A medical librarian (LM) performed comprehensive searches to identify studies that evaluated SRCs for dermatology care. Searches were conducted on March 1, 2023, and June 19, 2024, within the following databases: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, and Daily and Versions (1946 to June 19, 2024); Ovid Embase Classic + Embase (1947 to June 20, 2024); and Scopus. The search strategy included all appropriate controlled vocabulary and keywords for SRCs and dermatologic care. The full search strategies are available in Multimedia Appendix 1. A gray literature search was also conducted in Google and Google Scholar on February 16, 2023, and April 24, 2023 [13,14].

The 3 search engines used were selected given their comprehensive coverage and unique strengths in indexing medical and biomedical literature. The criteria enabled consideration and characterization of dermatology SRCs in the broadest sense to ensure the completeness of the scoping review. The study duration spanned 1947‐2024, incorporating 2 independent reviewers (SK, LL) with moderation by a certified medical librarian and was limited to English language studies.

All references were uploaded into Covidence (Veritas Health Innovation), an automated software to ease reference screening and selection. The references were screened by 2 authors (LL and SK) for relevance, and subsequently 23 full texts were assessed for eligibility. Discrepancies were addressed through consensus or a third-party reviewer (JBL and AA). Eight additional documents were identified through gray literature searches, contributing to a total of 31 documents included in the analysis.

To be selected for analysis, references had to conform to the following inclusion criteria: (1) SRC study setting, which is operationally led by medical students and can render condition-relevant treatments to patients, with dermatology care; (2) English-language papers; (3) discussion of a clinic within the United States; (4) characterized by any of the following: logistics, care, patients, or design; and (5) any study or document type, including gray literature that was not peer-reviewed (eg, conference abstracts, preprints, and letters to the editor). Conversely, exclusion criteria included (1) non-English language and (2) papers with duplicated or nongeneralizable data and limited scope.

Data were extracted from the 31 studies using Microsoft Excel (version 365; Microsoft Corp). Domains of data included conditions treated, services offered, top procedures performed, facilitators, barriers, attending volunteers, clinic location, demographics, frequency, years running, and the number of patient encounters. Data charting was completed by 2 reviewers (LL and SK). Results were qualitatively analyzed and presented under common themes (AA, SK, and HV). We used a descriptive analysis, via charting of results, of our study findings, using a predeveloped data collection instrument founded on the authors’ experiences and a literature review [15,16]. We have detailed this instrument in Multimedia Appendix 2.

Our review included 31 studies (Figure 1) characterizing 19 student-run free clinics with a dermatology initiative in the following geographic distribution: 7 Northeast, 7 South, and 4 West (Table 1). Furthermore, we explain important aspects of dermatology within student-run initiatives through three major themes, namely: (1) patient access and prevention, (2) prominent conditions, common diagnostics, and procedural interventions, and (3) logistics and operations. The studies largely involved quality improvement projects or retrospective chart reviews. The full details of each SRCs are in Multimedia Appendix 3.

Our review broadly aggregates the experiences of student-run dermatology clinics across the United States. In particular, we characterized dermatology SRCs across several domains, including operational, diagnostic, treatment logistics, and overall facilitators and barriers to successful clinic function (Table 2).

The variety of conditions encountered in SRCs is broad, similar to that seen in conventional clinics, spanning both acute and chronic dermatoses. The extent of coverage and diagnostic capability at dermatology SRCs is heavily dependent on the availability of physical, financial, and staffing resources. Frequent need for biopsy is a unique challenge to dermatology, as opposed to other specialties with SRCs [48]. Financial and logistic barriers to care remain a significant issue for dermatology SRCs in terms of capability for diagnosis and follow-up. Given the variability in financial data between SRCs and varying procedural and diagnostic services offered at each clinic, operational or financial efficacy comparisons could not be made. In addition, the up-front investment required for providing different dermatologic services imposed restrictions or limited services offered. The ability to make referrals for additional work-up or treatment of malignancy was noted as a challenge among many of the SRCs, and reliable access to dermatology attending physicians was important to ensuring high-quality care [19,20,35,41-43].

Overall, our review captures the state of dermatology SRCs across various regions and patient populations and clarifies the areas for improvement for further iteration, expansion, and creation of future SRCs. Dermatology student-run free clinics help reduce health care disparities while also training future generations of dermatologists in a manner that exposes them to diverse patient populations with vastly variable resources.

The lack of access to dermatologic care for patients who are minorities, uninsured, and low-income has been well documented in the literature. In October 2022, the American Dermatological Association proposed measures to address the downstream inequities for patients with skin disease arising from unequal access, including opportunities for trainees in underserved areas [49]. SRCs, with a 2014 nationwide census of 140,000 patients and support among 75% of accredited medical schools, may help close the gap in patient access [2]. Through SRCs, medical students gain immersive exposure to social determinants of health, including health literacy and language barriers, while developing their diagnostic skills [2]. While all patients with a dermatologic complaint should eventually be evaluated by a board-certified dermatologist, due to inequities in access, initial evaluation from a medical student can help patients eventually receive a consultation from a dermatologist [50].

