Community-university partnerships in community-based research.

PROBLEM: Community-engaged research (CEnR) is a complex, collaborative process that presents many challenges and requires investment of time and commitment by both community and university research partners. PURPOSE: This paper describes the experience of a group of university and community members developing a set of guidelines for the ethical conduct of CEnR projects. KEY POINTS: The paper outlines the process of guideline development and lessons learned from this collaborative effort, which was based upon approaches and methods of community-based participatory research (CBPR). CONCLUSIONS: The guidelines are included and may serve as a framework to be individualized by other partnerships. Our experience shows that the very process of review, revision, and engagement is extremely helpful in creating a framework that works for the specific communities and for establishing working relationships among the partners so that all stakeholders feel ownership and investment in the framework and the collaborative research efforts.

What is the quality of preventive care provided in a student-run free clinic?

BACKGROUND: The quality of preventive care provided in student-run free clinics has not been well documented, although an increasing number of vulnerable populations seek care in these settings. OBJECTIVE: To examine the rate of preventive care services provided in one student-run free clinic compared with national data. Design. Cross-sectional chart review. PARTICIPANTS: Randomly selected patients seen between October 2008 and 2009. MAIN MEASURES: Preventive screening guidelines by the U.S. Preventive Services Task Force (USPSTF) and the American Diabetes Association (ADA). KEY RESULTS: Among 114 patient charts examined, 48 (42.1%) received an HIV test, which did not differ from national rates (40.8%, p=.78). Similarly, 63.3% of patients received a fasting blood glucose test (64.2%, p=.92). Among eligible patients, 59.6% received a fasting lipid panel and 54.6% a Pap smear; lower than national rates (86.6%, p<.001, and 70.5%, p=.001 respectively), but not different compared with uninsured nationally (61.5%, p=.79, and 54.7%, p=.98). CONCLUSIONS: This student-run free clinic provided preventive services at comparable rates to national levels, but short of goals specified in Healthy People 2020.

Teaching pre-clinical medical students an integrated approach to medical interviewing: half-day workshops using actors.

Teaching medical students to integrate patient-centered skills into the medical interview is challenging. Longitudinal training requires significant curricular and faculty time. Unsupervised students risk harm if they uncover and inappropriately manage psychosocial issues in actual patients. They fear saying the wrong thing in emotionally charged situations. Two half-day workshops for pre-clinical students integrate patient- and physician-centered interviewing. The first occurs early in the first year. The second, late in the second year, presents interview challenges (e.g., breaking bad news). Ten professional actors portray standardized patients (SPs). Groups of 10 to 15 students interview an SP, each eliciting a part of the patient's story. Qualitative evaluation revealed that, for many students, SPs afford the opportunity to experiment without harming real patients. Students view the workshops as effective (mean score for first-year students, 6.6 [standard deviation (SD), 1.0], second-year students, 7.1 [SD, 0.7] on a Likert-type scale: 1 = not at all effective to 8 = very effective).