Medical students as teachers at CoSMO, Columbia University's student-run clinic: a pilot study and literature review

Opportunities and challenges for a standardized curriculum in a student-run clinic network

PURPOSE

Student-run clinics (SRCs) are prevalent in medical schools. Although these are popular among students and provide ample learning opportunities, these opportunities are not well-characterized. SRCs are poised to support medical schools' ability to meet accreditation standards and student growth and learning, particularly in areas missing from traditional curricula, such as social determinants of health, interprofessional education and inequities.

MATERIALS AND METHODS

At the Crimson Care Collaborative (CCC), a network of 7 Harvard Medical School affiliated student-faculty practices in the greater Boston area, we sought to understand what learning opportunities and challenges exist and if a standardized curriculum could improve learning and result in less duplication of teaching efforts. We conducted semi-structured individual interviews of student and faculty leaders and conducted a thematic analysis of the data.

RESULTS

Four key themes emerged: (1) Standardization provides opportunities and challenges, (2) Embrace the unique learning opportunities of each clinic, (3) Educational coaches enhance learning opportunities and increase efficiency, (4) Reflection is a useful tool for improvement & learning.

DISCUSSION

Our results demonstrate a benefit to both a standardized curriculum for all SRC sites focused on broad clinical, skill-based training and site-specific teaching focusing on the unique clinical needs of each student-run clinic.

Learning Outcomes from Participation in Student-Run Health Clinics: A Systematic Review

Student-run clinics (SRCs) offer unique opportunities for students to engage in healthcare delivery, but the student learning outcomes of such clinics have not yet been systematically examined in a comprehensive manner. The purpose of this review was to appraise and synthesize existing literature pertaining to student learning outcomes associated with participation in SRCs. A systematic review was undertaken using PubMed, CINAHL, and Web of Science databases. The quality of articles that met inclusion criteria articles was appraised using the Mixed Methods Appraisal Tool (MMAT). Study details, such as learning outcomes, were also extracted. Ninety-two studies met inclusion criteria. Most studies were conducted in North America (n = 73, 79.3%), and related to clinics involving solely medical students (n = 35, 38.0%) or multi-professional clinics (n = 34, 37.0%). Demonstrated learning outcomes of SRC participation include clinical skills, interprofessional skills, empathy/compassion for underserved patients, and leadership. SRC participation had little apparent impact on students' future career directions. Quality appraisal via the MMAT found mixed levels of research quality amongst reviewed studies. In summary, while SRC participation appears to offer benefits for student learning, improved study design and research outside of North American contexts would further advance knowledge.

Student-Run Free Clinics Stand at a Critical Junction Between Undergraduate Medical Education, Clinical Care, and Advocacy

Student-run free clinics (SRFCs) act as primary care providers that bring health care to populations in need and are an important source of undergraduate medical education (UME), guiding trainees through the art of history taking and physical examination. However, they are also social justice and advocacy initiatives-addressing disparity in access to care and educating medical trainees with firsthand exposure to socioeconomic determinants of health as well as language and medical illiteracy barriers. Here, the authors review academic literature examining the impact of SRFCs in their 3 roles: as medical care providers, as components of medical education, and as advocacy organizations. Based on the evidence of that literature and decades of direct SRFC leadership experience, the authors make the case that SRFCs are an undersupported means by which UME institutions contribute to correcting health care disparities and to serving social justice reform.

Demographics, clinical interests, and ophthalmology skills confidence of medical student volunteers and non-volunteers in an extracurricular community vision screening service-learning program

BACKGROUND

Medical school curricular hours dedicated to ophthalmology are low and declining. Extracurricular ophthalmology activities, such as participation in community vision screenings, may serve an important adjunctive role in medical school curricula. The Johns Hopkins University (JHU) Vision Screening In Our Neighborhoods (ViSION) Program is an example of a voluntary medical student-directed community service-learning program.

