This study confirmed that in the context of a large Canadian city, SRCs can play an important role in the provision of primary care for the homeless, offer considerable tangible benefits to patients, and provide a valuable contribution to medical education.
One of the benefits in evaluation planning is identifying inconsistencies, and we would argue, in the case of the SRC, that this is an important aspect of ensuring this program is actually involved in social change that improves the lot of the homeless . What became evident in this study was that several aspects of student-run clinics may help bridge limitations of traditional primary care for this population. When discussion of SRCs draws on models of primary care that focus on aspects such as continuity of care and long-term relationships with family physicians it will miss the obvious fact that people experiencing homelessness have very particular needs that cannot be accommodated by the healthcare system that is in place without some change.
SRCs are not without shortcomings. Using the appropriate model to identify shortcomings can provide adequate foresight and planning to address them and optimize operations, rather than providing decontextualized information that does not facilitate program improvement. In this case, for example, if the SRC was evaluated for outcomes concerning continuity of care it might be found lacking, whereas our results indicate that clients considered it a beneficial resource. We did not assess outcomes in this study, nor did we evaluate the effectiveness of the SRC as an intervention in this population.
Another aspect of primary care raised consistently in this study, which has been previously identified with SRCs in the United States  is interprofessional practice. Given the complex health needs of those who access SRCs  this appears to be an important aspect of SRCs, with the additional benefit of adding interprofessional educational opportunities [3, 17].
Clearly, SRCs can contribute to meeting the complex healthcare needs of underserved populations within urban settings. Lacking from the observations and comments of study participants was the importance of the flexibility, commitment and willingness to train embodied by the attending physician. The training in primary care in a SRC may be at odds with what students receive in medical school concerning matters of continuity, patient compliance, specialization, and so on. SRCs therefore have the potential to change medical education in Canada and we suggest this may become an explicit social change goal.
Our stakeholders’ discussions did not address the need for changes in how the system provided care to homeless people. Rather, participants suggested SRCs be modeled to try to meet all needs. These include extended hours and increased access to primary care physician services, which are deficiencies documented previously in research regarding the Canadian healthcare system  but never before assessed in the context of a SRC program. The suggestion that medical students could provide non-judgmental, empathetic care in comparison to care provided by physicians has been demonstrated in the United States , but is a novel finding in Canada. It raises the possibility of other students (e.g., nursing, social work) also being trained to do primary care assessments. Two studies [19, 20] have shown that students involved in SRCs are more likely to work with underserved populations in their future, but whether long-term interdisciplinary practice  is promoted through SRCs is unclear.
This study is, of course, not without limitations. Since the field researchers conducting the interviews were also involved in running the clinic, there is potential for social desirability bias to have influenced respondents. However, they were not performing clinical duties at the time of data collection, and had never had clinical contact with any client participants. Given the scope, we acknowledge that it is a snap-shot in time of access to primary care of a homeless population in one particular socio-political context. We recognize that even in the context of Calgary, additional research may be needed to determine how SRCs can serve families, youth, and Aboriginal people who comprise a large proportion of the homeless population in this setting. Furthermore, this study was not designed to evaluate outcomes or processes of care from the SRC, but simply an exploration of stakeholders’ views on the role of such a clinic.