Mechanisms, contexts and outcomes of interprofessional education in a student-run interprofessional clinic - a realist evaluation approach to developing programme theory.

Abstract

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. Aims: This study addresses this knowledge gap through a realist evaluation of a SRC, developing programme theories that identify and explain participant outcomes. Method: Using a qualitative approach and a single-case study design, clinic documentation were analysed 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 explained 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 programme theories have potential to support 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 modelling behaviours that can enhance collaborative behaviours. Engineering service integration and colocation is key to achieving positive patient and system outcomes.