Robust dermatology SRCs must work in tandem with efforts to address these systemic contributors to inequity. SRCs are uniquely poised to provide free or low-cost services to patients who otherwise would not be able to access dermatology care in a timely or affordable fashion due to having Medicaid or lack of ability to pay a consultation fee [51,52]. Research has shown that Hispanic and Black patients are less likely to present at outpatient dermatologic centers [53]. Improved access to dermatologic care through SRCs may help reduce these disparities.

Funding for dermatology diagnostic and therapeutic resources remains essential for these clinics. Our review highlighted that funding for existing efforts commonly draws from sponsoring departments and private donations. A 2007 survey of SRCs revealed private grants as familiar funding sources (71%), with a median operating budget of US $12,000 [54]. Private grants may reflect an untapped source for additional support. Pending additional resources, principles of high-value care, and quality improvement can help clinics achieve their mission with the little resources they may have. For example, one study rolled out 16 interventions over 2 months, demonstrating improvement across clinical operations and patient wait times [55]. Interventions around drug use and costs may be particularly relevant to dermatology; for example, closed formularies at 1 SRC demonstrated sizable savings while retaining similar levels of medical care [56].

Ongoing education can help ensure that care delivery evolves to meet the SRC patients’ needs. Numerous studies have identified learner’s difficulty in diagnosing conditions among skin-of-color patient populations, stemming from insufficient coverage in medical education and materials [57,58]. Fortunately, studies have additionally determined that relatively minor curriculum adjustments can help address these gaps, both for familiar and less common skin-of-color conditions, such as topical corticosteroid side effects and melanoma [59,60]. Furthermore, ongoing training and education through service learning at an SRC presents a robust means for education, having a benefits-to-cost ratio of 8.13 of clinic education expenses versus university-generated education [61]. Converting existing literature (eg, literature reviews) on the dermatology conditions around the pertinent SRC patient population into educational modules may be one way to help provide better patient show rates, context, and cultural sensitivity.

Integration into a local health care system can ultimately facilitate long-term sustainability and patient continuity. A dermatology SRC is well suited as a specialty addendum for a well-established SRC already operational in the academic medical center. On the other hand, stand-alone dermatology SRCs may require greater effort to implement, over a longer term duration, and should include ongoing discussions with departments of dermatology and medical education. An initiative assessment (demonstrated in Textbox 1) may assist those interested in creating a dermatology SRC at their institution.

Teledermatology at SRCs may be a promising tool to improve flexibility for consulting attending physicians, allowing clinics to expand their reach to patients who may lack transportation. One study in Philadelphia of the community health clinic Puentes de Salud identified teledermatology as a helpful triage tool [62]. Likewise, a survey of 9499 consults in the Los Angeles County Department of Health Services also proved the triage use of teledermatology at scale across a sizeable safety-net health system [63]. One of the SRCs studied showed a sizable reduction in no-show rates for telemedicine appointments compared with in-person visits [20]. These promising findings bode well for SRCs, which have proven capable of incorporating telehealth; telehealth in SRCs has handled acute and chronic health conditions, including opioid use disorder [64-66].

Beyond SRCs, addressing the overarching issues of limited dermatologic health care access among underserved populations remains paramount. Residency-level proposals at the intersection of dermatology education and health disparities have included using existing programing across national dermatology associations and societies, implementing residency class learning projects, and collaborating with the existing community or federally funded clinics (eg, via SRCs) [67]. Broader policy interventions to expand and augment insurance coverage of underserved populations, expanded teledermatology, and regulatory flexibility are examples of relevant policy reform. Research opportunities relevant to dermatology SRCs remain plentiful and can relate to medical education, advocacy, and medical care provision. Specific examples include integrating dermatologic surgery, incorporating biologics and new dermatologic therapeutics, controlling costs, and providing a continuous supply of resources and faculty.

Our review has several limitations. One is that the studies in our review vary in their coverage of care characterization. Thus, not all barriers or facilitators of implementation faced by each SRC have been delineated, and comparisons between SRCs are difficult to assess. Furthermore, SRCs differ in nature depending on the affiliated institution and community resources. Thus, the findings are not generalizable to all dermatology SRC settings. In addition, our primary focus on SRCs may underreport the important role that other free or low-income clinics, such as the Puentes de Salud dermatology clinic, which involved students but was primarily run by attendings and residents, have in promoting health equity in dermatology care. Finally, while this review followed a rigorous search protocol, the search may have missed certain dermatology SRCs because they have yet to be described in the literature.

SRCs have long been integral to undergraduate medical education, fostering compassion, cultural sensitivity, and a commitment to volunteerism among future physicians, while focusing on underserved populations. At the same time, dermatology has recognized the need to address health disparities and gaps in care for these communities. Dermatology SRCs contribute to these efforts by offering medical students valuable experiences at the intersection of education and community health. Despite the existence of more than 140 dermatology residency programs in the United States, we identified only 19 institutions with such clinics, highlighting significant opportunities for growth. Our scoping review provides a comprehensive overview of these clinics nationwide, with the hope of encouraging medical students, schools, and dermatology departments to establish and expand such clinics in their own communities.