http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2015; 29(1): 68–70 ! 2015 Informa UK Ltd. DOI: 10.3109/13561820.2014.934339
SHORT REPORT
Interprofessional student experiences on the HAVEN free clinic leadership board Elizabeth Anne Scott1 and Martha K. Swartz2 1
Community Health Center, Inc., Meriden, CT, USA and 2School of Nursing, Yale School of Nursing, Yale University, New Haven, CT, USA
Abstract
Keywords
In this study, we examined the experiences of students serving on the leadership board of HAVEN – the student-run free clinic of the Yale University health professional schools. Open-ended responses were collected from 18 of the 28 members of the 2011–2012 leadership board through an online survey. Students reported an overall positive experience participating on the board and valued the opportunity to be part of a committed community creating change. The majority of students reported that their time as a board member had improved their attitude towards interprofessional collaboration (78%) and had also fostered their leadership skills (67%). Around two thirds (67%) reported that their experience had positively impacted their future career plans, either reinforcing their desire to work with underserved populations or encouraging them to pursue leadership roles. Based on these data, it is suggested that the HAVEN Free Clinic offers a useful opportunity for students to experience the demands of clinical care leadership while working together in an interprofessional context.
Interprofessional education, survey, teamwork
Introduction Research has demonstrated that student-run clinics provide quality care with high patient satisfaction (e.g. Butala, Murk, Horwitz, & Graber, 2012; Ellett, Campbell, & Gonsalves, 2010). A survey of student members of the leadership board of the Healthcare, Advocacy, Volunteerism, Education, Neighborhood (HAVEN) Free Clinic at Yale University in New Haven, Connecticut, USA assessed the impact of board participation on students’ perspectives regarding interprofessional collaboration, leadership skills, and future career plans. It was postulated that interprofessional learning and practice experiences would increase medical, nursing, and public health students’ knowledge of the other professions, improve their ability to work collaboratively, and encourage students to continue to pursue leadership roles. Background Established in 2005, the mission of the HAVEN Free Clinic is to serve as a sustainable source of primary care for uninsured adults; to educate Yale health professional students about the value of working in health care teams; and to provide students with experience in community health and expose them to the challenges of managing patient care with limited resources (HAVEN Free Clinic, 2010). The clinic runs on Saturday
Correspondence: Dr. Martha K. Swartz, PhD, RN, CPNP, FAAN, School of Nursing, Yale School of Nursing, Yale University, PO Box 9740, 100 Church St. South, New Haven, CT 06536, USA. E-mail: [email protected]
History Received 4 November 2013 Revised 29 March 2014 Accepted 10 June 2014 Published online 8 July 2014
mornings, utilizing the facilities of the Fair Haven Community Health Center (FHCHC) in New Haven. Over 200 students from the Yale Health Professional Schools (medicine, nursing, public health, and the physician’s associate [PA] program at the medical school) volunteer annually to provide care at HAVEN within a team format. The HAVEN Leadership Board is a subset of about 27 students who are responsible for the operations and fiscal management of the clinic. The overall objectives/aims of the Board are to ensure smooth operational functioning of the clinic stemming from student leadership, and to offer students enhanced experiences in health care management within community settings. Students must apply and compete for the voluntary leadership positions, which are awarded based upon the students’ interest in community health care and management, leadership qualities and willingness to commit the extra time involved. While the overall make-up of the Leadership Board may vary from year to year, the Board is typically made up of medical and advanced practice registered nurse (APRN) students, with generally a fewer number of public health, PA or other students. Three co-directors of the Leadership Board are selected each year, one of which is a medical student taking an elective research year who receives a stipend intended to support him or her in performing the majority of administrative duties of the director position. The clinic also has two senior medical directors, one an APRN and the other a physician, both clinicians at FHCHC during the weekdays. The medical directors provide the board with guidance on clinical and administrative matters. A steering committee, composed of a faculty advisor from each of the health professional schools, the medical directors, student directors and other stakeholders meets quarterly, providing oversight and guidance.
HAVEN free clinic
DOI: 10.3109/13561820.2014.934339
Methods Data collection and analysis The study employed a survey that aimed to elicit demographic and open ended questions about experiences on the board. Questions focused on three areas of interest: leadership, interdisciplinary collaboration, and effect on future career plans. Student volunteers who served on the HAVEN Free Clinic board from 2011 to 2012 were surveyed. Twenty-one of the 28 students on the board responded to the survey, yielding a 75% response rate. Of those students, 18 responded to each of the seven survey questions, while three did not respond to any of the open-ended questions. Almost half of the respondents were medical students, (n ¼ 10, 48%) with APRN students making up another third of respondents (n ¼ 7). There was one student each from the PA program and the School of Public Health, and one student in a joint degree program from both of those schools. Most of the students surveyed had approximately 10 months of experience on the board. The narrative responses on the survey were analyzed through a content analysis approach.
