Medical Student Perspectives: Community Service during Medical School
Whenever possible, I try to elicit feedback from my patients. Sometimes the opportunities arise as I pre-round in early morning hours. Other times they don't present themselves until the afternoon lulls after I've finished my floor work for the day. But whenever those moments open up in front of me, I try to cherish and linger in them - partly because they beautifully offset the often-hectic pace of patient care; partly because they remind me I didn't choose medicine mainly for the science, pharmacology, or treatment plans, but the people that make those things matter; partly because after eighteen months on clinical rotations, I have learned that there is perhaps no truer, more penetrating, or more instructive perspective on my growth as a student than the one my patients provide. So I'm mindful of the fact that almost all of their answers to my most important question - which quality, above all others, they value most in their doctors - consistently center on altruism.
As obvious as this might sound, altruism is not just an attribute patients expect out of their physicians. Locally, altruism - as evidenced by service and community work - has long been an important consideration medical schools use in selecting applicants. Nationally, it is a quality the American Association of Medical Colleges found important enough to focus educational efforts on and include in the four core attributes emphasized in its Medical Schools Objectives Project. Individually, and most importantly, it is the trait most of us expected out of ourselves when we first donned our white coats and repeated our oaths, the one frequently easier to recognize than define, the one behind our deepest desires to help people and make a difference.
As our profession has continued to understand the importance of cultivating altruism among trainees, two instructive questions have arisen: first, whether focusing on altruism through service work derives benefit outside of deepening individual character, and if so, how to best promote this during undergraduate medical training. In regards to the first, it is clear from recent work studying the "outcomes" related to altruism that service work during medical school is associated with overall academic performance and residency performance, and in some cases, career choice. In other words, it is tied to academic and vocational, as well as personal, development. The second - about how medical schools can best foster habits of service among trainees - has been somewhat less clear. Most institutions have traditionally offered completely voluntary service opportunities. But several have begun offering formal, curriculum-based opportunities, with the belief that structured learning environments allow for more thorough preparation and reflection. An example of the latter is the Medical University of South Carolina (MUSC), which created a dedicated community service office to support a voluntary, but structured, service program. Students are encouraged to participate in service work and are provided opportunities and information by the service office. They are also asked to record their hours with the office, with annual recognition of the students with the most service hours.
My home institution, Baylor College of Medicine (BCM), has supported similar goals in a different way. By hosting one of the thirteen national sites for the Albert Schweitzer U.S. Fellowship Program, BCM allows its students - along with graduate healthcare professions students at surrounding institutions - to partner with community-based organizations in identifying unmet health needs, create rigorous, 200-hour projects around those needs, and carry the projects from idea to completion. Having just completed my fellowship year addressing HIV linkage and follow-up care, I feel that the Schweitzer fellowship provided a particularly powerful structure for cultivating service. First, it required that the students themselves identify unmet needs and craft project proposals, ensuring that we identified issues we personally encountered and then thought critically about to address them. Secondly, the work was done over twelve months concurrently with our academic/clinical responsibilities, allowing us to experience the time, energy, and resources required to serve our communities both as service workers and healthcare professionals. Thirdly, the multi-disciplinary, multi-institutional nature of the program allowed for a unique blend of encouragement, brainstorming, and growth. As a MD candidate, I brought certain clinical, patient-care perspectives that helped inform others' work, but I also learned a great deal about myself and my project from the other fellows who were studying public health and social work. Fourthly, the fellowship emphasized regular feedback, introspection, and planning, aspects that I found particularly helpful when I had to re-assess the direction of my project or face setbacks. All in all, the Schweitzer fellowship was as complete a service opportunity as I've ever experienced in medical school because it allowed me take ownership of my work while having access to ready support, persevere through tough periods while brainstorming creative alternatives with others, and realize that lifetimes of service begin with a few initial steps, ones I don't have to - and perhaps shouldn't - take alone.
Appropriately, service work is a broad area, and altruism should be fostered in a number of voluntary, diverse ways. But in light of work showing beneficial associations between structured service work and other trainee outcomes, students and institutions could benefit greatly from development of more formalized community service programs. And whether they choose to set up a program like that at MUSC, invest time like BCM to host a Schweitzer fellowship-like program, or forge a new, innovative path, it seems to me that the ultimate visions are the same: that undergraduate medical resources be leveraged to support better health through the cultivation of more empathic, selfless healthcare providers; that in identifying these issues, we do our best to support what we and our patients have long known to be true. Altruism matters.
For more information:
Joshua Liao, MS VI
Baylor College of Medicine
E-mail: jmliao@bcm.edu