Student-run Clinic Research Articles

Student-run clinics in Canada: an innovative method of delivering interprofessional education

The age of siloed healthcare delivery is coming to an end. Research demonstrates that interprofessional collaboration (IPC), the provision of comprehensive services to patients by multiple health providers who collaborate within and across settings, improves the efficiency of the healthcare system, work environments, and patient outcomes. However, developing IPC skills requires training, often referred to as interprofessional education (IPE). This report aims to describe an innovation in IPE: student-run clinics (SRCs). SRCs are organizations composed of students from various disciplines who collaboratively plan and deliver healthcare and health promotion. Recent trends in Canadian SRCs are contrasted with those in the United States. The literature supporting SRCs as a method of delivering IPE, as well as the benefits conferred to patients, students, and communities at large is explored. It is clear that SRCs in Canada are an evolving approach to IPE and are filling a previously undiscovered healthcare niche.

Successful management of latent tuberculosis infection in an underserved community by a student-run free clinic.

The management of latent tuberculosis infection (LTBI) most commonly consists of a nine-month course of isoniazid (INH) therapy and is complicated by low adherence and completion rates. The Latent Tuberculosis Initiative at the HAVEN Free Clinic was developed to provide LTBI treatment to an underserved, high-risk, foreign-born population. We conducted a retrospective chart review to evaluate the program. Of 39 patients enrolled, 26 (67%) successfully completed nine months of INH, eight (21%) discontinued, and five (12%) were lost to follow-up. Patients had a median of nine encounters during the course of treatment and mean self-reported medication adherence was 29/30 pills/month (96%). Median days-of-treatment was 273, 95, and 63 among completion, discontinuation, and lost to follow-up groups, respectively (p < .0001). There was one death in the program, related to a complication of a diagnostic procedure in a patient who had developed INH toxicity. These results are comparable to the most successful published programs (50-65% six-month completion rates), suggesting that student-run clinics serving high-risk populations may contribute to LTBI management and TB control efforts.

A nursing student-run health clinic – an innovative project based on reflective lifeworld-led care and education

Nursing students need support in order to be able to intertwine caring science theory with practice through reflection. In this theoretical paper a nursing student-run health clinic based on lifeworld led learning and caring is described and propounded as providing such support. The student nurses are offered possibilities for integrating theoretical and practical knowledge by the re-location of parts of the theoretical courses to this innovative learning environment. In applying a phenomenological attitude, both in the learning situation and in the caring situation, the natural (unreflective) attitude is challenged in order for the student nurses to gain a deeper and broader understanding of caring science within their caring practice and vice versa. This means that the nursing students can develop a reflective caring approach that is important in order to become both sensitive and sensible nurses. This paper can be supportive for nurse educators in developing nursing education to meet the needs of the modern society. Our perspective on health, well-being and reflective learning can also inspire persons who work in clinical practice and with health promotion.

Academic Achievement and Primary Care Specialty Selection of Volunteers at a Student-Run Free Clinic

Background: Previous studies have reached conflicting conclusions about the associations between service and academic achievement and service and primary care specialty choice. Purposes: This study examines the associations between service at a student-run clinic and academic achievement and primary care specialty choice. Methods: Retrospective review of medical student service and statistical analysis of grade point average (GPA), Step 1 and Step 2 Clinical Knowledge (CK) scores, and specialty choice were conducted, as approved by our Institutional Review Board. Results: Volunteers, compared to nonvolunteers, had higher GPA (3.59 ± 0.33 vs. 3.40 ± 0.39, p < .001), Step 1 (229 ± 19 vs. 220 ± 21, p < .001), and Step 2 CK (240 ± 18 vs. 230 ± 21, p < .001) scores, but did not pursue primary care specialties at a significantly higher percentage (52% vs. 51%, χ2 = .051, p = .82). Conclusions: Further exploration of the associations between service and academic achievement and primary care specialty choice is warranted.

