El andamiaje como estrategia de enseñanza en el aula

teams choose not to return to volunteer again

Box 2: IP primary care team CMO theory 2

Resource + Context => Reasoning = Outcome

First time experience as a student volunteer on an IP primary care team

Patient Contact Time

Low student contact with patients

Preparation Activities

When the time taken to prepare for the clinic experience is greater than time spent in contact with patients.

A Waste of My Time

Feeling Frustrated Question the value of the clinic to me.

Question my contribution to the patients and the clinic.

The clinic is poorly organized. A waste of my valuable time. They choose not to return to volunteer again

After their first experience as a volunteer on the interprofessional primary care team

(mechanism – resource), some students chose not to return to volunteer again (outcome 2). Students who did not return described feeling frustrated by their first clinic experience. Their frustration was associated with limited contact time with patients and the time required for preparation activities.

Context – Limited contact time with patients

Students who did not return to the clinic were reported as spending limited contact time with patients during their first volunteer experience (context). One student volunteer, who reported seeing only one patient during the four-hour clinic, summed this up as follows:

“ I was so frustrated, I waited a long time to get to volunteer in the clinic. I was so looking forward to getting to work with patients. Well, nope, it didn’t work out so well. I only saw one patient all night and all I did was take her vitals. It was so frustrating”.

(Student Volunteer)

The lack of patient contact time was reported to be a consequence of patients not attending their appointments as a result of difficulties providing adequate faculty clinicians

supervisors. As a result, some students spent very limited time interacting with patients during their first clinic experience. A student clinic manager described this as follows:

“Yeah, people get frustrated because sometimes you know, like in any clinic, you have people who cancel, people not come in. Or say your attending is stuck in surgery and, you know that type of stuff. They want to be working with the patients, but they end up just sitting around waiting, and that can be pretty frustrating, and they may not come back” (Student Clinic Manager).

Context – Time spent in preparation for the clinic experience

Greater levels of frustration were reported when students spent a disproportionately large amount of time in volunteer preparation activities compared to the time spent in contact with patients. One student volunteer expressed this situation as follows:

“When you’ve gone through a couple of hours of different training, you’ve sat through the presentations, done your blood-borne pathogens training, your HIPPA, all that stuff. And you come to the clinic and your like, I saw like half a patient assessment essentially. And so for students like me, that come to volunteer and that's all they get, that can be, that can be pretty frustrating, and so we don't come back” (Student Volunteer).

Mechanism reasoning – Wasted time

Students who have limited patient contact during their first volunteer experience (context) questioned if the experience had been of benefit to them if it had been a productive use of their time. The value of their time was measured with respect to time spent in the clinic versus potential study time. As illustrated in the following comment from a student volunteer:

“I took vitals, one time, that’s’ really not that beneficial to me. It might have been more beneficial to you know take that three or four hours to study” (Student

Volunteer).

Questioning my contribution to the patients

Students also questioned the usefulness of their contribution to the patients as illustrated in the following comments:

“I mean, how much help was I? I saw one person, I took their blood pressure and asked a few questions, but that’s all I could do. I didn’t really have anything to offer”

(Student Volunteer).

“So we have had students who volunteer that one time. Maybe just one patient comes in for their appointment. So they don’t really get a chance to do much or see much. They have told me they feel like they did nothing for the patient they saw. That it’s a waste of time” (Clinic Manager).

“We do hear this a lot, that they had exams to study for but they came to the clinic. When they only saw one patient they feel they wasted study time and they didn’t help at all” (Clinic Manager).

When students questioned the impact of their contribution and saw their participation as making no difference to the patients, the experience left them feeling they had nothing valuable to contribute.

Time spent in preparatory work

When the time spent in preparatory work, considerably outweighed the time spent in contact with patients, the students described the clinic as poorly organized, and the experience as a waste of their time (Mechanism – Reasoning), time that was valuable and in short supply, time they could have been using to study.

“ I am so short on time. Like, between classes, studying, there’s not much spare time. So I feel my time is precious. If I have any spare time I fill it studying. So when I took all that time to do the prep classes and all that for the clinic, then all I saw was one patient. Such a waste of my time”. (Student Volunteer)

“A waste of time with all that prep, and then what did I do, what did I like add for that one patient. Not much. Wasted my time and theirs.” (Student Volunteer)

And a student leader speaking about comments they had received from volunteers who completed the preparatory work and then had limited patient contact during their first volunteer experience:

“ They tell us about how frustrated they are, that we need to get more organized. That it’s too much time in the classes they have to take before they volunteer. Then so little time, well when only one patient turns up. They don't get to really

experience the clinic, when they just see the one person and are just sitting around waiting” (Student Leader).

Students who did not find value in the experience viewed it as a waste of their valuable time (mechanism reasoning) and chose not to return to volunteer again (outcome 2).

For students decisions to return or not to return to the clinic, no alternate responses to low or high contact were found beyond those presented in the primary care CMO 1 and 2.

5.1.2. IP Primary Care CMO Theories 3 & 4: Which