A mixed methods study to evaluate the impact of a student-run clinic on undergraduate medical education

Student-run free clinics may enhance medical students' self-confidence in their clinical skills and preparedness for clerkships

INTRODUCTION

Student-run free clinics (SRFCs) offer medical students a unique opportunity to develop their clinical, diagnostic, and social skills while providing care to medically underserved communities. This study aims to evaluate the value of SRFC involvement on students' self-reported confidence in various clinical domains and satisfaction with their medical education.

METHODS

We conducted a single-center retrospective pre-post assessment at an urban academic institution among second- to fourth-year medical students. We administered a 25-item questionnaire capturing the scope of clinic involvement and assessing self-reported confidence in multiple clinical domains following a one-year-long participation in student-run free clinics.

RESULTS

Fifty-six students completed the survey. Participation in SRFCs significantly increased self-reported confidence in patient history-taking (p < 0.001), performing oral presentations (p < 0.001) and physical exams (p < 0.001). Students also reported significantly greater confidence in working with translators (p < 0.001) or as part of an interprofessional team (p < 0.001) and understanding the needs of the population served (p < 0.001). Students also found SRCs to significantly improve their confidence in preparedness for clerkships (p < 0.001). SRFC involvement can improve medical students' confidence in their clinical and interpersonal skills and enhance preparedness for clerkships and working with diverse patient groups.

CONCLUSION

SRFCs are a useful tool in the medical school curriculum that help bridge the gap between classroom learning and clinic and may encourage practice in medically underserved communities. SRFCs also integrate classroom material and clinical practice, although standardized evaluation metrics need to be developed. SRFCs should be incorporated as a learning experience by medical schools nationwide.

Evaluation of a Novel Equity-Focused Curriculum for Early-Stage Medical Students

OBJECTIVES

Medical school curricula have increasingly incorporated topics and content related to health equity and affiliated social determinants of health. However, there is limited literature to guide how programs might measure the success of these initiatives. Previous studies assessed medical student attitudes and perceived knowledge, preparedness, and skills. Based on self-reported measures of these attributes, we compared within-group and between-group differences at the onset of a novel equity-focused curriculum implementation.

METHODS

A multi-component approach to "thread" lectures, panel discussions, and other content dedicated to health equity concepts was assessed using adapted versions of two validated survey instruments of the measured constructs. Baseline data were collected prior to coursework and at follow-up early in students' second year assessed change attributable to the equity-focused curriculum thread, with additional comparison to a cohort of second-year students who had no exposure to the curriculum. Data were collected at the beginning of academic years 2021-2022 and 2022-2023.

RESULTS

The multivariate analysis of variance indicated significant change over time (p < 0.001) with the analyses of variance identifying students' perceived current skills and topic knowledge increasing over time. No significant differences were found between two separate groups of M2 students.

CONCLUSIONS

Students' perceived skills at working with diverse patient populations and knowledge of topics focused on health equity increased across the study, despite a much smaller response rate for the same student cohort at follow-up. Students' perception that they are prepared to care for patients of diverse backgrounds was unaffected. Attitudinal assessment revealed a ceiling effect at baseline, which should be explored further with longitudinal assessment. For the ongoing effort to evaluate the success of equity-focused curricula and programs, this study contributes evidence of change on some but not all outcomes, and can help guide other programs in determining which outcomes best reflect areas of programmatic need and impact.

Identification of alternative topics to diversify medicine, dentistry, and pharmacy student theses: a mixed method study

INTRODUCTION

The impact of medicine, dentistry, and pharmacy student theses on public health is a crucial concern for policymakers in medical science universities. If student theses correspond to the needs of society, they can significantly affect students' scientific and practical abilities and lead to the provision of more efficient health services. This study aimed to identify alternative topics to diversify medicine, dentistry, and pharmacy student theses.

METHODS

This mixed method study with an exploratory sequential design was conducted at Kerman University of Medical Science from February to June 2021. The qualitative component entailed a focus group of faculty members (n = 16) and students (n = 4) to extract alternative topics to diversify medicine, dentistry, and pharmacy student theses. The quantitative component included a questionnaire based on emerging subjects and literature review to evaluate the extracted alternative topics. Qualitative data were analyzed using conventional content analysis and quantitative data were analyzed descriptively.