Matching physicians to newly arrived refugees in a context of physician shortage: innovation through advocacy

Purpose – Access to a continuum of care from a family physician is an essential component of health and wellbeing. Refugees have particular barriers to accessing medical care. The MUN MED Gateway Project is a medical student initiative in partnership with a refugee settlement agency that provides access to and continuity of health care for new refugees, while offering medical students exposure to cross-cultural health care. This paper aims to report on the first six years of the project. Design/methodology/approach – Here the paper reports on: client patient uptake and demographics, health concerns identified through the project, and physician uptake and rates of patient-physician matches. Findings – Results demonstrate that the project integrates refugees into the health care system and facilitates access to medical care. Moreover, it provides learning opportunities for students to practice cross-cultural health care, with high engagement of medical students and high satisfaction by family physicians involved. Originality/value – Research has shown that student run medical clinics may provide less than optimum care to marginalized patients. Transient staff, lack of continuity of care, and limited budgets are some challenges. The MUN MED Gateway Project is markedly different. It connects patients with the mainstream medical system. In a context of family physician shortage, this student-run clinic project provides access to medical care for newly arrived refugees in a way that is effective, efficient, and sustainable.

Legitimate workplace roles and activities for early learners

Given the calls for earlier student engagement in clinical experiences, educators are challenged to define roles for pre-clerkship students that enable legitimate participation in clinical practice. This study aimed to determine the student roles and activities, as well as the clinic characteristics, that allow early student engagement within a specific clinical experience. The authors conducted semi-structured interviews in December 2011 and January 2012 with a purposive sample of medical student and faculty volunteers at student-run clinics (SRCs). They were asked to discuss and compare student roles in SRCs with those in the core curriculum. An inductive approach and iterative process were used to analyse the interview transcripts. Themes identified from initial open coding were organised using the sensitising concepts of workplace learning and communities of practice and subsequently applied to code all transcripts. A total of 22 medical students and four faculty advisors were interviewed. Thematic analysis revealed pre-clerkship student roles in direct patient care (patient triage, history and physical examinations, patient education, laboratory and immunisation procedures) and in clinic management (patient follow-up, staff management, quality improvement). Students took ownership of patients and occupied central roles in the function of the clinic, with faculty staff serving as peripheral resources. Clinic-related features supporting this degree of legitimate participation included defined scopes of practice, limited presenting illnesses, focused student training, and clear protocols and operations manuals. Pre-clerkship students are capable of legitimately participating in patient care experiences to an extent not usually available to them. The SRC represents one example of how early clinical experiences in the core curriculum might be transformed through the provision of patient care activities of narrow scope.

The REACH project: implementing interprofessional practice at Australia's first student-led clinic.

REACH (Realising Education and Access in Collaborative Health) is an initiative of students of the University of Melbourne to improve access to primary health care services. It is driven by the voluntary commitment of over 120 students and is built upon the principles of collaboration, interprofessionalism and client-centered care. Summary of work: The feasibility of student-led clinics has been demonstrated with the operation of over 100 such clinics in North America. Senior students from Medicine, Physiotherapy, Nursing and Social Work attended a student-run clinics conference in Jacksonville, Florida, USA in 2010. On return, research was conducted to identify a local underserviced community appropriate for a clinic. On review of the literature, it was determined an interprofessional model of care would best serve this community. The student body engaged a local community health service as a project partner. The model of care at the REACH Clinic was developed by senior students from the schools of Medicine, Physiotherapy, Nursing and Social Work and managed by an interconnected student committee structure. The final consultation model involves a triage process and simultaneous consultation by two disciplines. This model of care was successfully implemented during a 4-week pilot period in October 2011. Several issues were identified during the REACH pilot, with dissonance between the at-times competing principles in health care of interprofessionalism, client-centered care and efficient care. An interprofessional model of care was developed and successfully implemented in a 4-week pilot student-run clinic within an established community health service. While providing a free health service, this model facilitated interprofessional learning at both a clinical and management level and highlighted logistical and ideological challenges that served as the basis for further refinement of this model of community service .

