A systematic review of service-learning in medical education: 1998-2012

Assessing resident experience of a new experiential learning health advocacy curriculum: a mixed methods study

BACKGROUND

Health Advocacy is considered one of the most difficult skills to teach. Many medical learners feel ill-equipped in social competencies and identify it as a significant gap in their medical training. Experiential learning has recently been emerging as a more effective method to teach health advocacy. The Post Graduate Medical Education (PGME) Health Advocacy Day is a new experiential learning curriculum designed to teach important competencies of health advocacy and social accountability to post-graduate medical residents at the University of Ottawa in Ottawa, Canada. The objective of this mixed-methods study was to assess resident experiences.

METHODS

Second-year trainees from all adult residency programs attended the Advocacy Day as part of a mandatory academic day. All participants completed a mandatory pre-and post-session quiz to assess knowledge of key topics before and after the course. We also distributed a voluntary survey to all participants and invited residents to participate in semi-structured interviews to provide feedback on the course. We used descriptive statistics to analyze quiz scores and survey results and conducted a paired t-test of pre and post-test quiz scores. We also performed a thematic analysis of qualitative feedback, specifically survey comments and semi-structured interviews.

RESULTS

One hundred and eighty-three residents participated in the Advocacy Day and 112 (61.2%) completed the post-course survey. Ten residents volunteered to be interviewed. Respondents were generally satisfied by the session and felt it was of good quality. Most residents felt the course enhanced their ability to advocate for individual patients or communities (N = 80; 71.5%) and understand patients and families' lived experience with illness (N = 87; 77.5%). Most residents also felt the course improved their knowledge of the impact of social determinants of health (N = 91; 81.2%) and increased their awareness of local resources that can support patients and their families (N = 88; 78.3%). Visiting community sites in-person and meeting persons with lived experiences were highlighted as the most valuable components of the course.

CONCLUSION

Experiential learning can be integrated within post-graduate medical curricula to teach health advocacy competencies. Future studies should examine the longitudinal impact of the curricula, to determine whether shifts in perspectives persist over time.

Systematic review of feedback literacy instruments for health professions students

Successfully managing and utilizing feedback is a critical skill for self-improvement. Properly identifying feedback literacy level is crucial to facilitate teachers and learners especially in clinical learning to plan for better learning experience. The present review aimed to gather and examine the existing definitions and metrics used to assess feedback literacy (or parts of its concepts) for health professions education. A systematic search was conducted on six databases, together with a manual search in January 2023. Quality of the included studies were appraised using the COSMIN Checklist. Information on the psychometric properties and clinical utility of the accepted instruments were extracted. A total 2226 records of studies were identified, and 11 articles included in the final analysis extracting 13 instruments. These instruments can be administered easily, and most are readily accessible. However, 'appreciating feedback' was overrepresented compared to the other three features of feedback literacy and none of the instruments had sufficient quality across all COSMIN validity rating sections. Further research studies should focus on developing and refining feedback literacy instruments that can be adapted to many contexts within health professions education. Future research should apply a rigorous methodology to produce a valid and reliable student feedback literacy instrument.

Training the next generation of community-engaged physicians: a mixed-methods evaluation of a novel course for medical service learning in the COVID-19 era

BACKGROUND

Medical school curricula strive to train community-engaged and culturally competent physicians, and many use service learning to instill these values in students. The current standards for medical service learning frameworks have opportunities for improvement, such as encouraging students to have more sustainable and reciprocal impact and to ingrain service learning as a value to carry throughout their careers rather than a one-time experience. PEDS 220: A COVID-19 Elective is a Stanford University course on the frontlines of this shift; it provides timely education on the COVID-19 pandemic, integrating community-oriented public health work to help mitigate its impact.

METHODS

To analyze our medical service learning curriculum, we combined qualitative and quantitative methods to understand our students' experiences. Participants completed the Course Experience Questionnaire via Qualtrics, and were invited to complete an additional interview via Zoom. Interview transcripts were analyzed using an interactive, inductive, and team-based codebook development process, where recurring themes were identified across participant interviews.

RESULTS

We demonstrate through self-determination theory that our novel curriculum gives students valuable leadership and project management experience, awards strong academic and community-based connections, and motivates them to pursue future community-engaged work.

CONCLUSIONS

This educational framework, revolving around students, communities, and diversity, can be used beyond the COVID-19 pandemic at other educational institutions to teach students how to solve other emergent global health problems. Using proven strategies that empower future physicians to view interdisciplinary, community-engaged work as a core pillar of their responsibility to their patients and communities ensures long-term, sustainable positive impact.

TRIAL REGISTRATION

N/A.

Examining the Effect of Contactless Intergenerational Befriending Intervention on Social Isolation Among Older Adults and Students' Attitude Toward Companionship: Content Analysis

BACKGROUND

Intergenerational friendship, a mechanism of social support, is an effective intervention to reduce the increasing risk of social isolation (SI) and develop companionship in the older adult population. The COVID-19 pandemic provided a unique opportunity to examine the psychosocial intervention of befriending via technology use as a primary form of contactless socialization.

OBJECTIVE

The study aims to explore the effectiveness of the befriending intervention through a contactless, intergenerational service-learning project on older adult emotions, especially boredom and loneliness as the key attributes of SI, and on students' attitude toward companionship.

METHODS

During the months of January to April 2022 , undergraduate students enrolled in a health administration course with a special focus on culture were asked to be involved in a contactless, intergenerational service-learning project (n=46). In this study, contactless intervention meant communication using the telephone and apps such as FaceTime and Zoom. Students were paired with older adults to have at least a 30-minute weekly conversation, for 8 weeks, via telephone or an internet-based app such as FaceTime. Students were asked to write a half-page diary after each interaction and a 1-page reflection at the end of the fourth week and at the end of the service-learning project. At the completion of the project, the researchers also surveyed the older adults to assess the impact of the project using a 5-item open-ended questionnaire. Following a heuristic approach and content analysis, student artifacts (110,970 words; 118-page, single-spaced Microsoft Word document) and the older adult surveys were analyzed using MAXQDA, (VERBI GmbH). Qualitative data were extracted to assess the impact of service learning on SI by measuring the attributes of boredom and loneliness among 46 older adults. Students' attitudes toward companionship were also assessed using data from their diaries and reflections.

RESULTS

Overall, three major constructs were identified: (1) meaningful engagement, defined as feeling safe, having increased confidence, and having reduced boredom; (2) internal motivation to participate in the weekly interaction, defined as discussion about daily life experience, level of happiness, and ability to exert personal control over the situation; and (3) intergenerational befriending, defined as perceived benefits from the friendly nature of the interaction, ability to comfortably connect with students, and positive feeling and attitude toward the student.

CONCLUSIONS

The contactless, intergenerational befriending intervention reduced boredom and loneliness among older adults and enhanced positive attitude and confidence among university students. Students helped older adults to develop digital skills for the use of apps and social media. Older adults showed interest in the intervention and shared their daily life experiences with the students, which helped to reduce the gap between generations. Findings indicate the effectiveness of an intergenerational service-learning intervention on SI reduction and increased positive attitude among college students.

The Impact of COVID-19 Service Learning on Medical Student Professional Identity Formation

OBJECTIVE

The COVID-19 pandemic affected in-person educational activities and required medical schools to adapt and enrich their curriculum to ensure ongoing professional development. During the height of the COVID-19 pandemic, students expressed a significant desire to contribute and continue their medical education. Service learning promotes experiential learning and Professional Identity Formation (PIF). This study examines the impact that a service-learning elective had on medical students' education and PIF.

METHODS

Offering a service-learning elective allowed students to remain engaged in educational activities and pandemic-relief efforts. We conducted a qualitative analysis of 132 written reflections by medical students who completed a 2- or a 4-week service-learning elective to assess for major themes and impact on PIF.

