Student Volunteers Make a Difference at VA Clinic

Spark of an Idea

Looking at her daughter, Hamilton suddenly had an idea. What if students like her daughter could be recruited to help fill the need to follow up with veterans on their hypertension control and colon cancer screenings? “What if Katherine Henkels, RNP, and I trained the student volunteers how to walk veterans through taking their blood pressure or getting their colon cancer screening done?” she wondered. Henkels is the registered nurse practitioner who helps coordinate the clinic, including student onboarding, organization of workflows, and materials used.

Not only would this help fill the gap created by staffing shortages, but it would give students who were considering a career in health care a chance to gain valuable direct patient care experience. And it just might help address students’ complaints about the monotony of endless Zoom classes.

Early in the COVID-19 pandemic, Rhonda Hamilton, MD, clinical assistant professor of primary care and population health and general medicine clinic section chief at the Veterans Affairs Palo Alto Health Care System, sat at her dining room table working remotely while her daughter Lauren Hamilton, across the table on her own laptop, attended yet another Zoom class, looking bored and uninspired.

Hamilton had newly stepped into the role of section chief of the VA’s largest primary care clinic in the region. With the pressure of the pandemic bearing down, “all of a sudden, I had 10,000 veterans whose primary care and chronic disease management needs were not being addressed in the way they had been,” she says.

Staffing numbers were below 50% for nurses and schedulers. The demands of the pandemic meant that leadership had to divert nurses from chronic disease management to acute COVID-19 care. Typically, nurses would do outreach to patients who needed help managing their hypertension, ensuring that they did their colon cancer screening stool tests and got their vaccines. Now, they didn’t even have enough nurses to make sure that patients were getting their primary care appointments. “So much of our energy and resources had to be redirected to COVID-19. We had to save the life in front of us,” says Hamilton.

At that moment, Hamilton was reading an email showing that their patients’ hypertension control numbers had slipped to a new low, when before the pandemic they had scored consistently high. “It was a real kick in the gut,” she says.

Spark of an Idea

Looking at her daughter, Hamilton suddenly had an idea. What if students like her daughter could be recruited to help fill the need to follow up with  

veterans on their hypertension control and colon cancer screenings? “What if Katherine Henkels, RNP, and I trained the student volunteers how to walk veterans through taking their blood pressure or getting their colon cancer screening done?” she wondered. Henkels is the registered nurse practitioner who helps coordinate the clinic, including student onboarding, organization of workflows, and materials used.

Not only would this help fill the gap created by staffing shortages, but it would give students who were considering a career in health care a chance to gain valuable direct patient care experience. And it just might help address students’ complaints about the monotony of endless Zoom classes.

Closing the Disparity Gap

Hamilton acted quickly on the idea, recruiting her own daughter and nine other students for the first cohort of volunteers. She ensured that the volunteers represented diverse backgrounds and races. “We did special outreach to make sure that underrepresented minority students knew about the opportunity,” she says.

Students came onto campus and were put through the full gamut of background checks before being issued ID badges. Then Hamilton and Henkels carefully trained them in how to help veterans take home blood pressure readings and how to perform a fecal immunochemical test (FIT), a common colon cancer screening test, at home. “Then they set about making phone calls to veterans,” says Hamilton.

The patients they called either were due for a FIT test or were failing the blood pressure metric that the clinic had set. The students would call and urge the veterans to get their colon cancer screening test completed or to take their blood pressure numbers and report them. If their blood pressure was found to be elevated, the students would help connect them to their provider for a virtual visit.

By August 2021, the project was completed, and the results were astonishing, Hamilton reports: “We ended up with the highest numbers in our region for both blood pressure control and colon cancer screening. Remarkably, we narrowed and actually closed the racial disparity gap.”

Prior to implementation of the volunteer program, Black patients had poorer hypertension control, compared with their white counterparts. But after the students’ calls, that difference no longer existed when compared with national VA metrics.

“It was a win-win-win,” says Paul Heidenreich, MD, professor and vice chair for quality at the Stanford Department of Medicine and chief of medical service at the Palo Alto VA. Not only did the patients’ health improve, but the students gained valuable experience that informed their career choices.

“We’ve now had two of the original students apply to medical school and get accepted using their experience at the VA,” says Hamilton. “Our goal was to help disparities at every level — including students entering the medical field.”

The cheery, bright innocence of young students rejuvenated the overworked staff, says Hamilton. “It really boosted everyone’s morale, because you have these happy, bubbly kids around the clinic.” What’s more, the students helped brighten the veterans’ lives, too. “They loved speaking to the students,” says Hamilton. “That was something I didn’t expect. We’d get requests for the students to call back.” Hamilton’s daughter, Lauren, was so intrigued with how effective the intervention was that she decided to pursue a career in cognitive science. It turns out that maybe simple human connection, especially during a time of deep isolation, is the best medicine.