Patient satisfaction rose when students were seen as helpful, not hindering care
A cross-sectional study from a student-run free clinic serving people experiencing homelessness found that patient satisfaction was high overall, but not all parts of the encounter carried the same weight. The most striking signal came from patients’ perceptions of student involvement: when students were viewed as beneficial to the visit, satisfaction scores increased. When the encounter felt too long, satisfaction fell.
The clinic experience was broadly favorable. Eighty-eight patients completed post-visit surveys between February 2024 and February 2025, and the mean overall satisfaction score reached 9.26 out of 10. In a setting where access barriers, competing social needs, and fragmented care often shape every clinic encounter, that level of approval suggests a strong baseline level of trust and goodwill toward the care team.
One sentence captures the practical tension in this model: students can enrich care, but time still matters.
Student presence seemed to improve the visit when patients saw a clear benefit
Separate linear regression models adjusted for age, gender, and race found that greater perceived benefit of student involvement was associated with higher satisfaction, with a β of .298 and a p value of .037. The direction of effect is important because it points to the patient experience as a relational rather than purely operational outcome. In a student-run free clinic, students are not just observers; they often serve as interviewers, examiners, educators, and advocates. When patients interpret that role as additive, the educational model appears to align with the care experience instead of competing with it.
That pattern makes clinical sense. People experiencing homelessness frequently encounter rushed, disjointed, or dismissive interactions in other healthcare settings. A student who listens carefully, explains next steps in plain language, and shows visible investment may convert a brief visit into one that feels respectful and human. In that context, student participation is less about training and more about whether the patient feels heard, understood, and not processed through a conveyor belt of care.
The study design cannot prove causation, and the sample is modest, but the association is still meaningful for clinics built around trainees. It suggests that the educational mission and the patient experience may reinforce one another when students are prepared to contribute in ways patients can recognize.
Visit length carried its own penalty
The opposite signal was just as clear. Perceiving the visit as too long was associated with lower satisfaction, with a β of −.285 and a p value of .019. For a population balancing shelter, transportation, mental health needs, substance use, food insecurity, and unstable schedules, prolonged clinic encounters can create real downstream strain. A longer visit may mean more waiting, more uncertainty, or more difficulty getting to a next destination before the day closes.
Long visits are not always bad visits, but they can feel costly when patients are already living under severe time pressure. In a free clinic, the meaning of “too long” may extend beyond inconvenience. It may reflect fatigue, limited patience after a long day, or the cumulative burden of being asked to wait for care in a system that has already failed to meet basic needs. Even when no adverse event occurs, time itself becomes a clinical variable.
This is where workflow design becomes part of patient-centered care. Educational depth, student supervision, and thorough evaluation all have value, yet they need to be balanced against the reality that some patients cannot absorb open-ended delays. A clinic can be generous and still efficient; the data suggest patients notice when that balance slips.
What the survey results mean for student-run free clinics
Student-run free clinics occupy a distinctive space in healthcare delivery. They provide access for underserved populations while also training future clinicians in communication, physical examination, social medicine, and interprofessional teamwork. For people experiencing homelessness, these clinics may offer continuity and dignity that are difficult to find elsewhere. The present findings indicate that patient satisfaction in this model may hinge on whether student participation is experienced as productive and respectful rather than merely prolonged.
The study was conducted at a single student-run free clinic and used post-visit surveys, so the findings should be read as a snapshot rather than a universal rule. Satisfaction is also shaped by factors not fully captured in a brief survey, including symptom burden, wait times before the encounter, prior experiences with healthcare, and the nature of the clinical issue addressed that day. Still, the fact that the overall satisfaction score was so high gives the regression findings added weight. Patients were not reluctantly tolerating the model; many were responding positively to it.
The setting matters here. A clinic serving people experiencing homelessness must often accomplish several tasks at once: deliver care, build trust, reduce barriers, and teach trainees to practice medicine in a socially complex environment. Student involvement can support those goals only if it is visible, efficient, and respectful. If students slow the visit without adding value, satisfaction drops. If they improve communication, attention, or perceived quality, satisfaction rises.
Efficient training may be the difference between helpful and burdensome care
No funding supported the study, and the investigators reported no competing interests. The work was approved by the Baylor College of Medicine Institutional Review Board, and the authors reported adherence to STROBE guidelines for cross-sectional studies. Those details matter because they frame the project as a carefully conducted observational assessment rather than a promotional exercise for the student clinic model.
For program directors and supervising clinicians, the message is direct. Student participation should not be judged only by educational yield. It also needs to be measured by whether patients feel the students improved the encounter. The data suggest that patients can tell the difference. When they perceive benefit, satisfaction climbs. When the visit feels too long, it falls. In a clinic built for people with limited time and high unmet need, that tradeoff is not abstract; it sits at the center of how care is experienced.