RESULTS

Participation in service learning had a favorable impact on PIF as expressed by the personal qualities student identified as having developed or improved upon because of their participation. Enhancement of communication skills, teamwork skills, compassion, and empathy were major themes conveyed in student reflections. Qualities of resilience were also portrayed through the write-up as students noted how the elective allowed for active engagement in community pandemic-relief efforts and created opportunities for overcoming obstacles related to service learning projects they participated in.

CONCLUSIONS

Service learning in medical school has a dual purpose of providing community support while imparting significant learning opportunities for PIF in medical students.

Transformational leadership competency: a cross-sectional study of medical university graduates in China

PURPOSE

To explore the transformational leadership competency of graduates from one medical university in China and its influencing variables.

METHOD

From 2020 to 2021, 851 medical graduates from seven hospitals affiliated with the Capital Medical University participated in this survey. The authors conducted a cross-sectional study to assess transformational leadership competency, particularly from three aspects, including values, Emotional Intelligence (EI) abilities, and behaviors using the socially responsible leadership scale (SRLS), emotionally intelligent leadership, and student leadership practices inventory (EILI and SLPI).

RESULTS

The SRLS scores were medium except for 'controversy with civility'. The EILI scores were medium. The SLPI scores were high except for 'enable others to act' and 'encourage the heart'. The influencing variables of SRLS, EILI, and SLPI were serving as student cadres, serving longer than two semesters (p = 0.01, 0.02 in EILI and SLPI), joining student organizations, participating in social practice, voluntary service (p = 0.001 in SLPI), in training classes for student cadres (p = 0.02, 0.01, 0.02 in SRLS, EILI, and SLPI), and attending lectures on leadership (except for indicated, p < 0.001). Regression analysis showed that attending lectures on leadership was associated with high SRLS, EILI, and SLPI scores (p = 0.04, SRLS; p < 0.001, others), and SRLS and EILI scores could affect SLPI score (F = 2674.44, p < 0.001, R2 = 0.86).

CONCLUSIONS

Medical graduates' transformational leadership competency at the Capital Medical University was medium measured from values, EI abilities, and behaviors. Group analysis indicated that knowledge learning, organizational involvement, and social/community involvement were associated with leadership capacity building, meanwhile, leaders' values and EI abilities would affect their behaviors, suggesting medical graduates should undertake leadership training from both knowledge learning and practicing.

A qualitative evaluation of the impact of a medical student school outreach project on both medical students and school pupils

OBJECTIVE

To explore medical student and school pupil experiences of an outreach school teaching project.

SETTING

Community engagement is increasingly commonplace within medical school. Secondary schools offer ample opportunities for community engagement as medical students teach and engage in service learning. There is a lack of research regarding the impact of school community engagement projects and the impact on pupils, as critical stakeholders in the service medical students provide. In this qualitative study, we explore the perspectives of medical students and school pupils involved in a school teaching project.

PARTICIPANTS

Ten medical students participated in individual interviews, and 17 school pupils across three schools participated in group interviews. Data were analysed using thematic analysis and the concept of service learning.

RESULTS

For medical students, the project fostered communication and teaching skills, but a lack of reflection hampered further benefit. For school pupils, experiences varied - learning about careers in medicine could be inspiring, but content pitched at the incorrect level disengaged some pupils. The conflict between session timing and medical students' exams negatively influenced engagement.

CONCLUSIONS

To shift the focus of community engagement projects that promote service-learning towards mutual benefit, designing in partnership with relevant community stakeholders and integrating opportunities to reflect on these experiences are critical.

Development of immersive learning framework (ILF) in achieving the goals of higher education: measuring the impact using a pre-post design

Emerging technological tools like Artificial Intelligence-based Chatbots, digital educational alternatives and market-driven educational systems pose a challenge to the fundamental aim of the higher education system; comprehensive education for well-being. Therefore, this research aims to devise and evaluate strategies to impart new-age competencies to innovate socially and morally appropriate solutions in a modern competitive innovative society. The 8-month-long immersive learning framework (ILF), was designed based on the volatility, uncertainty, complexity, and ambiguity (VUCA) paradigm. The framework was evaluated with 133 newly joined postgraduate students doing their science or arts programmes from a higher education institution in Kerala, India. The outcome variables included well-being, depressive symptoms, personality patterns, and sub-domains of philosophy of human nature. The follow-up scores showed a significant improvement in well-being (Mean difference: 1.15, p = 0.005), trustworthiness (Mean difference: 14.74, p = 0.000), strength of will (Mean difference: 10.11, p = 0.000), altruism (Mean difference: 12.85, p = 0.000), and independence (Mean difference: 11.93, p = 0.000). Depression scores did not improve significantly. However, the intervention shielded them from the adjustment issues that often accompany any transition. The ILF framework can help students develop their personal and professional selves if it is implemented collaboratively in a reflective setting. It can also instil moral rectitude and a prosocial mindset.

Clinical support during covid-19: An opportunity for service and learning? A cross-sectional survey of UK medical students

PURPOSE

Medical students providing support to clinical teams during Covid-19 may have been an opportunity for service and learning. We aimed to understand why the reported educational impact has been mixed to inform future placements.

METHODS

We conducted a cross-sectional survey of medical students at UK medical schools during the first Covid-19 'lockdown' period in the UK (March-July 2020). Analysis was informed by the conceptual framework of service and learning.

RESULTS

1245 medical students from 37 UK medical schools responded. 57% of respondents provided clinical support across a variety of roles and reported benefits including increased preparedness for foundation year one compared to those who did not (p < 0.0001). However, not every individual's experience was equal. For some, roles complemented the curriculum and provided opportunities for clinical skill development, reflection, and meaningful contribution to the health service. For others, the relevance of their role to their education was limited; these roles typically focused on service provision, with few opportunities to develop.

CONCLUSION

The conceptual framework of service and learning can help explain why student experiences have been heterogeneous. We highlight how this conceptual framework can be used to inform clinical placements in the future, in particular the risks, benefits, and structures.[Box: see text].

Diversity training for health professionals: Preparedness to competently address intellectual disability in the Western Cape Province, South Africa

Diversity training for health professionals in South Africa has traditionally been conceptualized as differences in gender, race or ethnicity, culture and sexual orientation. More recently physical disability and mental illness was included as a dimension. Intellectual disabilities received lip service as a diversity concern. This paper reports on health professionals' perceptions of the extent to which diversity training prepared them to competently deal with intellectual disabilities. This explorative study included a purposive sample of 18 health care professionals experienced in intellectual disability services. Two focus groups were facilitated over three sessions. Transcripts were analysed thematically. Health professionals felt inadequately prepared to consider intellectual disabilities as a diversity issue. They could not effectively advocate for reasonable accommodation. There was a differential familiarity with issues related to diversity and intellectual disability with profession constituting an additional intersecting dimension of diversity. Health professions did not perceive their diversity training to prepare them to deal competently with intellectual disabilities.

Enculturating a Community of Action: Health Professions Educators' Perspectives on Teaching With Wikipedia

PURPOSE

Health professions educators are increasingly called on to engage learners in more meaningful instruction. Many have used Wikipedia to offer an applied approach to engage learners, particularly learning related to evidence-based medicine (EBM). However, little is known about the benefits and challenges of using Wikipedia as a pedagogic tool from the collective experience of educators who have sought to improve their instructional practice with it. This study aims to synthesize the perspectives of health professions education (HPE) instructors on the incorporation of Wikipedia editing into their HPE courses.

METHOD

Applying a constructivist approach, the authors conducted semistructured interviews from July to December 2020, with 17 participating HPE instructors who had substantively integrated Wikipedia into their curriculum at 13 institutions. Participants were interviewed about their experiences of integrating Wikipedia editing into their courses. Thematic analysis was conducted on resulting transcripts.