Going “All In” to Transform the Tulsa Community’s Health and Health Care Workforce

Oklahoma's health status ranks among the lowest of the states', yet many Oklahomans oppose the best-known aspects of federal health reform legislation. To address this situation, the University of Oklahoma College of Medicine's School of Community Medicine in Tulsa adopted an "all-in," fully committed approach to transform the Tulsa region's health care delivery system and health care workforce teaching environment by leading community-wide initiatives that took advantage of lesser-known health reform provisions. Medical school leaders shared a vision of improved health for the region with a focus on equity in care for underserved populations. They engaged Tulsa stakeholders to implement health system changes to improve care access, quality, and efficiency. A partnership between payers, providers, and health systems transformed primary care practices into patient-centered medical homes (PCMHs) and instituted both community-wide care coordination and a regional health information exchange. To emphasize the importance of these new approaches to improving the health of an entire community, the medical school began to transform the teaching environment by adding several interdependent experiences. These included an annual interdisciplinary summer institute in which students and faculty from across the university could explore firsthand the social determinants of health as well as student-run PCMH clinics for the uninsured to teach systems-based practice, team-based learning, and health system improvement. The authors share lessons learned from these collaborations. They conclude that working across competitive boundaries and going all in are necessary to improve the health of a community.

Improving Quality of Preventive Care at a Student-Run Free Clinic

Student-run clinics increasingly serve as primary care providers for patients of lower socioeconomic status, but studies show that quality of care at student-run clinics has room for improvement.PurposeTo examine change in provision of preventive services in a student-run free clinic after implementation of a student-led QI intervention involving prompting.MethodReview of patient charts pre- and post-intervention, examining adherence to screening guidelines for diabetes, dyslipidemia, HIV, and cervical cancer.ResultsAdherence to guidelines among eligible patients increased after intervention in 3 of 4 services examined. Receipt of HIV testing increased from 33% (80/240) to 48% (74/154; p = 0.004), fasting lipid panel increased from 53% (46/86) to 72% (38/53; p = 0.033), and fasting blood glucose increased from 59% (27/46) to 82% (18/22; p = 0.059).ConclusionsThis student-run free clinic implemented a student-led QI intervention that increased provision of prevention. Such a model for QI could extend to other student-run clinics nationally.

Interest and Perceptions of Student-Run Health Clinics: A Survey at the Uniformed Services University of the Health Sciences

Medical students are interested in maximizing clinical experiences during preclinical years; we report an exploratory survey of student and faculty interest in a student-run health clinic (SHC) at the Uniformed Services University of the Health Sciences (USU). We distributed via e-mail a questionnaire to explore student and faculty opinions regarding the role of a SHC at the USU. Nearly half of the students (310/669; 46%) and one in five faculty members (78/427; 18%) responded. 227 students stated the USU should have a SHC and 247 students were willing to commit time to a SHC on a weekly or monthly basis. The majority of participants believe work in a SHC would benefit various clinical attributes representative of the Accreditation Council for Graduate Medical Education residency accreditation requirements. However, most participants believe work in a SHC would benefit only students pursuing careers in primary care whereas having less benefit to surgical careers. Our survey suggests that there is sufficient student interest at the USU to explore additional clinical opportunities early in the medical school experience; we furthermore identified a subtle yet profound difference of opinions in students and faculty regarding the benefits of early clinical exposure and different specialties.

An Interprofessional Collaborative Student-Run Clinic by Dental, Nursing and Medical Faculty and Students at University of Texas Health Science Center at San Antonio for Refugees

Abstract Introduction Carrick Institute for Learning and Teaching in Australia defines interprofessional education (IPE) as Occasions when two or more professions learn with, from, and about each o...

