Proto-professionalism: Opportunities for student learning and service to homeless people
The concepts of professionalism including ethical practice, reflection, self-awareness, respect, teamwork and social responsibility are present in the healthcare curriculum but rarely learned in combination. The concepts can be combined when students receive practical experiences on the challenges of delivering health and social care to populations experiencing poverty and disadvantage. We report on work with homeless people in our local communities designed to align social accountability responsibilities with healthcare curricula through a student volunteering project; initially established in a medical school. Using an ethical approach we developed this learning through a staff-student-community partnership. The outcome was learning consisting of theoretical teaching, practice learning and the potential to volunteer. We report on the development phases over several years (2013-2017). The pedagogical evaluation used a sequential mixed methods approach. One hundred and ninety-five student participants scored pre- and post-questionnaires. Of these 75% completed reflective assignments and many went on to volunteer. Twenty of those who volunteered participated in one-to-one interviews. Scored data were analysed statistically and reflective written materials were analysed using content analysis. The interview data were analysed using thematic analysis. The learning was positively experience and students reported changed attitudes and understandings of homelessness. Practice-placements and volunteering further enhanced these insights and student’s perceptions of readiness for clinical practice. This can be described as proto-professionalism. The student-staff-community partnership offers an ethical platform on which to build sustainable local outreach projects. The students gained a deeper appreciation of social injustice for homeless people.
Anderson, E. S., & Lennox, A. (2009). The Leicester Model of Interprofessional education: Developing, Delivering and Learning from student voices for 10 years. Journal of Interprofessional Care, 23(6), 557-573. https://doi.org/10.3109/13561820903051451
Arndell, C., Proffitt, B., Disco, M., & Clithero, A. (2014). Street Outreach and Shelter Care Elective for Senior Health Professional Students: An Interprofessional Educational Model for Addressing the Needs of Vulnerable Population. Education for Health, 27(1), 99-102. https://doi.org/10.4103/1357-6283.134361
Averill, N. J., Sallee, J. M., Robinson, J. T., McFarlin, J. M., Montgomery, A. A., Burkhardt, G. A., Schulz-Burton, M. D., & Elam, C. L. (2007). A First-Year Community-Based Service Learning Elective: Design, Implementation, and Reflection. Teaching and Learning in Medicine, 19(1), 47-54. https://www.tandfonline.com/doi/full/10.1080/10401330709336623
Boelen, C., Pearson, D., Kaufman, A., Rourke, J., Woollard, R., Marsh, D. C., & Gibbs, T. (2016). Producing a socially accountable medical school: AMEE Guide No. 109. Medical Teacher, 38(11), 1078–1091. https://doi.org/10.1080/0142159X.2016.1219029
Boelen, C., Dharamsi, S., & Gibb, T. (2019). The Social Accountability of Medical School and its indicators. Education for Health, 25(3), 180-194. https://doi.org/10.4103/1357-6283.109785
Boyer, E. L. (1990). Scholarship Reconsidered: Priorities of the Professoriate. Special Report: The Carnegie Foundation for the Advancement of Teaching. Available from [accessed 15th December 2021]. https://depts.washington.edu/gs630/Spring/Boyer.pdf
Braun, V., & Clarke, V. (2019a). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise & Health, 11(4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806
Braun, V., & Clarke, V. (2019b). To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample- size rationales. Qualitative Research in Sport, Exercise & Health, 13(2), 201–216. https://doi.org/10.1080/2159676X.2019.1704846
Campbell, D. J. T., Gibson, K., O’Neill, B. G., & Thurston, W. E. (2013). The role of a student-run clinic in providing primary care for Calgary’s homeless population: A qualitative study. BMC Health Services Research, 13, 277. https://doi.org/10.1186/1472-6963-13-277
Coles, C. R., & Grant, J. G. (1985). Curriculum evaluation in medical and healthcare education. Medical Education, 19(5), 405-422. https://doi.org/10.1111/j.1365-2923.1985.tb01345.x
Denzin, N. K., & Lincoln, Y. S. (Eds.) (2000). Handbook of Qualitative Research. Sage, Thousand Oaks, CA.