69
about pursuing leadership or management roles. Two students replied that their time on the board had no impact on their future career plans and two other students answered that they now wished to avoid administrative or operational commitments.
Discussion
Most respondents indicated that their experiences had positively affected their views of interprofessional collaboration. Two of the students also commented that it was unfortunate that this was the only time they were able to work with students from other professions. The sole negative response was from a medical student who found the board ‘‘difficult to navigate’’. Despite this, the respondent acknowledged improvement in management and collaboration skills.
The results suggest that students had an overall positive experience on the HAVEN Free Clinic leadership board and truly valued their opportunity to be part of a committed community creating change. Most students identified being part of a team as one of the best things about their board experience, and valued collaborating with students from other disciplines. Over 75% of the HAVEN student leaders reported that participating on the leadership board had a positive effect on their attitude towards interprofessional collaboration. This is in contrast to the original findings of Tunstall-Pedoe, Rink, and Hilton (2003), who found that over the course of a term of learning together in their classroom setting first-year health professional students tended to have less positive opinions of students from other health disciplines. A possible reason for this distinction is that the students in HAVEN leadership positions applied to join the board knowing it was an interdisciplinary setting, and were united in a common goal of running the free clinic. Also, the HAVEN student experience operationalizes recommendations which Tunstall-Pedoe et al. (2003) based on their original work, now suggest: greater emphasis on small group learning, team work communication skills, and longitudinal experiences. Overall, the majority of respondents felt that their time on the HAVEN Free Clinic leadership board positively impacted their leadership skills. Students also reported that they highly valued the opportunity to effect change and have a voice in the direction of the clinic. Six students expressed an interest in pursuing a leadership role in the future; suggesting that the benefits of this experience may impact students long after their term on the board is complete. In relation to study limitations, without longitudinal data, it is difficult to fully assess the long term impact of board service on students’ perceptions of interprofessional collaboration, leadership growth, and clinical specialty choices. Future studies that survey cohorts over time, multiple cohorts, or students from other institutions would provide a broader evidence base. It would also be beneficial to survey a broader cohort of students who actively volunteer to provide care in interprofessional clinics, not just those students who serve in leadership positions. Finally, gathering more in-depth qualitative data through interview or focus groups would illuminate some of the points that were only touched on in the students’ responses.
Leadership skills
Concluding comments
Overall, most respondents reported that the board experience had improved their leadership skills. In particular, presentation skills, teaching, delegating, providing constructive criticism, and building consensus were mentioned. One student responded in the negative, stating that ‘‘if anything, it’s taught me to take a step back from leadership’’.
HAVEN Free Clinic offers a venue for students to provide clinical care in interprofessional teams from the outset of their professional education. Expanding opportunities for voluntary student leadership within clinic governance structures enhances the opportunities for students to foster interprofessional collaboration, develop leadership skills and future career plans. These opportunities can be one part of the process that brings us closer to the goal stated in the Institute of Medicine (2010) report, that care teams make best use of each member’s education, skill, and expertise in order to maximize patient outcomes.
Ethical considerations An exemption was granted by the Yale University Human Subjects Investigation Committee. Respondents were informed that the data, collected anonymously, would be used as feedback to improve experiences for future board members.
Results Perceptions of the leadership experience Half of the respondents described positive aspects of the experience resulting from the sense of community, as well as the ability to create change and positively impact the quality of patient care, while also improving clinical skills. Regarding negative impressions, students expressed frustration with the length of the bi-weekly board meetings, operational inefficiencies, logistics and paperwork. Interprofessional collaboration
Future career plans Concerning the students’ future career plans, 44% of respondents referenced their prior interests in primary care and described their leadership board experience as reinforcing or strengthening that commitment. Seven students voiced a desire to continue to work with underserved or vulnerable populations. Three respondents reported an interest in directing a clinic and three others wrote
Declaration of interest The authors report no conflicts of interest. The authors were responsible for the writing and content of this article.
70
E. A. Scott & M. K. Swartz
References Butala, N.M., Murk, W., Horwitz, L.I., & Graber, L.K. (2012). What is the quality of preventive care provided in a student-run free clinic? Journal of Health Care for the Poor and Underserved, 23, 414–424. Ellett, J.D., Campbell, J.A., & Gonsalves, W.C. (2010). Patient satisfaction in a student-run free medical clinic. Family Medicine, 42, 16–18.
J Interprof Care, 2015; 29(1): 68–70
HAVEN Free Clinic. (2010). 2010 annual report. Retrieved from http:// havenfreeclinic.org/hfc/index.php?page=publications. Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.iom.edu/Reports/2010/ the-future-of-nursing-leading-change-advancing-health.aspx. Tunstall-Pedoe, S., Rink, E., & Hilton, S. (2003). Student attitudes to undergraduate interprofessional education. Journal of Interprofessional Care, 17, 161–172.
