Pulse
Learning by Serving
Medical students are helping the less fortunate for course credit. And it’s tough to tell who benefits the most.
Since he came to Mayo Clinic in 1998, Robert Bonacci, M.D., has always felt a little “bothered.” A graduate of Morehouse School of Medicine in Atlanta, a historically black institution, he often felt as if he were in a bubble at Mayo—out of touch with the needs of the greater community around him. “I kept trying to think of meaningful ways to give back, and at the same time I realized that students here weren’t getting a lot of exposure to underserved populations,” Bonacci says.
As a medical student Bonacci spent every Wednesday afternoon at an inner-city housing complex in Atlanta as part of a two-year service-learning initiative. Bonacci and a team of other medical, nursing, pharmacy, and physical therapy students studied the health needs of residents, discovered that a number of the women were not receiving prenatal care, and created a buddy system to encourage women to get the care they needed.
As an assistant professor of family medicine at Mayo Medical School, Bonacci wanted his students to have similar experiences. So two years ago, he partnered with the Rochester School District’s Hawthorne Education Center to create a service-learning elective for first-year students.
Service learning is a teaching method that dates back to the 1970s. Unlike volunteerism or community service alone, service learning combines academic instruction with meaningful service. For example, Mayo students who enroll in the elective develop their communication skills and learn about other cultures by teaching immigrants from places such as Somalia, Mexico, and the Sudan who are learning English as a second language how to communicate with health care professionals.
“We have competencies in health that our students must master here—everything from how to call the doctor to make an appointment to how to read a medicine bottle to the difference between OTC and prescription meds,” says Julie Nigon, Hawthorne’s family and adult literacy program manager.
Under Nigon’s direction, the medical students learn to break down complex ideas into simple words and sentences. They also learn to act out concepts and point to things in the environment to get across their message. “If the patient understands what the physician is saying, there will be much better compliance and follow-through on the part of the patient,” Nigon says.
The medical students then spend two hours a week at the Hawthorne Center from January through June. They also meet with Bonacci once a month to talk about how their experiences at Hawthorne bring home larger policy issues affecting health care in this country such as lack of insurance. “One student might say, ‘I met this guy who works two jobs and is uninsured. How does this happen?’” Bonacci says.
The Teacher as Learner
Last year, 13 medical students enrolled in the service- learning elective. This year, 18 participated. Jennifer Kruse, a 23-year-old first-year student is one of them. “This experience has helped me to feel more comfortable in situations that seem difficult—for instance, when language barriers hinder oral communication—and that’s going to help me become a better doctor,” Kruse says of what she’s learned during the Monday evenings she’s spent at Hawthorne. “If I feel comfortable and can use humor and body language to develop rapport with a patient, it helps them feel more comfortable as well and likely more willing to share things about themselves.”
Kruse says she’s been impressed by the perseverance and strength of the people she’s met at Hawthorne, some of whom left war-torn countries and political strife to come to the United States and start over. Having studied in Chile as an undergraduate, she remembers how isolated she felt and how difficult it was to communicate, even after studying Spanish for seven years. “Most of the students have had little to no exposure to English before coming to the U.S., and many of them are also working many, many hours and taking care of children,” she says. “Amazing, really.”
Sending a Message
At the University of Minnesota for the last three years, service learning has been a requirement for all first- and second-year medical students. During the first year, students spend several weeks learning about how different cultures view the human body and its relationship to the mind and spirit. They also learn about delivering care in various cultural settings.
Then groups of 8 to 10 students work with a service organization to design and complete a project that addresses the needs of a specific population. Students have worked with the Bosnian Women’s Network, the Minneapolis Urban League, Chicanos Latinos Unidos en Servicio (CLUES), the Family Opportunities for Living Collaboration, the American Indian Task Force, La Escuelita, and District 202, a community center for gay, bisexual, and transgender youth.
Some of the projects they’ve done include developing a pamphlet on heart disease for African American women in order to address a disparity in health outcomes among these women and assembling first aid fanny packs for homeless American Indians through the American Indian Community Development Corporation’s Kola mobile health outreach program. This year, students are evaluating the extent to which the kits are being used and the contents recipients find most useful.
Requiring service learning sends a message to students, says Karyn Baum, M.D., M.S.Ed., an assistant professor of medicine who directs the second year of the Physician and Society course. “I think it makes the students better doctors because it opens their eyes to the larger context of health care,” she says. “There is the context of seeing the next patient in the hospital or clinic, but there is also the context of the community: how they access care, how they are treated when they access care, and how we are doing as a health care profession in terms of delivering the care that we promised to deliver.”
Bonacci hopes that service learning will one day become mandatory at Mayo as it is at the University of Minnesota. “Many students come to medical school having had a lot of experience with service programs, with giving of themselves, and I think that in medical school we tend not to nurture that.” He says it’s rewarding to see how much the experience at Hawthorne has meant to the students. “When you talk to the medical students, they feel like they take away from Hawthorne more than they give, and when you talk to Hawthorne, they feel the students really give more than they learn,” he says. “The medical profession is a calling. Whether you are an ophthalmologist or orthopedic surgeon, as a physician, you are part of the community. And that means being involved with and responsive to it.”—Jeanne Mettner