Conclusions, limitations, recommendations for interprofessional student-run clinics and IPE, and

future research suggestions

This final section concludes the study by providing recommendations for the development and delivery of interprofessional student-run clinics and for interprofessional education, it also presents the study limitations, and implications for future research, and provides final concluding remarks.

6.6.1 Recommendations for the development and delivery of

interprofessional student-run clinics

The identification of the programme theories within this study makes a unique contribution to the literature on interprofessional SRCs. The programme theories identified in this study should have applicability to other interprofessional SRCs, providing a starting point for consideration of the programme theories at play within their own context.

In common with many interprofessional programmes, this study identified a lack of theory use in the design of the interprofessional student-run clinic. Unsurprising given that the health professional students who designed the clinic had not received training with respect to the theoretical or pedagogical design of interprofessional education prior to designing the clinic. This is typical of interprofessional clinics, which have been rapidly proliferating in the US and internationally, but without the application of theory to their design or evaluation.

For those considering starting an interprofessional SRC a recommendation would be to consider adopting a realist evaluation approach at the inception of the clinic design. This would assist evolving clinics to develop and articulate their implementation theory.

resources), to its various participants (for whom?), what is expected to happen to these various participants within the clinic in response to these resources (in which respects? - outcomes), and why these outcomes are expected to occur (mechanism reasoning). The programme theories identified in this study provide a starting point for consideration in uncovering the programme theories at play within other clinics.

Within empirical realism, mechanisms are considered to be real, being activated by the resources brought to bear during programme implementation, with outcomes being dependent on the various contextual factors at play within each unique setting. This would suppose that the mechanisms identified within this interprofessional SRC are also present within other clinics. While the identified contexts within this study may play a part in other settings, it is expected that other unique contextual factors will shape the outcome patterns for participating students and patients within other interprofessional student-run clinics. Considering the identified contexts within this study may prime clinic design teams to consider the unique contexts at play within their own environment.

Pawson (2008) suggests,

“Careful abstraction does allow us to generate middle-range propositions which account for a degree of regularity across time and place. New times and new places will always find these theories wanting” (p.25).

He highlights the need for greater specification with new settings and new implementations allowing the modification of middle-range theories. Therefore, the further study of the developed CMO theories within this study in other SRCs is argued to permit accumulation of knowledge and middle-range theory refinement.

The findings of this study have highlighted several explicit concepts and theories that can be applied to the design, re-design, and evaluation of various aspects of an interprofessional student-run clinic. Including authentic learning, colocation and integrated care, contact theory (particularly equal status), psychological safety, professional identity formation, and social identity theory. It is recommended that the concepts and theories identified in this study be considered in the design and evaluation of interprofessional SRCs currently lacking applied theory.

To address the student's lack of theoretical and pedagogical knowledge and skill it is recommended that both universities and faculty assume a more prominent role in the design, development, and delivery of interprofessional student-run clinics. Institutional support and resources should be brought to the development and operation of these clinics e.g. faculty lending their pedagogical knowledge and interprofessional expertise to the design of the educational aspects of the clinic. It is also recommended that university and clinic administrators clearly address the question of ownership of the clinic. Identifying who

should be responsible for its development and who is ultimately responsible for its success or failure, the university, the faculty, or the students?

6.6.2 Study Limitations

Throughout each stage of the research, process decisions have been made with the aim of selecting appropriate research practices to enhance the credibility and trustworthiness of the study findings. However, it should be noted, that the findings of this study should be considered within the context of the following study limitations.

1. This study focused on a single student-run interprofessional clinic within the US with resultant implication for the transferability of its findings to other interprofessional student-run clinics and other national settings. However, as previously discussed, empirical realism would suggest that mechanisms are real and do carry over to other settings with outcomes shaped by specific local contexts. Section 6.6.1 highlighted Pawson’s (2008) conceptualisation of programme theories as middle- range theories, the study of such theories within other programmes, times, and setting would provide the opportunity for further theoretical refinement.

2. The student participants included a higher proportion of physical therapy students than is representative of the clinic. The researcher is a physical therapist and this is stipulated in her credentials, contained within the recruitment emails and

documents. This may have played a part in the decisions of the physical therapy students to participate.

3. Despite recruitment efforts by the researcher and site gatekeeper, a limited number of one-time student volunteers were recruited. During interviews those who

participated stated they were concerned about how much they could offer to the study due to their limited time in the clinic and had considered not participating. This may have been a factor in other one-time volunteer students choosing not to participate.

4. Although patients represent a key stakeholder group in the clinic, patients were not