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Community S ervice L earning

1 Preparing tomorrow’s healers to act with compassion and justice.


University of Texas (UT) Health Science Center San Antonio More than 3,000 students per year train for careers in the health field within the UT Health Science Center’s schools of biomedical science, dentistry, health professions, medicine, and nursing. Established in 1959, the Health Science Center’s purpose is to provide the best in health careers education, biomedical research, patient care and community service to San Antonio and the South Texas region. It extends to campuses in the metropolitan border communities of Laredo and the Rio Grande Valley. The Health Science Center has a mission to serve the community by enhancing health care in medically underserved areas. As a result of this dedication to service, the Health Science Center has earned a place on the President’s Higher Education Community Service Honor Roll, the highest federal recognition a university can receive for its commitment to service learning and civic engagement. The Center for Medical Humanities & Ethics The Center’s vision is to provide a unique program that will make a significant difference in the quality of medical education in the United States. The program emphasizes ethics and professionalism and encourages service-based learning in organizations and clinics in San Antonio and South Texas, in the colonias of Laredo and Corpus Christi, and in missions abroad, where students experience medicine as it is practiced in resource-poor environments. The Center works to assure that students are knowledgeable about the principles of medical ethics related to their professional activities. They are expected to be able to identify, analyze and resolve moral conflicts that arise in the care of a patient. The program helps heighten students’ sensitivity to the patient’s experience and preserve their innate empathy.

Mission We strive to be a leading center educating medical students and health professionals in ethics and professionalism while nurturing empathy and humanitarian values. We fulfill our mission by: • Preparing students to identify, analyze and resolve moral conflicts in patient care and medical research; • Deepening the attentiveness to patients that will persist throughout students’ medical careers through exposure to arts and letters; and • Developing a distinguished interdisciplinary community service learning program that focuses on ethics in action and serves as a bridge between ethics education and development of empathy and humanitarian values.

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Contents Introduction................................................................................... 1

The Community Service Learning (CSL) Program��������������������������3 Definition of Community Service Learning 4 The Benefits of CSL 5 CSL Online Directory 6 How to Participate in CSL 7 Mini-grants8 Annual CSL Conference 9 Examples of CSL Projects 9 Roles and Expectations for CSL Partnerships�������������������������������10 Student10 Mentor  12 Community Partner 12 Center for Medical Humanities & Ethics 13 CSL Project Components�������������������������������������������������������������14 Orientation 14 Student Preparation 15 Monitoring  15 Results and Evaluation 15 Reflection 16 How to get Involved with the CSL Program���������������������������������17 Frequently Asked Questions��������������������������������������������������������18 Center for Medical Humanities & Ethics Contact Information ���19 Resources������������������������������������������������������������������������������������20 Appendix�������������������������������������������������������������������������������������21


Introduction

A student checks the blood pressure of a volunteer at an East Side San Antonio Barber Shop as part of a hypertension education project. 1


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ending to patients’ needs involves more than knowing the facts of an illness or intricacies of a procedure. As health professionals, we must know how to speak to patients – and when to stop talking and simply listen. We need to appreciate how the unique circumstances of a life can impact health. And we should never forget that each patient is a person deserving of our respect and compassion. The Center for Medical Humanities & Ethics at the UT Health Science Center is committed to imparting vital lessons like these to the next generation of doctors, nurses and other health professionals who will someday serve our San Antonio community and beyond. It’s our duty to nurture the empathic and committed health professionals that you would want for yourself or your family in a time of illness. Our efforts include coursework and opportunities for reflection, but they cannot end there. Recognizing that the most important lessons often come not from books or lectures but the people we encounter in our lives, we urge students to put ethical principles into action through community service learning. Consider the example of one medical student who volunteered in our student-run free clinics, which provide necessary health care to recovering drug addicts and the homeless. Afterward, the student reflected on his experience: “I learned how to put a face on the disease of addiction. So often as a health care provider, it is easy to categorize people and start to deem them worthy or unworthy of your time and your care. Working in the student-run clinic helped me understand that underneath an awful disease is a human being in need of compassion and kindness.” As his words illustrate, community service learning is a two-way street: The student addressed a real need, providing care to those who otherwise might not have received it. At the same time, he came away with a reawakened sense of empathy and the recognition that a health career can be more than a job but a calling to serve. Such insights would not occur without the experienced health professionals who mentor our students or the community organizations who host them. Their dedication and humanity set an important example for students, helping them to truly appreciate the 2 community’s needs and inspiring them to serve.


