1. COMBINING SERVICE AND LEARNING Clinical Rotations
Sandra P. Daley, M.D.
Assistant Dean of Diversity and Community Partnerships
University of California, San Diego
School of Medicine

2. PREAMBLE
We are a nation founded upon active citizenship and participation in community life. We have always believed that individuals can and should serve.

3. USEFUL DEFINITIONS Community Service Programs
Direct services that respond to critical human and environmental needs

4. USEFUL DEFINITIONS Cont’d
Service Learning:
Programs that emphasize the accomplishment of tasks which meet human needs in combination with conscious educational growth

5. USEFUL DEFINITIONS Cont’d
A philosophy of education that
Emphasizes active, engaged learning
Explores a social vision,
Acknowledges social responsibility
Develops an approach to community
(1969 definition from the Southern Regional Educational Board)

6. Factors that Distinguish Service Learning
Critical Reflection:
Encourages participants to see their actions within the larger context of issues of societal justice and social policy rather than charity (“doing for”)

7. Factors that Distinguish Service Learning
Reciprocity:
Both server and those served teach and both learn
The needs of the community determine what the service tasks will be
Dynamic and interactive creating a sense of mutual respect and responsibility

8. Experiential Education
All service-learning programs are experiential education programs but all experiential education programs do not have the service emphasis
An important distinction when designing clinical rotations

9. Principles of Good Practice In Combining Service and Learning
1. Engages people in responsible and challenging actions for the common good
- Active participation, accountability, risks, consequences

10. Responsible and Challenging Action
Students select clinical site
Clinical experience is part of core clerkship
Students understand expectations for performance
Students identify reasons for choosing this experience

11. Principles of Good Practice In Combining Service and Learning
2. Provides structured opportunities for people to reflect critically on their experience
- Intentional, continuous group discussions, individual reflections on moral questions and relevant issues with feedback from peers, program leaders and persons served

12. Principles of Good Practice In Combining Service and Learning
3. Articulates clear service-learning goals for everyone involved
- Through negotiations with all parties and in the context of the culture, determine what is to be accomplished and what is to be learned.

13. Clearly Articulate Goals
Clerkship directors, clinical staff, and students
Formalize goals
Prepare syllabus
Provide time for activities designed to meet the goals

14. Principles of Good Practice In Combining Service and Learning
4. Allows for those with needs to define those needs
- Community groups, community service programs, government agencies, private organizations in order to:
a) not take jobs from local community
b) involve tasks that would not be done
c) focus on tasks and approaches that area viewed as useful

15. Principles of Good Practice In Combining Service and Learning
5. As the program is developed clarify responsibilities of each person and organization involved
6. Match service providers and service needs through a process that recognizes changing circumstances
- Feedback, evaluation, unintended outcomes

16. Principles of Good Practice In Combining Service and Learning
7. Expects genuine, active, sustained organizational commitment
- Administrative support, budget, physical space, equipment, scheduled release time, in schools linked to curriculum, faculty commitment
8. Includes training, supervision, monitoring, support, recognition, and evaluation to meet service and learning goals

17. Principles of Good Practice In Combining Service and Learning
9. Insures that the time commitment for service and learning is flexible, appropriate, and in the best interest of all involved
10. Committed to program participation by and with diverse populations
- sensitivity to barriers such as transportation, family, safety, ability to make a contribution

18. References
Kendall J and Associates: “Combining Service and Learning, A Resource Book for Community and Public Service” Vol I, Vol II, 1990
Brush D, Markert R, Lazarus C. The Relationship Between Service Learning and Medical Student Performance Outcomes.  Teaching and Learning in Medicine 18 (1), 9-13, 2006. 
Elam C, Hafferty F, Messmer J, Blue A, Flipse A, Lazarus C, Chauvin S:  “Medical Students’ Perspectives on the Nature and Meaning of Community Service” Journal of Experiential Education Vol 26,  No 3, 2004

19. References Cont.
Lazarus C, Krane K, Bowdish, B: "An Innovative Partnership in Service" Academic Medicine (July, 2002)
Burrows M, Chauvin S, Chehardy P, Lazarus C:  “Required Service Learning for Medical Students: Program Description and Student Response,” Teaching and Learning in Medicine, Vol II, No. 4, 1999
Lazarus C:  “Implementation of a Foundations in Medicine Course,” Teaching and Learning in Medicine, Vol II, No. 3, 1999