Promoting sustainable community service in the 4th year of medical school: a longitudinal service-learning elective.

BACKGROUND: To address the country's most pressing healthcare needs, medical students must choose careers in primary care and commit to working with underserved populations. Involvement in student service organizations has been shown to strengthen leadership, empathy, and commitment to underserved health and may lead students to pursue careers in primary care. DESCRIPTION: In 2010, the University of Chicago Pritzker School of Medicine developed a novel 1-year longitudinal service-learning elective called SERVE (Service, Education, Reflection, Volunteerism Elective). Students earned elective credit for completing three course requirements: 10 service sessions, monthly reflections, and a service-learning project. EVALUATION: One third of the class enrolled in the course (33/99), 25 students completed the course, and 20 completed the final evaluation. Both quantitative and qualitative analyses of the final evaluations demonstrated high satisfaction with the course, and appreciation of the opportunity to volunteer, teach, and develop service projects. SERVE students reported a strong commitment to continuing community service after graduation, with 100% planning to continue volunteering and 70% strongly agreeing with the statement that they would practice in an underserved community in the future. This commitment was higher than that expressed by the graduating class of 2012 (34%) and higher compared to a national average (30.9%). CONCLUSIONS: SERVE is a unique 1-year course that reengages 4th-year medical students in service to their communities in a structured educational environment. SERVE students report that the course has increased their involvement in the community, supported their growth into a teaching role, and enhanced continuity within student-run free clinics. Future directions include assessing the impact of SERVE students on the experience of preclinical medical students in student-run free clinics; community response to SERVE projects; and the impact of SERVE on volunteerism, primary care specialty choice, and future practice in underserved communities for class participants during their medical careers.

Learning through vulnerability: a mentor-mentee experience.

The following essay, drawn from the journals and work notebook of a family medicine resident and a visiting clinical mentor, chronicles their work together in an Advanced Clinical Mentoring program. This program included afternoons of direct clinical observation immediately followed by feedback sessions. In addition to addressing specific professional issues, such as time management, limiting patient encounters, agenda matching, and the One-Minute Preceptor model, the authors developed personally as they opened themselves to learning and growing as a clinician and a teacher.

The impact of yoga in medically underserved populations: A mixed-methods study.

OBJECTIVES: We evaluated the acceptability, access, and impact of yoga among participants in yoga classes co-located in community health centers. DESIGN: Participants were invited to complete a mixed-methods program evaluation consisting of a pre/post survey at their first class and structured interviews at 4 months. SETTING: The study took place at two community health centers on the South Side of Chicago, IL, USA. INTERVENTIONS: Four weekly 1-1.5 hour yoga classes were provided by four certified yoga instructors trained to teach to all ability levels. MEASURES: Our primary outcome measures were pain and stress before and after the first class, and at 4-months. We gathered data about participant demographics, their health problems, how they accessed the classes, and motivations and barriers to attending. We also extracted themes from participants' qualitative feedback about their experiences. RESULTS: Overall, 70 participants completed the initial surveys; 44 completed the 4-month interviews. A racially and ethnically diverse group of middle- and low-income adult patients and community members attended, with flyers and word of mouth the major routes to the class. A single yoga class provided statistically significant decreases in pain and stress, but these benefits were not demonstrated at the 4-month follow-up. The primary motivators for yoga class attendance were stress relief, exercise, and overall health improvement. Primary barriers included family issues, schedule, illness, and work conflicts. Primary benefits included physical benefits, relaxation, emotional benefits, and community connectedness. CONCLUSIONS: Co-locating yoga classes in community health centers provides a variety of benefits and is a viable pathway to addressing disparities in yoga access.

Asthma And Injustice On Chicago's Southeast Side.

A physician discovers a potential environmental link to asthma attacks in a poor Chicago community.

PURLs: Aneuploidy screening: Newer noninvasive test gains traction.

Favorable results from the 2 studies reviewed here have prompted ACOG to recommend that cell-free DNA screening be discussed with all pregnant patients.

Sterile or non-sterile gloves for minor skin excisions?

Non-sterile gloves are just as effective as sterile gloves in preventing surgical site infection after minor skin surgeries.

Peer mentorship in student-run free clinics: the impact on preclinical education.

BACKGROUND AND OBJECTIVES: Our study examines the perceptions of first-year medical students (MS1s) toward fourth-year colleagues (MS4s) in student-run free clinics to investigate the impact of peer mentorship on augmenting the clinical education received by MS1s in a primary care setting. To our knowledge, this is the first study examining the impact of MS4 mentorship in free clinics. METHODS: A 55-item online questionnaire was administered to MS1s 9 months after matriculation in April 2012. Questions focused on MS1 perceptions of MS4 impact on comfort with patients, self-reported improvement in clinical skills, and overall satisfaction with mentorship in free clinics. The MS4s referenced in the questionnaire were enrolled in a longitudinal service-learning elective. Results were analyzed using one-sample Wilcoxon sign-ranked median test and ordered logistic regression with STATA software. RESULTS: Fifty-five of 77 (71.4%) eligible students began the online survey, with 48 (62.3%) completing it. Responses reflected experiences at four student-run free clinics. Overall, MS4 presence improved MS1 comfort with patients and enhanced interactions with attendings. MS1s were satisfied with the level of MS4 mentorship and agreed that MS4s had a distinct mentoring role from attendings. Ordered logistic regression showed that presence of MS4s was significantly associated with self-reported improvements to physical exam skills at one clinic. CONCLUSIONS: At each clinic, MS1s reported improved comfort with patients and satisfaction with mentorship received from MS4s. MS4s did not merely duplicate the role of attending physicians but enhanced interactions between MS1s and physicians. This suggests that the consistent presence of MS4s is a valuable adjunct to the educational experience of free clinics volunteering for MS1s.

PURLs: PSA testing: when it's useful, when it's not.

Routine PSA testing leads to more diagnoses of prostate cancer, but does not save lives. At least one group of men, however, may reap a small benefit.

PURLS: A-fib and rate control: don't go too low.

For patients with atrial fibrillation, more relaxed heart rate control is as effective as stricter control but, with fewer adverse effects.