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CERTIFICATE OF DISTINCTION IN SERVICE AND COMMUNITY HEALTH
Class 2017
   
Stephanie Briney, DO

Director, Service Learning

Community Health Initiative – Phoenix

University of Arizona, College of Medicine – Phoenix

APPROVED by the Curriculum Committee – 12/10/2013

Program Overview

The University of Arizona College of Medicine – Phoenix recognizes the value of providing ample service learning opportunities within the curriculum to facilitate the development of professional, community responsive physicians.

According to the LCME, service learning is defined as a structured learning experience that combines community service with preparation and reflection.  Medical students engaged in service learning provide community service in response to community-identified concerns and learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as citizens and professionals (standard IS-14-A).

Several studies have linked higher levels of service learning participation and community service with higher class rank and better USMLE Step 2 scores, even after controlling for premedical school performance.1   Though there is no direct evidence that students who participate in formal service learning programs are more likely to be involved in service later in their careers, curriculum based service learning opportunities have been linked to improved leadership skills.2

This curriculum will focus on the many different aspects of providing care for underserved patient populations; including patients of different racial, ethnic, and socioeconomic profiles.  Nearly 50 million Americans (and 18% of Arizonans) are uninsured, and another 30 million Americans are underinsured.3   Patients without insurance are less likely to receive care in all settings except the emergency department.4  They are less likely to receive recommended preventive services, adequate chronic disease management, appropriate medications for chronic conditions, and potentially life-saving diagnostic and therapeutic interventions.5  Irrespective of insurance status, disparities in health care and health outcomes persist between patients of different ethnic and racial backgrounds.6  With this is in mind, it seems prudent to offer early opportunities in service learning to provide our future physicians with the skills and tools essential to improving patient care through individual and systems based approaches.


Goals

  • Identify and support students with a passion for service to the community.  
  • Increase student and university involvement within our community. 
  • Encourage self-directed learning by providing appropriate service related experiences.
  • Increase exposure to and familiarity with underserved populations.  
  • Maximize learning about community needs through student participation and reflection.
  • Align students with various community engaged physicians.
  • Recognize students for their commitment and devotion to service.
  • Develop community-responsive physicians who will continue to serve after medical school.
  • Instill leadership in students who will more likely become involved in community needs.

Admission Criteria

  • Interested students shall register by January 15th of their first academic year. Acceptance into this program is not possible after the application deadline.

  • Failure to adhere to the student code of conduct will render students ineligible for this Certificate of Distinction.

  • To remain eligible, students must have passing grades in all blocks and courses, and may not receive more than two Level 1 ratings in behavioral competencies.  

  • Students who do not apply for this Certificate of Distinction are still eligible to participate in all CHIP programs and service learning sessions.  

  • A two to three page personal statement will be required which should address the student’s interest in service and outline individual learning objectives.

Course Objectives

Patient Care

  • Students will refine their skills in caring for patients with varying cultural, socioeconomic, ethnic, and religious backgrounds; sexual orientation; language; and literacy level.
  • Students will be able to formulate a patient plan which takes into consideration the community, social, economic and environmental factors affecting the patient’s health.
  • Students will be able to identify community and cultural influences which affect the patient’s health and adherence to proposed plan of care.
  • Students will develop the skills necessary to develop and manage a patient care plan which is culturally acceptable and financially feasible for underserved patients.

Medical Knowledge

  • Students will develop competency in diagnosing and caring for common illnesses and health-related conditions prevalent in the underserved setting.
  • Students will learn strategies for screening and prevention of disease and promotion of health in the underserved setting.

Societal Awareness and Responsiveness

  • Students will assess the role of health care providers, community health centers, and insurance plans as they relate to patient care.
  • Students will become familiar with the resources available to patients within the community and learn to collaborate with allied health personnel and other organizations to provide quality care to patients.

Interpersonal Communication

  • Students will improve their communication and relationship building skills.
  • Students will learn to use shared decision making models to improve patient care.
  • Students will learn to provide patient-centered care with attention to cultural differences, patient values, and patient literacy.
  • Students will learn to effectively use interpreters

Professionalism

  • Students will demonstrate honesty, integrity, compassion, empathy, and respect in all patient encounters.
  • Students will identify their individual strengths and weaknesses, as well as motivations for working with the underserved.

Leadership

  • Students will identify the difficulties experienced by physicians in providing high quality health care to underserved, uninsured, marginalized and racially diverse patient populations.   
  • Students will learn to work within a group to identify community needs, develop a plan to meet those needs, and implement appropriate strategies to meet these needs.