Guided by mentors, our students offer primary care at student-run clinics around San Antonio to those struggling with homelessness or addiction. Students also run Frontera de Salud, which provides health education, screenings, immunizations and home visits in impoverished parts of South Texas. Some students travel to resourcepoor settings including Haiti and Ethiopia, which present stark examples of the desperate conditions that exist when medical care and public health infrastructure are lacking. The many creative projects that students have led include helping teenage mothers learn to breastfeed their babies, designing a summer program to teach urban adolescents to make healthier choices for themselves and screening patrons of a barbershop for hypertension. For mentors and hosts, guiding our students can be personally fulfilling, even as the students lend necessary support to their missions. Some students will be so deeply affected that they will continue to work with the medically underserved throughout their careers. We hope all of them will become health professionals who understand their patients’ concerns, empathize with suffering and relate in a caring way to patients and their families. Nobel laureate Albert Schweitzer observed, “In everyone’s life, at some time, our inner fire goes out. It is then burst into flame by an encounter with another human being. We should all be thankful for those people who rekindle the inner spirit.” We hope you will consider supporting community service learning as a mentor or host, helping us to preserve the inner fire of these promising future health professionals. In partnership,

Ruth E. Berggren, M.D. Director, Center for Medical Humanities & Ethics Right: 3 Students get involved in their communities at home and abroad.


Definition of Community Service Learning Service learning is defined as a structured learning experience combining community service, mentored preparation and reflection. Students engaged in service learning provide community service in response to community-identified concerns and learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as citizens and professionals1. While volunteering and service learning both provide a service to the community, CSL requires preparation, outcomes monitoring, reflection, community feedback and a structured learning mentorship to achieve learning objectives. experience combining community service, 1 Seifer SD. “Service-learning: Community-campus mentored preparation partnerships for health professions education.” Academic Medicine, 73(3):273-277 (1998) and reflection.

The Community Service Learning (CSL) Program

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The Benefits of CSL Community service learning is a mutually beneficial process. The student benefits by acquiring knowledge, experience and a relationship with a mentor; the agency benefits by having identified needs addressed; and the community benefits by promoting civic responsibility and cultivating an academiccommunity partnership. Resources benefitting community organizations and the clients can include: • community needs assessments • focus groups • health and wellness education • health screenings and referrals • basic medical services provided under the guidance of faculty mentors • program evaluation and assessment • mentoring / medical accompaniment • assistance with advocacy and policy issues • enhanced capacity to reach agency’s mission

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CSL Online Directory The Center for Medical Humanities & Ethics hosts an online, sortable, directory that lists and describes the community service learning projects available to students as well as mentor profiles. The CSL projects in the directory include both student initiated pilot projects as well as established and ongoing CSL programs, such as the studentrun free clinic program. The mentor listing helps connect students with an appropriate mentor for their project. Any student, faculty, or community partner affiliated with the Health Science Center can create a login and submit a project to be considered for inclusion in the directory. The web-based directory is viewable by the public and is found at: http://www.texashumanities.org/csl/csl_home.asp

Above: A student uses a model to teach kids about cholesterol. Left: Pharmacy students get real-life experience counseling patients under the guidance of a mentor. 6


How do students participate in CSL? Students may choose to participate in CSL activities: • individually on their own time, • as part of a student organization, or; • through a course. How do faculty participate in CSL? • Be a mentor • Volunteer with an existing project • Create and update entries in the Online CSL Directory How do community agencies participate in CSL? • Host a project • Create and update entries in the Online CSL Directory

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How does the Center for Medical Humanities & Ethics support CSL? • Mini-grants • Annual CSL Conference • Guiding students to areas of funding The Center for Medical Humanities & Ethics awards mini-grants to Health Science Center students who wish to develop mentored CSL projects that document and address health disparities in the community. Mini-grants help cover project costs such as supplies, printing, and mileage in order to encourage participation in CSL. Mini-grant recipients present a professional poster of their project at the Annual CSL Conference held in the spring. Above: The Annual CSL Conference is an opportunity for networking, showcasing projects and continuing education. Left: Educational presentations at public health fairs like this one are examples of community service learning projects. 8


The Annual Community Service Learning Conference provides an opportunity to share and learn from CSL experiences of students, faculty, staff, and community partners in San Antonio and at the UT Health Science Center Houston and UT Medical Branch Galveston campuses. Guest presenters who are experts in CSL provide lectures and workshops. A student poster session showcases the service projects taking place that year. A student panel of the top four projects allows exemplary students to be recognized for their work with the community. The conference offers continuing education credit for medicine, nursing, and other health professions. Examples of CSL Projects • Health screenings of glucose, cholesterol and hypertension for underinsured community at a local church or barbershop • Pediatric dental sealant clinic • Oral hygiene education for students at a school for deaf children • Mini-symposium on arts and aging for seniors • Breastfeeding education and support for homeless teenage mothers

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Roles and Expectations for CSL Partnerships