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 student experiences on the HAVEN free clinic leadership board Elizabeth Anne Scott1 and Martha K. Swartz2 1
Community Health Center, Inc., Meriden, CT, USA and 2School of Nursing, Yale School of Nursing, Yale University, New Haven, CT, USA
Abstract
Keywords
In this study, we examined the experiences of students serving on the leadership board of HAVEN – the student-run free clinic of the Yale University health professional schools. Open-ended responses were collected from 18 of the 28 members of the 2011–2012 leadership board through an online survey. Students reported an overall positive experience participating on the board and valued the opportunity to be part of a committed community creating change. The majority of students reported that their time as a board member had improved their attitude towards interprofessional collaboration (78%) and had also fostered their leadership skills (67%). Around two thirds (67%) reported that their experience had positively impacted their future career plans, either reinforcing their desire to work with underserved populations or encouraging them to pursue leadership roles. Based on these data, it is suggested that the HAVEN Free Clinic offers a useful opportunity for students to experience the demands of clinical care leadership while working together in an interprofessional context.
Interprofessional education, survey, teamwork
Introduction Research has demonstrated that student-run clinics provide quality care with high patient satisfaction (e.g. Butala, Murk, Horwitz, & Graber, 2012; Ellett, Campbell, & Gonsalves, 2010). A survey of student members of the leadership board of the Healthcare, Advocacy, Volunteerism, Education, Neighborhood (HAVEN) Free Clinic at Yale University in New Haven, Connecticut, USA assessed the impact of board participation on students’ perspectives regarding interprofessional collaboration, leadership skills, and future career plans. It was postulated that interprofessional learning and practice experiences would increase medical, nursing, and public health students’ knowledge of the other professions, improve their ability to work collaboratively, and encourage students to continue to pursue leadership roles. Background Established in 2005, the mission of the HAVEN Free Clinic is to serve as a sustainable source of primary care for uninsured adults; to educate Yale health professional students about the value of working in health care teams; and to provide students with experience in community health and expose them to the challenges of managing patient care with limited resources (HAVEN Free Clinic, 2010). The clinic runs on Saturday
Correspondence: Dr. Martha K. Swartz, PhD, RN, CPNP, FAAN, School of Nursing, Yale School of Nursing, Yale University, PO Box 9740, 100 Church St. South, New Haven, CT 06536, USA. E-mail: [email protected]
History Received 4 November 2013 Revised 29 March 2014 Accepted 10 June 2014 Published online 8 July 2014
mornings, utilizing the facilities of the Fair Haven Community Health Center (FHCHC) in New Haven. Over 200 students from the Yale Health Professional Schools (medicine, nursing, public health, and the physician’s associate [PA] program at the medical school) volunteer annually to provide care at HAVEN within a team format. The HAVEN Leadership Board is a subset of about 27 students who are responsible for the operations and fiscal management of the clinic. The overall objectives/aims of the Board are to ensure smooth operational functioning of the clinic stemming from student leadership, and to offer students enhanced experiences in health care management within community settings. Students must apply and compete for the voluntary leadership positions, which are awarded based upon the students’ interest in community health care and management, leadership qualities and willingness to commit the extra time involved. While the overall make-up of the Leadership Board may vary from year to year, the Board is typically made up of medical and advanced practice registered nurse (APRN) students, with generally a fewer number of public health, PA or other students. Three co-directors of the Leadership Board are selected each year, one of which is a medical student taking an elective research year who receives a stipend intended to support him or her in performing the majority of administrative duties of the director position. The clinic also has two senior medical directors, one an APRN and the other a physician, both clinicians at FHCHC during the weekdays. The medical directors provide the board with guidance on clinical and administrative matters. A steering committee, composed of a faculty advisor from each of the health professional schools, the medical directors, student directors and other stakeholders meets quarterly, providing oversight and guidance.
HAVEN free clinic
DOI: 10.3109/13561820.2014.934339
Methods Data collection and analysis The study employed a survey that aimed to elicit demographic and open ended questions about experiences on the board. Questions focused on three areas of interest: leadership, interdisciplinary collaboration, and effect on future career plans. Student volunteers who served on the HAVEN Free Clinic board from 2011 to 2012 were surveyed. Twenty-one of the 28 students on the board responded to the survey, yielding a 75% response rate. Of those students, 18 responded to each of the seven survey questions, while three did not respond to any of the open-ended questions. Almost half of the respondents were medical students, (n ¼ 10, 48%) with APRN students making up another third of respondents (n ¼ 7). There was one student each from the PA program and the School of Public Health, and one student in a joint degree program from both of those schools. Most of the students surveyed had approximately 10 months of experience on the board. The narrative responses on the survey were analyzed through a content analysis approach.