Dungani, S., McGuire, R., & for IMAGINE Working Group. (2011). Development of IMAGINE: A three-pillar initiative to promote social accountability and interprofessional education. Journal of Interprofessional Care, 25(6), 454-456. https://doi.org/10.3109/13561820.2011.597525
Ellaway, R. H., Roy, K. V., Preston, R., Greenhill, J., Clithero, A., Elsanousi, S., Richards, J., Labarda, C., Graves, L., Mammen, M., Assayed, A. A., & Willems, S. (2018). Translating medical school missions to student experiences. Medical Education, 52(2), 171-181. https://doi.org/10.1111/medu.13417
Falter, R. A., Pignotti-Dumas, K., Popish, S. J., Petrelli, H. M. W., Best, M. A., & Wilkinson, J. J. (2011). A service learning programme in providing nutrition education to children. American Journal of Pharmaceutical Education, 75(5), 85. https://doi.org/10.5688/ajpe75585
Festinger, L. (1957). A theory of cognitive dissonance. Stanford, CA: Stanford University Press.
Fleet, L. J., Kirby, F., Cutler, S., Dunikowski, L., Nasmith, L., & Shaughnessy, R. (2008). Continuing professional development and social accountability: A review of the literature. Journal of Interprofessional Care, 22(sup1), 15-29. https://doi.org/10.1080/13561820802028360
Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., Fineberg, H., Garcia, P., Ke, Y., Kelley, P., Kistnasamy, B., Meleis, A., Naylor, D., Pablos-Mendez, A., Reddy, S., Scrimshaw, S., Sepulveda, J., Serwadda, D., & Zurayk, H. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet, 376(9756), 1923–1958. https://doi.org/10.1016/S0140-6736(10)61854-5
Global Consensus for Social Accountability of Medical Schools (GCSA). (2010). East London, South Africa. https://healthsocialaccountability.sites.olt.ubc.ca/files/2011/06/11-06-07-GCSA-English-pdf-style.pdf
Goodier, R., Uppal, S., & Ashcroft, H. (2015). Making international links to further interprofessional learning: a student-led initiative for the homeless population. Journal of Interprofessional Care, 29(3), 265-267. https://doi.org/10.3109/13561820.2014.944258
Gordon, A. (2019). Medical students faced with privilege faced with poverty. British Journal of General Practice, 69(687), 502. https://doi.org/10.3399/bjgp19X705785
Harden, R. M., & Roberts, T. E. (2015). ASPIRE: International recognition of excellence in medical education. Lancet, 385(9964), 230. https://doi.org/10.1016/s0140-6736(15)60058-7
Healey, M., Flint, A. & Harrington, K. (2014). Engagement through partnership: students as partners in learning and teaching in higher education. Higher Education Academy United Kingdom. York, HEA. Available at [Accessed 14th December 2021] https://scirp.org/reference/referencespapers.aspx?referenceid=1785375
Holmqvist, M., Courtney, C., Meili, R. Dick, A. (2012). Student-Run Clinics: Opportunities for Interprofessional Education and Increasing Social Accountability. Journal of Research in Interprofessional Practice and Education, 2(3), 29, 264, 277. https://doi.org/10.22230/jripe.2012v2n3a80
Hilton, S. R., & Slotnick, H. B. (2005). Proto-professionalism: how professionalisation occurs across the continuum of medical education. Medical Education, 39(1), 58-65. https://doi.org/10.1111/j.1365-2929.2004.02033.x
Hood, A., & Waters, J. (2017). Living standards, poverty and inequality in the UK: 2017–18 to 2021–22. Institute for Fiscal Studies, Joseph Rowntree Foundation. The Institute of Fiscal Studies; London. https://www.jrf.org.uk/sites/default/files/jrf/files-research/hood_and_waters_findings.pdf
Jarrell, K., Ozymy, J., Gallagher, J., Hagler, D., Corral, C., & Hagler, A. (2014). Constructing the foundations for compassionate care: how service-learning affects nursing students’ attitudes towards the poor. Nurse Education in Practice, 14(3), 299-303. https://doi.org/10.1016/j.nepr.2013.11.004
Joffe, H., & Yardley, L. (2004). Content and thematic analysis. In D. Marks & L. Yardley (Eds), Research methods for clinical and health psychology (pp. 56–68). London: Sage Publications.