Student: • Respect service site’s rules and regulations • Follow HIPAA procedures • Address community-identified needs • Provide project results to the community partner • Engage in mentored reflection • Take initiative in the learning process through problem solving and ethical decision making • Follow Health Science Center rules and regulations (media, government relations, travel, fundraising, etc.) • Report project outcomes through the CSL Online Directory and the Annual CSL Conference. Above: Faculty mentor meets with site supervisor and student. Left: Student screens blood sugar levels at a health fair. 10


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Mentor: • Assist student in developing a CSL project including defined objectives and evaluation strategy • Become oriented with the service site • Meet regularly with student to discuss progress and provide feedback • Engage in reflection to help student integrate service with academic and professional understanding • Document student’s service hours and submit project reports • Guide student in abstract and poster preparation and possibly manuscript preparation • Oversee exit interview between student participants and community partners. Community Partner: • Communicate the organization’s needs • Provide mentored students with an opportunity to perform meaningful service at the project site • Document and update project opportunity in the CSL Online Directory • Work with the Center to establish a Memorandum of Understanding (MOU) • Orient students to the organization’s mission and goals to ensure understanding of their roles • Communicate policies and procedures • Provide ongoing feedback to student and mentor

Left: A faculty mentor oversees a student’s interosseous interfusion training in preparation for a CSL project in a resource-limited area 12


Center for Medical Humanities & Ethics: • Promote and maintain an interactive online directory of CSL sites, mentors, and service project opportunities for Health Science Center students in all disciplines • Act as a liaison between community partners, individual students, student groups, and mentors in making referrals for CSL opportunities • Develop a Memorandum of Understanding (MOU) defining the roles of the university and the community organization as they relate to CSL • Plan the Annual CSL Conference • Answer questions, troubleshoot, and serve as a resource for CSL for students, faculty, and community partners • Organize an inter-professional CSL Planning Committee, with community representation.

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CSL Project Components Orientation Before starting, students must be oriented to the community agency, policies and procedures, as well as any risks associated with their work. Orientation allows students to understand the importance of their project to the clients, the agency, and the community. An orientation for the student(s) should include: • The mission and history of the agency • A tour of the site where they will be serving • Introductions to staff and other volunteers • Relevant policies and procedures • Overview of services the agency provides and to whom • Time for questions Above: Students discuss treatment options with their faculty mentor at a Student-Run Free Clinic. 14


Student Preparation Preparation for the student(s) will include: • Discuss needs with the agency, which may involve reviewing a needs assessment previously conducted or conducing one in conjunction with the agency • Create a CSL Project Plan, with specific measurable objectives, under the guidance of the mentor and with the input of the community partner Other forms of preparation for the student(s) may include: • Course work • Literature reviews • Specific skills training Monitoring • Collect data aligned with the project objectives • Track service hours to be documented by mentor Results and Evaluation: • Use evaluation tools such as a pre/post test, survey, focus group, etc. to determine the effectiveness of the CSL project

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• Report project outcomes through the CSL Online Directory • Present results to the targeted community • Present a poster at the UT Health Science Center Annual CSL Conference: consider abstract submission to other conferences and/or journals Reflection: Critical reflection is a key component that separates service learning from volunteerism. The process of reflection helps students connect their service with their academic work, and it clarifies how the CSL activity is affecting the student as a future health care provider. Reflection can take many forms, including discussions with the mentor and other students, journaling, blogging, and narrative writing. Upon beginning the project, the student and mentor will agree on an appropriate mechanism for and frequency of reflection, but reflection should be regular and ongoing.

Reflection can take many forms, including discussions with the mentor and other students, journaling, blogging, and narrative writing.

Above: Students plan the curriculum for a health literacy class Left: A student presents her findings at the annual CSL Conference

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How to get Involved with the CSL Program Agencies may post a project profile on the CSL Online Directory through the website of the Center for Medical Humanities & Ethics. The posting can describe a CSL project that is established and open to future students, or it may describe a project that is in need of being developed. Creation of a login and password is required to use the CSL Directory. It is up to the discretion of the Center to approve a project for posting. The CSL Directory is open to the public. The CSL Online Directory is available at: http://www.texashumanities.org/csl/csl_home.asp

