Ethical Dilemmas at Student-Run Clinics: A Narrative Review

Student-run clinics (SRCs) are a unique medical education and healthcare delivery model. On one hand, SRCs have the potential to bridge important care gaps and train future practitioners to address complex health disparities. On the other, allowing students to administratively "run" a clinic for the indigent, with varying levels of oversight, raises ethical questions. This review attempts to identify and synthesize the major ethical concerns scholars have raised about SRCs.

We searched PubMed, Embase, Ovid Medline, Web of Science, and SCOPUS, reviewed all publications in the non-indexed Journal of Student Run Clinic and The Free Clinic Research Collective, and iteratively snowball sampled the bibliographies and Google Scholar "cited by" results of included publications until saturation. We performed thematic analysis of included publications.

Of 7,584 initial results, we identified 503 publications on SRCs and 22 relevant to this review. In total, 4.3% (22/503) of the SRC literature focuses on ethical concerns, which we inductively categorize as: 1) Structural and systemic problems, 2) Lack of consistent administrative and clinical oversight, 3) Substandard quality-of-care, 4) Undue influence on patients, 5) Negative impact on trainees, and 6) Inadequate involvement of the community.

SRCs are a growing part of the U.S. healthcare safety net system. They are also an important nexus of ethical questions that impact patient care and trainee education. Many identified concerns relate to administrative, structural, and sociological issues which may be outside the direct training (and potentially awareness) of most medical students. Some work cautions that SRCs have potential to produce results discordant with their core aims, such as racial equity, health equity, and training service-oriented healthcare professionals. Increased awareness of these potential pitfalls offers new avenues for bioethical investigation and practical opportunities to support students and faculty in positioning these unique clinics for success.