http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2015; 29(3): 263–264 ! 2015 Informa UK Ltd. DOI: 10.3109/13561820.2014.936372
SHORT REPORT
Interprofessional education through service-learning: lessons from a student-led free clinic Janice L. Farlow, Charles Goodwin and Javier Sevilla Indiana University School of Medicine, Indianapolis, IN, USA
Abstract
Keywords
The academic community must replicate and strengthen existing models for interprofessional education (IPE) to meet widespread calls for team-based patient-centered care. One effective but under-explored possibility for IPE is through student-led clinics, which now exist in the majority of medical schools. This short report presents the Indiana University Student Outreach Clinic (IU-SOC), which involves seven different professional programs across three institutions, as a model for how IPE can be delivered formally through service learning. Lessons learned, such as nurturing an intentional interprofessional program, structured orientation and reflection, and resource and knowledge sharing between the clinic and academic institutions, can be applied to all student-led clinics, but also can inform other IPE initiatives in health professional curricula.
Free clinic, health and social care, interprofessional education, patient-centered practice, service-learning, team-based care
Introduction Calls for improving interprofessional education (IPE) have been growing since the 1970s (Institute of Medicine, 1972; World Health Organization, 2010). While notable models for IPE have emerged, IPE activities must be increased across more schools, evaluated for learner outcomes and ultimately focused more on the goal of improving patient care (Thibault, 2012). Student-led clinics present a vehicle for interprofessional education whose impact is not yet well understood. It is projected that these clinics are present in over half of US medical schools (Simpson & Long, 2007), and while some include a collaborative component, detailed data on interprofessional student-led clinics are not currently available. The prevalence and the nature of student-led clinics present an under-appreciated opportunity for IPE, grounded in service-learning. As a student-led clinic with an integrated team of students and faculty from seven different professions (medicine, pharmacy, dentistry, law, social work, physical therapy, occupational therapy) spanning three US institutions (Indiana University, Butler University, University of Indianapolis), along with its community partner, the Neighborhood Fellowship Church, the Indiana University Student Outreach Clinic (IU-SOC) serves as a model for embracing a patient-centered interprofessional culture through service-learning.
The interprofessional program The near eastside of Indianapolis continues to face significant barriers to healthcare. The IU-SOC, open each Saturday for four hours, serves as a bridge to access for patients with little to no Correspondence: Dr. Javier Sevilla, Indiana University School of Medicine, Long Hospital Suite 200, 1110 West Michigan Street, Indianapolis, 46202 IN, USA. E-mail: [email protected]
History Received 3 December 2013 Revised 25 March 2014 Accepted 16 June 2014 Published online 7 January 2015
healthcare in this community. In 2012, 30–35 patients on average were seen at each clinic, with over 1500 patient encounters for the year. All services, lab testing and formulary medications provided are free. The IU-SOC uses a vertical mentoring model, where novice and advanced medical students perform a focused history and physical, develop an assessment and plan, and present to a faculty physician together. Medical and pharmacy students collaborate to elicit medication histories, develop intervention plans, dispense medications from an in-house formulary and provide patient education. Physical and occupational therapy students also consult for initial assessments and to coordinate care plans. As part of their visit, patients can receive dental care, ranging from routine cleanings to extractions. Dental and medical students work together to identify those in need of services, and a program is planned to use oral, head and neck exams for interprofessional learning. Furthermore, social work and law students are intimately involved in identifying and utilizing community resources. Throughout the patient visit, wait times are utilized for health education and promotion, connecting patients with community resources and special programing. Programs include a variety of specialty clinics ranging from vision screening to dermatology consults, as well as non-medical activities, such as printing birth certificates, employment counseling and more. Orientation and reflection While the structure of the patient-centered visit provides many organic IPE opportunities, additional programs set the stage and allow for reflection on IPE experiences. At the beginning of each clinic following individual partner orientations, an interprofessional orientation is held to reinforce the clinic mission and emphasize the importance of interprofessional interactions in fulfilling that mission. By introducing volunteers and defining roles at the beginning, efficient lines of communication are
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J. L. Farlow et al.
established, allowing for more effective team-based care and learning. Towards the end of clinic, an interprofessional roundtable is held to discuss a couple of patients who received services from several partners that day. Faculty physicians receive Continuing Medical Education (CME) credits for leading a roundtable, and the IU-SOC is currently developing a mechanism to evaluate learning outcomes of students after this activity. IU-SOC leadership involvement also serves as a rich source for IPE. Monthly meetings among all partners are held, involving discussions to coordinate between medicine, social work and pharmacy to access pharmaceutical patient assistance programs; organize inter-institutional data collection and follow-up initiatives; develop volunteer and patient education about relevant health policy and common clinical presentations; and optimize clinic flow. Due to the patient-centered approach, the richest interprofessional interaction typically occurs in the interprofessional IU-SOC patient education subcommittees. Beyond operational meetings, student leaders gather biannually for retreats, which consist of formal IPE instruction, team building and strategic planning.