Critical Appraisal and Quality Improvement

  • Students will develop proficiency with available technology and resources to make effective decisions and improve their medical knowledge.
  • Students will be able to use evidence-based medicine effectively to aid in diagnosis, treatment, and prevention of disease.
  • Students will learn to review journal articles in order to improve their own personal knowledge in caring for patients in the underserved setting.


 Requirements for Completion 

  • Students will attend a minimum of ten service learning sessions during their pre-clerkship years (i.e. students will have two years to attend 10 sessions).  

  • During the third and fourth years, students will be expected to attend a combined total of six sessions.  If the student will be spending more than six months on away rotations, he or she may complete a reading assignment and a reflective paper, which will reduce the number of required sessions to three.

  • Each student will be required to present a topic, facilitate a journal club, or arrange an outside speaker twice during the four year curriculum.  

  • Students will complete a minimum of 180 service hours through approved service learning (CHIP) programs over four years.  Attendance at service learning sessions is not included in service hours.

  • Each student’s Scholarly Project should include an emphasis on the care of the underserved.  The service learning director may make exceptions on a case by case basis.  If the student is unable to complete a Scholarly Project with a focus on underserved medicine, a separate longitudinal project will be assigned.  If an exception is granted, the student must still complete the Scholarly Project requirement for graduation.

  • All requirements must be completed by April 1st of the fourth year in order for the Certificate of Distinction to be awarded.


Program Description

  • There will be a minimum of ten service learning sessions made available to students each year, which will include outside speakers, journal clubs, and reflection sessions.  Students are expected to arrive prepared to participate in an active discussion related to each session’s topic; there will be a short reading or reflection assignment which students must complete prior to each session.

  •   Because reflection is a key component of service learning, students will be expected to actively participate in the discussion during the service learning sessions.  This will take the place of written reflection assignments 

  • Sessions will primarily be scheduled in the evenings so students from all levels are able to attend.

  • Students will be assigned a community mentor with whom they will meet quarterly (students may also select their own mentor but this mentor must be approved by the service learning director).  The mentor will be a community physician or faculty member within any specialty who has appropriate service experience.  The role of the community mentor is to provide positive role-modeling and to engage the student in on-going reflection and self-improvement.  Formative review of the students will occur yearly to gage student progress in the Service Learning COD program.  Students will also have the opportunity to evaluate their mentors at the end of each year.


Alternative Longitudinal Project

Should a student be unable to complete a scholarly project relevant to the care of underserved populations, he or she may develop an appropriate alternative project which must be approved by the service learning director.  Some examples are listed below, but it is possible for students to identify other opportunities which may meet the longitudinal requirement.  Students should expect to spend 20-40 hours over the four year curriculum on the alternative longitudinal project and will be expected to present a final paper or poster at a service learning session in their fourth year.

  • Suggested alternative longitudinal projects:
  • Development of a new CHIP program.  This process should include a community needs assessment, program development and oversight, and periodic program evaluation and enhancement.
  • Partnership with a community physician to develop a clinical quality improvement project relevant to the care of underserved patients.
  • Partnership with a community health center to review available community and national resources which would be beneficial to the center’s patients.  
  • Generation of a systematic review of a relevant topic and development of guidelines or informational materials to be presented to fellow students or physicians, with the purpose of improving the care of underserved patients.  


References

  1. Blue AV, Geesey ME, Sheridan MEB, and Basco WT.  Performance Outcomes Associated with Medical School Community Service.  Acad Med. 2006; 81(10 Suppl):S79-S82.
  2. Goldstein AO, Calleson D, Bearman R, Steiner B, Frasier P, and Slatt L.  Teaching Advanced Leadership Skills in Community Service (ALSCS) to Medical Students.  Acad Med.  2009; 84:754-764.
  3. U.S. Census Bureau, Current Population Survey, 2009-2012 Annual Social and Economic Supplements
  4. Committee on Quality of Health Care in America.  Crossing the Quality Chasm: A New Health System for the 21st Century.  Washington, DC: National Academies Press, 2001.
  5. National Research Council.  Care Without Coverage: Too Little, Too Late.  Washington, DC: The National Academies Press, 2002.
  6. Cene CW, Cooper LA.  Death Toll from Uncontrolled Blood Pressure in Ethnic Populations: Universal access and Quality Improvement May Not Be Enough.  Ann Fam Med 2008; 6:486-489.