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Student led physical rehabilitation groups and clinics in entry level health education

a scoping review protocol

Wynne, Donna1; Cooper, Kay1,2

JBI Database of Systematic Reviews and Implementation Reports: June 2019 - Volume 17 - Issue 6 - p 1092–1100
doi: 10.11124/JBISRIR-2017-003990
SYSTEMATIC REVIEW PROTOCOLS
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Review objective/questions: The objective of this scoping review is to identify, map and describe the characteristics of student led physical rehabilitation groups and clinics in entry level health education.

More specifically, the review questions are:

  • What types of student led groups/clinics with a physical rehabilitation focus exist?
  • What are the characteristics of these groups? This may include the structure of the groups/clinics, how the groups/clinics are run, who runs the group/clinic and the types of service users involved.
  • How are student led groups/clinics currently evaluated and what are the outcomes used?
  • Who is evaluated and how are these evaluations undertaken? This may include consideration of participants/service users as well as students running the groups and other relevant stakeholders

1School of Health Sciences, Robert Gordon University, Aberdeen, Scotland

2The Scottish Centre for Evidence-based, Multi-professional Practice: a Joanna Briggs Institute Centre of Excellence

Correspondence: Donna Wynne, d.wynne@rgu.ac.uk

There is no conflict of interest in this project.

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Introduction

Student led groups and clinics are an emergent phenomenon which is steadily becoming more prevalent in entry level health education programs across the world.1 Student led groups or clinics are modes of healthcare delivery activity in which healthcare students take primary responsibility for organizing and running a healthcare service,2 and these are generally initiated and coordinated by students under the guidance of supervising staff.3 The terms student led groups and student led clinics are commonly referred to as student led groups, and this concept includes a variety of student groups.4 Service learning is defined as an experiential learning opportunity that combines clear educational goals and services to the community,5 and therefore student led groups/clinics are often defined as a type of service learning. For the purposes of this review, the term student led groups will be referred to to encompass the above concepts, forthwith.

Commonly used and established within the medical education curriculum,2 student led groups typically involve students being responsible for many aspects of the service and can include individual service user interaction as well as organizational duties such as documentation and appointment booking. Student led groups can take many forms and vary considerably, ranging from community to hospital based, general diagnostic to intervention, funded or unfunded, and scheduled as part of the curriculum or extra-curricular run by volunteers.6 Common to all student led groups is the learning opportunity potential for students6 and the potential benefits to service users.7 Non-medical health professionals (HPs) are beginning to adopt the model as an integral part of the entry-level curriculum.1 In addition, similar models of student led groups for general physical rehabilitation are used within the health and exercise field of kinesiology and sports therapy, with experiential learning as a key driver for their implementation.8 For the purposes of this review, HPs can in the widest sense be considered to include nurses, pharmacists, allied health professions (AHPs) (e.g. physiotherapists, occupational therapists) and exercise professionals such as kinesiologists and sports therapists.

Internationally, the drivers for the adoption of student led groups varies. Student led groups are implemented in both uniprofessional and interprofessional frameworks.9 Student led groups are emerging around the world as a means of providing support to underserved populations4 and many of these are undertaken in an interprofessional format,10 for example, a group exercise and education class for people with neurological conditions with input from a variety of health professionals. Some professional regulators have a requirement for uniprofessional student led groups to take place as an integral part of the curriculum.1 The Pro Bono model which is prevalent in the United States (US) provides a clinical service run by students to underserved populations at little/no cost.4 Where it is utilized, this model fulfills local, national and international health polices by providing healthcare and improving overall health and wellbeing at little or no cost.6 However, little is known about the true cost benefit of the model.2 More recently, interest has grown with regard to the potential substitution of clinical placement hours in some parts of the world where clinical placement capacity is challenged.11,12 The practice of student led groups is a relatively new area within Europe,11 however anecdotally it is accepted that student led groups and learning have formed a part of entry level healthcare education as a means of providing contextualized learning13 alongside high fidelity simulation (HFS) which can further enhance clinical reasoning.14 High fidelity simulation is concerned with the use of imitation real world scenarios, often of patient encounters, to allow students to practice their skills, learning and reasoning.15

The objectives of student led learning in the rehabilitation context are to target specific skills development and to experience real life healthcare with populations and conditions.1 This is considered to provide benefit not only to the students themselves but also to service users involved in the rehabilitation process.15 In spite of some of the perceived benefits, some limitations include time and sustainability as well as access to physical and human resources for the groups.15

Although medical and clinic-based student led services, for example, those run by medical, nursing or pharmacy students, are prevalent within entry level curricula internationally,4 such clinics often follow the medical model and only comprise diagnostic and single interventions for practices such as imaging and prescription of medication.2 It is recognized that students participating in student/service led activities learn about the specific context in which the service is provided and the skills required for that service and practice.16 To that end, as this scoping review is concerned with physical rehabilitation, the scope will only consider studies which can evidence elements of physical rehabilitation, either by inclusion of physical rehabilitation professionals and or/inclusion of exercise as an intervention as part of the group or clinic.