Kolb, D. A. (1984). Experiential learning – Experience as a source of learning and development. Upper Saddle River, NJ: Prentice Hall.
Laks, J., Wilson, L. A., Khandelwa, C., Footman, E., Jamison, M., & Roberts, E. (2016). Service-Learning in Communities of Elders (SLICE): Development and Evaluation of an Introductory Geriatrics Course for Medical Students. Teaching and Learning in Medicine, 28(2), 210-218. https://doi.org/10.1080/10401334.2016.1146602
Larkins, S. L., Preston, R., Matte, M. C., Lindemann, I. C., Samson, R., Tandinco, F. D., Buso, D., Ross, S. J., Pálsdóttir, B., Neusy, A-J., & THEnet. (2013). Measuring Social accountability in health professional education: development and international pilot testing of an evaluation framework. Medical Teacher, 35(1), 32-45. https://doi.org/10.3109/0142159X.2012.731106
Lingard, L., Albert, M., & Levinson, W. (2008). Qualitative Research: Grounded theory, Mixed Methods and Action Research. British Medical Journal, 337, a567. https://doi.org/10.1136/bmj.39602.690162.47
Meili, R., Fuller, D., & Lydiate, J. (2011). Teaching social accountability by making the links: Qualitative evaluation of student experiences in a service-learning project. Medical Teacher, 33(8), 659-666. https://doi.org/10.3109/0142159X.2010.530308
Nakamura, M., Altshuler, D., & Binienda, J. (2014). Clinical Skills development in student run free clinic volunteers: A multi-trait multi-measure study. BMC Medical Education, 14, 250. https://doi.org/10.1186/s12909-014-0250-9
QS Stars. (2021). The Rise of Social Responsibility In Higher Education Featuring best practice examples from the QS Stars rating system. QS Stars: London. [Accessed 26th November 2021] https://www.topuniversities.com/qs-stars
Robinson, G., & Barnett, L. (1996). Service learning and community colleges: Where we are? Washington, DC: American Association of Community Colleges.
Schutte, T., Tichelaar, J., Dekker, R. S., van Agtmael, M. A., de Vries, T. P. G. M., & Richir, M. C. (2015). Learning in student-run clinics: a systematic review. Medical Education, 49, 249-263. https://doi.org/10.1111/medu.12625
Sheu, L. C., Zhend, P., Coelho, A. D., Lin, L. D., O’Sullivan, P. S., O’Brien, B. C., Yu, A. Y., & Lai, C.J. (2011). Learning through service: Student perceptions on Volunteering at interprofessional Hepatitis B student-run clinics. Journal of Cancer Education, 26, 228-233. https://doi.org/10.1007/s13187-010-0142-6
Sigmon, R. L. (1994). Serving to Learn, Learning to Serve. Linking Service with Learning. Council for Independent Colleges Report.
THEnet. (n.d.). Training Self Equity Network. https://thenetcommunity.org/ [Accessed 14th December 2021]
Tracy, S. J. (2010) Qualitative Quality: Eight ''Big-Tent'' Criteria for Excellent Qualitative Research. Qualitative Inquiry, 16(10), 837-851. https://doi.org/10.1177/1077800410383121
Tsoukas, H., & Cummings, S. (1997). Marginalization and recovery: the emergence of aristotelian themes in organization studies. Organization Studies, 18(4), 655–683. https://doi.org/10.1177/017084069701800405
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