METHODS

We used a mixed-methods cross-sectional approach, including an online survey and semi-structured interviews. JHU School of Medicine students enrolled in MD or MD/PhD programs during the 2019-2020 academic year were surveyed regarding demographics, career and service interests, involvement in ophthalmology-related activities, and confidence in their ophthalmology-related skills. Survey responses were compared between ViSION volunteers and non-volunteers using Fisher's exact chi-square tests. Semi-structured interviews were conducted via webconference with 8 prior or current ViSION volunteers and responses analyzed using inductive thematic analysis. Data were collected when ViSION volunteers were in variable stages of their medical education and involvement with the ViSION program.

RESULTS

A total of 118 medical students were included, representing an overall response rate of 24.6% of JHU medical students. ViSION volunteers reported greater involvement in ophthalmology-related research (42% vs. 4%, p < 0.001), intent to apply to ophthalmology residency programs (35% vs. 1%, p = 0.001), and confidence with multiple ophthalmology knowledge and clinical skill domains. In particular, ViSION volunteers were more likely to feel confident estimating cup-to-disc ratio using direct ophthalmoscopy (20% vs. 0%, p < 0.001). In open-ended survey and interview questions, most volunteers attributed at least some degree of their ophthalmology skill development and desire to pursue ophthalmology and public health careers to their ViSION experience.

CONCLUSIONS

Medical students who volunteered with a student-led community vision screening program were more likely to have a prior interest in ophthalmology than those who did not volunteer, but only 1/3 of volunteers planned to pursue a career in ophthalmology. Overall, volunteers reported higher confidence performing ophthalmology-related clinical skills, suggesting that student-led community vision screening programs may provide an important avenue for medical students to explore public health aspects of ophthalmology, while practicing ophthalmology exam skills and learning about common ophthalmic pathologies, regardless of their career intentions.

Peer-assisted learning (PAL): skills lab tutors' experiences and motivation

BACKGROUND

Peer-assisted learning (PAL) is a common teaching and learning method in medical education worldwide. In the setting of skills laboratories (skills labs), student tutors are often employed as an equivalent alternative to faculty teachers. However, to the best of our knowledge, there is a lack of qualitative studies which explore the reasons for the personal commitment of student tutors. The aim of our study was to examine how undergraduate students experienced and evaluated their roles as skills lab student tutors, what their motivation was, and whether social and cognitive congruence played a role in their teaching experiences.

METHODS

We conducted in-depth, semi-structured interviews with student tutors who were currently teaching in a skills lab. After the interviews had been transcribed verbatim, two independent investigators performed a qualitative content analysis according to Mayring.

RESULTS

In total, we conducted nine interviews with student tutors. Our results revealed that all student tutors showed great enthusiasm and motivation for their jobs as peer teachers. One of the main motivating factors for student tutors to teach in a skills lab was the possibility to simultaneously share and improve their knowledge and expertise. In general, the participants of our study had high aspirations for their teaching. They found it particularly important to be empathetic with the student learners. At the same time, they thought they would personally benefit from their teaching activities and develop a certain expertise as student tutors.

CONCLUSIONS

With the present study we are able to gain some insight into what motivates student tutors to teach in a skills lab and what kind of experiences they have. Our results provide an important input for the future training of highly qualified student tutors.

Peer-assisted learning versus didactic teaching in osteology for first-year Indian undergraduate medical students: a quasi-experimental study

PURPOSE

The utility of peer-assisted learning (PAL) in anatomy education has been recognized. In this study, PAL was incorporated into osteology teaching for the first-year medical students and compared to traditional didactic methods (TDM).

METHODS

This was a cross-over intervention study. The class of 60 students was divided into two equal groups. The first group underwent PAL for five upper limb osteology sessions and TDM for all lower limb osteology classes. The second group underwent TDM for five upper limb osteology classes and PAL for lower limb osteology classes. A pre-session test (PrST) and post-session test (PoST) were conducted for each session using multiple choice type questions. Perceptions of students about PAL were collected using a questionnaire. Between and within group differences were estimated using the independent sample T test and paired T test, respectively. The responses in the questionnaire were summarized and open-ended responses categorized into broad themes.