Discussion Beyond just offering the services of multiple professions, the IUSOC environment and student-led nature encourages meaningful interaction between professions and community partners. Other student-led clinics could easily implement interprofessional orientation and reflection, and patient and volunteer education can serve as a starting point for encouraging interprofessional collaboration. Student-led clinics face common challenges in adoption or enhancement of interprofessional programs. Intra- and interinstitutional expansion can entail difficult political climates for students and faculty to navigate. Many clinics do not have the financial resources or political capital to involve other licensed health professionals in the absence of partnering health professions schools. Furthermore, the operations of student-led clinics are traditionally removed from the expertise of curricular design, student assessment and program evaluation. The IU-SOC leadership team has begun to address these issues by strengthening collaborations between regional campuses and engaging
J Interprof Care, 2015; 29(3): 263–264
international organizations related to student-led clinics. Educators are involved to align the IU-SOC with the formal curricula of the partnering health professions school, as well as to collect data on knowledge and attitudes before and after IU-SOC IPE experiences. As student-led clinics become more common, resource and knowledge sharing between clinics and institutions will be essential to addressing these common challenges. Scarce data exist about the role of interprofessional student-led clinics in nations and communities with different healthcare environments. However, existence of these clinics in very different communities suggests that there are likely always at-risk populations who could benefit from this model of teambased care. Further work remains to explore how interprofessional student-led clinics can be altered to reflect local healthcare practices. The calls for IPE and service-learning can both be met through student-led clinics, which are becoming widespread sources of patient care and student education. Ownership of a patientcentered program by students increases the meaningfulness of the endeavor and opportunities for professional development. Lessons learned can be applied to other student clinics and other IPE initiatives. It is critical that future healthcare professionals learn how to effectively deliver patient-centered team-based care, and programs like the IU-SOC represent an under-utilized opportunity to address this need.
Declaration of interest The authors report no conflicts of interest. The authors are responsible for the writing and content of this paper.
References Institute of Medicine. (1972). Educating for the health team. Washington, DC: National Academy of Sciences. Simpson, S.A. & Long, J.A. (2007). Medical student-run health clinics: Important contributors to patient care and medical education. Journal of General Internal Medicine, 22, 352–356. Thibault, G.E. (2012). Interprofessional education in the USA: Current activities and future directions. Journal of Interprofessional Care, 26, 440–441. World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. Geneva: World Health Organization.
Copyright of Journal of Interprofessional Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
SHORT REPORT
Interprofessional education through service-learning: lessons from a student-led free clinic Janice L. Farlow, Charles Goodwin and Javier Sevilla Indiana University School of Medicine, Indianapolis, IN, USA
Abstract
Keywords
The academic community must replicate and strengthen existing models for interprofessional education (IPE) to meet widespread calls for team-based patient-centered care. One effective but under-explored possibility for IPE is through student-led clinics, which now exist in the majority of medical schools. This short report presents the Indiana University Student Outreach Clinic (IU-SOC), which involves seven different professional programs across three institutions, as a model for how IPE can be delivered formally through service learning. Lessons learned, such as nurturing an intentional interprofessional program, structured orientation and reflection, and resource and knowledge sharing between the clinic and academic institutions, can be applied to all student-led clinics, but also can inform other IPE initiatives in health professional curricula.
Free clinic, health and social care, interprofessional education, patient-centered practice, service-learning, team-based care
Introduction Calls for improving interprofessional education (IPE) have been growing since the 1970s (Institute of Medicine, 1972; World Health Organization, 2010). While notable models for IPE have emerged, IPE activities must be increased across more schools, evaluated for learner outcomes and ultimately focused more on the goal of improving patient care (Thibault, 2012). Student-led clinics present a vehicle for interprofessional education whose impact is not yet well understood. It is projected that these clinics are present in over half of US medical schools (Simpson & Long, 2007), and while some include a collaborative component, detailed data on interprofessional student-led clinics are not currently available. The prevalence and the nature of student-led clinics present an under-appreciated opportunity for IPE, grounded in service-learning. As a student-led clinic with an integrated team of students and faculty from seven different professions (medicine, pharmacy, dentistry, law, social work, physical therapy, occupational therapy) spanning three US institutions (Indiana University, Butler University, University of Indianapolis), along with its community partner, the Neighborhood Fellowship Church, the Indiana University Student Outreach Clinic (IU-SOC) serves as a model for embracing a patient-centered interprofessional culture through service-learning.
