U of T’s emerging leaders

On November 6, Mishaal Arshad received the Susan J. Wagner Student Leadership Award from U of T’s Centre for Interprofessional Education. The award recognizes one student from among eleven health sciences programs who has demonstrated leadership, dedication and excellence through promotion and engagement of interprofessional education and care.  “This is an incredible honour,” says Arshad. “I hope our work at IMAGINE continues to inspire change and ways to create accessible healthcare across the country.”