RESULTS

The authors observed 2 broad themes among participants' expressed benefits of teaching with Wikipedia. First, Wikipedia provides a meaningful instructional alternative that also helps society and develops learners' information literacy and EBM skills. Second, Wikipedia supports learners' careers and professional identity formation. Identified challenges included high effort and time, restrictive Wikipedia sourcing guidelines, and difficult interactions with stakeholders.

CONCLUSIONS

Findings build on known benefits, such as providing a real-world collaborative project that contextualizes students' learning experiences. They also echo known challenges, such as the resource-intensive nature of teaching with Wikipedia. The findings of this study reveal the potential of Wikipedia to enculturate HPE students within a situated learning context. They also present implications for HPE programs that are considering implementing Wikipedia and faculty development needed to help instructors harness crowd-sourced information tools' pedagogic opportunities as well as anticipate their challenges.

Characteristics of International Rotations for Undergraduate Medical Education at United States Medical Schools: A National Study

OBJECTIVE

Medical education is criticized that it does not prepare students to serve in an increasingly globalized society. Evidence that global educational experiences can alleviate these concerns have contributed to the rise in international medical education experiences. This study explores surrounding characteristics and institutional support for international rotations across medical schools in the US.

METHODS

The authors conducted a sequential mixed methods exploratory national survey of international rotation coordinators at 185 US medical schools and 15 semi-structured interviews in fall 2018. Quantitative data were analyzed with descriptive statistics and qualitative data were coded and analyzed using interpretive description to identify themes across data.

RESULTS

There were 57 responses to the survey for an overall response rate of 31%, with 77% percent of respondents (n = 44) indicating that their medical school offered international rotations. Fifteen individuals representing 13 medical schools were identified as interviewees for the second stage of the study. International rotation coordinators described components of international rotations, including partnerships with host communities, use of third-party organizations, and supporting administrative and academic structures.

CONCLUSION

Although international rotations are common in medical education, they are not positioned as core academic programming within medical schools. This leads to challenges in planning, implementation, and evaluation, and immense variation in rotation components across medical programs. Future research should explore best practices for pre-departure preparation, post-travel debriefing, and evaluation of student activity as well as impact on the host site. Additional research should include exploration of unique benefits of international versus domestic sites, and aspects of sustainable partnerships between medical schools and host communities.

The experiences of community organizations partnering with a medical school to improve students' understanding of the social determinants of health: A qualitative study

PURPOSE

There has been increasing interest among national organizations for medical schools to provide students experiential training in the social determinants of health (SDH) through community partnerships. Despite this interest, there is limited data about how these experiential activities can be designed most effectively, and community organizations' views of partnering with medical schools on these curricula is unknown. The authors' objective was to determine community organizations' and clinical clerkship directors' perceptions of the benefits and challenges of utilizing academic-community partnerships to improve medical students' understanding of the SDH.

METHODS

The authors conducted a qualitative study consisting of open-ended, semi-structured interviews (between 2018 and 2021). All community organizations and clinical clerkship directors who partnered with a health equity curriculum were eligible to participate. Semi-structured interviews elicited participants' perceptions of the academic-community partnership; experience with the curriculum and the students; and recommendations for improving the curriculum. All interviews were audio recorded and transcribed. The authors used a directed content analysis approach to code the interviews inductively and identified emerging themes through an iterative process.

RESULTS

Of the fifteen participants interviewed, ten were from community organizations and five from clinical clerkships. Three primary themes emerged: (1) community organizations felt educating students about the SDH aligned with the organization's mission and they benefited from consistent access to volunteers; (2) students benefited through greater exposure to the SDH; (3) participants suggested standardizing students' experiences, ensuring the students and organizations are clear about the goals and expectations, and working with organizations that have experience with or the capacity for a large volume of volunteers as ways to improve the experiential activity.

CONCLUSION

This study found that community organizations were very willing to partner with a medical school to provide students experiential learning about the SDH, and this partnership was beneficial for both the students and the organizations.

Evaluating nutrition education interventions for medical students: A rapid review

BACKGROUND

Unhealthy diets account for 20% of all deaths globally. Most medical schools do not sufficiently teach their students the clinical application of nutrition science. Evaluating the efficacy of nutrition education interventions is therefore important for their widespread implementation.

METHODS

A rapid review of the literature published between 2015 and 2020 was conducted to identify nutrition education interventions delivered to undergraduate medical students. The modified Kirkpatrick hierarchy score was used to evaluate the outcome measures. Study characteristics and outcomes were charted and discussed using narrative synthesis. Included studies were appraised using the MERSQI criteria.

RESULTS

Fifteen nutrition education interventions met the inclusion criteria. Twelve were from the USA and most were optional rather than compulsory. Interventions involved a mixture of methods including cooking sessions, lectures, and student-led programs. The content covered was variable and the median duration was 11 h (range 90 min to 75 h). The modified Kirkpatrick scores varied and the median MERSQI score was 12.8/18. No studies reported the use of national or standardised guidance to inform the learning objectives of the interventions.

CONCLUSIONS

The interventions reviewed are heterogenous in their nature and outcomes. This review highlights the advantages of utilising interprofessional learning, focusing on student's personal health behaviours and harnessing novel teaching methods such as hands-on cooking. Using national guidance to develop learning outcomes will help to standardise the content taught. Future studies may aim to use validated assessment tools and investigate the long-term impacts on delivery of care and patient outcomes.

Students as Community Vaccinators: Implementation of A Service-Learning COVID-19 Vaccination Program

While the COVID-19 pandemic has caused major educational disruptions, it has also catalyzed innovation in service-learning as a real-time response to pandemic-related problems. The limited number of qualified providers was primed to restrict SARS-CoV-2 vaccination efforts. Thus, New York State temporarily allowed healthcare professional trainees to vaccinate, enabling medical students to support an overwhelmed healthcare system and contribute to the public health crisis. Here, we describe a service-learning vaccination program directed towards underserved communities. A faculty-led curriculum prepared medical students to communicate with patients about COVID-19 vaccines and to administer intramuscular injections. Qualified students were deployed to public vaccination clinics located in under-served neighborhoods in collaboration with an established community partner. Throughout the program, 128 students worked at 103 local events, helping to administer 26,889 vaccine doses. Analysis of a retrospective survey administered to participants revealed the program taught fundamental clinical skills and was a transformative service-learning experience. As new virus variants emerge and nations battle recurrent waves of infection, the need for effective vaccination plans continues to grow. The program described here offers a novel framework that academic medical centers could adapt to increase vaccine access in their local community and provide students with a uniquely meaningful educational experience.

Service-Learning Programs and Projects for Medical Students Engaged With the Community

Introduction

The medical school curriculum has changed from using the term “pedagogy” to framing adult learning theories with the goal of applying knowledge to a clinical situation or real-life experiences. Service-learning programs (SLPs) in medical schools illustrate one of several adult learning principles and practices now used in today’s curriculum that better prepare medical students for working with a variety of patients. 

Objective

The researchers’ aim was to assess medical students’ learning experiences while participating with nonprofit organizations during a curricula-designed SLP.

Method

The authors analyzed 60 reflective essays over a three-year academic period from 192 medical students placed in teams of two to four. A qualitative study with a thematic analysis research design was employed in our study. This iterative approach allowed the researchers to identify themes and interpret meaning. The study was completed in 2020 using data from 2017-2020.

