Reporter’s Notebook: A guide to investigating colossal topics

college student waiting at health center Duke University student Rose Wong says she worries her school and its campus health clinic are not capable of keeping people safe during the pandemic. (Bonnie Jo Mount / The Washington Post)

By Meryl Kornfield and Austin R. Ramsey

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Since The Washington Post published “A crisis in campus care” this month, an extensive examination into the health care available to college students, dozens of undergraduates, alumni, parents and faculty have shared on social media and with the Post how their own interactions with their on-campus clinics mirror the findings of the year-long investigation.

“I remember how bad the college health center was and how it was basically a campus joke. It never even occurred to me that we deserved better care,” Tal Kopan, a San Francisco Chronicle reporter, shared.

“Great reporting here that seriously investigates what everyone sort of knows and discovers it’s even worse than expected,” Ohio State University assistant professor Benjamin McKean tweeted.

How does the investigation effectively parallel what readers can relate to from their college years, especially as the world of campus care is enormous and varied? 

Access for medical resources is already in greater demand as the country grapples with the coronavirus pandemic. But this reporting, which began months before the first case of the virus was discovered, underscores a history of concerns relating to the quality of, access to and cost of care for college students. The story documents how shortcomings could be barriers amid a pandemic as students return to campuses in the fall.

To fully grasp the universe of student health centers, a team of reporters, including three Investigative Reporting Workshop interns, sourced from thousands of Google reviews, court documents and more. Because there is little to no state or national oversight of these clinics, we created our own databases with information about approximately 1,700 four-year residential institutions. Our goal was to understand what services and access student health centers provide and what the cost is for students. 

With direction from Jenn Abelson and Nicole Dungca of the Post’s investigative desk, we and fellow IRW intern Lucas Smolcic Larson, as well as IRW editor John Sullivan and his practicum students Verónica Del Valle and Jacob Wallace, collaborated on one of the most sweeping looks into “the Wild West of medical care.”

The team employed several investigative tactics that could be replicated in other endeavors to understand subjects that have vast terrains.

  1. Tapping into Google reviews: When we began our search for student sources who could talk about their own experiences, we went to social media and student journalism as a tried and true cache of voices. But we learned that a review website like Google could be a treasure trove because young people document their lives and opinions there. Andrew Ba Tran, an investigative data reporter for the Post, helped scrape the platform by institution and put them in a searchable database. We went through about 5,500 reviews to sort them by quality, access or cost, based on details shared in the description of the review. Google usernames were often tied to the reviewer’s real name or email, making it easier to reach out to them. The reviews commonly described long wait times, misdiagnoses, rude or unhelpful staff and/or costly bills. 
  1. Surveying a random sample: In addition to interviewing various health care providers on college campuses, we also conducted a survey of 200 institutions, asking them identical questions to assess budget, staffing, operating hours, as well as other issues. To ensure the sample was representative, we randomly selected public and private colleges from a list that varied by enrollment and location and that included those with religious affiliations as well as historically Black colleges and universities. We first reached out to college and university health centers using an online management survey software. We sent schools personalized links to identical survey web pages that automatically populated the database of health center information we were amassing. We established an ongoing dialogue with the universities to clarify data and ensure that we understood what the budgets included as well as separate out the analysis for schools that integrated medical and mental health care and those that had separate centers. Not all of the colleges provided information voluntarily, so we submitted dozens of records requests and kept track of those efforts.
  1. Teamwork accountability: Because there is no federal or state oversight agency that collects and verifies data on student health centers, the information we were compiling was, to the best of our knowledge, the first of its kind. That meant the onus for accurate data entry and analysis was on the reporters and interns who worked on the project. Sometimes it takes a lot of pairs of eyes to make sure things are right — not just two and certainly not just one. The database we built for the student health center universe in the U.S. relied on several people manually entering data, several people double and triple checking those data points and several people fact-checking the information we all gleaned from the data together. 
  1. Covering every state: As with any national story, it’s important to ensure that there are no states left out because of size or location, especially because campus care is relevant everywhere. We used mailing lists through Microsoft Office to improve our reach and ensure responses as we contacted student clinics and state regulators. In an effort to determine if states require the clinics to be licensed or to report adverse events, we created an email listserv to poll all 51 regulatory agencies, including the District of Columbia’s, and keep up contact when responses were slow.