Underserved Community Engagement through Medical Student Service Learning

Underserved Community Engagement through Medical Student Service Learning Projects Linda Kanzleiter, M. Ps. Sc. , D. Ed Professor Vice Chair of Education and Outreach Director of the PA AHEC Program Department of Family & Community Medicine Penn State University College of Medicine Milton S. Hershey Medical Center Jarrett Sell, M. D. Assistant Professor Co Director of the PA AHEC Program Department of Family & Community Medicine Penn State University College of Medicine Milton S. Hershey Medical Center

Disclosures • Dr. Linda Kanzleiter - None • Dr. Jarrett Sell - None

Objectives 1. Define the essential components of service learning and how it can be utilized as a teaching method in the setting of medical student education 2. Present student reflections representative of lessons learned during service learning projects 3. Explore ways that service learning can be incorporated into medical education to integrate primary care and public health

Outline A. Defining Service Learning B. Underserved Curriculum Service Learning at Penn State C. Student Reflections D. Lessons Learned E. Application of Service Learning in Medical Education

Defining Service Learning

What is Service Learning? Work with a partner to define. Spend 2 -3 minutes with the individual next to you and briefly discuss what you believe service learning to be.

Service Learning Definition “a structured learning experience that combines community service with explicit learning objectives, preparation, and reflection. ” (Pew Health Professions Commission, 1995)

Roots of Service-Learning • John Dewey (1859 -1952) – Experiential Education • David Kolb (1939 -) – Experiential Learning:

Evolution of Service-Learning “service-learning is unique among engagement and experiential education models in that reflection is a central, required pedagogical component in servicelearning and not necessarily featured in the other forms of engagement and experiential learning. ” (Stewart et al. , 2015)

Key Elements of Service Learning • • Active participation Thoughtfully organized experiences Focus on community needs Academic curriculum integration Structured time for reflection Opportunities for application of skills and knowledge Development of a sense of caring for others (Stewart, 2014) The action, learning goals and objectives, and community needs should be aligned. (Stewart, 2015)

Areas of Application • • • Primary and Secondary School Undergraduate Public Health Nursing Medical School – International + Local • Residency

Rationale in Medicine � 2012 IOM (Institute of Medicine) report on Primary Care and Public Health: Need “to develop the workforce needed to support the integration of primary care and public health” through “curriculum development and clinical experiences that favor the integration of primary care and public health. ” �

Improving Population Health: How? • Community Engagement • Integration

Application to Medical Student Learning • Increase medical students’ awareness and understanding of the social determinants of health. • Supports medical students learning in limited health resource communities through: – Application of clinical knowledge – Improving leadership skills – Discovery of the art of collaboration – Furthering communication skills – Identifying health needs in underserved communities – Improve the lives of the underserved (Stewart, 2014)

A Systematic Review of Service-Learning in Medical Education: 1998– 2012 (Stewart et al. , 2015) • Location: Urban (73%) > Rural (13%) • Design: Selective (37. 5%) > Elective (33%) > Requisite (29%) • Implementation: – Educational/training programs (52%) – Clinical-based programs (24%) – Social justice and philanthropic paradigms (24%)

Underserved Curriculum Service Learning at Penn State Underserved Medicine Domestic Health Clerkship (“the AHEC Rotation”)

Underserved Curriculum PSUCOM • The Underserved Medicine Domestic Health (UMDH) clerkship – – Required in 3 rd or 4 th year 4 weeks of clinical training In partnership with the PA Area Health Education Center (AHEC) Ambulatory primary care medicine in areas of physician shortage and medically underserved populations – Focus on knowledge and clinical skills needed to practice with at-risk populations in limited health resource areas – Uses an apprenticeship model of training • Students are required to complete a service learning project during their clerkship experience within the context of the community-at-large – Working with their preceptor, service learning projects focus on identified health concerns of special groups or populations

Challenges to Implementation • Credibility within Penn State College of Medicine’s course of study – responds to the need for Primary Care physicians to practice in areas of medically underserved and health shortage areas • Development of the clerkship with the SLP requirement – agreement of faculty to teach rural and underserved medicine as a required clerkship – develop consensus for integrating a model of primary care and public health into the clerkship – develop an experience to teach leadership in medicine – identify core content areas different than the Family & Community Clerkship • Role of Health Promotion and Disease Prevention in Practice – teaching students to view SLP as responding to the needs of the community, then recognizing the physician’s role of leadership in the community

