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For a PDF version of this announcement, click here.

One of the overarching goals of Healthy People 2020, the government’s just-released 10-year health improvement agenda, is to “achieve health equity, eliminate disparities, and improve the health of all groups.”

A new study in the Journal of Health Care for the Poor and Underserved suggests that a particular type of community service experience—one that is mentored, entrepreneurial, reflective, and multidisciplinary—may be a key way to mobilize emerging health professionals towards effectively achieving this goal.

Contrary to previous reports—which have found that interacting with populations in need during health professional training may actually discourage students from pursuing paths that involve working with underserved groups[1]—the new study finds that programs offering a mentored, entrepreneurial, reflective, and multidisciplinary community service experience may both:

  • Decrease health professional students’ perceived barriers to future service, and increase their confidence in skills related to working effectively with community agencies and their clientele; and
  • Provide “significant benefit” to community agencies and their clientele

“In addition to social determinants like poverty, education, and housing, it’s clear that suboptimal opportunities for service and interdisciplinary collaboration in traditional health professional education may contribute to disparities in health and health care,” said Jan Walker, RN, MBA, the study’s lead author.

“We wanted to explore the impact of programs that work to counteract those factors—specifically, programs that provide health professional students with opportunities to care for underserved individuals, while working collaboratively across disciplines,” Walker said of the motivation for the study (“Health Professional Students in Community Service,” Journal of Health Care for the Poor and Underserved, Volume 21, Number 4, November 2010, pp. 1292-1303). “Such programs may hold the key to developing a workforce of health professionals who are dedicated and skilled in meeting the health needs of underserved people.”

Accordingly, the service experiences of nearly 600 U.S. Schweitzer Fellows—as well as insights from the community-based agencies with whom they partnered—form the basis of the study. U.S. Schweitzer Fellows, supported by The Albert Schweitzer Fellowship (ASF), are health-focused graduate students who undertake a mentored, entrepreneurial, reflective, and multidisciplinary service program. In contrast to traditional service opportunities for health professional students—which are often short-term electives, or options to fill the summer gap—Fellows spend a full year partnering with community agencies to create and carry out service projects aimed at addressing unmet health needs, all on top of their usual professional coursework. Fellows also participate in leadership development and other trainings, as well as structured individual and group reflection with multidisciplinary peers.

Walker and her team of colleagues (including the study’s senior author, Lachlan Forrow, MD) gathered pre- and post-service experience survey data from 566 Schweitzer Fellows from 2002 through 2007. The team found that Fellows’ confidence in 11 of 16 service-related skills increased, and that their perceived barriers to future work with underserved people diminished.

That positive trend was also reflected in the responses of Fellows’ community agency mentors, who valued their participation in ASF and reported that:

  • 85 percent of Fellows’ projects “made significant contributions to their agencies or clients”;
  • 61 percent of Fellows’ projects were expected to continue beyond the Fellowship year;
  • 73 percent of mentors reported that they would participate again as mentors; and
  • 82 percent would recommend ASF to another community agency.

“As the nation considers how to improve community-based care directed to the underserved, these findings are encouraging,” the study’s authors write. “Our evidence suggests that an entrepreneurial, mentored service experience during health professional training, combined with structured personal and interdisciplinary peer reflection, may have measurable positive impacts on participants’ knowledge, skills, and confidence relevant to ongoing service. Finally, it may provide significant benefit to community-based agencies and the people they serve.”

The study’s authors plan to focus future evaluation on the program’s long-term impact on health professional students’ commitment to working with underserved people. “Right now, the U.S.—and the world—needs stronger pipelines that produce skilled, committed, and effective service-oriented health professionals,” says Forrow. “At ASF, we are committed, with rigorous evaluation, to developing one.”

To read the full paper, click here.

Supported by a grant from The Merck Company Foundation, the paper’s authors include:

  • Jan Walker, RN, MBA, Director of Evaluation for The Albert Schweitzer Fellowship and an Instructor in Medicine at Harvard Medical School (HMS)
  • Kari Hannibal, MA, Program Manager, International and Language Programs, Office of Enrichment Programs, HMS
  • Meghan L. Johnson, MS, National Program Director of The Albert Schweitzer Fellowship
  • Roger B. Davis, ScD, Associate Professor of Medicine, HMS, Division of General Medicine & Primary Care, Beth Israel Deaconess Medical Center, and Department of Biostatistics, Harvard School of Public Health
  • Lachlan Forrow, MD, President of The Albert Schweitzer Fellowship, Associate Professor of Medicine at HMS, Division of General Medicine & Primary Care, Beth Israel Deaconess Medical Center

To schedule an interview with Jan Walker or Lachlan Forrow, contact Patrice Taddonio at 617.667.5628 or ptaddoni at bidmc.harvard.edu.

[1] Wear, Delese  and Kuczewski, Mark G. “Medical Students’ Perceptions of the Poor: What Impact Can Medical Education Have?” Academic Medicine. 83.7 (July 2008): 639-645.