Results

Four major themes and one overarching theme emerged that reflect adult learning theories including: (1) transfer learning of one’s skills and knowledge to community and practice; (2) articulate a variety of ways to communicate with multiple, diverse community audiences; (3) employ a creative process for quality improvement strategies; (4) create positive trusting and rewarding relationships that highlight an enhanced level of conduct and professionalism. An overarching theme found was: collaboration emerges almost without forethought. Medical educators may find that replicating this SLP into the curriculum infrastructure provides agency and student buy-in. We established an SLP as part of the medical school curriculum that brings privilege and reward to students and to the community. Reflection provides for meaningfulness from SLP and helps students identify how experiential learning affects their professional development as members of the community and future health care providers.

Conclusion

Implementing SLPs into any medical school curriculum strengthens the adult learning theoretical delivery approach. Disseminating projects and lessons learned to and from the community also showcases experiential learning opportunities for medical students and other professionals. Many aspects of awareness from the medical students’ engagement during the SLP emerged. They learned about specific aspects of community engagement and found it a privilege to give and take many lessons from the experiences and opportunities.

A Qualitative Analysis of Clinical Year Veterinary Student Journal Entries for a Shelter Medicine Rotation

Veterinary medical schools are tasked with not only providing experiences necessary to graduate veterinarians proficient in the skills and knowledge used most frequently in private practice, but also develop expertise in animal behavior, welfare, ethics, veterinary forensics, and cultural competency. Integrating all these knowledge areas into the curriculum can be challenging. Shelter medicine is increasingly identified by educators as an optimal learning environment to offer exposure to these topics. It can not only meet learning objectives in veterinary medical curriculum, but also provide students with authentic learning experiences to engage in and gain a deeper understanding of cultural humility, implicit bias, diversity, and inclusion. This includes documentation of international learning outcomes for shelter medicine in veterinary medical curriculum. There have been no studies evaluating authentic learning experiences specific to shelter medicine programs and their impacts on students. The aim of this study was to determine the individual activities and thematic categories on which veterinary students chose to reflect on and their potential impacts during a clinical rotation in shelter medicine at Penn Vet through qualitative content analysis of their journal entries. In our study, students found experiences on the shelter medicine rotation to be beneficial to their growth as a future veterinarian, provided them with takeaways that they found applicable and practical, helped them self-identify knowledge gaps, and changed their perspectives on several important topics related to collective human and animal welfare. These results speak to the value perceived by students of the rotation and suggest an authentic learning experience through a shelter medicine program can help cultivate more practice-ready and culturally competent veterinary graduates.

Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs

Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities.

"More than just a medical student": a mixed methods exploration of a structured volunteering programme for undergraduate medical students

BACKGROUND

As a result of the COVID-19 pandemic Imperial College School of Medicine developed a structured volunteering programme involving 398 medical students, across eight teaching hospitals. This case study aims to explore the relationship between the processes, context, participant experiences and impacts of the programme so that lessons can be learned for future emergencies and service-learning programmes.

METHODS

Using an illuminative approach to evaluation we invited all volunteers and supervisors to complete a mixed-methods survey. This explored differences in experience across demographics and contextual factors, correlations between aspects of induction, supervision and overall experience, and reviewed the impacts of the programme. Quantitative responses were statistically analysed and qualitative reflections were thematically coded to triangulate and explain quantitative findings. Follow up interviews were carried out to check back findings and co-create conclusions.

RESULTS

We received responses from 61 students and 17 supervisors. Student participants described predominantly altruistic motivations and transformational changes to their professional identity driven by feeling included, having responsibility, and engaging in authentic workplace-based learning afforded by freedom from the assessed curriculum. They reported new perspectives on their future professional role within the multidisciplinary team and the value of workplace-based learning. They reported increases in wellbeing and self-esteem related to feeling included and valued, and positively contributing to service provision at a time of need. Significantly higher overall satisfaction was associated with a personalised induction, active supervision, earlier stage of training, and male gender. Gender-related differences were not explained through our data but have been reported elsewhere and warrant further study. The duration, intensity and type of role that volunteers performed was similar across demographics and did not appear to modulate their overall experience.

CONCLUSIONS

Whilst acknowledging the uniqueness of emergency volunteering and the survey response rate of 15% of volunteers, we suggest the features of a successful service-learning programme include: a learner-centred induction, regular contact with engaged and appreciative supervisors, and roles where students feel valued. Programmes in similar settings may find that service learning is most impactful earlier in medical students' training and that students with altruistic motivations and meaningful work may flourish without formal outcomes and assessments.

Improving Food Insecurity Education in Medical School Through Integrative Service Learning

Introduction

The COVID-19 pandemic has left more than 38% of households food insecure in the United States. Improved education of food security topics in medical school can improve screening for food insecurity and improve health outcomes. The first aim of this study was to address if participation in an experiential integrative service learning program improved medical students' understanding of food insecurity. The second aim was to compare knowledge of food insecurity between the general body of medical students and those who participated in the service learning program.

Methods

This was a cohort study at a large medical school in southeast Michigan in 2019-2020. We administered the Food Insecurity for Health Professionals (FISHP) survey to medical student participants; higher scores on the FISHP survey suggest higher knowledge and comfort with food security topics. We administered online Qualtrics surveys to the volunteer group before and after volunteering 12 hours at an urban farm. We also administered a one-time survey to a control group of medical students. We performed univariable and bivariable statistical analyses with StataSE 16. The study was exempted by the institutional IRB.

Results

Medical students in the volunteer group (n = 18) and the control group (n = 66) completed online surveys. Participants in the volunteer group had increased knowledge of food security after volunteering in the service learning program (p = .03). There was a statistically significant difference between the mean FISHP scores for the control group and the volunteer group (p = .001).

Conclusion

Medical student participation in an experiential integrative service learning program improved knowledge of food security topics and increased comfort discussing food insecurity with patients, compared to students who did not participate. Experiential integrative service learning may improve holistic patient care through physician recognition of food insecurity and other social determinants of health.

Tips for Building a Community for Incoming Medical Students Virtually in the COVID-19 Era

A sense of community benefits medical trainees by preserving mental well-being, nurturing collegiality and mentorship, and grounding ties with partnering organizations and services. Within medical school, building these support relationships often begins shortly after matriculation. In the current pandemic and the accompanying shift to a virtual class format, we believe that a dedicated effort to foster this sense of community is crucial for students who otherwise may feel untethered to their new learning environment. Here, we detail tips for building a medical school community virtually in the COVID-19 era between peers, within the school institution, and within the surrounding environment.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01447-z.

The impact of longitudinal integrated clerkships on patient care: a qualitative systematic review

BACKGROUND

Longitudinal Integrated Clerkships (LIC) are a relatively novel type of clinical placement model within medical education, particularly within the UK. The research on LICs primarily focuses on the impact of the model on students, tutors, communities, and organisations. The impact of LICs on patients has not yet been adequately synthesised. This systematic review aims to fill this gap by examining empirical evidence regarding the impact of LICs on patient care using quality-of-care measures, namely, health process measures and outcome measures.

METHODS

A systematic search was conducted in MEDLINE, PsycINFO, Academic Search Premier, Education Research Complete, CINAHL Complete, ERIC, Web of Science, and Scopus. Two reviewers independently conducted the screening process for study selection. Results across studies were analysed and summarised by thematic analysis.

RESULTS

The reviewers screened 1632 records. Seven studies met the inclusion criteria following a full-text review, from which four themes were created. Three themes describe health process measures, including: 1) Advocacy within healthcare system, 2) Provision of supplementary and personalised care, and 3) Providing companionship with care. One theme described a health outcome measure: Therapeutic Alliance.

CONCLUSION

Current evidence demonstrates an overall beneficial impact of LICs on patient health processes and outcome measures. However, the available evidence is weak and limited. Further research is required to illuminate the true impact of LICs on patient health.

