CERTIFICATE OF DISTINCTION IN SERVICE AND COMMUNITY HEALTH: Curriculum for Class of 2018

   
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
Revised and Approved 8/12/2014

    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 apply by October 15th of their first academic year. Acceptance into this 
program is not possible after the application deadline.
 Interested students must meet with the Service Learning director to discuss their scholarly project 
prior to submitting an application.
 Students must select a Scholarly Project (SP) topic relevant to community or underserved health prior 
to submitting an application. 
 An admission committee comprised of the Service Learning director, SP director, and optional 
additional faculty will review all applications with specific attention to the SP topic to determine 
eligibility.
 Students will be notified of their eligibility for the Certificate of Distinction (COD) by November 1st
 Failure to adhere to the student code of conduct will render students ineligible for this COD.
 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 cannot receive more than one Certificate of Distinction.
Students who do not apply or are not accepted will remain eligible to participate in all CHIP programs
and service learning sessions. 

Course objectives
 Patient Care
        o Students will refine their skills in caring for patients with varying cultural, socioeconomic, ethnic, and religious backgrounds; sexual orientation; language; and literacy level.
        o 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.
        o Students will be able to identify community and cultural influences which affect the patient’s health and adherence to proposed plan of care.
        o 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
o Students will develop competency in diagnosing and caring for common illnesses and health-related conditions prevalent in the underserved setting.
o 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

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

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


 Leadership
o Students will identify the difficulties experienced by physicians in providing high quality 
health care to underserved, uninsured, marginalized and racially diverse patient populations. 
o 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
o Students will develop proficiency with available technology and resources to make effective 
decisions and improve their medical knowledge.
o Students will be able to use evidence-based medicine effectively to aid in diagnosis, 
treatment, and prevention of disease.
o 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 of Certificate of Distinction in Service and Community Health
 Students will attend a minimum of ten service learning sessions during their pre-clerkship years.
 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.
 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 will include an emphasis on service or community health. Students 
should refer to the learning objectives when selecting a suitable topic. The selected topic must be 
approved by the COD director and SP director. Failure to complete an appropriate Scholarly Project 
will render the student ineligible for the COD.
 Students must complete a COD director approved 4-week community health elective during their
fourth year. Students may choose from pre-approved electives or may create their own elective with 
the approval of the director. 
 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 may be a short 
reading or reflection assignment which students shall complete prior to the 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 
 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 and Community Health COD. Students will 
also have the opportunity to evaluate all service learning sessions and their community mentors.





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.
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