Student-Led Clinics in Aotearoa New Zealand: A Scoping Review with Stakeholder Consultation

Figures & data

Table 1 Research Questions

Aspects	List of Questions
General	What types of SLCs currently exist in Aotearoa New Zealand?
	What patient populations are served?
Underpinning model	What models of practice are utilised?
	What is the scope of student contributions?
Cultural/community considerations	How were communities consulted in clinic development, implementation, and evaluation?
	What cultural supports are available to students (and staff) during placement at a SLC?
	What cultural/Te Ao Māori practices are incorporated into SLCs?
Implementation	With regards to developing and implementing a SLCs, what were the reported:
	Benefits? Challenges? Lessons?
Evaluation	How were SLCs evaluated? What outcomes were measured (eg student, academic, community)?
	What methods were used?

Box 1 Search Terms

Tertiary OR student* OR undergraduate* OR graduate* OR volunteer*

AND led OR run OR facilitated OR managed OR assisted

AND service* or centre* OR center* OR clinic*

AND Zealand OR Māori OR Maori OR Maaori OR kaupapa

Notes: *Indicates use of a wildcard symbol that broadens the search to words that begin the same but may have different endings, for example “centre*” would find “centre”, “centres” and “centred”.

Figure 1 PRISMA flow diagram.

Note: Adapted from Liberati A, Altman D, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of Clinical Epidemiology. 2009;62(10)e1-e34. Creative Commons.⁶⁴

Table 2 Location, Type and Focus of Documents Included in Scoping Review

Ref	First Author (Alphabetical)	Location	Document Type	Focus
[^Citation37]	Allan et al 2011	Unspecified: three clinics in Aotearoa New Zealand plus seventeen clinics across Australia	Research article	Consultative enquiry of the goals, possibilities, and challenges of clinics and conceptualising and describing the role of context, particularly rural, for these clinics.
[^Citation29]	Friary et al 2018	Auckland University of Technology, Auckland	Research article	Phenomenological exploration of the experiences of clients, students and educators associated with a university clinic-based interprofessional programme for clients with Parkinson’s disease.
[^Citation34]	Godbold et al 2019	Auckland University of Technology and Auckland District Health Board, Auckland	Opinion article	Reflection on the ethical issues raised for students in an interprofessional clinic through the application of a human-centred approach to design in a collaborative health context.
[^Citation30]	Morgan et al 2019	Auckland University of Technology, Auckland	Research article	Mixed methods study exploring the learning experiences of health students, clinical educators, interprofessional facilitators and health administrators associated with a student clinic pilot programme for patients living with type 2 diabetes.
[^Citation31]	O’Brien et al 2013	Auckland University of Technology, Auckland	Research article	Mixed methods study exploring student beliefs and attitudes regarding clinical placements at a university clinic that aim to develop interprofessional collaborative practice.
[^Citation32]	O’Brien et al 2016	Auckland University of Technology, Auckland	Research article	Mixed methods study exploring and evaluating the outcomes and experiences of clients, staff and students piloting an integrated interprofessional programme for community members with type 2 diabetes.
[^Citation33]	O’Brien et al 2015	Auckland University of Technology, Auckland	Research article	Understanding the organization of interprofessional student learning opportunities through mapping key participants, practices, and structures in an interprofessional student-led health service.
[^Citation35]	Pullon et al 2013	University of Otago, Wellington	Research article	Mixed methods study testing the feasibility of delivering an interprofessional-based course component to health students, including home visits.
[^Citation28]	Tucker 2012	Auckland University of Technology, Auckland	MPhil Thesis	Qualitative descriptive exploration of service user’s experiences, expectations and understanding of care received at an interprofessional student-lead health service.
[^Citation36]	Vaughan 2018	Unitec Institute of Technology, Auckland, plus two in Australia and one in the United Kingdom	Research article	Implementing Rasch analysis to investigate the construct validity of the Osteopathy Clinical Teaching Questionnaire as a tool for evaluating clinical education in an on-campus, student-led osteopathy clinic environment.