SLP Goals and Objectives Medical students: begin to understand the relationship of social health determinants and public health needs of communities to the complex health challenges they will encounter in patient care and population health management experience the ascribed role of the physician as a leader in caring for the health of a community

Student Reflections Over all theme: “I remember why I wanted to study medicine”

Reflective Student Remarks … “ my experience with (Megan’s House) has helped me grow as a provider, It encourages me to look past just seeing a disease and to see all the factors that can affect it both positively and negatively. If my project helps one person, I would be satisfied. ” (SLP – Survival Skills - Homeless Shelter for Women and Children) …with all of the various responsibilities we have in medical school, it is easy to overlook that our roles do not only apply to our patients, but also to the community we are apart of. As physicians, we will not only be healers, but also teachers and role models. Medicine does not only encompass treatment interventions, but also teaching on prevention (SLP: Cared for several eye injuries in clinic with children, Eye Safety and First Aid) …in the end, it was a truly rewarding experience…the project was a significant part of the rotation which changed my thoughts and opinions regarding primary care medicine in a rural community. More importantly, I felt I was actually making an impact on the community because I could see the lack of knowledge in the clinical setting (SLP: Melanoma and skin cancer protection – Radio Talk Show)

Reflective Student Remarks. . . the presentation taught me that you are never to prepared, and you must be able to adapt to any situation at a moments notice. On the day of my presentation, I realized that the TV was not big enough for the attendees to read what I had on my slides. Even though I used slides throughout the talk, I realized that some of the individuals could not understand the jokes and had to ask me multiple times what as on the slide because they could not read. I also learned that when working with this populations (seniors) …make sure to always have a microphone since most individuals have trouble hearing…having dealt with fear of speaking in public my entire life, I was surprised that instead of fear I was mostly excited to share the information I had with the audience…I could sense I made an impact on how they perceived their condition now that they understand a little bit more about it (SLP – hypertension/medication compliance – Senor Center) …As I get set for the next rotation in my third year, I came away from the SLP with a new found respect for patients and physicians. I learned that each community has its own specific needs…physicians have a great responsibility in identifying and managing those needs. It requires doctors to engage their community and constantly refine their understanding of the patient behind the disease…I was amazed at the commitment of my preceptor to uphold the well being of his patients. I came away with a heightened appreciation of patients…listening to patients is vital to effective health care delivery…the SLP taught me that listening to patients is vital to their healthcare.

Lessons Learned

Review the SLP Mandatory telephone conference call the third day of the clerkship § It is not a research project § Select a topic important to managing the health of the community and that links to your interests in health care § Engage your preceptor § Engage key members from the community who are vital to the success of your project; however leadership of the project rests with you § Check materials for accuracy and reliability of source and information § Evaluation is specific to the audience engaged in learning

Embed within the Context of Medicine • Introduce the SLP as a dimension of medical training since students do not always link public health and medicine • Reinforce the role of physicians as leaders within a community and the SLP as a means to experiencing the role of leadership in medicine

Student Pushback • Eliminated with reframing the SLP as a dimension of medicine and a key role of a doctor in the community • Eliminated when talking through the model of SLP and alleviating the concept of research in four weeks

Breakout into Small Groups How can service-learning can be incorporated into other aspects of medical education? Spend 5 -10 minutes within a small group to devise plans for incorporating Service Learning into Medical Education at your Institution

Conclusions Service Learning • Teaches students in real time dimensions of the social determinants of health and their role in managing the health of the community that are not experienced within the walls of medical school • Increases confidence in assuming the role of leadership within the context of community and public health concerns • Teaches clinical skills that will improve the quality of patient care • Introduces students to the integration of public health and primary care Questions? ? ? jsell@hmc. psu. edu

References 1. IOM. Primary Care and Public Health: Exploring Integration to Improve Population Health. ; 2012. 2. Stewart T, Wubbena ZC. A Systematic Review of Service-Learning in Medical Education: 1998– 2012. Teach Learn Med. 2015; 27(2): 115 -122. 3. Stewart T, Wubbena Z. An overview of infusing servicelearning in medical education. Int J Med Educ. 2014; 5: 147 -156.

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