Psychometric evaluation of the Danish language version of the field practice experiences questionnaire for students in teacher education (FPE-DK) using item analysis according to the Rasch model

The aim of the study was to conduct a first validation of three field practice experience scales intended to measure students' opportunities to learn through observation of other teachers, own practice and feedback on own practice of 12 key teaching activities while in field practice placement as part of teacher education programs. The scales were translated and adapted from the elementary teaching candidate survey from the Development of Ambitious Instruction project. Items were adapted to refer to the teaching subject students were training in, and the response scale was modified. A four-step translation-back-translation strategy was used, and subsequently the Danish and a Norwegian and Icelandic translations were mutually adjusted for meaning to facilitate later cross-Nordic studies. Participants were 345 Danish students in the teacher education program from one university college, who had been in at least one field practice placement. Data were collected using a targeted online survey during one month immediately following field placement. Data was analysed using the Rasch model. Each of the three field experience scales fitted a Rasch model, with no evidence against overall homogeneity of scores for low versus high scoring students, local dependence between items, or DIF in relation to level of field practice, campus, type of teacher education program, gender or age. Reliability of each scale was excellent for most subgroups, while the targeting of the scales to the study sample was not very good, as there were too few teaching activities occurring rarely during field practice (i.e. too few difficult items). For all three scales there were significant differences in mean scores dependent on level of field practice placement. Thus, while the scales should be expanded to get better coverage of students' opportunities to learn in relation to all the core teaching activities present in that are to be trained in the field practice placement, the very good psychometric properties of the three scales, shows promise for future research.

Unintended Consequences? Assessing the Impact of Curricular Change on Medical Student Participation in a Student-Run Free Clinic

INTRODUCTION

In a prior qualitative study of the impact of a new (ACE) medical school curriculum, students and faculty reported decreased participation in the student-run free clinic (SRFC) attributed to more intensive scheduling and more frequent testing compared to the previous (Legacy) curriculum.

MATERIALS AND METHODS

To verify and understand this perception formed during curriculum reform, we conducted a mixed method study to measure student participation in the SRFC before and after curricular change and assessed student beliefs and motivations about SRFC participation using focus groups.

RESULTS

Overall SRFC participation did not decrease among students in the ACE cohort following curriculum change. Additionally, both Legacy and ACE groups showed lower participation during test weeks, but the decrease was not significantly different between the ACE and Legacy cohorts. Focus groups confirmed the pervasive misbelief that SRFC participation was indeed lower among ACE students and attributed to reduced student discretionary time plus increased preparation time for frequent testing. Focus groups also revealed several "values" about volunteering at the SRFC which should be endorsed and promoted by schools considering curricular change. Participants valued the SRFC for educational items that were most effectively taught in the SRFC, notably social determinants of health, interprofessional practice, and interviewing with medical interpreters. They also valued the SRFC for professional validation, opportunities to apply course content, practice clinical skills, form important professional relationships, and provide community service.

CONCLUSIONS

Our findings validate the value of SRFC experience as reported by students and demonstrate that, contrary to misbeliefs, participation was not negatively impacted by curricular reform.

Residency Education Reform Program in Department of Anesthesiology and Critical Care: An Academic Reform Model

Background

Reform in medical education is a basic process in every academic department, especially in residency programs.

Objectives

This study was designed to assess the indices of education and research as part of the Medical Education Reform program (MERP) in the Department of Anesthesiology and Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU) for four years.

Methods

MERP in DACC, SBMU was designed and implemented as a modern academic reform model; different outcome measures in education and research were assessed to demonstrate the effects of the reform plan in academic improvements.

Results

there were significant improvements regarding education indices (i.e., teaching methods, passing comprehensive exams, mentorship, assessment methods, faculty development, professionalism in medical education, integration in education, and crisis management) and research indices (targeted research activities, innovation in research approaches, increasing the impact of research).

Conclusions

Based on the experiences of DACC, SBMU regarding clinical anesthesiology residency, reform could be achieved using painstaking plans and continuous efforts with tangible documented outcomes. Often, the management period is not durable, and these reforms require meticulous care to sustain.

Using Kern's 6-Step Approach to Integrate Health Systems Science Curricula Into Medical Education

The term "health systems science" (HSS) has recently emerged as a unifying label for competencies in health care delivery and in population and community health. Despite strong evidence that HSS competencies are needed in the current and future health care workforce, heretofore the integration of HSS into medical education has been slow or fragmented-due, in part, to a lack of evidence that these curricula improve education or population outcomes. The recent COVID-19 pandemic and the national reckoning with racial inequities in the United States further highlight the time-sensitive imperative to integrate HSS content across the medical education continuum. While acknowledging challenges, the authors highlight the unique opportunities inherent in an HSS curriculum and present an elaborated curricular framework for incorporating health care delivery and population health into undergraduate medical education. This framework includes competencies previously left out of medical education, increases the scope of faculty development, and allows for evidence of effectiveness beyond traditional learner-centric metrics. The authors apply a widely adopted 6-step approach to curriculum development to address the unique challenges of incorporating HSS. Two examples-of a module on quality improvement (health care delivery) and of an introductory course on health equity (population and community health)-illustrate how the 6-step approach can be used to build HSS curricula. The Supplemental Digital Appendix (at http://links.lww.com/ACADMED/B106) outlines this approach and provides specific examples and resources. Adapting these resources within local environments to build HSS curricula will allow medical educators to ensure future graduates have the expertise and commitment necessary to effect health systems change and to advocate for their communities, while also building the much-needed evidence for such curricula.

COVIDReady2 study protocol: cross-sectional survey of medical student volunteering and education during the COVID-19 pandemic in the United Kingdom

BACKGROUND

The coronavirus disease 2019 pandemic has led to global disruption of healthcare. Many students volunteered to provide clinical support. Volunteering to work in a clinical capacity was a unique medical education opportunity; however, it is unknown whether this was a positive learning experience or which volunteering roles were of most benefit to students.

METHODS

The COVIDReady2 study is a national cross-sectional study of all medical students at medical schools in the United Kingdom. The primary outcome is to explore the experiences of medical students who volunteered during the pandemic in comparison to those who did not. We will compare responses to determine the educational benefit and issues they faced. In addition to quantitative analysis, thematic analysis will be used to identify themes in qualitative responses.

DISCUSSION

There is a growing body of evidence to suggest that service roles have potential to enhance medical education; yet, there is a shortage of studies able to offer practical advice for how these roles may be incorporated in future medical education. We anticipate that this study will help to identify volunteer structures that have been beneficial for students, so that similar infrastructures can be used in the future, and help inform medical education in a non-pandemic setting.

TRIAL REGISTRATION

Not Applicable.

Implementing Service-Learning Programs in Physical Education; Teacher Education as Teaching and Learning Models for All the Agents Involved: A Systematic Review

Service-learning (SL) is the subject of a growing number of studies and is becoming increasingly popular in physical education teacher education (PETE) programs. The objective of this study was to conduct a systematic review of the implementation of SL programs with PETE students. The databases used were Web of Science, SPORTDiscus (EBSCO), and SCOPUS. Articles were selected on the basis of the following criteria: (a) published in a peer-reviewed journal; (b) covers the use of SL programs with PETE students; (c) relates to physical education or physical activity programs; (d) availability of a full-text version in English and/or Spanish. Thirty-two articles met the inclusion criteria. Two types of findings were observed: firstly, findings relating to the study characteristics and objectives and, secondly, recommendations for improvement of this type of intervention. The objectives of the different studies focused on (a) the impact of the SL methodology on PETE students’ professional, social, and personal skills; (b) its impact on the community; (c) analysis of the effectiveness and quality of the programs. All but two studies analyzed the impact of SL on PETE, while only four analyzed community participants and only three analyzed the quality of the SL program. Recommendations for improving SL programs used with PETE students included: all stakeholders, e.g., students and community participants, should be studied and coordinated; the quality of the programs should be assessed, as studying the effectiveness of SL programs could help to attain the objectives of both students and the community; mixed methods should be used; and intervention implementation periods should be extended to provide more objective, controlled measurements.

