Rural and remote speech-language pathology service inequities: An Australian human rights dilemma

Access to healthcare is a fundamental human right for all Australians. Article 19 of the Universal Declaration of Human Rights acknowledges the right to freedom of opinion and to seek, receive and impart information and ideas. Capacities for self-expression and effective communication underpin the realisation of these fundamental human rights. For rural and remote Australian children this realisation is compromised by complex disadvantages and inequities that contribute to communication delays, inequity of access to essential speech-language pathology services and poorer later life outcomes. Localised solutions to the provision of civically engaged, accessible, acceptable and sustainable speech-language pathology services within rural and remote Australian contexts are required if we are to make substantive human rights gains. However, civically engaged and sustained healthcare can significantly challenge traditional professionalised perspectives on how best to design and implement speech-language pathology services that seek to address rural and remote communication needs and access inequities. A failure to engage these communities in the identification of childhood communication delays and solutions to address these delays, ultimately denies children, families and communities of their human rights for healthcare access, self-expression, self-dignity and meaningful inclusion within Australian society.

Needs Assessment for Creating a Patient-Centered, Community-Engaged Health Program for Homeless Pregnant Women

Purpose

Women who experience homelessness during pregnancy have poorer birth outcomes than the general population. This exploratory research describes the needs assessment of homeless women currently living at a shelter in Milwaukee, Wisconsin, to identify unmet needs related to maternal and infant perinatal health as the first step in designing a mutually beneficial patient-centered service-learning program for medical students to address these needs.

Methods

Two 1-hour focus groups were held at a shelter for women who are homeless and/or victims of domestic violence. A total of 13 women participated in each session; four medical students and a physician served as facilitators and scribes at each session. The facilitators alternated asking predetermined open- and close-ended questions, followed by discussion among participants. Questions elicited experiences during pregnancy, what went well, what women living in the shelter struggled with, and what support they wished for but did not have. Scribes captured the conversation through hand-written notes and used content analysis in order of frequency.

Results

Thirteen themes were identified. The 5 most frequently identified themes were a need for pregnancy education, access/transportation, baby care, advocacy, and material necessities. Participating shelter residents and the medical students expressed interest in working with one another and forming a long-term partnership with the shelter.

Conclusions

Results of this needs assessment will inform the creation of a new shelter-based medical education program that will meet homeless women's needs while preparing medical students for patient-centered, community-responsive care.

The Application of an Implementation Science Framework to Comprehensive School Physical Activity Programs: Be a Champion!

Comprehensive school physical activity programs (CSPAPs) have been endorsed as a promising strategy to increase youth physical activity (PA) in school settings. A CSPAP is a five-component approach, which includes opportunities before, during, and after school for PA. Extensive resources are available to public health practitioners and school officials regarding what should be implemented, but little guidance and few resources are available regarding how to effectively implement a CSPAP. Implementation science provides a number of conceptual frameworks that can guide implementation of a CSPAP, but few published studies have employed an implementation science framework to a CSPAP. Therefore, we developed Be a Champion! (BAC), which represents a synthesis of implementation science strategies, modified for application to CSPAPs implementation in schools while allowing for local tailoring of the approach. This article describes BAC while providing examples from the implementation of a CSPAP in three rural elementary schools.

A Model to Promote Public Health by Adding Evidence-Based, Empathy-Enhancing Programs to All Undergraduate Health-care Curricula

Fostering empathy in future health-care providers through service-learning is emerging as central to public health promotion. Patients fare better when their caregivers have higher relationship-centered characteristics such as the ones measured by the Jefferson Scale of Empathy. Unfortunately, these characteristics often deteriorate during health-care professional training. Nevertheless, growing literature documents how we can promote empathy, and other patient-centered characteristics, throughout health-care professional students’ undergraduate education. As for proven treatment plans, we believe we should also use evidence-based guidelines to foster relationship-centered characteristics in our students when training them to practice as part of an interdisciplinary health-care team.

Linking public health nursing competencies and service-learning in a global setting

BACKGROUND

Nurse educators in baccalaureate programs are charged with addressing student competence in public health nursing practice. These educators are also responsible for creating nursing student opportunities for civic engagement and development of critical thinking skills. The IOM report (2010) on the Future of Nursing emphasizes the nurse educator's role in promoting collaborative partnerships that incorporate interdisciplinary and intraprofessional efforts to promote health.

AIM

The purpose of this article is to describe an innovative approach to address public health nursing competencies and to improve the health and well-being of indigenous populations in a global setting through promotion of collaboration and service- learning principles.

METHODS

As part of a hybrid elective course, baccalaureate nursing students from various nursing tracks participated in a 2 week immersion experience in Belize that included preimmersion preparation. These students were to collaborate among themselves and with Belizean communities to address identified health knowledge deficits and health-related needs for school-aged children and adult populations.

RESULTS

Students successfully collaborated in order to meet health-related needs and to engage in health promotion activities in the Toledo district of Belize. They also gained practice in developing public health nursing competencies for entry-level nursing practice. Implementation of service-learning principles provided students with opportunities for civic engagement and self-reflection.

DISCUSSION

Some challenges existed from the students', faculty, and global community's perspectives. Lack of culturally appropriate and country specific health education materials was difficult for students and the community. Faculty encountered challenges in communicating and collaborating with the Belizean partners.

CONCLUSION

Commonalities exist between entry-level public health nursing competencies and service-learning principles. Using service-learning principles in the development of public health experiences increases the likelihood of success in achieving these competencies. While students demonstrated intraprofessional collaboration in a global setting, these same collaborative opportunities can occur in local communities.

Service Learning in Public Health: Exploring the Benefit to Host Agencies in CDC's Public Health Associate Program

The "learn by doing" approach to training is common in the public health field and is a core component of service-learning programs. Trainee satisfaction, learning, and application of learning have been studied. What is less understood is the perspective of the agencies that host trainees. This study aimed to identify whether and how the Centers for Disease Control and Prevention's Public Health Associate Program (PHAP) adds value to the agencies that host trainees during 2-year field assignments. An exploratory, qualitative study design consisting of 9 semistructured telephone interviews with PHAP host agency supervisors was used. Results suggested that PHAP increased host agencies' capacity by assigning capable trainees to host agencies. Trainees made quality contributions that led to agency- and/or community-wide improvements and positively affected the agencies' culture. Further evaluation of the host perspective is necessary; as coupled with the trainee's perspective, it will provide a more holistic understanding of program value.

