longitudinal service learning impacts students' attitdues toward primary care

Authors

Rucker
Lisa; Santos
Maria; Purcell
Jennifer; Conley
Elizabeth

Theme

Curriculum Planning / Community Oriented Medical Education

INSTITUTION

Albert Einstein College of Medicine

Background

     SERVICE- LEARNING IS A TEACHING AND LEARNING STRATEGY THAT INTEGRATES MEANINGFUL COMMUNITY SERVICE WITH INSTRUCTION AND REFLECTION TO ENRICH THE LEARNING EXPERIENCE, TEACH CIVIC RESPONSIBILITY, AND STRENGTHEN COMMUNICATION.

(from http://educationprogram.duke.edu/service-learning)

 

     LCME standard IS-14-A

Medical schools should make available sufficient opportunity for medical students to participate in service-learning activities and should encourage and support student participation.                                                                          

  

Research question

  The impact of longitudinal programs on student attitudes toward primary care is unclear.We asked "What is the impact of an extracurricular service learning opportunity on attitudes toward primary care, self-efficacy working with the underserved, and  career plans?"

Summary of Work

 

ECC--Einstein Cares for the Community                                          a 3-year funded HRSA/ARRA grant

 

          ECC Goals

 

Create longitudinal partnerships with community-based organizations

·  Improve students’ attitudes toward working with community groups

·   Increase students’ self-efficacy in providing care for underserved

·   Foster students’ interest in primary care


 

 

  ECC program study design

Students volunteer to participate in a semi structured, mentored service –learning experience in Bronx.

Students were surveyed at the start of the year and at the end.


 

Primary Care and

Community Engagement Survey

Validated 2011

Administered to ECC participants and controls in Sept 2011 and May 2012

Intervention group—MS1 & MS2 students in the ECC program

Control Group—MS1 students who expressed interest in ECC but did not join

Acknowledgement

Thanks to the Albert Einstein College of Medicine, the departments of Family Medicine, Pediatrics and Internal Medicine, and Montefiore and Jacobi Hospitals

Summary of Results

ECC affected attitudes toward working with underserved communities

 

 

Intervention

   Control

Chronbach’s alpha

 

mean/sd

  mean/sd

     

Pre-test

4.28/0.60

 3.72/0.62

      0.87

Post-test

4.31/0.53

    3.67/0.58

      0.89

Adj. gain score

   0.140

  -0.108

ANCOVA  0.043

 

 

 

    ECC affected confidence in pursuing a Primary Care career


·         

Intervention

      Control

 

 

mean/sd

     mean/sd

     

Pre-test

2.83/1.04

    2.76/0.95

     

Post-test

3.22/0.94

    2.36/0.99

     

Adj. gain score

   0.407

       -0.369

 ANCOVA 0.000


 


ECC did not affect self–efficacy in

working with the medically underserved


 

Intervention

      Control

Chronbach’s alpha

 

mean/sd

     mean/sd

     

Pre-test

4.09/0.62

    4.05/0.65

      0.91

Post-test

4.14/0.56

    4.22/0.53

      0.90

Adj. gain score

   0.080

       0.160

ANCOVA  0.618

 

 


 

 


ECC did not affect attitudes towards

Primary Care 


·         

Intervention

      Control

Chronbach’s alpha

 

mean/sd

     mean/sd

     

Pre-test

4.04/0.30

    3.83/0.30

      0.73

Post-test

4.09/0.29

    3.86/0.31

      0.74

Adj. gain score

   0.128

       -0.006

 ANCOVA 0.135


 

 

Generalized linear models compared results between groups, controlling for initial measures. 

Conclusion

                                 The ECC Program 

Positively affected attutudes toward working with underserved communities  


Affected confidence in pursuing a primary care career


Did not affect self-efficacy in working with the medically underserved


Did not affect attitudes towards primary care.

Take-home Messages

Students who self-select into extracurricular service learning programs are different from other students.  Participation in such programs may support students' intentions to pursue a career in primary care and to work with the underserved, while non-participants' intentions decrease.

Background

BRONX    is an inpoverished county in New York, USA

Population  1,385,000                                                                 28% live below federal poverty level

    Poorest congressional district in US                                            Mortality  ranked 61/62 counties in New                                                                                                                       York state

           Social and economic factors ranked 62/62 in New York state                                                                            


 

US census data 2010  

Summary of Work
Acknowledgement
Summary of Results

 

Significant differences existed between intervention and control groups at baseline for attitudes, confidence in their choice to pursue primary care and interest in working with underserved populations, but not self-efficacy.     Effect sizes were large.  

Conclusion

Problems and challenges

Small number of respondents

  18/29  ECC students completed post survey 

  29/49 control students completed post survey

 

Control students were involved in other service clubs

Free Clinic, HIV outreach group, Physicians for social responsibility, Physicians for human rights

 

Big time investment for mentors and administrators

Different focus at each site

(Research, Health education, Advocacy)

Bureaucratic obstacles

 

Funding issues for sustaining the program

Take-home Messages
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