Table 3 Characteristics of Student-Led Clinics Identified in the Literature

Student-Led Clinics (Alphabetical)	Description of Student-Led Health Service	Student Disciplines (Alphabetical)	Population Served
Auckland University of Technology Integrated Health – Interprofessional programmes*	One-day/week, seven to twelve-week programmes: includes IP in-service, IP appointments, IP education and interactive discussion-based sessions, IP group tutorial sessions and IP client focused care conferences led by health students.	Case management Counselling psychology Exercise and nutrition Health administration Health promotion Nursing Occupational therapy Oral health Physiotherapy Podiatry Psychotherapy	Staff, students, and local community; three documents focused specifically on patients with Parkinson’s disease and type 2 diabetes.
Design for Health and Well-being (DHW) Lab	Students at both undergraduate and postgraduate levels engage with a hospital through a design lab and have access to the real-world context of acute health care.	Design	District Health Board acute health services.
Three unspecified clinics from New Zealand and seventeen from Australia	The most common clinic type described was an on-campus university clinic provided by a single professional group, often co-located with other clinics.	Audiology Dental Human movement and exercise physiology Multidisciplinary Podiatry Physiotherapy Psychology Psychotherapy Occupational therapy Optometry Speech Veterinary	Varied but not reported in detail: urban and rural; typically run in partnership with healthcare providers or near existing populations of high need eg aged care facility; target high waiting lists.
Unitec Osteopathy clinic (and others from Australia and the United Kingdom)	Osteopathy students are responsible for the management of patients; approximately five to seven students are simultaneously supervised by a qualified osteopath.	Osteopathy	Not described.
University of Otago	Groups of three health students undertook a home visit with a patient; students worked together to share decision-making, construct a joint management plan, and make recommendations.	Dietetics Medicine Physiotherapy	Patients attending a local primary care provider and receiving health care for a number of comorbidities.

Note: *Also included in the consultation process.

Table 4 Characteristics of Additional Student-Led Clinics Consulted

Student-Led Clinics (Alphabetical)	Description of Student-Led Health Service	Student Disciplines (Alphabetical)	Population Served
Otago Polytechnic Massage Clinic	Undergraduate massage programme students deliver massage therapy and write client notes under supervision (approx. student:staff ratio 3:1). Students complete 50–70 hours at the clinic/year depending on level of study.	Massage	Self-referrals of staff, students, and general public.
University of Otago Physiotherapy Clinic	Undergraduates in 2nd-4th year of study and postgraduates deliver treatment under the supervision of a registered physiotherapist. Placement lengths vary between 1 morning/week for 3 weeks to 6 weeks full time (approx. student:staff ratio 4:1).	Physiotherapy	Self-referrals of students, staff, and general public with musculoskeletal injuries and balance challenges.
Victoria University Psychology Centre	Students in 4–6th year of study (postgraduate clinical psychology programme). Students lead care under supervision of clinical psychologist.	Psychology	Self-referrals or via GPs for clients (children, youth, and adults) with mild-moderate mental health needs.
Wintec Biokinetic Clinic	Students design and run exercise programmes with referred clients under supervision of accredited clinical exercise physiologist. Programmes last 8 weeks.	Clinical exercise physiology	Clients accessing the Green Prescription programme through Sport Waikato; referrals from local primary healthcare providers.

Table 5 Models of Practice and Scope of Student Contributions Within Student-Led Clinics

Student-Led Clinics	Model of Practice	Scope of Student Contributions
Auckland University of Technology Integrated Health – Interprofessional programmes*	Business/private practice model.^Citation33 Informed by Wenger model of Communities of Practice.^Citation33 Client-centred, collaborative, holistic, and interprofessional care.^Citation29^–^Citation32	Students plan and deliver interventions in an interprofessional environment, under the supervision of an appropriately registered health professional. As part of the IP programme, students facilitate a one-hour interactive self-management education group each week. Each student is assigned one patient, and all patient appointments are attended by student pairs from different disciplines. Client-focused conferences, led by health students, are held each week. Students reassess patients at the end of the program and compile a comprehensive report sent to their GP.
Design for Health and Well-being (DHW) Lab	Project-based defined as research Industry partnership.	Students engage in a collaborative design process with staff and patients, working through ethics, data collection, and design process
Otago Polytechnic massage clinic	Business/private practice model.	Students plan and implement massages and write up client notes independently. Second- and third-year students also set up appointments directly, manage payments and pay expenses for use of the space/materials.
Three unspecified clinics from New Zealand and seventeen from Australia	On-campus clinics provided by a single professional group.	-
Unitec Osteopathy clinic (and others from Australia and the United Kingdom)	-	-
University of Otago	Interprofessional, care-based course component.	In interprofessional groups of three, students arrange and undertake a home visit to consult with patient with comorbidities. Students then collaborate on group presentations for peers/teaching staff outlining the person’s conditions and develop a multidisciplinary care/management plan.
University of Otago physiotherapy clinic	Business/private practice model.	Students plan and implement treatments and record client notes.
Victoria University psychology centre	Business/private practice model (subsidised by the university). Scientist/practitioner model.	Students provide psychological services, according to level of study, from observation to leading.
Wintec Biokinetic clinic	Not-for-profit, structured programme delivery.	Students complete an assessment with clients and send a feedback report to the referrer; plan and implement an 8-week intervention; and complete a final feedback report.

Box 2 Benefits and Opportunities of Student-Led Clinics

For students

Generate real-world opportunities to implement practice (clinical and operational) and contextualise teaching and learning. Exposure to a diversity of clinical presentations. Students gained a holistic appreciation of the person. Create understanding of authentic and effective interprofessional teamwork Learning can be scaffolded in a safe/controlled learning environment. Chance to give back to the community.