RESULTS

Greater group differences were noted in the PrST as compared to the PoST mean scores, with the PAL group showing higher mean scores for both upper and lower limb sessions. Significantly higher PoST scores compared to PrST scores for all the sessions were observed regardless of the method used. Significantly higher scores in the PrST or PoST scores were noted in the PAL group for five sessions. Most aspects of PAL were appreciated by the students.

CONCLUSIONS

This study provides evidence that PAL is at least as effective as TDM in learning osteology among the first-year medical students.

Implementing Peer Learning in Clinical Education: A Framework to Address Challenges In the "Real World"

Phenomenon: Peer learning has many benefits and can assist students in gaining the educational skills required in future years when they become teachers themselves. Peer learning may be particularly useful in clinical learning environments, where students report feeling marginalized, overwhelmed, and unsupported. Educational interventions often fail in the workplace environment, as they are often conceived in the "ideal" rather than the complex, messy real world. This work sought to explore barriers and facilitators to implementing peer learning activities in a clinical curriculum.

APPROACH

Previous peer learning research results and a matrix of empirically derived peer learning activities were presented to local clinical education experts to generate discussion around the realities of implementing such activities. Potential barriers and limitations of and strategies for implementing peer learning in clinical education were the focus of the individual interviews.

FINDINGS

Thematic analysis of the data identified three key considerations for real-world implementation of peer learning: culture, epistemic authority, and the primacy of patient-centered care. Strategies for peer learning implementation were also developed from themes within the data, focusing on developing a culture of safety in which peer learning could be undertaken, engaging both educators and students, and establishing expectations for the use of peer learning. Insights: This study identified considerations and strategies for the implementation of peer learning activities, which took into account both educator and student roles. Reported challenges were reflective of those identified within the literature. The resultant framework may aid others in anticipating implementation challenges. Further work is required to test the framework's application in other contexts and its effect on learner outcomes.

Student and Preceptor Experiences at an Inter-Professional Student-Run Clinic: A Physical Therapy Perspective

Purpose: Student-run clinics (SRCs) provide a unique opportunity for inter-professional education; they prepare health care students for a collaborative future by enabling them to interact with other such students in a clinical setting focused on inter-professional learning and collaboration. Physical therapy (PT) students are increasingly being included in SRCs; however, most research on student experiences in SRCs has been carried out with medical students. This qualitative study explores the perceived benefits of the PT experience in an SRC through the lens of PT students and their preceptors. Method: A qualitative interpretive-descriptive approach consisting of face-to-face, semi-structured interviews was used. Interviews were audiotaped and transcribed verbatim. Data were analyzed using a constant comparative approach. Results: Seven PT students and eight preceptors who volunteered at the SRC between September 2013 and May 2015 participated in the study. Three themes emerged from the interviews: (1) exposure to marginalized patient populations, (2) learning through inter-professional interactions, and (3) experience with different patient care approaches. Conclusions: Participating in an SRC enhances PT students' understanding of their and other health care professionals' roles. Students gained an appreciation for the social determinants of health and improved their knowledge of inter-professional collaboration. The knowledge gained from this study has the potential to inform PT professional development, SRCs, and PT education.

A novel approach to teaching pharmacotherapeutics--feasibility of the learner-centered student-run clinic

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Medical students should be better prepared for their future role as prescribers. A new educational concept to achieve this is learning by doing. This encompasses legitimate, context-based training and gives students responsibility as early as possible in their medical education. Student-run clinics (SRCs) are an example of this concept.

Aim

Describe the development of a new SRC for insured patients, primarily focused on medical (pharmacotherapy) education, the learner-centered student-run clinic (LC-SRC), and its feasibility.

Methods

Teams each comprising of three students (first, third, and fifth year) performed consultations including proposing management plans, all under the supervision of an internist. Patients were voluntary selected from the internal medicine outpatient clinic for follow-up in the LC-SRC. Feasibility was evaluated using a set of questionnaires for patients, supervisors, and students.