The concept of a student led group is a teaching methodology16 as well as an intervention for service users17 and a social enterprise,4 therefore it is of interest to scope all of these aspects as part of the review. Student led groups are considered to be of mutual interest to both students and service users involved, thereby providing benefits for all.8 This scoping review aims to establish the literature base in these areas.

Data gathered in this scoping review will allow for an understanding of the range and scope of student led groups and clinics within a physical rehabilitation context and establish evaluations undertaken to date from a student, service user and stakeholder perspective, as well as identification of any other important factors in the design, execution and feasibility of the concept. It will also identify gaps in the literature that can be addressed by further research.

A preliminary search was undertaken in the JBI Database of Systematic Reviews and Implementation Reports, CINAHL, Cochrane Library (Systematic Reviews), Education Search Complete, ERIC, PEDRO, PubMed, PROSPERO and Scopus to establish whether systematic or scoping reviews published or underway on this topic already existed and none were found.

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Inclusion criteria

Participants

This review will include entry level students involved in student led groups in the field of non-medical health professionals and sports. These may be uniprofessional or interprofessional groups including AHP entry level students and/or sport students involved in student led groups, for example, kinesiology or sports therapy students.

This review will consider student led groups with all types of service users/group participants which include a physical rehabilitation component. For example, this will include those with both specific and multiple pathologies who are receiving physical rehabilitation as an element of the group.

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Concept

The concepts of interest for this scoping review may include but will not be limited to:

  • Types of student led physical rehabilitation clinics/groups in existence.
  • Characteristics of student led physical rehabilitation groups:
    • Purpose of the student led physical rehabilitation clinics/groups.
    • Content and nature of the student led physical rehabilitation clinics/groups.
    • Where in the curriculum student led rehabilitation clinics/groups take place.
  • Evaluation of student led physical rehabilitation groups:
    • Reported learning undertaken by students who experience student led physical rehabilitation groups.
    • Reported student assessment practices used for students who experience student led physical rehabilitation groups.
    • Reported measures used to capture student led rehabilitation groups’ effectiveness and acceptability from group participants’ perspectives.
    • Reported measures used to capture tutors’ and stakeholders’ perceptions/observations of students during student led rehabilitation groups.
    • Reported measures used to capture feasibility and sustainability of student led rehabilitation groups.
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Context

This scoping review will consider literature in the field of AHP or sport entry-level education internationally. Groups or clinics run by students with a focus upon physical rehabilitation will be included and these can be within a public or private healthcare setting to include community and hospital settings as well as third/voluntary sector and other organizations, for example, education facilities. These can include groups where students are volunteering or participating as a standard part of their curriculum or clinical education hours. The students may or may not be assessed as part of their involvement. Groups or clinics which undertake medical interventions or screenings alone will not be included.

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Types of studies

The current scoping review will consider all quantitative and qualitative studies of any design, as well as text/opinion pieces and reports. Conference papers/abstracts will also be eligible for inclusion. Government and regulatory body reports, expert opinion, discussion papers and other forms of text will also be considered to inform the review objective.

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Exclusion criteria

Studies that operate a medical model with no physical rehabilitation element will be outwith the scope of this review.

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Methods

This scoping review will be conducted according to Joanna Briggs Institute methodology for scoping reviews.18

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Search strategy

A three-step search strategy will be utilized in this scoping review. An initial limited search of CINAHL and MEDLINE databases will be undertaken, followed by analysis of text words contained in the titles and abstracts and of the index terms used to describe the articles. A second search using all identified keywords and index terms will then be undertaken across all databases to be included. Following this, the reference lists of all papers and text/opinion pieces will be reviewed for additional studies. If required, the reviewers will contact authors for additional information. Only literature written in English will be included. Literature published from 1998 onwards will be included as identified from a literature review7 which previously did not find literature in this area prior to that date. The full search strategy for MEDLINE is shown in Appendix I.

The databases to be searched include: MEDLINE, CINAHL, Scopus, ERIC, Embase, AMED and PEDro.

The search for unpublished studies will include: OpenGrey, Google+, electronic thesis databases, relevant professional body websites in developed nations. A full list of professional and regulatory bodies in 51 countries of interest will be compiled prior to commencing the research.

