Optimizing the Clinical Learning Environment of Interprofessional Student-run Free Clinics

Background: Interprofessional student-run clinics (SRCs) serve as valuable settings for interprofessional education but there is a lack of understanding of how these clinics work or the processes and outcomes of interprofessional education within them. Addressing this knowledge gap, this presentation presents the findings of a realist evaluation that developed program theories identifying and explaining participant outcomes within a SRC.

Method: Using a qualitative approach and a single-case study design, clinic documentation were analyzed and realist semi-structured interviews conducted with 25 key stakeholders (student leaders, volunteers, and faculty clinicians) within one SRC that ran between June 2015 and February 2016. An analytic induction and framework analysis connected threads of key contexts-mechanisms, and outcomes.

Findings: Twenty-four programme theories emerged that explain student and patient experiences. Exposure to different forms and durations of interprofessional work framed three main clinic learning experiences with diverse student outcomes. Equal status among students, facilitated by psychological safety and a shared novice identity, had positive effects. Perceived student inequality, fostered by limited interprofessional engagement and role modelling of hierarchy and professional dominance by faculty clinicians, were negative. Patient contact ensured that students valued their experiences and service colocation facilitated better quality, more holistic, integrated care, and positive patient and system-level outcomes.

Discussion and conclusions: A realist approach was successful in uncovering how the interprofessional SRC works and the developed program theories have potential to optimize the development and evaluation of SRCs. It is recommended that training be provided for faculty and student leaders on fostering equal status, psychological safety, co-development of interprofessional and professional identities, and role modeling behaviors that can enhance collaborative behaviors. Engineering service integration and colocation are key to achieving positive patient and system outcomes and optimizing the clinical learning environment.