"BURSTING THE BUBBLE": Service learning in schools

BACKGROUND

At Imperial College, we developed a novel teaching programme for medical students based within a local primary school, with the aim of developing students' teaching skills and centring social accountability in our curriculum. Similar service-learning programmes have shown significant benefit for student participants, including: improving communication skills, developing an understanding of the social determinants of health, and increased empathy. In partnership with a local primary school, the programme involved a group of medical students designing, developing and delivering a teaching session to primary school children.

METHODS

Medical students completed written reflections on the programme and semi-structured interviews were conducted with teachers who had participated in the programme. These were then thematically analysed.

RESULTS

Themes from student reflections included: improvement in teaching and communication skills; and an increased awareness of social accountability. Themes from teacher interviews included: benefits of an aspirational figure in the school; engagement of the children; and the ongoing inspirational benefit for the pupils.

DISCUSSION

Our analysis suggested students and the school community benefitted. Students reported the experience was an effective way to learn teaching skills and to improve their communication with children. The programme delivered skills transferrable to other clinical contexts including leadership and behavioural management, adaptability and creative thinking. Teacher interviews suggested the programme was mutually beneficial. The framing of medical students as role models raised the possibility that such programmes may help tackle the challenge of widening participation in medicine. We would recommend medical educators to consider developing other mutually beneficial service-learning programmes.

Evaluation of Constructing Care Collaboration - nurturing empathy and peer-to-peer learning in medical students who participate in voluntary structured service learning programmes for migrant workers

BACKGROUND

Experiential learning through service provides opportunities to nurture and practice empathy. Of growing concern, studies showed significantly decreased empathy scores as students progress through medical school. Additionally, peer-to-peer learning provides an effective way for students to learn. Constructing Care Collaboration (CCC) is a student initiated, structured-service-learning-program that promotes the development of empathy and peer-to-peer teaching. CCC is conducted in cycles of 6 sessions. This is a mixed methods study that explores the effectiveness of CCC as a service learning platform in developing student participants' empathy, social and cultural competencies, communication skills and peer-to-peer teaching skills, ultimately aiming to promote a culture of serving the underprivileged.

METHODS

The study comprised of a self-administered quantitative questionnaire and qualitative interviews. Both evaluated if CCC participation developed volunteers' social-awareness, cultural competency, communication, confidence and motivation to teach their peers.

RESULTS

Quantitative data were collated from 38 completed student volunteers' questionnaires. Volunteers generally agreed CCC improved social-awareness and cultural competency. It increased confidence of participants in approaching migrant-workers, communicating with people from different social backgrounds, and promoted a culture of peer-to-peer teaching. Thematic analysis of 17 interviews was conducted. Themes identified include: increased empathy towards migrant-workers, improved communication skills, and identifying benefits and challenges in peer-to-peer teaching.

CONCLUSION

From the quantitative and qualitative information gathered, CCC has been shown to be effective in nurturing participants' self-reported empathy, cultural competence, communication skills and improved attitude towards peer-to-peer teaching. Given its effectiveness, CCC can be adopted as a model for structured service-learning.

Experiential Learning: Transforming Theory into Practice through the Parkinson's Disease Buddy Program

Problem: Persons over age 65 constitute a large proportion of patients presenting for healthcare services; therefore, physicians must be prepared to provide care to patients that face degenerative neurological diseases. Medical students can have difficulty identifying and caring for older patients with neurological difficulties, and often perceive neurology to be a challenging specialty. Medical education service-learning programming that engages community members and medical students, while fostering specialized neurology training, may help improve care for this patient population. Intervention: We developed the Parkinson's Disease Buddy Program for first year medical students (M1s), which involved pairing students with patients with Parkinson's disease (PD) to engage in a social relationship. Students attended monthly seminars covering a range of topics specific to PD patient care and met with their PD buddies throughout the year. A mixed-methods approach was used to evaluate the program and involved pre/post assessments, as well as focus groups with both students and patients. Context: The University of Louisville's School of Medicine and College of Education implemented this volunteer service-learning program for students by partnering with a locally based nonprofit, dedicated to serving PD patients. A total of 70 (35 M1s and 35 PD patients) participated. Outcome: Students' total correct PD knowledge scores significantly increased after participation with a large effect size (pre-test mean = 14.77, [SD = 2.57]; post-test mean = 19.69 [SD = 2.06], Cohen's d = 1.64) and a paired t-test indicated a significant change in students' Parkinson's Attitude Scale scores (t (34) = 2.22, p < .05). Ninety-one percent of students (31) indicated they would recommend the program and 82% (29) indicated they would participate again. During focus groups, students reflected on the relationships they formed with their buddies, indicating the program provided a support system while helping them learn about PD. Patients indicated the program expanded their social circle and meetings with M1s were beneficial. Lessons Learned: An experiential learning opportunity can help medical students become better acquainted with patients living with a neurological disease. We identified an impact on PD patients' self-efficacy and social behavior that was not originally expected. We learned the importance of incorporating active learning modalities such as PD buddy panels and peer-to peer group discussions. The resources required to implement programs like ours can be lightened by engaging with local community partners and collaborating within and outside departments.

Student led physical rehabilitation groups and clinics in entry level health education: a scoping review protocol

REVIEW OBJECTIVE/QUESTIONS

The objective of this scoping review is to identify, map and describe the characteristics of student led physical rehabilitation groups and clinics in entry level health education.More specifically, the review questions are.

Learning relationships in community-based service-learning: a social network analysis

BACKGROUND

Little is known about the social learning of students within community-based clinical placements and ways in which it can be supported. In an allied health service-learning program, we analysed students' learning relationships to quantify what, and from whom students learnt.

METHODS

We conducted a social learning network survey in four domains of learning (clinical knowledge, procedural skills, professional development, and complex determinants of health) to explore learning relationships (ties) with other people (alters) that students (egos) formed during their placement. We quantified how different roles (supervisors, health professionals, administrators, peers, schoolteachers, and clients) contributed to the students' learning in each of the four domains. We used exponential random graph models (ERGMs) to test which relational processes contributed to the structure of the observed learning networks.

RESULTS

Data was available from a complete cohort of 10 students on placement in a network of 69 members, thus providing information on 680 potential learning relations. Students engaged in similar ways in the domains of clinical knowledge, procedural skills, and professional development. Learning relations with academic supervisors were significantly more likely. Also students reported reciprocal learning relations with peers - i.e. they formed learning pairs. This effect was absent in learning networks about complex determinants of health (including socio-economic and cultural factors). Instead, local administrative staff were significantly more often the source of learning about the local contextual factors.

CONCLUSIONS

Understanding the structure of student learning networks through social network analysis helps identify targeted strategies to enhance learning in community-based service-learning programs. Our findings suggest students recognised important learning from each other and from administrative personnel that is unrelated to the content of their placement. Based on this insight clinical educators could prepare students to become agentic learners, learning with each other and from sources outside their program.

Twelve tips for implementing effective service learning

Service learning is an educational methodology that facilitates transformation of students' knowledge, attitudes and attitudes around holistic care through work with community organizations. To implement academically, defensible service learning requires faculty endorsement, consideration of course credit, an enthusiastic champion able to negotiate agreements with organizations, organizations' identification of their own projects so they are willing to both fund and supervise them, curricular underpinning that imparts the project skills necessary for success, embedding at a time when students' clinical identity is being formed, small packets of curriculum elements delivered "just in time" as students engage with their project, flexible online platform/s, assessment that is organically related to the project, providing cross cultural up-skilling, and focused on the students' responsibility for their own product. The result is a learning experience that is engaging for medical students, links the university to the community, and encourages altruism which is otherwise reported to decline through medical school.