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Study selection

All identified citations will be uploaded to Refworks (ProQuest LLC, Ann Arbor, USA) following the search. Duplicates will be identified and removed. Titles and abstracts will be screened by two independent reviewers for relevance to the review objectives and concept. For titles/literature in doubt, the full article will be retrieved. Studies which are deemed relevant for inclusion in the review will be assessed against the inclusion criteria. Full text literature which does not meet the criteria will be excluded and accounted for in the report. The results of the search strategy will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)19 flow diagram, indicating the number of articles found by each search method and articles/sources excluded. Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

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Data extraction

Data will be extracted from studies included in the scoping review by two independent reviewers using methods recommended by Peters et al.18 The draft data extraction tool developed for this review is shown in Appendix II. Data extracted will include: authors/date of publication, type of publication, country of origin, aims of group/clinic, type/characteristics of group/clinic, evaluation methods and subjects, and feasibility/outcomes. If more than one paper is found for one study/project, they will be treated as one for the purposes of data extraction. The draft data extraction tool will be modified and revised as required during the process of extracting data from each included study. All modifications will be fully outlined in the full report.

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Presentation of results

The extracted data will be presented in tabular form and presented in a way in which fulfils the objectives of this review. Each table will include data on author, date of publication, country of origin, as well as data relevant to the review questions such as the types and characteristics of student led physical rehabilitation groups as well as data relating to the evaluation of these groups. Appendix III details draft results tables; as with the data extraction tool, this will be piloted and may be subject to modification. A narrative summary will accompany the results presented to aid the context and provide further commentary and how the results link to the original review objectives. The representation of the results will depend on the studies/sources included. Conclusions will be made and suggestions for possible systematic review questions and further primary research which arise as a result of the conclusions will be proposed.

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Appendix I: Search Strategy for MEDLINE (via OVID)

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Figure

Keyword=(kw) MeSH heading= (mh)

Dates: from 1998 – present

Planned Limits: English Language only

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Appendix II: Data extraction tool

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Appendix III: Draft presentation of results

Characteristics of student led rehabilitation groups

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Evaluation of student led rehabilitation groups

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References

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2. Simpson S, Long J. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education. J Gen Intern Med 2007; 22:352–356.
3. Lie DA, Forest CP, Kysh L, Sinclair L. Interprofessional education and practice guide No. 5: Interprofessional teaching for prequalification students in clinical settings. J Interprof Care 2016; 30 3:324–330.
4. Schutte T, Tichelaar J, Dekker RS, van Agtmael MA, de Vries, Theo PGM, Richir MC. Learning in student-run clinics: a systematic review. Med Educ 2015; 49 3:249–263.
5. Sheu L, O’Brien B, O'Sullivan P, Kwong A, Lai C. Systems Based practice learning opportunities in student-run cliics: a qualitative analysis of student experiences. Acad Med 2014; 89 4:831–836.
6. Stuhlmiller C, Tolchard B. Developing a student-led health and wellbeing clinic in an underserved community: collaborative learning, health outcomes and cost savings. BMC Nursing 2015; 14:32.
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10. Gustafsson L, Hutchinson L, Theodoros D, Williams K, Copley A, Fagan A, et al. Healthcare students’ experiences of an interprofessional, student-led neuro-rehabilitation community-based clinic. J Interprof Care 2016; 30 2:259–261.
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12. Nicole N, Fairbrother M, Nagarajan S, Blackford J, Sheepway L, Penman M, et al. Student-led services in a hospital aged care temporary stay unit: Sustaining student placement capacity and physiotherapy service provisions. Asia-Pac J Coop Educ 2015; 16 4:327–342.
13. HEA. Engaged student learning: High impact strategies to enhance student achievement. York: Higher Education Academy; 2016.
14. Coon E, Khoramshahi C, Popoff M. Simulated learning for occupational therapy and physiotherapy students. Waterloo: Knowledge Impact Strategies Consulting Ltd; 2014.
15. Kavanagh J, Kearns A, McGarry T. The benefits and challenges of student-led clinics within an Irish context. Journal of Practice Teaching and Learning 2015; 13 (2–3):58–72.
16. Beling J. Impact of service learning on physical therapist students’ knowledge of and attitudes toward older adults and on their critical thinking ability. J Phys Ther Educ 2004; 18 1:13–21.
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18. Peters M, Godfrey C, Khalil H, McInerney P, Parker D, Soares C. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015; 13 3:141–146.
19. Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med 2009; 6 67:e1000097.
Keywords:

Learning; outcomes; rehabilitation; student-led clinics; student-led groups

© 2019 by Lippincott williams & Wilkins, Inc.