PGY1 Pharmacy Resident
MedStar Union Memorial Hospital
Hands-on experience in the education of health care professionals has been widely accepted as a core component of instructional design. Nursing programs typically have formal hands-on experience (i.e., clinicals) from the start of instruction whereas medical and pharmacy programs typically have two or three didactic years followed by clinical rotation years. In these programs, students begin working with patients and applying their skills before graduation and stepping into new practitioner roles. In a review article, this approach to learning has historically been one-sided and focuses on how the student can benefit.1 In recent years, perspectives in health education have shifted the focus equally on student learning and service to patients and communities.1 Service-learning can be defined as, “a structured learning experience that combines community service with explicit learning objectives, preparation, and reflection, in which students learn about the context in which the service is provided, the connection between the service and their academic coursework, and their roles as citizens.”1
The benefits of service-learning have been described as creating community-responsive, culturally competent healthcare practitioners, cultivating citizenship, and achieving social change, and transforming relationships between communities and educational institutions. 1 My experience with service-learning began my first year of pharmacy school. Notre Dame of Maryland University School of Pharmacy created an innovative Advocaring program that pairs students with community-based organizations for the course of their four years of study.2 While students are not ready to be clinical practitioners on day one, they can begin to learn to value the basics of human interaction, respect, cultural awareness, and respect.1 My first Advocaring assignment was at the Arc of Baltimore. As a group of 10 pharmacy students, we were responsible for providing health education through interactive activities about topics such as healthy eating, proper handwashing, and stress management for children and adults with developmental disabilities. We had a pharmacist mentor who would oversee our work and help guide us through the process and debrief afterword. These experiences provided us with a chance to work on our communication skills, build rapport with the community, better understand the needs of our underserved communities in Baltimore, MD.
In addition to building on the soft skills early on necessary to be health care professionals, we were responsible for developing education events for service-learning. For example, our group identified that the children would benefit from a lesson around hand-hygiene given flu season was approaching. We designed an interactive lesson to explain what germs were, why they can be dangerous, and how we can help prevent spreading our germs by washing our hands. Next the group worked together to draft materials for the session and made necessary edits based on evaluation by our mentor. After implementing the group would meet with the pharmacist and evaluate the event and submit a reflection. This process, also known in instructional design as the ADDIE process, was repeated as we encountered new community groups and continued to identify needs.
As healthcare continues to focus on a patient-centered approach, how can instructional design incorporate more service-learning? An article about incorporating service-learning into medical education recommends building university-community partnerships, establishing structure, funding, and recognition for faculty as a few ways to get started.3 The article suggests service-learning activities can be categorized into three categories: 1. educational/training (i.e. diabetes education) 2. Clinic/community-based (i.e. health fair for elderly), 3. Advocacy, policy, and outreach (autism awareness, fundraising).3 The service should be meaningful, have academic integrity and put the student in a position of responsibility and ownership.3 An important part of instructional design and service learning is reflection. Best practices for reflection in service-learning include setting goals, knowing the audience, making time, sharing expectations, identifying resources, reviewing skills, creating transparent evaluations, demonstrating the importance of different types of reflection, and embracing/capitalizing on teachable moments. 3 Typical pedagogical learning measured student outcomes through exams and quizzes for example. Student service-learning should still be assessed but may be better suited by written reflections, open-ended questions, or poster-presentations to share the experience with faculty and other students. 3
In summary, service-learning has the potential to develop healthcare students and improve the lives of underserved communities through the identification of community needs and instructional design.
References:
1. Kayser C. Cultivating community-responsive future healthcare professionals: Using service-learning in Pre-Health Humanities Education. Journal of Medical Humanities. 2017;38(4):385–95.
2. The advocaring program [Internet]. Notre Dame of Maryland University. [cited 2021 Oct 18]. Available from: https://www.ndm.edu/colleges-schools/school-pharmacy/resources/advocaring-program.
3. Stewart T, Wubbena A. An overview of infusing service-learning in medical education. International Journal of Medical Education. 2014;5:147-156.
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