What and how do students learn in an interprofessional student-run clinic? An educational framework for team-based care

Figures & data

Table 1 Question guides for focus groups for interprofessional student-run clinic, Keck School of Medicine of the University of Southern California, 2016

Key questions	Probes
Uniprofessional groups
1. Tell us what you learned about another profession that was new or surprising to you, and which profession/s you were most likely to learn something new about.	• Why were you surprised? • How will your learning about the other professions help you in future practice?
2. What were the aspects of team-based care that were improved/worsened compared with care in settings where care is provided by one profession only?	• Why do you think this aspect of care was enhanced/made worse? • Please give an example.
3. Other than interprofessional learning, what else did you learn from the SRC that is likely to impact your future practice?	• Has the experience affected your career choice? Clinical skills? • What did you learn about leadership and management?
4. Share your thoughts about the value of the SRC experience for professional development.	• No probes.
Multiprofessional groups
1. What are best ways for you to learn to prepare for future practice?	• How do you prepare for future practice? • How do you learn best? • What qualities of precepting help you?
2. How is precepting in the IPE model different or similar from your experience of precepting in your training?	• What did you learn from preceptors? • How is it different from what you learned in your own program rotations?
3. How did the process of care impact your learning in the SRC?	• What did you learn from seeing the patient as a team? • What did you learn from the huddle process?
4. Tell us what you think is the optimal learning environment for IPE.	• No probes.

Table 2 Demographics of students participating in focus groups, Keck School of Medicine of the University of Southern California, 2016, N=50

Student profession	Total number in focus groups (N)	Age/years N for age groups 18–24, 25–29, 30–34, 35–40	Female (N)
Medicine	14	9, 5, 0, 0	8
Occupational therapy	9	0, 6, 1, 2	8
Pharmacy	12	9, 3, 0, 0	9
Physician assistant	15	1, 10, 2, 2	14

Table 3 Major themes and typical quotes, interprofessional student-run clinic focus groups, Keck School of Medicine of the University of Southern California, 2016

Major themes	Representative quotes, by student profession and letter
Uniprofessional groups (N=36)
Recognition of other professions’ roles and scope of practice	• I didn't realize the extent of medication reconciliation that pharmacy can do … how much they know dosing and interactions … how much physicians lean on them. (OT/C) • I had no understanding … that PAs played such a large role in managing primary cases as well as … performing surgery. (OT/A) • I thought everything musculoskeletal went to PT …. That was one thing I'll use now and in practice: hand issues to OT. (PA/C)
Appreciation of benefits of team-based care	• I don't think I'll ever overestimate my profession … asking other professions for help leads to better outcomes in patients. (PA/E) • (I learned) that collaboration is for the patient's benefit … the ultimate goal of getting them … healthy. (OT/B) • (Patients’) concerns addressed from multiple angles and different people spend time with them, that's a benefit. (Medical/C)
Patient experience of student-run clinic	• If the patient has access to people influencing social determinants … you can tackle a problem from all angles …. (PA/A) • It can also help the patients, giving them increased access to care because if they were only seen by one provider, they would need to get a referral (Pharmacy/A) • The majority (of patients), greater than 90%, would choose team-based care over regular, single provider care …. (Medical/A)
Role of advocacy/systems care	• It make sense see how an interprofessional patient-centered medical home could be key to cost reduction, increased quality. (PA/A) • … taught me how to be between the student and the preceptor to ensure balance between learning and student engagement … teaches initiative. (Pharmacy/C) • I wasn't expecting to take on as much responsibility, and it's been a tremendous learning in leadership. (Medical/A)
Improved leadership and clinical skills	• What I gained is (the skill) advocacy, speaking up, explaining the role of OT … fighting for our place in student-run clinic. (OT/A) • … the SRC influenced me to go into that areas like the Veterans Administration or underserved clinics. (Pharmacy/A)
Impact on own future career	• (The student-run clinic) solidified in me that teaching and team-based care … is a part of me … for the rest of my career. (OT/B) • … more time for the patient's story… directed my future career path to go into (primary care) to allow me to do so. (Pharmacy/D) • The SRC exposed me to … homeless and impoverished populations … I see myself working with in the future. (Medical/B)
Multiprofessional groups (N=14)
Most valuable learning occurred in the patient encounter	• Sitting with the patient taking turns asking questions is effective … we see how professions phrase questions differently (Pharmacy/10) • I believe that when we (students) are all in the room together interviewing the patient, it is the best learning situation. (OT/7)
Learning takes place in the huddle, during informal conversations, and during the patient encounter	• I've learned from other professions different ways to ask things and the motivation for asking. (Medical/1) • Pulling back the lens, seeing it from a wider perspective. Every time you huddle you see the patient in a more holistic way. (OT/7) • We definitely learn from the other disciplines when we are around them. (OT/4)
Learning occurs with patients, seniors, peers, and preceptors from other professions	• Exposure to students further along in their training facilitates (my) learning. (Medical/5) • Informal chitchatting with other professions is helpful. (PA/13) • We (have) preceptors who are not OTs and that adds a whole other dimension to what we learn. (OT/4)
Most helpful teaching technique is direct feedback with hands-on practice	• I want immediate feedback … instructors that are willing to show first and then have me repeat back are most helpful. (OT/4) • (Preceptors are) more helpful if they give me the clinical reasoning behind what they're doing. (OT/3) • They show you … then you do it with their guidance. (PA/5)

Medical=medical student; OT=occupational therapy student; Pharmacy=pharmacy student; PA=physician assistant.

Fig. 1 Proposed framework for learning in interprofessional student-run clinic environment.