Community-based interprofessional education in rural primary care

Abstract

Health disparities and workforce shortages persist in the rural United States. In response, academic health professions programs are providing opportunities for students to participate in rural clinical rotations. We expanded an existing academic-practice partnership with a rural primary care clinic, in which students completed 4-week rotations in their discipline, to add an interprofessional community-based component. The goals were to: 1. Accelerate students’ acquisition of teamwork competence, specifically skills in team effectiveness, team communication, reflective practice, and situational awareness; and 2. Immerse students in community-based rural primary care practice with patients characterized by high rates of chronic illness and adverse social determinants of health. Teams of students participated in home visits with older adult patients that focused on social determinants of health and reducing barriers to health care.We applied a realist evaluation framework to evaluate the program, using data on patient profiles, student profiles, student pre- and post-scores on a teamwork measure; student reflections; preceptor observations of student performance; and perspectives about the program from clinic staff. The ACE-15 was used to measure teamwork. Forty-eight rural patients and 38 students participated. The ACE-15 mean score at T1 was 51.4 (SD 6.6) and at T2 was 56.7 (SD 3.6), a significant improvement (p < .05). Preceptor observations suggested that students’ teamwork skills improved over time. Student self-reflections indicated their appreciation for the opportunity to work in an interprofessional team and the value of visiting rural patients in their homes. Staff observed that patients received better care, and that the program benefited both students and patients.