A hybrid educational approach to service learning: impact on student attitudes and readiness in working with medically underserved communities

Figures & data

Table 1. Comparison of in-person and hybrid program formats.

In-person Model	Hybrid Model
18 Classroom didactic learning sessions	9 Virtual didactic learning sessions
Documentary screenings Small group discussions with faculty Journal clubs Community member panels	Small group seminars co-led by community members, senior medical students, and faculty Case-based learning sessions led by community health workers and researchers
Longitudinal Community Partnerships	Longitudinal Community Partnerships
One-to-one mentoring relationships between students and community members from local community organizations Group dinners with community members at organization sites	Students matched with one of three community organizations Virtual and in-person service activities following needs assessment

Figure 1. Hybrid service learning elective curriculum framework during the COVID-19 pandemic.

Table 2. Demographic information for study participants.^a

Demographic Characteristics	Hybrid (n = 15)	In-person (n = 13)	Control (n = 29)	p
Gender
Male	5 (33%)	2 (15%)	11 (38%)	.23
Female	8 (53%)	11 (85%)	18 (62%)
Other	1 (7%)
Unanswered	1 (7%)
Average Age, years	24.4	25.6	24.9	.29
21 to 23	4 (27%)	4 (31%)	13 (45%)
24 to 26	10 (67%)	7 (54%)	11 (38%)
27 to 29	1 (7%)	1 (8%)	5 (17%)
30+	0 (0%)	1 (8%)	0 (0%)
Race/Ethnicity
Caucasian	11 (73%)	7 (54%)	20 (69%)	.13
African American	0 (0%)	2 (15%)	0 (0%)
Other	3 (20%)	3 (23%)	9 (21%)
Unanswered	1 (7%)	1 (8%)	0 (0%)
Have been involved in projects providing care to the medically needy	11 (73%)	11 (85%)	15 (52%)	.09

^aPreviously presented in [15] for In-person and Control cohorts.

Figure 2. Mean total medical student attitudes toward the underserved (MSATU) score for hybrid and in-person curriculum cohorts.

Table 3. Mean pre- and post-scores and Cronbach’s Alpha for MSATU total scale and subscale scores for in-person (n = 13) and Hybrid (n = 15) program formats.^a

Section	Pre	Post	Effect Size (dz)
Total (α = .91)
In-person	4.42	4.63†	0.53
Hybrid	4.36	4.41	0.24
Attitudes (α = .83)
In-person	4.33	4.51†	0.51
Hybrid	4.27	4.37	0.37
Societal Expectations (α = .57)
In-person	4.24	4.51†	0.53
Hybrid	4.20	4.33	0.36
Professional Responsibility (α = .83)
In-person	4.39	4.50	0.40
Hybrid	4.32	4.39	0.23
Services (α = .95)
In-person	4.74	4.95	0.40
Hybrid	4.74	4.67	−0.16
Basic Services (α = .98)
In-person	4.90	5.00*	0.61
Hybrid	4.78	4.81	0.10
Costly Services (α = .86)
In-person	4.58	4.90	0.35
Hybrid	4.71	4.53	−0.29

^aCronbach’s Alpha calculated for Pre-program Scores

†p < .10, *p < .05

Figure 3. Degree of increase in knowledge of health challenges and barriers faced by medically underserved populations for each virtual didactic session.

Table 4. Impact of hybrid elective curriculum on student comfort and confidence in working with medically underserved communities.

	Pre	Post	Effect Size (dz)
Comfort discussing social determinants of health with patients^a Average of 9 items	3.26	3.33	0.10
Homelessness	3.47	3.53	0.07
Disability	2.87	3.13	0.25
Parenting or life with a new child	3.27	3.13	−0.15
Intimate partner or domestic violence	2.47	3.13*	0.62
Substance use and addiction	3.20	3.43	0.20
Sexual orientation	3.60	3.67	0.12
Gender identity	3.53	3.67	0.22
Race and ethnicity	3.47	3.07	−0.39
Cultural background	3.47	3.13	−0.31
Confidence in directing patients affected by social determinants to local community resources^b Average of 7 items	2.31	3.02**	0.84
Homelessness	2.40	2.87	0.45
Disability	1.93	2.60*	0.66
Parenting or life with a new child	2.80	3.13	0.31
Intimate partner or domestic violence	2.00	3.67**	1.55
Substance use and addiction	2.53	3.27†	0.55
Gender identity	2.12	3.13*	0.75
Race and ethnicity	2.33	2.47	0.10

^aRated on a 5-point Likert scale, 1 (Not at all comfortable) to 5 (Extremely comfortable)

^bRated on a 5-point Likert scale, 1 (Not at all confident) to 5 (Extremely confident)

†p < 0.10, *p < 0.05, **p < 0.01

Figure 4. Impact of hybrid service learning curriculum on future interest in working with medically underserved communities.

Table 5. Qualitative student comments on impact of hybrid service learning elective curriculum.

Theme	Representative Comments
Understanding patient perspective	‘I think we are so quick to judge and often slow to remember all the system barriers that prevent people from seeking health-promoting choices.’
	‘I have truly learned a lot from the candid conversations that invited speakers have had with us about their observations and experiences [with] medically underserved people … ’
Preparing for patient care	‘I am beginning to have a better understanding of the kinds of questions and considerations I should have when caring for an individual with disabilities …’
	‘I am excited to continue to build long-term relationships and connect patients with helpful resources in our community that go beyond what we can do in a 20-minute appointment in clinic.’
Connecting with community resources	‘[The community partnership] taught me the importance of community support and home visits for new families and encourages me to always know my local resources/have lists of resources available for patients.’
	‘The most valuable thing I learned is that there are tons of different community-based programs that are built to help. If someone comes to me with a problem now, I may not have the direct knowledge to fix it but I likely can refer them to people who can.’

Briggs AM, Wang SY, Bhowmik S, et al. The beyond the books program: improving medical student attitudes toward the underserved. Health Equity. 2018;2(1):98–102.

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