PP048—A systematic review on learning in a student run clinic

Medical students should be better prepared for their future role as therapeutic prescribers, to reduce medical errors and health costs. Context-based learning is widely known for its positive effects on learners; however, the extent to which context learning is applied in different pharmacotherapy-curricula varies. The optimal and most realistic form of context learning in pharmacotherapy education would be learning (to prescribe) in a learner-centered student run clinic (LC-SRC). In contrast to regular student-run clinics (SRCs), which are clinics organized and run by student-teams who mainly care for the underserved and homeless populations in the United States, LC-SRCs do not exist.

The role of a student-run clinic in providing primary care for Calgary’s homeless populations: a qualitative study

BackgroundDespite the increasing popularity of Student-Run Clinics (SRCs) in Canada, there is little existing literature exploring their role within the Canadian healthcare system. Generalizing American literature to Canadian SRCs is inappropriate, given significant differences in healthcare delivery between the two countries. Medical students at the University of Calgary started a SRC serving Calgary’s homeless population at the Calgary Drop-In and Rehabilitation Centre (CDIRC). This study explored stakeholders’ desired role for a SRC within Calgary’s primary healthcare system and potential barriers it may face.MethodsIndividual and group semi-structured interviews were undertaken with key stakeholders in the SRC project: clients (potential patients), CDIRC staff, staff from other stakeholder organizations, medical students, and faculty members. Convenience sampling was used in the recruitment of client participants. Interview transcripts were analyzed using a coding template which was derived from the literature.ResultsParticipants identified factors related to the clinic and to medical students that suggest there is an important role for a SRC in Calgary. The clinic was cited as improving access to primary healthcare for individuals experiencing homelessness. It was suggested that students may be ideally suited to provide empathetic healthcare to this population. Barriers to success were identified, including continuity of care and the exclusion of some subsets of the homeless population due to location.ConclusionsSRCs possess several unique features that may make them a potentially important primary healthcare resource for the homeless. Participants identified numerous benefits of the SRC to providing primary care for homeless individuals, as well as several important limitations that need to be accounted for when designing and implementing such a program.

Systems-Based Practice Learning Opportunities in Student-Run Clinics

Student-run clinics (SRCs) provide preclerkship medical students with systems-based practice (SBP) experiences as they engage in patient care and manage clinic operations. This study explored the types and context of SBP activities students participate in at SRCs. Between November 2011 and February 2012, the authors conducted in-depth, semistructured interviews with a purposive sample of medical students who served as volunteers and coordinators (student leadership role) at four independently run SRCs within the University of California, San Francisco, School of Medicine. They also interviewed SRC faculty advisors. Interviews focused on student roles in SRCs, SBP learning opportunities in SRCs, and comparisons of SBP experiences in SRCs with those in the formal preclerkship curriculum. The authors used thematic analysis techniques to code and synthesize data. Data from interviews with 8 volunteers, 14 coordinators, and 4 faculty suggested six major domains related to SBP learning opportunities in SRCs: interprofessional roles and collaboration; clinic organization; patient factors affecting access to care; awareness of the larger health care system and continuity of care; resource acquisition and allocation; and systems improvement. Coordinators, who managed SRCs, demonstrated greater depth of SBP understanding than volunteers, who provided patient care. Students and faculty agreed that SRCs provided students with SBP learning opportunities beyond those available in the formal curriculum. Preclerkship students' participation in SRCs provides opportunities for in-depth learning of SBP, particularly among students who take on leadership roles. SRCs may model ways to effectively introduce key components of SBP to early medical learners.