Improving Quality in Teen Pregnancy Prevention Through Effective Replication: A Mixed Methods Focus on Fidelity

Fidelity monitoring is an essential component of evidence-based replication in teen pregnancy prevention. Fidelity toolkits ensure that core curriculum is adhered to, by providing a detailed checklist of expected activities. When systematically reviewed, fidelity toolkits offer critical information on challenges and barriers that can inform and improve future programming. The purpose of this project was to implement an educational program to improve sexual health in teens, using a fidelity toolkit to promote and evaluate program fidelity. Participants, from a suburban Ohio county, included faculty, junior-level baccalaureate nursing students, and females, 15-19 years of age. Plan-do-study-act methodology was used to carry out this quality improvement initiative. Twenty-three nursing students, divided among 3 clinical sections, and their 3 faculty members completed the fidelity toolkits. Part I fidelity ranged from 82.73% to 100% (M = 97.8%), Part II fidelity ranged from 75% to 95.83% (M = 92.76%), Part III fidelity ranged from 81.5% to 95.83% (M = 91.8%), and Part IV fidelity ranged from 57% to 100% (M = 98.2%). Overall, fidelity of the program averaged 96.4%. Several themes were identified as a result of the qualitative analysis of narrative toolkit responses, in the categories of participant factors, site factors, and presenter factors. Toolkit use led to a high level of program fidelity.

The Role of Subjective Task Value in Service-Learning Engagement among Chinese College Students

Most service-learning studies in higher education focused on its effects on students' development. The dynamic processes and mechanisms of students' development during service-learning, however, have not been explored thoroughly. Student engagement in service-learning may affect service-learning outcomes and be affected by subjective task value at the same time. The present study aimed to explore the effect of subjective task value on Chinese college student engagement during service-learning. Fifty-four Chinese college students participated in a 9-weeks service-learning program of interacting with children with special needs. Students' engagement and subjective task value were assessed via self-report questionnaires and 433 weekly reflective journals. The results indicated that the cognitive, emotional and behavioral engagement of Chinese college students demonstrated different developmental trends during service-learning process. Subjective task value played an essential role in student engagement in service-learning activities. However, the role of subjective task value varied with different stages. Finally, the implications for implementing service-learning in Chinese education were discussed.

The Effects of Service-Learning on College Students' Attitudes Toward Older Adults

The current U.S. health care workforce shortage is at crisis levels for providers who specialize in elder care. Barriers such as ageism, lack of awareness of the need for workers, and lack of contact with seniors can affect the career choice of young professionals. To explore ways to increase the number of students who pursue gerontology and to expand the elder care workforce, the researchers conducted a qualitative content analysis on the impact of service learning in senior care facilities on students' attitudes toward older adults. Students with senior contact reported increases in positive perceptions of seniors, discovered their own ageist stereotypes, and developed an interest in a career in elder care. Twenty-one months after the service-learning experience, students were surveyed again with their responses indicating continued positive attitude changes along with professional development demonstrating beneficial long-term effects from the experience.

Assessing Interprofessional Education Collaborative Competencies in Service-Learning Course

Objective. To investigate the effect of an interprofessional service-learning course on health professions students' self-assessment of Interprofessional Education Collaborative (IPEC) competencies. Design. The semester-long elective course consisted of two components: a service component where students provided patient care in an interprofessional student-run free clinic and bi-weekly workshops in which students reflected on their experiences and discussed roles, team dynamics, communication skills, and challenges with underserved patient populations. Assessment. All fifteen students enrolled in the course completed a validated 42-question survey in a retrospective post-then-pre design. The survey instrument assessed IPEC competencies in four domains: Values and Ethics, Roles and Responsibilities, Interprofessional Communication, and Teams and Teamwork. Students' self-assessment of IPEC competencies significantly improved in all four domains after completion of the course. Conclusion. Completing an interprofessional service-learning course had a positive effect on students' self-assessment of interprofessional competencies, suggesting service-learning is an effective pedagogical platform for interprofessional education.

An Exploration of Dental Students' Assumptions About Community-Based Clinical Experiences

The aim of this study was to ascertain which assumptions dental students recalled feeling prior to beginning community-based clinical experiences and whether those assumptions were fulfilled or challenged. All fourth-year students at the University of Iowa College of Dentistry & Dental Clinics participate in community-based clinical experiences. At the completion of their rotations, they write a guided reflection paper detailing the assumptions they had prior to beginning their rotations and assessing the accuracy of their assumptions. For this qualitative descriptive study, the 218 papers from three classes (2011-13) were analyzed for common themes. The results showed that the students had a variety of assumptions about their rotations. They were apprehensive about working with challenging patients, performing procedures for which they had minimal experience, and working too slowly. In contrast, they looked forward to improving their clinical and patient management skills and knowledge. Other assumptions involved the site (e.g., the equipment/facility would be outdated; protocols/procedures would be similar to the dental school's). Upon reflection, students reported experiences that both fulfilled and challenged their assumptions. Some continued to feel apprehensive about treating certain patient populations, while others found it easier than anticipated. Students were able to treat multiple patients per day, which led to increased speed and patient management skills. However, some reported challenges with time management. Similarly, students were surprised to discover some clinics were new/updated although some had limited instruments and materials. Based on this study's findings about students' recalled assumptions and reflective experiences, educators should consider assessing and addressing their students' assumptions prior to beginning community-based dental education experiences.

Service-Learning in Communities of Elders (SLICE): Development and Evaluation of an Introductory Geriatrics Course for Medical Students

PROBLEM

Medical students have limited exposure to Geriatrics in their traditional training. Service-learning offers students the opportunity to engage with older adult communities and become more comfortable interacting with this population.

