In response to a lack of geographically accessible human healthcare, community members contacted a university supported student-run human medicine clinic in a larger nearby city about providing care in this rural area. The new medical clinic began seeing patients in 2012, staffed by medical and nurse practitioner students and supervised by licensed physician volunteers. In 2013, the clinic was transformed into a One Health center after community members expressed a lack of accessible veterinary care in their town (11).

The veterinary clinic was first held in the winter of 2013 in a parking lot adjacent to the human health clinic and led by students and faculty from the veterinary school. Since that time, it has been housed in various local buildings including a community center, library, and hunting club, ranging in distance from a quarter to a half mile from the human medical clinic. At its inception, the veterinary clinic was held in close proximity to the existing health care clinic for people in order to improve cross disciplinary communication including shadowing, interprofessional journal club, and to provide people with collaborative care and convenient, co-located services for their pets. As the veterinary clinic has moved farther from the human medical clinic, connections with the medical team have become more challenging. Furthermore, the COVID-19 pandemic severely hampered this relationship as the provision of health care was interrupted and established connections with student and faculty leaders at the human medical clinic were lost.

In 2021, a relationship with a university-run, Master's Entry Program in Nursing (MEPN) was established to promote interprofessional education and practice, and again collocate health services for animals and people. Pre-licensure nursing students, supervised by registered nurse clinical faculty, attend rounds with veterinary medicine teams and connect with the client while their pet is being seen. The nursing team offers support and advocacy, asking questions about social determinants of health and resource barriers that impact all family members. Nursing students focus on preventive care offering health screenings, including blood glucose and blood pressure checks, as well as health education resources. Donated supplies have periodically allowed for COVID-19 tests and home blood pressure monitors to be provided at no cost to clinic attendees. Nursing students also participate in journal club rounds that occur prior to the clinic and the group debrief at the close of the clinic, prompting discussions on the similarities and differences between human and animal health and healthcare management. This addition of the nursing students realigned the One Health clinic focus by allowing health needs to be addressed for all family members.

The OHC occurs once monthly at a community building on an appointment-based system, accommodating walk-in appointments when possible. Clients are eligible to participate through residency in one of two designated zip codes, though physical proof of residency is not required. Supplies and pharmaceuticals are acquired through a combination of corporate donations, grant funding, and philanthropic support. Financial donations from clients are accepted but not required.

Veterinary and undergraduate students provide the clinic organization with oversight from faculty and staff. At its inception, the faculty veterinarian involvement was on a voluntary basis, but in 2022 funding was secured to provide for a part-time faculty appointment to oversee the program. Additional veterinary oversight during the clinic day is provided by volunteers from both within and outside of the university. The original process to include veterinarians from outside the university involved establishing a faculty appointment without pay for each volunteer. That process took several months to complete and was reported to be a barrier to volunteer veterinarians participating in the clinic. In an effort to encourage a wider volunteer base, the process for enrolling veterinary professionals was modified in 2022 to involve a background check, volunteer application and acknowledgment of our Principles of Community as the only required steps. This process can be completed in < 1 week. Veterinary technician involvement was also initially only available on a volunteer basis, but grant support allowed for the hire of a part-time veterinary technician in 2023. Additional volunteer technicians are recruited in the same fashion as volunteer veterinarians. Nursing clinical instructors are all faculty at the school of nursing and participate as part of their faculty positions.

All veterinary students participate on a volunteer basis and nursing students participate either on a volunteer basis or as part of a class, depending on the time of year. Undergraduate students participate as part of a 1–2 credit course, and the demand for this class far exceeds the available enrollment. The selection process for the undergraduate course includes a comprehensive application that evaluates responses to prompts on topics including Access to Care (12) and One Health (13). Additionally, there is a separate application process to select Spanish language interpreters. To ensure an adequate number of interpreters at each clinic, Spanish speaking undergraduate students who pass a translation competency test are given higher rankings in the course selection process.

The undergraduate students participate in several roles at the clinic depending on their current level of completed training, including medical scribe, veterinary assistant, and Spanish language interpreter. All participating students work in healthcare teams consisting of 1–2 veterinary students, 1 undergraduate student, 1 veterinarian overseeing the team and a nursing student and technician, if available. The nursing faculty circulate during the clinic, providing oversight of their students, as well as direct patient contact.

Recruitment of volunteer students and clinical staff varies seasonally and depending on conflicting activities. Clinic organizers have worked to build a diverse workforce by encouraging students, technicians and veterinarians to bring colleagues. Moreover, grant funding has provided for compensation for volunteer veterinarians and technicians to offset their travel expenses related to clinic attendance.

To describe the current scope of monthly veterinary clinics, veterinary patient records and clinic operational data from July 2022 to July 2024 were reviewed. This time frame was selected to reflect the most current, post-COVID-19 clinic operations. Review of clinic operational data collected and managed by DVM student leadership provided information on the types and numbers of volunteers, vaccinations, medications prescribed, and referral surgeries.