The interprofessional program The near eastside of Indianapolis continues to face significant barriers to healthcare. The IU-SOC, open each Saturday for four hours, serves as a bridge to access for patients with little to no Correspondence: Dr. Javier Sevilla, Indiana University School of Medicine, Long Hospital Suite 200, 1110 West Michigan Street, Indianapolis, 46202 IN, USA. E-mail: [email protected]
History Received 3 December 2013 Revised 25 March 2014 Accepted 16 June 2014 Published online 7 January 2015
healthcare in this community. In 2012, 30–35 patients on average were seen at each clinic, with over 1500 patient encounters for the year. All services, lab testing and formulary medications provided are free. The IU-SOC uses a vertical mentoring model, where novice and advanced medical students perform a focused history and physical, develop an assessment and plan, and present to a faculty physician together. Medical and pharmacy students collaborate to elicit medication histories, develop intervention plans, dispense medications from an in-house formulary and provide patient education. Physical and occupational therapy students also consult for initial assessments and to coordinate care plans. As part of their visit, patients can receive dental care, ranging from routine cleanings to extractions. Dental and medical students work together to identify those in need of services, and a program is planned to use oral, head and neck exams for interprofessional learning. Furthermore, social work and law students are intimately involved in identifying and utilizing community resources. Throughout the patient visit, wait times are utilized for health education and promotion, connecting patients with community resources and special programing. Programs include a variety of specialty clinics ranging from vision screening to dermatology consults, as well as non-medical activities, such as printing birth certificates, employment counseling and more. Orientation and reflection While the structure of the patient-centered visit provides many organic IPE opportunities, additional programs set the stage and allow for reflection on IPE experiences. At the beginning of each clinic following individual partner orientations, an interprofessional orientation is held to reinforce the clinic mission and emphasize the importance of interprofessional interactions in fulfilling that mission. By introducing volunteers and defining roles at the beginning, efficient lines of communication are
264
J. L. Farlow et al.
established, allowing for more effective team-based care and learning. Towards the end of clinic, an interprofessional roundtable is held to discuss a couple of patients who received services from several partners that day. Faculty physicians receive Continuing Medical Education (CME) credits for leading a roundtable, and the IU-SOC is currently developing a mechanism to evaluate learning outcomes of students after this activity. IU-SOC leadership involvement also serves as a rich source for IPE. Monthly meetings among all partners are held, involving discussions to coordinate between medicine, social work and pharmacy to access pharmaceutical patient assistance programs; organize inter-institutional data collection and follow-up initiatives; develop volunteer and patient education about relevant health policy and common clinical presentations; and optimize clinic flow. Due to the patient-centered approach, the richest interprofessional interaction typically occurs in the interprofessional IU-SOC patient education subcommittees. Beyond operational meetings, student leaders gather biannually for retreats, which consist of formal IPE instruction, team building and strategic planning.
Discussion Beyond just offering the services of multiple professions, the IUSOC environment and student-led nature encourages meaningful interaction between professions and community partners. Other student-led clinics could easily implement interprofessional orientation and reflection, and patient and volunteer education can serve as a starting point for encouraging interprofessional collaboration. Student-led clinics face common challenges in adoption or enhancement of interprofessional programs. Intra- and interinstitutional expansion can entail difficult political climates for students and faculty to navigate. Many clinics do not have the financial resources or political capital to involve other licensed health professionals in the absence of partnering health professions schools. Furthermore, the operations of student-led clinics are traditionally removed from the expertise of curricular design, student assessment and program evaluation. The IU-SOC leadership team has begun to address these issues by strengthening collaborations between regional campuses and engaging
J Interprof Care, 2015; 29(3): 263–264
international organizations related to student-led clinics. Educators are involved to align the IU-SOC with the formal curricula of the partnering health professions school, as well as to collect data on knowledge and attitudes before and after IU-SOC IPE experiences. As student-led clinics become more common, resource and knowledge sharing between clinics and institutions will be essential to addressing these common challenges. Scarce data exist about the role of interprofessional student-led clinics in nations and communities with different healthcare environments. However, existence of these clinics in very different communities suggests that there are likely always at-risk populations who could benefit from this model of teambased care. Further work remains to explore how interprofessional student-led clinics can be altered to reflect local healthcare practices. The calls for IPE and service-learning can both be met through student-led clinics, which are becoming widespread sources of patient care and student education. Ownership of a patientcentered program by students increases the meaningfulness of the endeavor and opportunities for professional development. Lessons learned can be applied to other student clinics and other IPE initiatives. It is critical that future healthcare professionals learn how to effectively deliver patient-centered team-based care, and programs like the IU-SOC represent an under-utilized opportunity to address this need.
Declaration of interest The authors report no conflicts of interest. The authors are responsible for the writing and content of this paper.
References Institute of Medicine. (1972). Educating for the health team. Washington, DC: National Academy of Sciences. Simpson, S.A. & Long, J.A. (2007). Medical student-run health clinics: Important contributors to patient care and medical education. Journal of General Internal Medicine, 22, 352–356. Thibault, G.E. (2012). Interprofessional education in the USA: Current activities and future directions. Journal of Interprofessional Care, 26, 440–441. World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. Geneva: World Health Organization.
Copyright of Journal of Interprofessional Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