INTERVENTION

A preclinical elective course was developed to expand medical students' experiences in Geriatrics through service-learning. In this course, students conducted needs assessments in diverse older adult communities, created health education projects to address community-identified needs, and reflected on their experiences through written assignments and presentations. The course instructor presented lectures on special topics in Geriatrics, including ageism and health literacy. The curriculum aimed to familiarize students with older adults' needs in a variety of settings.

CONTEXT

Over 3 years, 74 students participated in the service-learning course. Students were assigned to older adult community sites, where they conducted needs assessments and designed and implemented original educational projects targeting community concerns. Program evaluation methods included a validated survey assessing students' attitudes toward older adults, course evaluations, review of student assignments and projects, and feedback from older adult participants and site coordinators.

OUTCOME

Students gained hands-on experience working with older adults and designing appropriate health education projects. Analysis of attitude surveys demonstrated students' increased interest in Geriatrics as a career. Both students and older adult participants described enjoyable, valuable experiences gained from service-learning activities.

LESSONS LEARNED

Students appreciated the combination of community and classroom learning about Geriatrics. Service-learning was most constructive at sites with responsive coordinators, engaged older adults, and a need for health education resources. The course challenged students to assess health needs in communities that included cognitively impaired elders and to design educational projects tailored to older adults.

An Assessment of Service-Learning in 34 US Schools of Pharmacy Follow Up on the 2001 Professional Affairs Committee Report

Objective. To determine if the service-learning components used at a convenience sample of schools and colleges of pharmacy meet the intent of the 2001 AACP Professional Affairs Committee (PAC) report. Methods. An online questionnaire was used to survey faculty members or staff involved with service-learning education at their school of pharmacy. Questions addressed aspects of service-learning including types of activities used, duration of student involvement with community partners, and association of learning objectives with service-learning activities. Results. The majority (85.3%) of respondents reported their institution used service-learning. Activities reported as part of service-learning ranged from working at health fairs to involvement with pharmacy school recruitment. More than half (64.3%) of service-learning activities involved long-term interactions with one community partner, and 74.1% of respondents indicated there was always an opportunity for student reflection on the service-learning activity. Conclusion. There is increasing though inconsistent application of PAC guidelines regarding service-learning.

Developing Dental Students' Awareness of Health Care Disparities and Desire to Serve Vulnerable Populations Through Service-Learning

Service-learning in dental education helps students integrate knowledge with practice in an underserved community setting. The aim of this study was to explore how a service-learning experience affected a small group of dental students' beliefs about cultural competence, professionalism, career development, desire to practice in a community service setting, and perceptions about access and disparities issues. Prior to beginning their first year of dental school, five first-year dental students at one U.S. dental school participated in a six-week service-learning program in which they interned at one of three at-risk settings in order to experience health care delivery there. After the program, 60 reflective writing assignments completed by the participants were analyzed using grounded theory methods; interviews with the students were used to corroborate the findings from that analysis. Seven themes identified in the journal reflections and interview findings showed enhanced awareness of social health care issues and patient differences, as well as a social justice orientation and desire to address disparities. Building on this study, future research should explore the curricular components of service-learning programs to ensure students receive ample opportunity to reflect upon their experiences in order to integrate previously held assumptions with their newfound knowledge.

Service-learning's impact on dental students' attitude towards community service

BACKGROUND

This study evaluated service-learning programme's impact on senior dental students' attitude towards community service at Virginia Commonwealth University (VCU) School of Dentistry. Experience gained through service-learning in dental school may positively impact dental students' attitude towards community service that will eventually lead into providing care to the underserved.

MATERIALS AND METHODS

Two surveys (pre- and post-test) were administered to 105 senior dental students. For the first survey (post-test), seventy-six students of 105 responded and reported their attitude towards community service immediately after the service-learning programme completion. Three weeks later, 56 students of the 76 responded to the second survey (retrospective pre-test) and reported their recalled attitude prior to the programme retrospectively.

RESULTS

A repeated-measure mixed-model analysis indicated that overall there was improvement between pre-test and post-test. Scales of connectedness, normative helping behaviour, benefits, career benefits and intention showed a significant pre-test and post-test difference. An association between attitude towards community service and student characteristics such as age, gender, ethnicity and volunteer activity was also examined. Only ethnicity showed an overall significant difference. White dental students appear to have a differing perception of the costs of community service.

CONCLUSIONS

The service-learning programme at VCU School of Dentistry has positively impacted senior dental students' attitude towards community service.

Youth peers put the "invent" into NutriBee's online intervention

BACKGROUND

Early adolescents perceive peers as credible and relatable. Peers therefore have a unique conduit to engage early adolescents in positive health behaviors through nutrition learning such as that recommended by the U.S. Institute of Medicine (IOM).

PURPOSE

We developed an online, peer leader component to an existing in-person preventive nutrition intervention called NutriBee. We reasoned that youth ages 13-18 could create intervention materials that could remain engaging, credible and relatable to younger peers ages 10-12 online. Peer leaders could potentially derive health benefits from their service-learning experience.

METHODS

From 2013-2014 youth could apply online to relate a personal interest to nutrition, an opportunity promoted at NutriBee pilot sites and through social media. The peer leaders with diverse backgrounds honed original ideas into tangible projects with the support of adult subject-matter experts chosen by the youth. Nutrition expertise was provided by NutriBee staff who then also converted the youth-invented projects from various media into an online curriculum.

RESULTS

19 of 27 (70%) of selected youth from 12 states and diverse backgrounds, created an online curriculum comprising 10% of NutriBee's 20-hour intervention. All 19 online projects modeled 1 or more of NutriBee's 10 positive health behaviors; 8 evoked the chemosenses; 6 conveyed food texture; and 13 provided social context. Peer leaders perceived career advancement and service learning benefits. The dose, pedagogic approach, and project content align with the IOM recommendation.

CONCLUSIONS

Youth created intervention materials which communicate positive health behaviors online in ways peers can adopt. In a customarily sight-sound digital platform, youth leveraged the senses of smell, taste and touch and social context important for food selection. Peer leaders derived health benefit, as indirectly assessed by IOM criteria.

Beyond Assessment: Conducting Theoretically Grounded Research on Service-Learning in Gerontology Courses

Service-learning is a useful pedagogical tool and high-impact practice, providing multiple benefits. Gerontology (and other) courses frequently include service-learning activities but lack theory-based, intentional research on outcomes. Here, the authors define service-learning and contextualize it in higher education, provide an overview of research and assessment in service-learning and gerontology courses, demonstrate the shortcomings of program evaluations, and offer suggestions for future research to advance and generate theory.

Use of a simulation game for HIV/AIDS education with pre-service teachers

The article describes the use of a simulation game in HIV/AIDS education with pre-service teachers in Johannesburg, South Africa. The use of a simulation game, as novel experiential pedagogy, was an attempt to raise awareness about HIV and AIDS and to demonstrate that anyone can be at risk of HIV infection. Using a generic qualitative research design, the data were collected over a three-year period by way of video recordings of the simulation game, recordings of large and small group discussions afterwards, and via questionnaires and written reflections by the education students four weeks afterwards. Content analysis and discourse analysis led to the construction of three main themes. First, we found that the novelty factor of the simulation game for raising HIV/AIDS awareness was confirmed both during the game itself and after a period of time had elapsed. Second, in light of many education students' naivety about the intersection of biological, socio-cultural and economic issues at play in the spread of HIV, the game prompted more reflexivity about the disease and helped to broaden the participants' discussions. Lastly, the data revealed the disjuncture between theory and practice in HIV/AIDS education. We propose that in raising awareness of HIV and AIDS, educators should move towards more engaging and challenging pedagogies that address the learning needs of the 'new' generation of university students.

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

PHENOMENON: In the United States, the Affordable Care Act has increased the need for community-centered pedagogy for medical education such as service-learning, wherein students connect academic curriculum and reflections to address a community need. Yet heterogeneity among service-learning programs suggests the need for a framework to understand variations among service-learning programs in medical education.

APPROACH

A qualitative systematic review of literature on service-learning and medical education was conducted for the period between 1998 and 2012. A two-stage inclusion criteria process resulted in articles (n = 32) on service-learning and Doctor of Medicine or Doctor of Osteopathic Medicine being included for both coding and analysis. Focused and selective coding were employed to identify recurring themes and subthemes from the literature.

FINDINGS

The findings of the qualitative thematic analysis of service-learning variation in medical education identified a total of seven themes with subthemes. The themes identified from the analysis were (a) geographic location and setting, (b) program design, (c) funding, (d) participation, (e) program implementation, (f) assessment, and (g) student outcomes. Insights: This systematic review of literature confirmed the existence of program heterogeneity among service-learning program in medical education. However, the findings of this study provide key insights into the nature of service-learning in medical education building a framework for which to organize differences among service-learning programs. A list of recommendations for future areas of inquiry is provided to guide future research.

Dental hygiene students' views on a service-learning residential aged care placement program

PURPOSE

To record the views of final year dental hygiene students from the University of Newcastle, Australia about a placement in 17 residential aged care facilities, on the NSW Central Coast.

METHODS

Final year dental hygiene students undertook a 12 week placement, 1 day per week, in 1 of 17 residential aged care facilities. They were asked to participate in focus group discussions after the placement to determine their ability to transition from the classroom to the real-life experience of the residential aged care facility placement.

RESULTS

Students felt ill-equipped for the aged care placement program even though they had attended a pre-placement orientation. Students expressed feelings of being overwhelmed by the residential aged care environment, particularly by the smells and unexpected sights of the aged, fragile and cognitively impaired residents, and the difficulties in providing them with oral hygiene care.

CONCLUSION

To enable students to transition from the classroom to the aged care environment in a more effective manner, a more realistic pre-placement orientation program is necessary.

Dental students and faculty members' attitudes towards care for underserved patients and community service: do community-based dental education and voluntary service-learning matter?

The objectives of this study were to explore 1) how students across the four years of a dental curriculum differed in attitudes towards underserved patients and community service at the beginning and end of each school year; 2) how these attitudes changed as a function of participating in required vs. voluntary community-based activities; and 3) what attitudes faculty members held about the effects of community service-learning on students. Surveys were distributed to 440 students at one dental school at the beginning and end of the school year. The overall response rate for those surveys was 75 percent, with variations among classes: first year, 94 percent; second year, 92 percent; third year, 69 percent; and fourth year, 43 percent. Survey data were also collected from twenty-two students (out of a possible forty-seven) who participated in voluntary service-learning and from fifty-four faculty members (out of approximately 150). The results showed that, at the beginning of the year, the first-year students' attitudes were more positive than the responses of students in all other cohorts. However, at the end of the year, their attitudes were less positive. Participating in voluntary service-learning improved students' attitudes towards treating underserved patients only in the short run, and experiencing ten weeks of community-based dental education did not improve their attitudes. The faculty respondents' attitudes, however, were quite positive. The decrease in students' positive attitudes towards treating underserved patients and participating in community service should raise questions about why this loss of idealism occurred.

Association of community-based dental education components with fourth-year dental students' clinical performance

The purpose of this study was to assess which components of a community-based dental education (CBDE) program at The University of Iowa College of Dentistry & Dental Clinics were associated with overall student performance. This retrospective study analyzed data for 444 fourth-year students who graduated in 2006 through 2011. Information pertaining to students' CBDE rotations and their final grades from the comprehensive clinic (in two areas: Production and Competence) were used for statistical analysis. Bivariate analyses indicated that students who completed CBDE in the fall were more likely to receive an A or B in Production compared to students who completed CBDE in the spring. However, students who completed CBDE in the beginning or end of the academic year were more likely to receive an A or B in Competence compared to those who completed CBDE in the middle of the year. Students who treated a variety of patient types during CBDE experiences (comprehensive and emergency care vs. mainly comprehensive care) were more likely to receive better grades in Production, while CBDE clinic type was not associated with grades. Dental schools should consider how CBDE may impact students' performance in their institutional clinics when developing and evaluating CBDE programs.

Students' perceptions of a community-based service-learning project related to aging in place

This article describes a service-learning project that was designed to help undergraduate health professions students understand the complexities related to aging in place. The service-learning project also incorporated a research component to expose the students to the research process. Students' reflections regarding the benefits that they derived from the experience suggest that they value learning about older adults through one-on-one interactions more than they value the opportunity to participate in the research project. Implications for undergraduate health professional education are discussed.

A collaborative approach to combining service, teaching, and research

OBJECTIVE

To describe a faculty-student collaborative model and its outcomes on teaching, service, and scholarship.

DESIGN

A Medicare Part D elective course was offered that consisted of classroom and experiential learning where pharmacy students participated in community outreach events to assist Medicare beneficiaries with Part D plan selection. The course training was expanded to include medication therapy management (MTM) and the administration of immunizations. At the completion of the course, students collaborated with faculty members on research endeavors.

EVALUATION

During the first 6 years of this course, the class size more than doubled from 20 to 42 students, and all students participating in the course met the IPPE requirements for community outreach. Over that same period, the number of beneficiaries receiving assistance with their Part D plan grew from 72 to 610; and with the help of students starting in 2011, faculty members had 28 poster presentations at national conferences, 7 invited podium presentations at national/international meetings, and published 8 manuscripts in peer-reviewed journals.

CONCLUSION

Through collaborative efforts, this model took an elective course and provided classroom and experiential learning for students, needed health services for the community, and opportunities to pursue wide ranging research projects for faculty members and students.

Community needs assessment to reach out to an underserved population

A community-based participatory research project was conducted to identify health information needs of clients (an underserved population) at a homeless shelter. Staff at the shelter, medical students, and public librarians were sought as outreach partners; their needs and challenges in accessing health information resources to serve underserved populations were also assessed. The community needs assessment yielded results that helped shape a medical library's efforts in supporting medical students' service-learning activities related to humanistic education. The resulting data also informed library decisions on health information education outreach programs tailored to vulnerable, underserved populations and community partners serving the specific populations in the communities.

Community-based dental education and dentists' attitudes and behavior concerning patients from underserved populations

The objectives of this study were to explore how dentists with well-structured vs. not well-structured community-based dental education (CBDE) experiences differ in perceptions of their CBDE and its impact on their professional lives and in their professional attitudes and behavior related to treating patients from underserved populations. The relationships between CBDE evaluations and impact on the dentists' professional lives and professional attitudes and behavior were explored as well. Data were collected from 254 dentists who participated in CBDE before graduating from the University of Michigan School of Dentistry between 1970 and 2011. The results showed that the alumni with well-structured experiences rated the quality of their CBDE more positively and its impact on their professional lives as stronger than those with less well-structured experiences. They also had more positive attitudes concerning treating underserved patients and were more likely to treat underserved patients than their peers with less well-structured experiences. These dentists' perceptions of the quality of CBDE and impact on their professional lives correlated significantly with their attitudes and behavior concerning treating underserved patients. Their perceptions of the quality of their CBDE experiences and perceptions of benefits from these experiences were significantly related to their professional attitudes and behavior related to providing care for patients from underserved populations.

Incorporating the principles of the patient-centered medical home into a student-run free clinic

As the health care delivery landscape changes, medical schools must develop creative strategies for preparing future physicians to provide quality care in this new environment. Despite the growing prominence of the patient-centered medical home (PCMH) as an effective model for health care delivery, few medical schools have integrated formal education on the PCMH into their curricula. Incorporating the PCMH model into medical school curricula is important to ensure that students have a comprehensive understanding of the different models of health care delivery and can operate effectively as physicians. The authors provide a detailed description of the process by which the Weill Cornell Community Clinic (WCCC), a student-run free clinic, has integrated PCMH principles into a service-learning initiative. The authors assessed patient demographics, diagnoses, and satisfaction along with student satisfaction. During the year after a PCMH model was adopted, 112 students and 19 licensed physicians volunteered their time. A review of the 174 patients seen from July 2011 to June 2012 found that the most common medical reasons for visits included management of hypertension, hyperlipidemia, diabetes, gastrointestinal conditions, arthritis, anxiety, and depression. During the year after the adoption of the PCMH model, 87% were very or extremely satisfied with their care, and 96% of the patients would recommend the WCCC to others. Students who participate in the WCCC gain hands-on experience in coordinating care, providing continuity of care, addressing issues of accessibility, and developing quality and safety metrics. The WCCC experience provides an integrative model that links service-learning with education on health care delivery in a primary care setting. The authors propose that adoption of this approach by other student-run clinics provides a substantial opportunity to improve medical education nationwide and better prepare future physicians to practice within this new model of health care delivery.

Training medical students in the social determinants of health: the Health Scholars Program at Puentes de Salud

PURPOSE

Given the large influence of social conditions on health, physicians may be more effective if they are trained to identify and address social factors that impact health. Despite increasing interest in teaching the social determinants of health in undergraduate medical education, few models exist.

PARTICIPANTS AND METHODS

We present a 9-month pilot course on the social determinants of health for medical and other health professional students, which is based at Puentes de Salud, Philadelphia, PA, USA, a community health center serving a Latino immigrant population. This service-learning course, called the Health Scholars Program (HSP), was developed and implemented by volunteer medical and public health faculty in partnership with the community-based clinic. The HSP curriculum combines didactic instruction with service experiences at Puentes de Salud and opportunities for critical reflection. The HSP curriculum also includes a longitudinal project where students develop, implement, and evaluate an intervention to address a community-defined need.

RESULTS

In our quantitative evaluation, students reported high levels of agreement with the HSP meeting stated course goals, including developing an understanding of the social determinants of health and working effectively with peers to implement community-based projects. Qualitative assessments revealed students' perception of learning more about this topic in the HSP than in their formal medical training and of developing a long-term desire to serve vulnerable communities as a result.

CONCLUSION

Our experience with the HSP suggests that partnerships between academic medical centers and community-based organizations can create a feasible, effective, and sustainable platform for teaching medical students about the social determinants of health. Similar medical education programs in the future should seek to achieve a larger scale and to evaluate both students' educational experiences and community-defined outcomes.

Promoting sustainable community service in the 4th year of medical school: a longitudinal service-learning elective

BACKGROUND

To address the country's most pressing healthcare needs, medical students must choose careers in primary care and commit to working with underserved populations. Involvement in student service organizations has been shown to strengthen leadership, empathy, and commitment to underserved health and may lead students to pursue careers in primary care.

DESCRIPTION

In 2010, the University of Chicago Pritzker School of Medicine developed a novel 1-year longitudinal service-learning elective called SERVE (Service, Education, Reflection, Volunteerism Elective). Students earned elective credit for completing three course requirements: 10 service sessions, monthly reflections, and a service-learning project.

EVALUATION

One third of the class enrolled in the course (33/99), 25 students completed the course, and 20 completed the final evaluation. Both quantitative and qualitative analyses of the final evaluations demonstrated high satisfaction with the course, and appreciation of the opportunity to volunteer, teach, and develop service projects. SERVE students reported a strong commitment to continuing community service after graduation, with 100% planning to continue volunteering and 70% strongly agreeing with the statement that they would practice in an underserved community in the future. This commitment was higher than that expressed by the graduating class of 2012 (34%) and higher compared to a national average (30.9%).

CONCLUSIONS

SERVE is a unique 1-year course that reengages 4th-year medical students in service to their communities in a structured educational environment. SERVE students report that the course has increased their involvement in the community, supported their growth into a teaching role, and enhanced continuity within student-run free clinics. Future directions include assessing the impact of SERVE students on the experience of preclinical medical students in student-run free clinics; community response to SERVE projects; and the impact of SERVE on volunteerism, primary care specialty choice, and future practice in underserved communities for class participants during their medical careers.

Strategies for service-learning assessment in dental hygiene education

A large body of literature exists on the instructional pedagogy known as service-learning. Service-learning is a teaching and learning approach characterized by the dental hygiene student's practical application of academic studies and occurs within a community setting, to the benefit of both the student and community. Dental hygiene educators use service-learning to enhance student knowledge and application of oral health curriculum. This manuscript reports on the importance of service-learning assessment to the National Dental Hygiene Research Agenda as well as the future of the profession of dental hygiene and the successful strategies in service-learning evaluation available for utilization by dental hygiene educators.

Participants' perceptions of a multidisciplinary training program for graduate and postgraduate students in drug use management and policy

OBJECTIVE

To determine graduate and postgraduate students' perceptions of a drug use management and policy program that applied wide-ranging policy research skills to inform pharmaceutical decision-making.

DESIGN

Nine cohorts of graduate and postgraduate students from diverse academic and professional backgrounds were paired with health-system preceptors for 4 months, and supported by faculty advisors and administrators, to complete research projects that generated evidence to inform policy decisions.

ASSESSMENT

A self-administered survey instrument was sent to all alumni of the program over the previous 10 years. The majority of respondents indicated: their prior academic coursework could be applied to everyday life; service-learning projects complemented university programs; participation led to greater awareness of decision-makers' needs and appreciation of their tacit knowledge; and communication abilities were enhanced with decision-makers, and academics. Many also reported personal desire to fulfill healthcare-system research needs; personal belief in their ability to make a difference; and increased postgraduation marketability.

CONCLUSION

A drug use management and policy program allowed graduate students from various disciplines to develop new skills and collaborate with experts to produce research evidence that was relevant to drug policy that addressed real-world problems.

Partnership between CTSI and business schools can promote best practices for core facilities and resources

Biomedical research enterprises require a large number of core facilities and resources to supply the infrastructure necessary for translational research. Maintaining the financial viability and promoting efficiency in an academic environment can be particularly challenging for medical schools and universities. The Indiana Clinical and Translational Sciences Institute sought to improve core and service programs through a partnership with the Indiana University Kelley School of Business. The program paired teams of Masters of Business Administration students with cores and programs that self-identified the need for assistance in project management, financial management, marketing, or resource efficiency. The projects were developed by CTSI project managers and business school faculty using service-learning principles to ensure learning for students who also received course credit for their participation. With three years of experience, the program demonstrates a successful partnership that improves clinical research infrastructure by promoting business best practices and providing a valued learning experience for business students.

Teacher Characteristics and Perceptions of Pest Management Curricula: Clues to Adoption and Continuation

Educate to Eradicate is a K-12 curriculum project using termite biology and control as the basis for science education that has been implemented in over 350 Hawaii public school classrooms. To encourage sustained implementation of the project, we aimed to identify factors that influence the adoption and continuation of pest management curricula in public school classrooms. Regression analysis of teacher survey data were used to create predictive models of teacher continuation. Teachers motivated by “exciting students about science”, who perceived increases in “student understanding and comprehension of major termite knowledge concepts” and/or students as “more interested in termites after participating in this project” were more likely to continue curriculum. Teachers who had worked at their current school over 21 years at the time of curriculum adoption, and/or who identified having subject specialties not listed on the survey were less likely to continue curriculum. Additionally, teachers servicing lower socioeconomic level students were less likely to continue the curricula.

Effects of academic service learning in drug misuse and addiction on students' learning preferences and attitudes toward harm reduction

OBJECTIVE. To examine academic service-learning pedagogy on student learning and perceptions of drug misuse and addiction. DESIGN. Third- and fourth-year pharmacology students were exposed to an academic service-learning pedagogy that integrated a community service experience with lectures, in-class discussions and debates, group projects, a final paper, and an examination. Reflective writing assignments throughout the course required students to assimilate and apply what they had learned in the classroom to what they learned in their community placement. ASSESSMENT. Changes in students' responses on pre- and post-course survey instruments reflected shifts toward higher-order thinking. Also, subjective student-learning modalities shifted toward learning by writing. Students' perspectives and attitudes allowed improved context of issues associated with drug misuse and harm reduction models. CONCLUSION. Academic service-learning pedagogy contributes to developing adaptable, well-rounded, engaged learners who become more compassionate and pragmatic in addressing scientific and social questions relating to drug addiction.

Impact of a service-learning course on first-year pharmacy students' learning outcomes

OBJECTIVES

To assess the differences in learning outcomes of first-year (P1) pharmacy students enrolled in a course based on service learning with those of a comparable group of students not enrolled in a course involving service learning.

DESIGN

Students on 2 campuses of a school of pharmacy completed a required P1 course involving service learning. A control group of students at a different school completed typical P1 courses, none of which involved service learning.

ASSESSMENT

A questionnaire was administered to P1 students in the study group at the conclusion of the service-learning course, and a similar questionnaire was administered to P1 students in the control group in the spring of their P1 year. Survey questions inquired about what the students had learned generally and in the areas identified as common to the 2 groups of respondents. Differences in the learning outcomes of the students were identified, most notably in the areas of professional communication, cultural competence, the elderly, and awareness of service-providing agencies in the community.

CONCLUSION

This study demonstrated that service-learning positively impacts pharmacy students' learning outcomes.

Service learning in Guatemala: using qualitative content analysis to explore an interdisciplinary learning experience among students in health care professional programs

Introduction

Interprofessional collaboration among health care professionals yields improved patient outcomes, yet many students in health care programs have limited exposure to interprofessional collaboration in the classroom and in clinical and service-learning experiences. This practice gap implies that students enter their professions without valuing interprofessional collaboration and the impact it has on promoting positive patient outcomes.

Aim

The aim of this study was to describe the interprofessional experiences of students in health care professional programs as they collaborated to provide health care to Guatemalan citizens over a 7-day period.

Methods

In light of the identified practice gap and a commitment by college administration to fund interprofessional initiatives, faculty educators from nursing, occupational therapy, and physical therapy conducted a qualitative study to explore a service-learning initiative focused on promoting interprofessional collaboration. Students collaborated in triads (one student from each of the three disciplines) to provide supervised health care to underserved Guatemalan men, women, children, and infants across a variety of community and health care settings. Eighteen students participated in a qualitative research project by describing their experience of interprofessional collaboration in a service-learning environment. Twice before arriving in Guatemala, and on three occasions during the trip, participants reflected on their experiences and provided narrative responses to open-ended questions. Qualitative content analysis methodology was used to describe their experiences of interprofessional collaboration.

Results

An interprofessional service-learning experience positively affected students’ learning, their growth in interprofessional collaboration, and their understanding and appreciation of health care professions besides their own. The experience also generated feelings of gratitude for the opportunity to be a member of an interprofessional team and to serve those in need by giving of themselves.

Conclusion

The findings support service learning as a platform to encourage interprofessional collaboration among students in health care professional programs. The research will inform future service-learning experiences in which interdisciplinary collaboration is an outcome of interest.

The Assessment, Development, Assurance Pharmacist's Tool (ADAPT) for ensuring quality implementation of health promotion programs

OBJECTIVE

To develop and validate the Assessment, Development, Assurance Pharmacist's Tool (ADAPT), an instrument for pharmacists and student pharmacists to use in developing and implementing health promotion programs.

METHODS

The 36-item ADAPT instrument was developed using the framework of public health's 3 core functions (assessment, policy development, and assurance) and 10 essential services. The tool's content and usage was assessed and conducted through peer-review and initial validity testing processes.

RESULTS

Over 20 faculty members, preceptors, and student pharmacists at 5 institutions involved in planning and implementing health promotion initiatives reviewed the instrument and conducted validity testing. The instrument took approximately 15 minutes to complete and the findings resulted in changes and improvements to elements of the programs evaluated.

CONCLUSION

The ADAPT instrument fills a need to more effectively plan, develop, implement, and evaluate pharmacist-directed public health programs that are evidence-based, high-quality, and compliant with laws and regulations and facilitates documentation of pharmacists' contributions to public health.

A diabetes self-management education class taught by pharmacy students

OBJECTIVE

To assess the impact of pharmacy students teaching a diabetes self-management education (DSME) class on their competence and confidence in providing diabetes education.

DESIGN

Pharmacy students enrolled in a service-learning elective first observed pharmacy faculty members teaching a DSME class and then 4 weeks later organized and taught a DSME class to a different group of patients at a student-run free medical clinic.

ASSESSMENT

Student performance as assessed by faculty members using a rubric was above average, with a mean score of 3.3 on a 4.0 scale. Overall, student confidence after teaching the group DSME class was significantly higher than before teaching the class.

CONCLUSION

Organizing and teaching a DSME class improved third-year pharmacy students' confidence and diabetes knowledge and skills, as well as provided a valuable service to patients at a free medical clinic.

An elective course to engage student pharmacists in elementary school science education

OBJECTIVE

To develop and assess the impact of an elective course (HealthWISE) on student pharmacists' skills in communication and health promotion and elementary school students' knowledge of and attitudes toward science.

DESIGN

Three colleges and schools of pharmacy collaborated to develop a 1-credit elective course that used online and classroom teaching and learning techniques to prepare student pharmacists to teach science in elementary school classrooms. Student pharmacists delivered 6 science lessons to elementary students over the course of 2 months.

ASSESSMENT

In weekly journal reflections and a final paper, student pharmacists reported improved communication and health promotion skills. Elementary teachers reported they were satisfied with student pharmacists' performance in the classroom. On pretest and posttest evaluations, elementary students demonstrated increased science knowledge and enhanced enthusiasm for science following the lessons taught by student pharmacists.

CONCLUSIONS

The HealthWISE elective course provided positive benefit for student pharmacists, elementary school teachers, and elementary students.

State boards of pharmacy regulation of the supervision of pharmacist interns

OBJECTIVES

To compare the regulations of state boards of pharmacy for pharmacist intern supervision and review publications of service-learning experiences in pharmacy curricula for methods of supervision.

METHODS

Online state pharmacy statutes and board of pharmacy regulations were searched to characterize which states' regulations included provisions for the supervision of pharmacist interns, permitted nonpharmacist supervision for student volunteers, and included provisions on interns participating in the practice of pharmacy. Additionally, a PubMed search was conducted for articles describing the supervision of service-learning experiences of pharmacy students at various colleges and schools of pharmacy.

RESULTS

The state boards of pharmacy in all 51 jurisdictions included regulations for the supervision of pharmacist interns. Regulations specifically permitted only pharmacist supervision of interns in 45 (88%) jurisdictions, and 3 (6%) states included provisions allowing nonpharmacist supervision of pharmacist interns. Provisions allowing nonpharmacist supervision on a case-by-case basis existed in 6 (12%) jurisdictions. Among the 32 identified reports of service-learning experiences offered in pharmacy curricula, 14 contained the words "supervision" or "supervise," and 9 indirectly described methods of student supervision.

CONCLUSIONS

State boards of pharmacy regulations largely prohibited nonpharmacist supervision of pharmacy students, and reports of pharmacy student service-learning experiences frequently omitted descriptions of student supervision. Boards of pharmacy should consider revising existing regulations to address the growing need for service-learning in pharmacy curricula.

An exercise prescription course to improve pharmacy students' confidence in patient counseling

OBJECTIVES

To create, implement, and evaluate an elective course on the foundational aspects of exercise prescription to increase pharmacy students' knowledge about exercise and confidence in offering exercise advice in pharmacy practice.

DESIGN

A course was designed as an elective using the American College of Sports Medicine guidelines for exercise prescription for healthy and clinical populations.

ASSESSMENT

Surveys of students who did and did not take the elective were conducted over 2 years to assess the impact of the course on students' confidence in knowledge and counseling. Students' confidence in counseling patients about exercise increased after taking the course and remained higher after 6 months.

CONCLUSIONS

This course increased pharmacy students' knowledge and confidence in incorporating exercise prescriptions in their advice to various patient populations.

A regional poison prevention education service-learning project

OBJECTIVE

To create a service-learning project to provide poison prevention education to preschool through fifth-grade students.

DESIGN

The School of Pharmacy collaborated with the Illinois Poison Center and campus departments to train pharmacy students as poison prevention educators. Seventy-eight first-year pharmacy students developed and gave age-appropriate, interactive presentations to more than 8,000 students at preschools and elementary schools.

ASSESSMENT

Preintervention and postintervention evaluations and reflections were collected from the pharmacy students. Ninety-nine percent agreed that they enjoyed the experience and 88% stated that they would continue to provide poison prevention presentations. Based on written assessment of the presentations, most of the preschool and elementary teachers agreed or strongly agreed that the presentations were organized, clear, appropriate for the students, and relevant, and that the pharmacy students appeared knowledgeable and professional.

CONCLUSION

Poison prevention education was an appropriate service-learning project for pharmacy students and provided a beneficial service to the community.

A service-learning course for first-year pharmacy students

OBJECTIVES

To describe the design of a required service-learning course offered to first- year (P1) pharmacy students, and to assess student learning and the relevance of this learning in the pharmacy curriculum.

DESIGN

A 14-week service-learning course was designed and community organizations were recruited to participate. All first-year students enrolled in the School completed the course. A post-course survey was administered to the students, inquiring about what they had learned from the course; supervisors at the students' service sites also completed a short survey.

ASSESSMENT

The course and the student survey instrument were completed by 195 students, and of these 190 gave permission for the information they provided to be used in the study. Notable learning outcomes were identified, especially in the areas of communication and the social and behavioral aspects of pharmacy.

CONCLUSION

The survey administered at the conclusion of the course described in this article demonstrated that students in the course had achieved the desired learning outcomes. This shows that service-learning is a pedagogy that educators can employ to effect relevant learning in the pharmacy curriculum.

A service-learning elective in Native American culture, health and professional practice

OBJECTIVES

To evaluate the success of an elective course in Native American culture, health, and service-learning in fostering interest in experiences and careers with the USPHS Indian Health Service (IHS), and in shaping reflective practitioners.

DESIGN

Students conducted readings, kept reflective journals, and engaged in discussions with Native American and non-Native American speakers. Students orally presented a Native American health issue and spent their fall break in Chinle, Ariz, providing social and healthcare services to the Diné under the supervision of IHS pharmacists. Opportunities for additional IHS experiences were discussed, as was discerning the Creator's call to a professional life of service.

ASSESSMENT

Thirteen of 15 students who had completed the service-learning course by January 2007 responded to a brief survey indicating that not only were the course objectives met, but the experiences had a lasting impact on professional mindset and career plans.

CONCLUSION

The course had a lasting impact on students' understanding of Native American social and health care issues, and on how they will practice their profession and live their lives.

A diabetes camp as the service-learning capstone experience in a diabetes concentration

OBJECTIVES

To assess the effectiveness of a service-learning advanced pharmacy practice experience (APPE) in a diabetes camp to improve student confidence in diabetes knowledge and related skills

DESIGN

Pharmacy students assisted medical staff during a week-long diabetes camp for children. Students participated in all aspects of diabetes care, as well as wrote pre- and post-camp reflection papers, completed online quizzes, presented an educational training session, and completed pre- and post-camp survey instruments.

ASSESSMENT

Students' confidence in their diabetes knowledge and patient care skills increased as a result of participating in the camp.

CONCLUSION

A diabetes camp APPE improved students' confidence in their knowledge and ability to manage diabetes, and allowed them to gain experience working with an interdisciplinary team in a unique real-world environment.

A service-learning elective to promote enhanced understanding of civic, cultural, and social issues and health disparities in pharmacy

OBJECTIVES

To evaluate the effectiveness and impact of an elective service-learning course offered in cooperation with a charitable pharmacy providing services to the surrounding community.

METHODS

The 33 students enrolled in the service-learning elective were given a 23-question preservice survey instrument and a 32-question postservice survey instrument. The survey instruments were designed to measure change in the students' perceived knowledge and understanding regarding civic, cultural, and social issues and health disparities.

RESULTS

Significant differences in responses on the presurvey and postsurvey instruments suggested changes in students' attitudes and perceptions about the patients and the community in which they serve.

CONCLUSIONS

Results of the survey indicated that by exposing students to issues affecting individuals and the community during this elective, a positive change in the student's perception of their knowledge and understanding of broader issues facing the community was observed. Service-Learning courses provide additional opportunities for students to develop as competent, engaged, and caring health care professionals.