Integrated Models of Education and Service Involving Community-Based Health Care for Underserved Populations

Throughout the United States numerous models of local programs, including student-run clinics, exist to address the issue of access to care. The role of these clinics in serving the local community and contributing to medical education has been documented only in limited detail, however. The purpose of this article is to describe the clinic models, patient demographics, and services provided by four student-run clinics in New Orleans. This is a retrospective, multisite chart review study of adult patients examined at student-run clinics between January 1, 2010 and July 31, 2011. During a 19-month period, 859 patients collectively were seen at the clinics, for a total of 1455 visits. The most common reasons for seeking care were medication refills (21.6%) and musculoskeletal pain (12.0%). Counseling and health education were provided primarily for smoking cessation (9.0%), diabetes management (7.1%), and hypertension management (5.8%). Nearly one-fifth of patients were given a referral to primary care services. In the 2010-2011 academic year, 87.6% of preclinical medical students volunteered at ≥1 of these clinics and spent 4508 hours during 1478 shifts. This article highlights the role of student-run clinics in the community, the safety-net healthcare system, and medical education. Future directions include the establishment of a new clinic, fundraising, and prospective studies to further assess the impact of student-run clinics.

Community Health Education at Student-Run Clinics Leads to Sustained Improvement in Patients’ Hepatitis B Knowledge

While student-run clinics are often important healthcare safety nets for underserved populations, their efficacy for improving patient health knowledge has not been thoroughly explored. From September 2011 to April 2012, we assessed patients' retention of hepatitis B virus (HBV) knowledge after receiving student-led education at two student-run HBV screening and vaccination clinics. Patient education was provided by trained first and second-year medical, nursing, and pharmacy students, aided by a script and interpreters. Patient knowledge of HBV was evaluated at three points: before education, after the initial visit, and at one-month follow-up. Student-led education produced improved knowledge of HBV transmission, prevention, and management, which was retained 1 month after education for 52 patients tracked through time. Mean scores on an HBV knowledge survey improved from 56.4 % (SD = 15.2 %) at baseline to 66.6 % (SD = 15.1 %) after education, and 68.3 % (SD = 15.2 %) after one month. There was a statistically significant difference between the first and second (paired T test, p < 0.001) and the first and third tests (paired T test, p < 0.001), but no difference between the second and third tests (paired T test, p = 0.45). Multivariate analysis demonstrated that retention was correlated with patient educational background but independent of patient age, gender, income, primary language and number of years lived in the United States. Our study suggests that trained health professional students can effectively impart health knowledge that is retained by patients for at least 1 month. These results warrant consideration of student-led educational sessions at SRCs as a promising community health education model.

Editorial: Complex Care and the Need for Collaborative Brains

With the rising complexity of patient care comes a rising need for collaborative work. The articles in this issue explore two important questions in this regard: How should we organize collaborative work? And how should we prepare future genera tions for it? Packard et al. [1] test whether students’ performance working up a case and per ceptions of interprofessional skills would improve if they are given modeled exam ples of interprofessional communication and a team reasoning framework. Holmqvist et al. [2] highlight the need for co-ordinated research efforts to deter mine the usefulness of student-run clinics as ideal sites to advance learning in team work and social accountability. Newhouse et al. [3] add to our understanding of how to design effective heart failure management programs. Using a Delphi process, they report data from a series of consultations among health professionals, patients, and family caregivers. Hutchison et al. [4] test the hypothesis that clinical pharmacists, physicians, and other healthcare professionals providing medication therapy management can improve outcomes and reduce costs among patients at high risk of adverse reac tions from medication. Arar et al. [5] provide insights into the cycles of growth through which multidis ciplinary research teams operate. And finally, Butson et al. [6] examine the problems that can affect the creation of interprofessional virtual communities of practice. All of these studies reflect variations on the theme of care complexity and the need for multidimensional platforms to address that complexity. These studies also highlight the kinds of skills we need to hone—dialogue, compassion, attention to the other, extending loyalties, and social interdependencies. Indeed, when care is complex, when interactions among health professionals and patient become intri cate, with the need to process higher amounts of information, it pays to hone our collaborative brains to broaden our perspective, widen our insights, and extend our predictive abilities. Such collaborative brains would work their way, through succes sive approximations, toward a better understanding of interprofessional practice. Armed with ideas, tools, and vocabulary, they would elevate their approaches to problems—each new understanding building on another, each new insight the source of a productive vitality that can carry the group for a while, until the next problem, the next challenge to its imagination, the next insight.