Implementation and Outcomes of a Community Assessment Service-Learning Activity Within Academic Learning Communities

A community needs assessment and engagement activity was implemented in 2013 in the core preclinical curriculum as part of the doctoring course within Academic Communities at UC San Diego School of Medicine. This required educational experience included curricular learning objectives as well as goals to strengthen community service within academic communities. This activity was implemented and sustained within the academic communities with each community serving a different community of San Diego. Survey data from preclinical students from 2014 to 2017 consistently reported that the community assessment activity helped sustain or develop a service project in the academic community (67.1%-79.6% strongly agree or agree) and increased students' knowledge of the needs in the assigned San Diego community (76.3%-80.6% strongly agree or agree). Students felt that the community assessment and engagement activity was a valuable learning experience (62.5%-77.8% strongly agree or agree). As a result of this educational intervention, 14 projects were implemented in the community. A subset of particularly interested and motivated medical students then took on leadership roles in these projects. Student-led scholarly assessment of the impact of some of these interventions resulted in 2 peer-reviewed publications thus far and 9 national presentations at the time of this publication. These assessments demonstrate not only educational impact, but health-system-level changes and meaningful change in patient outcomes.

Exploring the Effects of Participation in a Shelter Medicine Externship on Student Knowledge and Self-Confidence

With the recognition of shelter medicine as a sub-discipline of veterinary medicine, many veterinary programs are including clinical shelter experiences in their curricula. A concurrent mixed-methods study was designed with the aim to determine the effectiveness of a 4-week clinical shelter medicine program on students' perception of canine and feline surgical proficiency and shelter medicine knowledge as well as gain information on student attitudes toward shelter medicine and interest in pursuing this career path. Year 4 veterinary students at Western University of Health Sciences who were enrolled in a shelter medicine externship from 2014 to 2016 were invited to complete pre- and post-course online surveys. Of the 168 enrolled students, 77.4% were invited to participate, and 114 completed the survey. There was no statistically significant difference in student veterinary career interest before and after completing the externship. There was an overall increase in student rating of their ability to perform six shelter medicine tasks as well as ovariohysterectomy/ovariectomy (OVH/OE) and castration surgeries after completing their externship; all were statistically significant ( p < .001). There was a statistically significant difference in the proportion of students who were familiar with the Asilomar Accords and the Association of Shelter Veterinarians (ASV) Guidelines for Standards of Care in Animal Shelters after completion of their externship ( p < .001). Students largely supported pediatric spay and neuter, stating it was an effective means of population control. Based on the themes that emerged from the qualitative analysis, it appeared most students had an accurate understanding of the term no-kill.

Lessons learned from a student-driven initiative to design and implement an Organ and Tissue Donation course across Canadian medical schools

The competencies required of the well-trained physician are constantly evolving, and medical education must adapt accordingly. In response, a growing number of influential medical education licensing and accreditation bodies have proposed frameworks that outline society's expectations of physician competencies. In Canada, undergraduate and graduate curricula have undergone major changes to meet the specifications of the CanMEDS framework, and similar efforts are underway internationally. Nonetheless, ensuring the values enshrined within such frameworks become integral to a physician's identity remains challenging. We believe that student-led curricular initiatives represent a novel way of approaching this shifting medical education landscape.In this article, we reflect on lessons we learned as medical students spearheading an initiative to change how organ and tissue donation is taught in Canadian medical schools. Citing relevant medical education literature where applicable, we include a detailed description of our approach as a roadmap for students contemplating their own curricular innovations. By outlining the factors influencing this project's implementation, as well as the benefits and limitations of student participation in curriculum reform, we offer educators a fresh perspective on optimizing the student role in this important process. Ultimately, the authors argue that not only can student participation render curricular content more accessible to learners, but that the responsibilities students take on in this role naturally lead to the development of CanMEDs-based competencies such as advocacy, scholarship, and inter-professionalism.

A co-created intervention with care home residents and university students following a service-learning methodology to reduce sedentary behaviour: The GET READY project protocol

BACKGROUND

There is a growing demand for long-term care settings. Care-home residents are a vulnerable group with high levels of physical dependency and cognitive impairment. Long-term care facilities need to adapt and offer more effective and sustainable interventions to address older residents' complex physical and mental health needs. Despite the increasing emphasis on patient and public involvement, marginalised groups such as care-home residents, can be overlooked when including people in the research process. The GET READY project aims to integrate service-learning methodology into Physical Therapy and Sport Sciences University degrees by offering students individual service opportunities with residential care homes, in order to co-create the best suited intervention with researchers, older adults of both genders (end-users) in care homes, health professionals, caregivers, relatives and policy makers.

METHODS

Stage 1 will integrate a service-learning methodology within a Physical Therapy module in Glasgow and Sport Sciences module in Barcelona, design two workshops for care home residents and one workshop for staff members, relatives and policy makers and conduct a co-creation procedure. Stage 2 will assess the feasibility, safety and preliminary effects of the co-created intervention in a group of 60 care home residents, within a two-armed pragmatic randomized clinical trial. ClinicalTrials.gov Identifier: NCT03505385.

A validation study of public health knowledge, skills, social responsibility and applied learning

OBJECTIVES

To design and validate a questionnaire to measure medical students' Public Health (PH) knowledge, skills, social responsibility and applied learning as indicated in the four domains recommended by the Association of Schools & Programmes of Public Health (ASPPH).

METHODS

A cross-sectional study was conducted to develop an evaluation tool for PH undergraduate education through item generation, reduction, refinement and validation. The 74 preliminary items derived from the existing literature were reduced to 55 items based on expert panel review which included those with expertise in PH, psychometrics and medical education, as well as medical students. Psychometric properties of the preliminary questionnaire were assessed as follows: frequency of endorsement for item variance; principal component analysis (PCA) with varimax rotation for item reduction and factor estimation; Cronbach's Alpha, item-total correlation and test-retest validity for internal consistency and reliability.

RESULTS

PCA yielded five factors: PH Learning Experience (6 items); PH Risk Assessment and Communication (5 items); Future Use of Evidence in Practice (6 items); Recognition of PH as a Scientific Discipline (4 items); and PH Skills Development (3 items), explaining 72.05% variance. Internal consistency and reliability tests were satisfactory (Cronbach's Alpha ranged from 0.87 to 0.90; item-total correlation > 0.59). Lower paired test-retest correlations reflected instability in a social science environment.

CONCLUSIONS

An evaluation tool for community-centred PH education has been developed and validated. The tool measures PH knowledge, skills, social responsibilities and applied learning as recommended by the internationally recognised Association of Schools & Programmes of Public Health (ASPPH).

Impact of a Required Service-Learning Curriculum on Preclinical Students

PURPOSE

The impact of brief service-learning curricula on physician assistant (PA) students is not well reported. This study explores student learning immediately and then one to 2 years after a preclinical service-learning experience through written reflections and a survey.

METHODS

The 16-hour curriculum within a behavioral science course involved community immersion and engagement with underserved clients. Reflections written by students from 3 consecutive classes were coded for major themes, and theme frequency was assessed. We then administered a survey to explore the curricular impact after students completed their clinical clerkships.

RESULTS

All students (132/132) completed the required curriculum. We identified 4 major themes from 132 reflections. The themes were (most to least frequent) self-discovery (54/132), patient focus (30/132), community resources (28/132), and patient-provider relationship (20/132). The primary attitude change (self-discovery) was student awareness of their own biases and recognition of the need for cultural humility when caring for underserved clients. In the postcurriculum survey (response 69/95), students recalled community resources as the most important learning, followed by self-discovery. Students viewed the curriculum positively and noted that the exposure increased their comfort with caring for underserved patients in their clerkships.