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Frequently Asked Questions Who is this handbook for? Community organizations and potential mentors interested in collaborating with the Center for Medical Humanities & Ethics in providing community service learning (CSL) opportunities for UT Health Science Center students. How is service learning different from volunteering? Both volunteering and service learning provide a service to the community. Service learning extends beyond volunteerism, however, in that service learning requires preparation, outcomes monitoring, reflection, and the guidance of a mentor to tie in the service with learning objectives. Why is it important to serve the community through service learning? Community organizations can enhance their services to their members by utilizing the resources and skills of mentored students who will be tomorrow’s health care providers. Students gain a better understanding of the social determinants of health, further their clinical and cultural competency, and become better equipped to care for patients in the future. Does the community agency have to keep track of the student’s hours? No. Students are responsible for keeping track of their hours. The student’s project mentor will be asked to sign the student’s documentation of service hours. How can I learn more about the CSL program at the Center for Medical Humanities & Ethics? Please view our website and/or contact CSL staff listed below in the Center Contact Information. On our website, you can also sign up for our CSL listserv, which will allow you to stay informed about CSL opportunities and events. 18


Center Contact Information Website: www.texashumanities.org Email: csl@uthscsa.edu Faculty and Staff: Jessica Mendez CSL Program Coordinator (210) 567-0749 Melanie Stone, MPH, M.Ed. Assistant Director for Community Service Learning (210) 567-0523 Ruth Berggren, MD Director, Center for Medical Humanities & Ethics (210) 567-0795

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Resources Jacoby B & Mutascio P. Looking In Reaching Out: A Reflective Guide for Community Service Learning Professionals. Campus Compact, 2010. Learn and Serve America’s National Service Learning Clearinghouse http://www.servicelearning.org/ Schiebel J, Bowley M & Jones S. The Promise of Partnerships: Tapping into the College as a Community Asset. Campus Compact, 2005. Seifer SD. “Service-learning: Community-campus partnerships for health professions education.” Academic Medicine, 73(3):273-277 (1998)

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The University of Texas Health Science Center at San Antonio  NAME OF ORGANIZATION  Community Service Learning  Memorandum of Understanding      This agreement pertains to the provision of a Community Service  Learning (CSL) educational experience (hereby referred to as “CSL  experience”) at NAME OF ORGANIZATION (hereby referred to as the  “CSL site”) for University of Texas Health Science Center at San Antonio  (“Health Science Center”) students who participate in CSL activities  through the Center for Medical Humanities & Ethics (“Center”).      a. It is understood that the Center will continue to have  responsibility for the quality of the Health Science Center  students’ CSL experience and must retain authority over the  student(s) activities.  The Center has the right to conduct an on‐ site review of the CSL site.    b. The CSL experience, designed for one or more students at a  time, will take place at NAME, ADDRESS OF ORGANIZATION, as  assigned by the student’s mentor.  NAME OF ORGANIZATION  has the right to decline acceptance of a new Health Science  Center student(s) any time during the year.        c. Administrative, educational, and supervisory responsibility for  the Health Science Center student(s) at the CSL site will belong  to the onsite coordinator, (ON‐SITE COORDINATOR NAME).   This responsibility includes direct or indirect supervision of the  Health Science Center student(s) and ensuring appropriate  teaching and evaluation.  If this responsibility is delegated to  another individual, the Center’s CSL Coordinator must be  provided timely written notification.    d. The purpose of the CSL experience is for Health Science Center  students to learn the context in which service is provided, the  connection between their service and their academic  coursework, and their roles as citizens and professionals.  Center for Medical Humanities & Ethics | Name of Organization/ MOU Effective (enter date)

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e.

f.

g.

Each Health Science Center student, in collaboration with their  mentor and the on‐site coordinator, will develop a set of  learning objectives for the CSL experience.  The Center will  approve these learning objectives.      The onsite coordinator shall have the right to require the Center  to remove a Health Science Center student from this CSL  experience at his/her sole discretion.   Health Science Center students shall cooperate in the prompt  preparation of documentation of activities they have performed  at the CSL site in accordance with local regulations and bylaws.   The ownership and right of control of all reports, records, and  supporting documents prepared in connection with this CSL  experience shall belong to the CSL site. 

h.

Once approved by both parties this MOU shall continue in effect  until modified or terminated by mutual agreement of the  parties hereto.    UT Health Science Center San Antonio  Affiliated Site        FRANCISCO GONZALEZ‐SCARANO,  NAME, TITLE  M.D., DEAN, SCHOOL OF    MEDICINE        _______________       RUTH E. BERGGREN, M.D.  NAME OF COMMUNITY SERVICE  DIRECTOR, CENTER FOR MEDICAL  LEARNING SITE  HUMANITIES & ETHICS              (Enter date) Effective Date:  ______________________________         

Center for Medical Humanities & Ethics | Name of Organization/ MOU Effective (enter date)

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C S L

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7703 Floyd Curl Drive, MC 7730 San Antonio, TX 78229-3900 (210) 567-0795 • csl@uthscsa.edu www.texashumanities.org/csl.cfm

Community Service Learning (CSL) Handbook  

Center for Medical Humanities & Ethics' CSL Program at the UT Health Science Center San Antonio.

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