For the community

Fill a healthcare gap and a meet community need: there is a demand for services. Provision of affordable, good quality healthcare. Interprofessional teamwork between students was enjoyed by clients. Interprofessional practice provided clients with a one-stop shop for accessing services.

For educators

Collaborations with health provider partners: potential satellite services. Provides some of the necessary placements and practicum experiences students require. Consistent with government strategy and policies on health and well-being. Health practitioners all held accountable to the same overarching legislation (Health Practitioners Competence Assurance Act, 2003).

Box 3 Lessons Learned About Developing and Implementing Student-Led Clinics

Lessons about teaching and learning

Planning is required to provide consistent education and supply of expert supervision. Student experiences were positive, practice was transformative. Aligning participation with course requirements impacts attendance and commitment. Interprofessional components can be successfully introduced across existing pre-registration health professional degree courses in an Aotearoa New Zealand context. Clinics can provide an authentic interprofessional environment. A sharing of the vocabularies, cultures and worldviews of each disciplines requires making knowledge explicit to enable situated learning to occur. Aligning of curriculum is needed to facilitate consistent and sustainable interprofessional learning opportunities within a student-led clinic. Creation of practice stories and heuristics may be important in the NZ context. Educators gained valuable insight into their own collaborative processes and learning, and into difficult aspects of interprofessional teamwork for students.

Lessons learned about operational factors

Start small and build up: do not over-reach or over-commit. Multi-perspective planning and staff facilitation is required for success. A clear vision and clinic objectives are essential. Policies and procedures need to support and reflect interprofessional practice and prevent siloed practices and communication. A focus on interprofessional practice should come from the leadership team. Plan to ensure ongoing supply and diversity of patients: locating in an area of high need is insufficient evidence this will occur. Successful examples were outreach clinics and partnerships with established healthcare providers. The physical environment can facilitate or inhibit effective interprofessional practice. Educational institutions operate within different financial arrangements than healthcare providers. Recommendation to operate as a quality healthcare provider and have strong processes in place for managing equipment and materials etc. Having a single point of entry for referrals is useful for external providers. Having a front-facing administrator can support health students to stay focused on clinical learning experiences with clients.

Table 6 Challenges of Developing and Implementing Student-Led Clinics

For the Learner

For the Academic Institution

Limited diversity in range of conditions seen: high number of patients with the same problem. Complexity of chronic conditions. Interpersonal challenges, co-operation, and partnership. Differences and misunderstandings in perceptions about what students should do and learn. The volume and complexity of knowledge and skills to be acquired during interprofessional teamwork can leave a learner feeling uncertain. Logistics, such as “getting up in the morning to information overload”.^Citation31 (p85) Arranging clinical contacts.

Do not generate all placements required. Patient supply (except where developed in response to community need). Tension between curriculum requirements, students’ learning needs and patient needs. Timetabling. Continuity of care: student availability to run clinics throughout the year. Operating as a healthcare provider and accountability. Potentially in direct competition with other health providers. Staffing: clinic management not recognised in academic workloads.

Table 7 Evaluation Methods and Outcomes of SLCs

Student-Led Clinic	Focus of Evaluation	Evaluation Method(s)
Auckland University of Technology Integrated Health – Interprofessional programmes*	Explore and evaluate the experiences of clients, students and educators.^Citation29,Citation32 Explore student and educator experiences.^Citation30 Explore student perceptions of the placement and the utility of the IPE Student Questionnaire.^Citation31 Explore service-user perspectives.^Citation28	Phenomenological hermeneutic interpretive approach; individual semi structured interviews with clients and focus groups with students and educators.^Citation29,Citation32 Client demographic details, clinical indicators (BMI, waist circumference, blood pressure, blood glucose) and COPM scores.^Citation32 Focus groups.^Citation30 IPE Student Questionnaire.^Citation31 Qualitative descriptive design with an interpretative approach using semi-structured interviews.^Citation28
Design for Health and Well-being (DHW) Lab	Not a formal evaluation.	NA
Otago Polytechnic massage clinic	No known formal evaluation.	NA
Three unspecified clinics from New Zealand and seventeen from Australia	Examine the goals, possibilities, and challenges of university clinics.	Consultative enquiry conducted within a context-input-process-products (CIPP) systems framework. Semi-structured interviews were conducted with people in management, operations, or delivery of education within a university clinic or who were students.
Unitec Osteopathy clinic (and others from Australia and the United Kingdom)	Investigate the construct validity of the Osteopathy Clinical Teaching Questionnaire as used in student-led clinics.	Rasch analysis.
University of Otago	Evaluate changes in student attitudes to interprofessional practice, IPE, and the effectiveness of health care teams.	Focus groups with students and educators.
University of Otago physiotherapy clinic	No known formal evaluation.	NA
Victoria University psychology centre	No known formal evaluation.	NA
Wintec Biokinetic clinic	For accreditation purposes.	Accreditation checklist.

Note: *Also included in the consultation process.

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