Service Learning – Its Role in Enhancing Global Health Competencies for Students and Residents Sam C. Matheny, MD MPH Maria Gabriela Castro, MD Katherine McCormick, PhD Some slides adapted from those developed by Esther Livingston, Barbara Jacoby & Janet Eyler

Activity Disclaimer ACTIVITY DISCLAIMER It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. Sam Matheny, MD MPH, Maria Gabriela Castro MD and Katherine McCormick PhD have indicated they have no relevant financial relationships to disclose.

Objectives Review key elements of service learning Delineate role of service learning in developing competencies of community engagement in Global Health Education Discuss challenges of implementation in short- term experiences Identify key elements of service learning as an educational modality Delineate the role of service learning as an educational tool in Global Health education to achieve competencies related to community engagement with a focus on resource-limited settings Present challenges and concerns of these guiding principles in typical environments of short-term global health educational experiences

Continuum of Campus & Community Partnerships for Engagement Adapted from Furco, 2000

S-L Definition for UK: Credit-bearing learning experiences designed to enhance mastery of course concepts and content, gain appreciation of the discipline within the societal context, and promote civic responsibility through meaningful community service that meets a community-identified need.

Service-Learning ... Is different from volunteerism Is a type of experiential learning Requires a deliberate connection between service and academic learning objectives Involves planning, preparation, and thoughtful reflection Balances the service and learning; equal exchange between community partner and students Traditional courses Usually do not include any type of service or provide real-world application Internships and cooperative education Experience may be separate from academic classes Lack guided reflection activities to enhance learning and connect to academic content Volunteer activities and opportunities Isolated from academic components, may be exclusively about the service Lack guided reflection activities and connection to academic content

Key Principles Most often a credit- bearing, educational experience Addresses community- identified need through student activity/action Uses Reflection & Reciprocity among partners

Community Need = Service When students meet a community identified need - this is the service aspect of Service-Learning

Connected to Discipline or Content of Study = Learning When the service is connected to the student’s discipline or a content of study (i.e., civic responsibility, global citizenship) this is the learning part of Service-Learning

Principles of Service Learning should guide the design of Global Health Educational experiences Delineate the role of service learning as an educational tool in Global Health Service Learning is a very important tool for GHE. In fact, we argue that the key principles of service learning mentioned prior should serve to guide the development of GHC’s, especially with regard to community engagement and especially in LRS’s. There is important overlap in the key elements and the desired outcomes of service learning and in the core competencies in Global Health There should be deliberate attention on building GHE experiences that include these elements (4 stage model) Service learning experiences might be a necessary (but not sufficient) experience for learners develop competency in core areas Principles of SL should should guide the design of GHE experiences in order to achieve a mutually desired outcome of promotion of civic responsibility through meaningful service that meets a community identified need and appreciation for discipline within a societal context. This requires of the learner: Building relationships with and gaining the trust of community partners (engagement, cultural competency) Hearing and being led by community voice (empowerment) Developing skills for teamwork and collaboration This requires of the instructors: Collaboration with community partners for needs assessment Communication and negotiation with community partners to articulate desired project outcomes, methods, roles and resources Careful and deliberate planning of educational methods and objectives that are aligned with projects Recognition and empowerment of community partners as valued educators and experts in their experience the role of service learning in medical education SL in Medical Education (Sam’s slides 10-13) 4 stage model (Stewart, Wubbena 2014) key elements planning and preparation (instruction) action (community service + instruction) reflection and demonstration assessment and celebration outcomes: enriched learning experience, civic responsibility, strengthen community; critical thinking and problem solving skills, application of real world knowledge prepares health science students to work in communities of need

prep planning action reflection Service Learning can provide a framework for collaborative development of GH Competencies prep planning action reflection Delineate the role of service learning as an educational tool in Global Health education to achieve competencies related to community engagement with a focus on resource-limited settings SL can provide a collaborative framework to help academic institutions and educators in HRC engage in more equitable development of Global Health competencies with community partners especially in low resource settings IP Global Health Competencies were developed to set a minimum standard across health professions with the idea that they could be customized to the needs of individual professions; these are broad and numerous consider the many areas of study and the complex nature of global health work. Admirable achievement in breadth and scope. Critique of GHC’s is that they are unilateral developed in and with only the perspective of High resource countries; Developed with HRC learners and academic settings in mind Not sufficiently inclusive of community partners, esp in LRC’s The common focus of community engagement as both a key element of service learning and a central theme in many of the core competencies for Global Health provides an opportunity to use SL as a framework that is more inclusive and democratic Provides community voice and reciprocity Includes collaborative development of GHC (shared mind) Includes more meaningful learner outcome measures (self-directed, desirable difficulties, resourcefulness learning)

… when balanced with benefit to the community Service learning in low resource settings can provide excellent opportunities for Global Health learners Good opportunity but caution / pitfalls with vulnerable settings … when balanced with benefit to the community

Which Global Health competencies are best met by service learning?

http://www.annalsofglobalhealth.org/article/S2214-9996(15)01156-X/pdf Report of CUGH Global Health Competency Subcommittee. 2015

Committee report 13 disciplines 82 competencies 12 domains 4 levels Level one-global citizen level. Competencies required for all post-secondary students pursing any filed with bearing on global health Level two—Exploratory level. That level required of students at exploratory stage consideriing futurer global health careers or activites. Level three—Basic Operational; :for students spending a moderate amount oftime, but not entire career in global health Level Four—advanced level. Competency sets required of students whose engagement with global health will be significant and sustained.

Domains Global Burden of Disease Globalization of Health and Health Care Social and Environmental Determinants of Health Capacity Strengthening Collaboration, Partnering and Communication Ethics Professional Practice Health Equity and Social Justice Program Management Sociocultural and Political Awareness Strategic Analysis

Challenges of Global Health Service Learning Activities Objectives Need to develop student learning objectives for educational experiences Who develops these and how? Conflict of individualist vs. collective approaches—lack of focus on attributes acquired through social interaction and participation (Eichbaum) Interdisciplinary: students value this experience but faculty struggle with concordance of objectives across professions Methodology: Assurance of following all components of service learning—don’t leave out reflection! Look at the bigger picture—don’t forget social determinants of health! Evaluation Should be appropriate to objectives Must include all stakeholders (faculty, students, residents and community partners) Important to do educational objectives for the service learning component as well as the class experience Evaluation instruments are important. May have difficult being appropriate for the educational experience Hard to get disciplines to agree on sometimes simple things. All components of service learning important—reflection may help with a self-directed assessment. Have assessment focus on qualitative and narrative approaches rather than numbers. Difficult on occasion to get disciplines to look past their immediate interest. Medicine, pharmacy, etc. Opportunity to look at broader picture of health determinants. Develop new competency of “interprofessional colllaboration” Individualist vs collective approaches to assessment is issue. If evaluate how group does as whole, may emphasize how teams work together in health care setting.

What are your challenges?

References Jogerst K., Callender B, Adams V.et.al. Identifying Interprofessional Global Health Competencies for 21st-Century Health Professionals. Annals of Global Health. Vol. 81, No. 2, 2015. Eichbaum Q. The Problem With Competencies in Global Health Education. Academic Medicine Vol. 90, (4) April, 2015.

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