RESULTS

A total of 20 key participants took part in the focus group meeting, and from 20 questionnaires, 15 were returned with a response rate of 75%. A list of 18 alternative topics was generated and five categories were identified: individual development, research, education, healthcare, and social services.

CONCLUSIONS

The gap between what we know and what is seen in practice is quite large in medical and health-related professions. Alternative topics for medicine, dentistry, and pharmacy student theses contribute to turning knowledge into practice.

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.

Effectiveness of alternative approaches to integrating SDOH into medical education: a scoping review

BACKGROUND

There is increasing recognition of including social determinants of health (SDOH) in teaching for future doctors. However, the educational methods and the extent of integration into the curriculum vary considerably-this scoping review is aimed at how SDOH has been introduced into medical schools' curricula.

METHODS

A systematic search was performed of six electronic databases, including PubMed, Education Source, Scopus, OVID (Medline), APA Psych Info, and ERIC. Articles were excluded if they did not cover the SDOH curriculum for medical students; were based on service-learning rather than didactic content; were pilot courses, or were not in English, leaving eight articles in the final study.

RESULTS

The initial search yielded 654 articles after removing duplicates. In the first screening step, 588 articles were excluded after applying inclusion and exclusion criteria and quality assessment; we examined 66 articles, a total of eight included in the study. There was considerable heterogeneity in the content, structure and duration of SDOH curricula. Of the eight included studies, six were in the United States(U.S.), one in the United Kingdom (U.K.) and one in Israel. Four main conceptual frameworks were invoked: the U.S. Healthy People 2020, two World Health Organisation frameworks (The Life Course and the Michael Marmot's Social Determinants of Health), and the National Academic of Science, Engineering, and Medicine's (Framework For educating Health Professionals to Address the Social Determinants of Health). In general, programs that lasted longer appeared to perform better than shorter-duration programmes. Students favoured interactive, experiential-learning teaching methods over the traditional classroom-based teaching methods.

CONCLUSION

The incorporation of well-structured SDOH curricula capturing both local specification and a global framework, combined with a combination of traditional and interactive teaching methods over extended periods, may be helpful in steps for creating lifelong learners and socially accountable medical school education.

Assessing the Impact of Demographic Factors on Presenting Conditions or Complaints Among Internal Medicine Patients in an Underserved Population in Central Florida

Background and objective

Patients’ demographics (race, age, gender, and ethnicity) have been determined to affect patients’ health status. It has been established that chronic disease prevalence varies by race, age, gender, and ethnicity; however, not much is known about how these demographic factors influence presenting conditions or complaints within a student-run clinic (SRC). This study aimed to investigate how demographic factors in the Apopka community in Florida determine what internal medicine (IM) conditions or complaints patients present with at a student-run free clinic.

Methods

Electronic medical record (EMR) data for adult patients seen at the clinic from February 2019 to February 2020 were reviewed to collect information on patient demographics, IM presenting conditions or complaints, and body mass index (BMI). Binary logistic regressions were employed to investigate the relationship between demographic factors and presenting conditions or complaints.

Results

The majority of the patients were female (62.2%), with an almost equal representation of Hispanic (50.3%) and non-Hispanic individuals. About half of the patients visiting the clinic were either overweight or obese. Of the 167 patients, the average age was 44.17 and 44.32 years for males and females respectively. The most common presenting conditions or complaints included cardiac conditions (25.07%), diabetes (9.64%), gastric pain (9.21%), and upper respiratory infection (URI)/allergies (6.15%). Cardiac conditions were further broken down into hypertension (18.94%), dyslipidemia (3.94%), and palpitations (2.19%). Patient age was a contributing factor to the incidence of diabetes (p=0.002), hypertension (p<0.0001), and cardiovascular conditions excluding hypertension (p=0.021). There was a significant relationship between obesity and diabetes (p=0.036) and hypertension (p=<0.001).

Conclusion

SRCs can make use of the information obtained from this study to advocate for coverage of medications to treat diabetes and hypertension in this undocumented population to prevent morbidity rates. We believe our findings can also provide guidance in terms of instituting screening programs for these illnesses among the broader population and SRCs with different patient makeups.