Results

In total, 31 consultations were conducted; 31 students and 4 clinical specialists participated. A pharmacotherapeutic treatment plan was drawn up in 33 % of the consultations. Patients were content with the care provided and rated the consultation with a 7.9 (SD 1.21) (1(min)-10(max)). Supervisors regarded LC-SRC safe for patients with guaranteed quality of care. They found the LC-SRC a valuable tool in medical education although it was time-consuming. Students appreciated their (new) responsibility for patient care and considered the LC-SRC a very valuable extracurricular activity.

Discussion

The LC-SRC is feasible, and all participants considered it to be a valuable educational activity. It offers students the opportunity to learn in a real interprofessional and longitudinal setting for their future role as prescriber in clinical practice. The benefits and learner effects need to be investigated in a larger study with a longer follow-up.

Electronic supplementary material

The online version of this article (doi:10.1007/s00228-015-1916-x) contains supplementary material, which is available to authorized users.

The Medical Education Pathway: description and early outcomes of a student-as-teacher program

PROBLEM

Although senior medical students at the University of Rochester School of Medicine and Dentistry (URSMD) have a long history of teaching junior peers, no formal educational training existed for students until 2007. The Medical Education Pathway (MEP) at the URSMD is a longitudinal student-as-teacher program that addresses both the local precedent of medical student teaching and the ongoing need to prepare students for teaching in residency and beyond.

APPROACH

In 2007, administrative faculty spearheaded efforts to create the MEP Committee, whose members then designed and implemented an elective curriculum. The curriculum balances didactics and experiential learning. A rigorous two-step application process precedes acceptance into the MEP. Participating students receive mentoring, assessment, and formative feedback on lecture delivery and leadership of various small-group formats.

OUTCOMES

Since 2007, 89 students have enrolled in the MEP: 49 have successfully completed it, and 40 are currently enrolled. MEP students teach in basic science and clinical courses, and they regularly make novel contributions to the medical school curriculum. Student learner peers demonstrate an ability to give constructive feedback to MEP students. Exit survey comments demonstrate that the MEP influences participating students' career plans. Lessons learned from implementing the MEP include the importance of institutional support, dedicated faculty who value student teaching, and flexibility in scheduling.

NEXT STEPS

Future improvements to the MEP include enhancing the assessment process and tracking the careers of graduates as outcome data. The MEP serves as a model for a successful student-as-teacher program in other institutions and settings.

Learning in student-run clinics: a systematic review

CONTEXT

Student-run clinics (SRCs) have existed for many years and may provide the most realistic setting for context-based learning and legitimate early clinical experiences with responsibility for patient care. We reviewed the literature on student outcomes of participation in SRCs.

METHODS

A systematic literature review was performed using the PubMed, EMBASE, PsycINFO and ERIC databases. Included articles were reviewed for conclusions and outcomes; study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

A total of 42 articles met the inclusion criteria and were included in the quantitative synthesis. The effects of participation on students' attitudes were mainly positive: students valued the SRC experience. Data on the effects of SRC participation on students' skills and knowledge were based mainly on expert opinions and student surveys. Students reported improved skills and indicated that they had acquired knowledge they were unlikely to have gained elsewhere in the curriculum. The quality of specific aspects of care delivered by students was comparable with that of regular care.

CONCLUSIONS

The suggestion that students should be trained as medical professionals with responsibility for patient care early in the curriculum is attractive. In an SRC this responsibility is central. Students valued the early training opportunity in SRCs and liked participating. However, little is known about the effect of SRC participation on students' skills and knowledge. The quality of care provided by students seemed adequate. Further research is needed to assess the effect of SRC participation on students' skills, knowledge and behaviour.

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

Background

Despite 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.

Methods

Individual 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.

Results

Participants 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.

Conclusions

SRCs 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.

Integrated models of education and service involving community-based health care for underserved populations: Tulane student-run free clinics

OBJECTIVES

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.

METHODS

This is a retrospective, multisite chart review study of adult patients examined at student-run clinics between January 1, 2010 and July 31, 2011.

RESULTS

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.

CONCLUSIONS

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.