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Unintended Consequences? Assessing the Impact of Curricular Change on Medical Student Participation in a Student-Run Free Clinic

Abstract

Introduction

In a prior qualitative study of the impact of a new (ACE) medical school curriculum, students and faculty reported decreased participation in the student-run free clinic (SRFC) attributed to more intensive scheduling and more frequent testing compared to the previous (Legacy) curriculum.

Materials and Methods

To verify and understand this perception formed during curriculum reform, we conducted a mixed method study to measure student participation in the SRFC before and after curricular change and assessed student beliefs and motivations about SRFC participation using focus groups.

Results

Overall SRFC participation did not decrease among students in the ACE cohort following curriculum change. Additionally, both Legacy and ACE groups showed lower participation during test weeks, but the decrease was not significantly different between the ACE and Legacy cohorts. Focus groups confirmed the pervasive misbelief that SRFC participation was indeed lower among ACE students and attributed to reduced student discretionary time plus increased preparation time for frequent testing. Focus groups also revealed several “values” about volunteering at the SRFC which should be endorsed and promoted by schools considering curricular change. Participants valued the SRFC for educational items that were most effectively taught in the SRFC, notably social determinants of health, interprofessional practice, and interviewing with medical interpreters. They also valued the SRFC for professional validation, opportunities to apply course content, practice clinical skills, form important professional relationships, and provide community service.

Conclusions

Our findings validate the value of SRFC experience as reported by students and demonstrate that, contrary to misbeliefs, participation was not negatively impacted by curricular reform.

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Fig. 1

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Author information

Affiliations

Authors

Contributions

All authors contributed to the conception of this study. Drs. Witt and Nilsen, Ms. Kohman, and Mr. Petz contributed to the analysis of the data. Drs. Witt, Nilsen, and Walling contributed to the writing of the manuscript, and all authors contributed to editing and agreed to the final approval of the submission.

Corresponding author

Correspondence to Laurel Witt.

Ethics declarations

Ethics Approval

The study was approved by the Institutional Review Board of the hosting University (IRB#: STUDY00143880).

Consent to Participate

Quantitative study: N/A (numerical data retrieval: no identifiable individuals). Qualitative study: written and verbal consent obtained from participants.

Conflict of Interest

The authors declare no competing interests.

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Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix

Focus Group Guide

  1. 1.

    Why do you volunteer at the JayDoc clinic?

  2. 2.

    Any gains/benefits to volunteering?

  3. 3.

    Any avoided losses?

  4. 4.

    Any actual losses?

  5. 5.

    What barriers do you experience to volunteering?

  6. 6.

    How does testing affect how you volunteer?

  7. 7.

    How does volunteering affect academic performance?

  8. 8.

    Were you involved in leadership positions?

    1. (a)

      If no, why not?

    2. (b)

      If yes, why?

  9. 9.

    We’ve noticed from our volunteer data that every year volunteer numbers steadily decline through the year (fewer volunteers in March than August, for example). Why do you think that is?

  10. 10.

    How do you think Jaydoc functions with fewer volunteers?

  11. 11.

    Specific to class of 2019 (?): what explains the lower volunteer rates later in the year (relative to other years)?

  12. 12.

    Specific to class of 2020 (?): volunteer numbers were very high in June. Why do you think that is?

  13. 13.

    Specific to class of 2021 (?): volunteer numbers were lower throughout your M2 year but experienced a sharp decline as M2 went on (much steeper decline than that of other years). Why do you think that is?

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Witt, L., Nilsen, K.M., Kohman, M. et al. Unintended Consequences? Assessing the Impact of Curricular Change on Medical Student Participation in a Student-Run Free Clinic. Med.Sci.Educ. 31, 1653–1662 (2021). https://doi.org/10.1007/s40670-021-01356-1

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Keywords

  • Student-run free clinics
  • Curricular change
  • Curricular reform
  • Service-learning activities