Internal review of clinic patient and provider safety, student preparedness, and exploration of interprofessional training opportunities was completed by faculty observations done from the spring to fall of 2022. These assessments identified a need for updated student training protocols and increased oversight to achieve an optimal balance of experiential learning and quality patient care. Changes to clinic protocols were implemented from 2022 to 2024. The first tier of educational modifications addressed medical issues as well as patient and provider safety.

At the clinic's inception, veterinary student teams conducted client visits, then presented their findings and recommendations to an attending faculty veterinarian for approval. Veterinary students performed vaccinations and venipuncture as indicated. In these conditions, the supervising veterinarian might oversee 3–5 cases simultaneously. As the caseload grew, supervising veterinarians were responsible for a greater number of patients and their attention became divided, raising concern about the level of oversight affecting student and patient safety, teaching opportunities, and length of visits. In response, the care-team structure was changed to include veterinary students with a range of experience levels, a supervising veterinarian, an undergraduate student, and when available, an RVT and nursing student. This change allowed for a more streamlined approach, direct supervision, and clinical instruction during each patient visit. Working with RVTs familiarizes students with these important members of the veterinary care team, while providing opportunities to learn safe patient handling skills from their wealth of experience. Additionally, online low stress patient handling courses (17) were added to the undergraduate student class to better prepare them for positive patient interactions.

Initially, medications were authorized by faculty veterinarians with students completing all other parts of the process, including requesting the medications from the pharmacy student, and writing prescription instructions. A double-signature system was implemented beginning in November of 2022 to improve prescription accuracy. In current practice, all prescriptions are evaluated and approved by a veterinarian both before and after the medications are filled to ensure accuracy. We also regularly discuss these concepts as a group and provide opportunities for students to ask the clinical instructors prescription-related questions. In addition, as part of their required training, undergraduate students receive a lecture on veterinary and pharmacy law regarding prescription provision, dispensation, and labeling.

The second tier of educational modifications addressed cultural issues and included methods to better prepare students for the unique aspects of the OHC. Programs for underserved (18) communities do not always provide students with training on the causes of health disparities (19) but those that offer information about the culture and community result in increased opportunities to actualize cultural humility appreciation and understanding (20–23). The undergraduate course curriculum was updated and includes new information on the principles of ethical community engagement (24) cultural humility (25, 26), and the social determinants of health (27–32). For the veterinary student volunteers, a video that highlights our philosophy of ethical community engagement was created and is a prerequisite to clinic attendance.

Each clinic day begins with a pre-clinic meeting of all students and clinical instructors to review clinic flow, announce healthcare teams, and share pertinent information which might include seasonal or weather-related reminders. Core principles are reviewed: translation etiquette, how to embrace spectrum of care (33–35) and contextualized care (36–38), and the importance of implementing relationship-centered communication and shared-decision making (26, 39, 40). While the scope of these topics exceeds the time available in the pre-clinic meeting, the concepts are introduced, and students are encouraged to work with the clinical instructors throughout the clinic day to discuss further.

An important service offered at this OHC is interpretation/translation services, given that a large proportion of clients speak Spanish as their primary language. Language barriers not only impede access to veterinary care (41), but there is also strong evidence indicating that they can lead to health consequences for human patients, such as prolonged hospital stays and development of serious medical conditions (42–45). Previous studies have shown that patients prefer to receive care from providers who speak their primary language (46, 47) and that if interpreter services are needed, students should be trained in proper interpretation etiquette (48, 49). Interpretation services at this OHC are provided by professional and student volunteers who have professional Spanish proficiency. To improve student preparedness in this area and facilitate best patient outcomes, all professional and student volunteers at the clinic are provided with a brief training and modeling on how to properly communicate with clients via an interpreter. Undergraduate volunteers also receive a lecture on interpretation and translation etiquette, and may take on the role of interpreter after passing a translation proficiency exam. Students receive real-time feedback during the clinic on how to best utilize an interpreter to facilitate open conversations with clients who would otherwise not receive care due to their language barrier.

The third tier of modifications included increased opportunities for education about clinical One Health and time for self-reflection. Interprofessional One Health journal rounds had previously been part of the OHC but were discontinued in 2020 as a result of the COVID-19 pandemic. The new partnership with the school of nursing allowed for reintroduction of One Health rounds during the pre-clinic meeting. Nursing and veterinary student leaders are invited to select and lead the discussion around a One Health related journal article with faculty or staff support.

A group debrief is held at the end of each clinic to facilitate deeper discussion of collaborative case management in a community OHC. The value of service learning and One Health education is well documented in the literature (50–52) and a community One Health clinic adds an opportunity that is rarely available in a tertiary care center setting. During this session, the teams gather to discuss similarities and differences in our professions' goals, priorities, and methods to achieve positive patient outcomes. Additionally, students are challenged to consider the impact of collaboration in breaking down barriers faced by bonded families seeking care. Faculty and staff model and implement interprofessional collaboration, which has been shown to have documented benefits in both medical care delivery (53–55) and education (56–58). The students are encouraged to actively participate and delve deeper into subjects, including discussions on how the social determinants of health can lead to health disparities and how our professions may be more effective if we work together to reduce barriers to care. Reflections gathered from the undergraduate students who participated in the course and clinic demonstrate the effectiveness of the aforementioned strategies: