Learning Service Learning
Departments across the School of Medicine & Health Sciences get way into Service Learning—and learn a lot about the health system and their community in the process.
As the trend toward “service learning” has become more common across colleges and universities in the United States, disciplines of all sorts have made an effort to get students off campus and into environments where classroom-based skills and concepts can be applied to the broader community in a direct way.
Medical schools, perhaps obviously, are no exception: from medicine to occupational therapy, public health to physician assistant studies, the UND School of Medicine & Health Sciences (SMHS) too has been cultivating its service learning programs over the past decade.
And in many cases, such efforts are being led by students themselves.
“We were both members of the UND Honors Program, and that is where I was first exposed to the concept of service learning,” recalled Michael Storandt, second-year medical student at the SMHS and referring to his partner in crime Jacob Greenmyer, a third-year medical student at the SMHS. “In the Honors Program, we began to dive deeper into service experiences by asking questions: Are we actually helping anyone with our service? Why do we choose to do the service that we do? This provided a foundation for me to begin to better understand my community involvement and how to take it to the next level.”
Having brought his undergraduate training with him to the SMHS, Greenmyer launched the School’s first Service Learning Day, wherein more than a dozen medical students discussed service learning with an audience of faculty, staff, and students, in 2018.
While Greenmyer did much of the work in 2018, he was off-campus at clinical rotations this year, meaning Storandt managed this year’s event.
“I had been volunteering for various things since high school,” continued Storandt, who has devoted the bulk of his volunteer work to North Dakota Special Olympics and credits his service work with making him a better student of medicine. “[This work] has prepared me to be a better physician. If there was a specialty that solely dealt with individuals with intellectual disabilities, that’s what I would do. But I am also interested in oncology, and I believe Special Olympics has better equipped me to work in any field that is extremely challenging in that you are working with patients dealing with very serious conditions, helping them navigate and cope with what is likely one of the most stressful situations they will experience."
Avoiding “drive-by service”
Although university-based volunteer initiatives have been around for decades, they came under increasing scrutiny near the end of the past century for engaging in so-called “drive-by service” or (in the case of the often religiously affiliated medical mission trips abroad) “slum humanitarianism.” The critique of such programs was that although they often made volunteers feel good about helping those suffering from a lack of resources as much as illness, they did nothing to change the conditions that contributed to the community’s poverty or poor health outcomes in either the long or short term.
Responding to such critiques, schools of all types have made more of an effort to embed genuine, long-lasting, and self-critical service learning programs into their curricula.
Greenmyer’s and Storandt’s Service Learning Days notwithstanding, the SMHS medical curriculum includes elective courses that send faculty and students to places like Peru and Haiti to gain hands-on experience treating a variety of medical needs in resource poor environments.
Or consider the courses that fall under the health sciences umbrella at UND.
“We needed a link between in-class academics and fieldwork,” explained Associate Professor in UND’s Department of Occupational Therapy Cindy Janssen, PhD, OTR/L, CLA. “Service learning is a high-impact learning practice which facilitates hands-on learning in a way that benefits clients, organizations, schools, and students.”
Explaining how for a decade now she has followed the “Prepare, Act, Reflect, Evaluate” (PARE) model of service learning, Janssen noted too that students are told early on that the needs of the community come first.
“Our number one focus has to be on win-win scenarios,” she said, referencing her department’s partnerships with organizations that serve everyone from senior citizens to immigrants. “The best outcomes are when the clients and organizations feel they’ve gotten something positive and sustainable out of the experience.”
UND’s Department of Physician Assistant Studies too has embedded service learning into its curriculum, including in the course PA567 (“Professional Issues & Role Development II”), which asks students to develop, execute, and reflect upon a service learning project in students’ clinical communities.
Getting to the core of not only the PARE model, but the service learning scholarship of innovators in the field like Barbara Jacoby, the PA567 assignment encourages students to “Develop insight into racial, ethnic and socioeconomic health disparities on health care delivery,” asking them to answer hard questions like “Did the ‘service’ empower the recipient to become more self-sufficient?” and “How, specifically, has the community benefited?”
“This type of assignment gives students a grounding for continued community service work in their home areas throughout their careers,” said Jeanie McHugo, PA-C, PhD, chair of the School’s Department of Physician Assistant Studies, who helped her department embed service learning into the PA curriculum in a more formal way in 2016. “Our hope is that these students will become a vibrant part of that community in which they will be practicing, so we want them to be thinking about how they can work on blood drives or hypertension screenings or other community-based service opportunities. When assignments are done well, you can have students who have that ‘wow’ moment where they realize the [socioeconomic] variability of people in their community and how that connects to their access to care, for example.”
Service Learning Day
Hoping to expand medical students’ Service Learning Day to all departments in the School, Storandt wants to see the event grow to “something comparable to [graduate researchers’] Frank Low Research Day, where we could have a poster session in addition to an oral presentation portion.”
In each case, it seems the “learning” that occurs on students’ behalf goes way beyond medicine or clinical practice.
“Much of my service work and volunteerism wasn’t directly in medicine,” said second-year medical student Carissa Klarich, who spoke on a bicycling program she helped develop in Bozeman, Mont. Calling the exercise program a “gateway to becoming better acquainted with my community,” Klarich added that the service taught her less about medicine than the social determinants of health.
“It helped to teach me about the needs of my community as well as the socioeconomic issues affecting my community,” she said. “Above all, it made me acutely aware that if we don’t understand the socioeconomic and environmental issues within our community and local or state populations, we will be hamstrung in our medical practices, unable to fully help our patients improve their health and manage their conditions.”
Second-year medical student Elena Danielson, who spent time in India volunteering with an organization called Himalayan Health Exchange, agreed.
“My experience in India made me think critically about the types of socioeconomic and structural barriers that patients in general can face,” she noted. “For where we were in Spiti Valley, one huge barrier was limited access to medical professionals due to the geography of the region. It was important to understand our patients’ everyday lives in order to understand the medical conditions they were developing, and how we could counsel them to be healthier and hopefully prevent some of these problems.”
Or, as first-year medical student Hannah Drazenovich concludes, speaking of her time in Haiti for Service Learning Day, “When you consider an individual patient’s condition, such as a broken arm, it is easy to assume that the next step is to get an X-ray, stabilize the break, and get surgery to repair the injury. However, this seemingly simple chain of events becomes much more complicated when you incorporate this case into how a health care system functions. In the hospital where I volunteered, payment would need to be provided before any care was given. This may result in patients waiting extended periods of time before they receive any diagnostic measures or treatment. Being outside of my comfort zone and volunteering in a new health care system taught me to really inspect the intricacies of each system to gauge whether this the best for our patients and greater society and, thus, spark change.”