69
about pursuing leadership or management roles. Two students replied that their time on the board had no impact on their future career plans and two other students answered that they now wished to avoid administrative or operational commitments.
Discussion
Most respondents indicated that their experiences had positively affected their views of interprofessional collaboration. Two of the students also commented that it was unfortunate that this was the only time they were able to work with students from other professions. The sole negative response was from a medical student who found the board ‘‘difficult to navigate’’. Despite this, the respondent acknowledged improvement in management and collaboration skills.
The results suggest that students had an overall positive experience on the HAVEN Free Clinic leadership board and truly valued their opportunity to be part of a committed community creating change. Most students identified being part of a team as one of the best things about their board experience, and valued collaborating with students from other disciplines. Over 75% of the HAVEN student leaders reported that participating on the leadership board had a positive effect on their attitude towards interprofessional collaboration. This is in contrast to the original findings of Tunstall-Pedoe, Rink, and Hilton (2003), who found that over the course of a term of learning together in their classroom setting first-year health professional students tended to have less positive opinions of students from other health disciplines. A possible reason for this distinction is that the students in HAVEN leadership positions applied to join the board knowing it was an interdisciplinary setting, and were united in a common goal of running the free clinic. Also, the HAVEN student experience operationalizes recommendations which Tunstall-Pedoe et al. (2003) based on their original work, now suggest: greater emphasis on small group learning, team work communication skills, and longitudinal experiences. Overall, the majority of respondents felt that their time on the HAVEN Free Clinic leadership board positively impacted their leadership skills. Students also reported that they highly valued the opportunity to effect change and have a voice in the direction of the clinic. Six students expressed an interest in pursuing a leadership role in the future; suggesting that the benefits of this experience may impact students long after their term on the board is complete. In relation to study limitations, without longitudinal data, it is difficult to fully assess the long term impact of board service on students’ perceptions of interprofessional collaboration, leadership growth, and clinical specialty choices. Future studies that survey cohorts over time, multiple cohorts, or students from other institutions would provide a broader evidence base. It would also be beneficial to survey a broader cohort of students who actively volunteer to provide care in interprofessional clinics, not just those students who serve in leadership positions. Finally, gathering more in-depth qualitative data through interview or focus groups would illuminate some of the points that were only touched on in the students’ responses.
Leadership skills
Concluding comments
Overall, most respondents reported that the board experience had improved their leadership skills. In particular, presentation skills, teaching, delegating, providing constructive criticism, and building consensus were mentioned. One student responded in the negative, stating that ‘‘if anything, it’s taught me to take a step back from leadership’’.
HAVEN Free Clinic offers a venue for students to provide clinical care in interprofessional teams from the outset of their professional education. Expanding opportunities for voluntary student leadership within clinic governance structures enhances the opportunities for students to foster interprofessional collaboration, develop leadership skills and future career plans. These opportunities can be one part of the process that brings us closer to the goal stated in the Institute of Medicine (2010) report, that care teams make best use of each member’s education, skill, and expertise in order to maximize patient outcomes.
Ethical considerations An exemption was granted by the Yale University Human Subjects Investigation Committee. Respondents were informed that the data, collected anonymously, would be used as feedback to improve experiences for future board members.
Results Perceptions of the leadership experience Half of the respondents described positive aspects of the experience resulting from the sense of community, as well as the ability to create change and positively impact the quality of patient care, while also improving clinical skills. Regarding negative impressions, students expressed frustration with the length of the bi-weekly board meetings, operational inefficiencies, logistics and paperwork. Interprofessional collaboration
Future career plans Concerning the students’ future career plans, 44% of respondents referenced their prior interests in primary care and described their leadership board experience as reinforcing or strengthening that commitment. Seven students voiced a desire to continue to work with underserved or vulnerable populations. Three respondents reported an interest in directing a clinic and three others wrote
Declaration of interest The authors report no conflicts of interest. The authors were responsible for the writing and content of this article.
70
E. A. Scott & M. K. Swartz
References Butala, N.M., Murk, W., Horwitz, L.I., & Graber, L.K. (2012). What is the quality of preventive care provided in a student-run free clinic? Journal of Health Care for the Poor and Underserved, 23, 414–424. Ellett, J.D., Campbell, J.A., & Gonsalves, W.C. (2010). Patient satisfaction in a student-run free medical clinic. Family Medicine, 42, 16–18.
J Interprof Care, 2015; 29(1): 68–70
HAVEN Free Clinic. (2010). 2010 annual report. Retrieved from http:// havenfreeclinic.org/hfc/index.php?page=publications. Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.iom.edu/Reports/2010/ the-future-of-nursing-leading-change-advancing-health.aspx. Tunstall-Pedoe, S., Rink, E., & Hilton, S. (2003). Student attitudes to undergraduate interprofessional education. Journal of Interprofessional Care, 17, 161–172.
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.