CONCLUSIONS

Immersion in a community-based service-learning experience with underserved clients is associated with increased self-awareness and intent to change behavior. Students perceive the experience as important for future clerkships. Preclinical service-learning curricula prepare students to care for underserved patients.

Building a patient-centered and interprofessional training program with patients, students and care professionals: study protocol of a participatory design and evaluation study

Background

A common approach to enhance patient-centered care is training care professionals. Additional training of patients has been shown to significantly improve patient-centeredness of care. In this participatory design and evaluation study, patient education and medical education will be combined by co-creating a patient-centered and interprofessional training program, wherein patients, students and care professionals learn together to improve patient-centeredness of care.

Methods

In the design phase, scientific literature regarding interventions and effects of student-run patient education will be synthesized in a scoping review. In addition, focus group studies will be performed on the preferences of patients, students, care professionals and education professionals regarding the structure and content of the training program. Subsequently, an intervention plan of the training program will be constructed by combining these building blocks. In the evaluation phase, patients with a chronic disease, that is rheumatoid arthritis, diabetes and hypertension, and patients with an oncologic condition, that is colonic cancer and breast cancer, will learn together with medical students, nursing students and care professionals in training program cycles of three months. Process and effect evaluation will be performed using the plan-do-study-act (PDSA) method to evaluate and optimize the training program in care practice and medical education. A modified control design will be used in PDSA-cycles to ensure that students who act as control will also benefit from participating in the program.

Discussion

Our participatory design and evaluation study provides an innovative approach in designing and evaluating an intervention by involving participants in all stages of the design and evaluation process. The approach is expected to enhance the effectiveness of the training program by assessing and meeting participants’ needs and preferences. Moreover, by using fast PDSA cycles and a modified control design in evaluating the training program, the training program is expected to be efficiently and rapidly implemented into and adjusted to care practice and medical education.

Community action research track: Community-based participatory research and service-learning experiences for medical students

Community-based participatory research (CBPR) and service-learning are unique experiential approaches designed to train medical students how to provide individualized patient care from a population perspective. Medical schools in the US are required to provide support for service-learning and community projects. Despite this requirement, few medical schools offer structured service-learning. We developed the Community Action Research Track (CART) to integrate population medicine, health promotion/disease prevention and the social determinants of health into the medical school curriculum through CBPR and service-learning experiences. This article provides an overview of CART and reports the program impact based on students' participation, preliminary evaluations and accomplishments. CART is an optional 4‑year service-learning experience for medical students interested in community health. The curriculum includes a coordinated longitudinal program of electives, community service-learning and lecture-based instruction. From 2009-2015, 146 CART students participated. Interests in public health (93%), community service (73%), primary care (73%), CBPR (60%) and community medicine (60%) were the top reasons for enrolment. Significant improvements in mean knowledge were found when measuring the principles of CBPR, levels of prevention, determining health literacy and patient communication strategies (all p's < 0.05). Most students (73%) were satisfied with CART. Projects were disseminated by at least 65 posters and four oral presentations at local, national and international professional meetings. Six manuscripts were published in peer-reviewed journals. CART is an innovative curriculum for training future physicians to be community-responsive physicians. CART can be replicated by other medical schools interested in offering a longitudinal CBPR and service-learning track in an urban metropolitan setting.

Follow-up of a healthy lifestyle education program (the EdAl study): four years after cessation of randomized controlled trial intervention

BACKGROUND

An important challenge of school-based childhood obesity (OB) intervention programs is understanding the maintenance of the effects after cessation of the intervention to overcome the limitations of follow-up studies. The aim of this study is to verify the sustainability of the benefits achieved at a 4-year follow-up of the post-Educació en Alimentació (EDAl) program intervention cessation by assessing the OB-related outcomes and lifestyles of 13- to 15-year-old adolescents.

METHODS

This paper describes a 4-year follow-up study after the cessation of a school-based randomized controlled intervention in adolescents (n = 349, intervention; n = 154, control) with baseline and 4-year follow-up data from high schools in Reus (intervention group), Salou, Cambrils and Vila-seca (control group). The outcomes are body mass index (BMI), BMI z-score, and OB prevalence according to the World Health Organization and International Obesity Task Force criteria and lifestyle data (obtained from questionnaires).

RESULTS

Compared with the control girls, the intervention girls showed reduced BMI z-scores (-0.33 units, p < 0.01) from baseline (2007) to the 4-year follow-up post-intervention (2014). Compared with the control boys, the intervention boys showed reduced OB prevalence (-7.7%; p = 0.02). Compared with the control boys, more boys in the intervention group (19% increase; p = 0.059) showed ≥4 h/week after-school physical activity (PA). A decrease in the consumption of dairy products, fruits and fish was observed in both groups.

CONCLUSIONS

At the 4-year post-intervention follow-up of the EdAl program, compared with the control groups, girls had lower BMI z-scores and boys had lower OB prevalence from the intervention. The encouragement in after-school PA was long-lasting and maintained after the cessation of the intervention, whereas healthy food habits must be further reinforced in adolescents.

TRIAL REGISTRATION

ISRCTN29247645 .

Helping Trainees Develop Scholarship in Academic Medicine From Community Service

Introduction

Service in the community and academic medicine are often seen by trainees as unrelated. This may be one reason for the lack of faculty diversity and the declining interest in academic medicine among new trainees.

Methods

We developed an educational workshop through the application of the Kern model to help medical students and residents understand the relationship between community service work and scholarship as it pertains to a career in academic medicine. Specifically, the workshop helped trainees (1) understand the terms service and scholarship, (2) understand the benefits of achieving community service scholarship, and (3) identify steps to achieve community service scholarship through mock cases and personal stories.

Results

The workshop was implemented at five conferences with a total of 139 trainees. Results of a paired-samples t test of learners' responses pre- and postworkshop showed statistically significant growth in their confidence to publish service-related work, as well as more positive agreement with the notion that community service work aligns with an academic medicine career.

Discussion

This effective module can help trainees understand how community service and academic medicine are aligned, and raise their confidence in building a foundation for an academic medicine career through conducting community service scholarship.

Decentralised training for medical students: a scoping review

BACKGROUND

Increasingly, medical students are trained at sites away from the tertiary academic health centre. A growing body of literature identifies the benefits of decentralised clinical training for students, the health services and the community. A scoping review was done to identify approaches to decentralised training, how these have been implemented and what the outcomes of these approaches have been in an effort to provide a knowledge base towards developing a model for decentralised training for undergraduate medical students in lower and middle-income countries (LMICs).

METHODS

Using a comprehensive search strategy, the following databases were searched, namely EBSCO Host, ERIC, HRH Global Resources, Index Medicus, MEDLINE and WHO Repository, generating 3383 references. The review team identified 288 key additional records from other sources. Using prespecified eligibility criteria, the publications were screened through several rounds. Variables for the data-charting process were developed, and the data were entered into a custom-made online Smartsheet database. The data were analysed qualitatively and quantitatively.

RESULTS

One hundred and five articles were included. Terminology most commonly used to describe decentralised training included 'rural', 'community based' and 'longitudinal rural'. The publications largely originated from Australia, the United States of America (USA), Canada and South Africa. Fifty-five percent described decentralised training rotations for periods of more than six months. Thematic analysis of the literature on practice in decentralised medical training identified four themes, each with a number of subthemes. These themes were student learning, the training environment, the role of the community, and leadership and governance.

CONCLUSIONS

Evident from our findings are the multiplicity and interconnectedness of factors that characterise approaches to decentralised training. The student experience is nested within a particular context that is framed by the leadership and governance that direct it, and the site and the community in which the training is happening. Each decentralised site is seen to have its own dynamic that may foreground certain elements, responding differently to enabling student learning and influencing the student experience. The insights that have been established through this review have relevance in informing the further expansion of decentralised clinical training, including in LMIC contexts.