Student-Run Clinics: Opportunities for Interprofessional Education and Increasing Social Accountability

Background: Collaborative practice is a necessary component of providing effective, socially responsive, patient-centred care; however, effective teamwork requires training. Canadian student-run clinics are interprofessional community service-learning initiatives where students plan and deliver clinical and health promotion services, with the assistance of licensed healthcare professionals.Methods and Findings: In this article, we use a reflective approach to examine the phenomenon of student-run clinics in Canada. First, we briefly review the history of student-run clinics and then describe one particular clinic in detail. Then, drawing on the experiences of student-run clinics across the country, we identify common themes and challenges that we believe characterize these programs.Conclusion: Student-run clinics in Canada emphasize health equity, interprofessionalism, and student leadership. As more student-run clinics are developed, both nationally and internationally, co-ordinated research efforts are needed to determine their effects on students, institutions, communities, and healthcare systems. If educators can learn to collaborate effectively with student leaders, student-run clinics may be ideal sites for advancing learning around interprofessionalism and social accountability.

Impact of Student-Run Clinics on Preclinical Sociocultural and Interprofessional Attitudes: A Prospective Cohort Analysis

Descriptive studies suggest student-run clinics (SRCs) positively affect preclinical students' sociocultural and interprofessional attitudes, but few studies use validated measures. In a pre-post design, first-year medical, nursing, and pharmacy students who did and did not participate in SRCs completed demographic and open-ended questions, as well as two validated surveys, the Sociocultural Attitudes in Medicine Inventory (SAMI) and Readiness for Interprofessional Learning Scale (RIPLS), at the beginning and end of the year. With 68% (n=182/267) matched surveys we found no significant differences between groups over time (SAMI p=.53, RIPLS p≥.28 for each subcategory). However, of SRC participants, 99% reported commitment to the underserved and 57% reported improved interprofessional attitudes. Students participating in SRCs perceive positive benefits, but do not score differently from those who do not. The SRC experiences may not be frequent enough to affect these measures, particularly since our students were high-scoring upon entry.

Potential advantage of student-run clinics for diversifying a medical school class

The purpose of this study was to evaluate the influence of a student-run clinic on the diversification of a medical student class. We distributed a two-page, 20-item, paper survey to students of the University of Missouri School of Medicine (MU SOM) class of 2015 in July of 2011. The survey gathered information on general demographics, opinions on the importance of medical education opportunities, and opinions on the importance of medical school characteristics in applying to and attending MU SOM. A total of 104 students responded to the survey. A majority of the students identified the MedZou Community Health Clinic, a student-run, free health clinic affiliated with MU SOM, and simulated-patient encounters as important educational experiences (81% and 94%, respectively). More than half of the self-identified "non-white" students reported MedZou as an important factor in their choice to apply to (60%; 95% confidence interval [CI], 32 to 88) and attend (71%; 95% CI, 44 to 98) MU SOM, over half of the females reported MedZou as important in their choice to apply (59%; 95% CI, 43 to 76) and attend (57%; 95% CI, 40 to 74), and over half of non-Missouri residents reported MedZou as important in their choice to apply (64%; 95% CI, 36 to 93) and attend (71%; 95% CI, 44 to 98). According to the above results, it can be said that students clearly value both MedZou and simulated-patient encounters as important educational experiences. Women, minorities, and non-Missouri residents value MedZou more highly than their peers who are First Year Medical Students who are Missouri residents, suggesting that MedZou may provide a promising opportunity to advance diversity within MU SOM. These results highlight the need for additional research to further explore MedZou's potential to enhance the recruitment of a diverse medical student class.