AAMC Reporter: November 2006

Public Service Builds Young Docs Along With Communities

By Gregg Siegel, Special to the Reporter

"I will remember that I remain a member of society, with special obligations to all my fellow human beings...." —Modern Hippocratic Oath

The medical profession has long attracted individuals with a fervent commitment to helping others. For medical students, reaching out to people in need can begin as early as the first year of studies and can continue throughout residency and an entire career.

Around the country, medical students and residents are carving time out of their challenging schedules to serve their communities and, in the process, not only provide help but make themselves more experienced, more compassionate, and more skilled as healers.

Many academic medical institutions have programs in place to help encourage and fund the community service efforts of both medical students and residents. The AAMC, for example, sponsors the Caring for Community grant program in conjunction with the Pfizer Medical Humanities Initiative. Every year, the program awards up to 10 grants to community outreach projects that are initiated, developed, and operated primarily by medical students. According to Ally Anderson, program coordinator in the AAMC's Division of Medical School Affairs, Caring for Community receives more than 50 applications every year.

"Compassion and service are essential components of being a doctor," she noted. "If the enthusiastic response to our program is any indication, medical students throughout the country wholeheartedly share this belief."

Similarly, the AAMC encourages the efforts of residents through a program coordinated by its Organization of Resident Representatives (ORR). Each year, the ORR bestows its Community Service Recognition Award on residents who have effectively led community service activities, either in health care or in other need areas.

"One of the values of medicine is to advocate for your patients and to work to serve the best interests of your patients at large," explained ORR Executive Secretary Alexis Ruffin. "We want to acknowledge those who have demonstrated this vital ethic of the medical profession at an early stage of their careers."

This Bus Stops for All

Students at the University of Iowa Roy J. and Lucille A. Carver College of Medicine first got the idea to expand a mobile clinic for Iowa City's needy populations after finding problems in the shelter facilities.

"There wasn't enough room at the shelter to provide the best care—they were seeing patients on the porch and in the yard," said Penny Rembolt, a financial aid counselor and student adviser. "Appropriate privacy and patient dignity were big concerns."

Rembolt recalled that staffers suggested procuring a van or small trailer to bolster capacity.

"But these are med students," Rembolt said. "They think big."

After researching the matter, students wound up purchasing a used, full-size city bus, and with the help of university engineering students and faculty, renovated the interior to include four separate, appropriately equipped patient rooms.

For more than two years, a multi-disciplinary group of students has taken the bus on weekends to shelters and other underserved areas throughout greater Iowa City. They provide physicals, hypertension and diabetes screenings, dental evaluations, nutritional advice, and various social services and health care referrals and information.

According to Rembolt, last year 225 student volunteers logged nearly 1,750 hours of time in direct patient service and almost 3,800 hours of committee work as part of the project, which is supported by a Caring for Community grant. The popularity of the project on campus is growing, she noted, with nearly onethird of the incoming students expressing interest in the program. That is not surprising, Rembolt noted, given that students seem to derive as much benefit from the program as patients.

"Participating in this project enriches the educational experience immeasurably," she said. "Early on, they are developing outstanding examination skills and patient interaction skills.When it comes to clinical rotations, especially, they are getting excellent evaluations, and I have to think that's at least partially due to their experience on the bus. In addition, they are becoming excellent health educators, a skill that many believe is lacking among the nation's doctors. They're learning to work together with colleagues from different disciplines to form a patient-focused team."

Having a Ball

Philadelphia elementary school students dance as part of Ballroom Dance for LIFE, which was created by medical resident Even S. Fieldston

When Evan S. Fieldston, M.D., chief pediatric resident at the Children's Hospital of Philadelphia, saw "Mad Hot Ballroom," a documentary tracking New York City elementary students who take up ballroom dancing, it inspired him to do two things. The first was to take ballroom dancing lessons.

"I was horrible," he laughed.

However, the second, more successful inspiration Fieldston drew from the film was to see the similarities between poor New York City neighborhoods and those of south Philadelphia. He then created his own concept: Ballroom Dance for LIFE (Living Intelligently with Food and Exercise).

"I could see the benefits that the project could potentially deliver for children in Philadelphia," Fieldston said. "Increased self-esteem, better relationships between people of different ethnicities, exposure to and developing an appreciation for the arts, as well as reducing the threat of childhood obesity."

In January 2006, in his third year of residency, Fieldston, the recipient of this year's ORR Community Service Recognition Award, recruited nine residents and a prominent ballroom instructor to participate in a pilot effort at an ethnically diverse inner-city school. Biweekly, residents gave third-graders a lesson on healthy eating and exercise followed by a dance class. Fieldston hoped that the students would greet the concept enthusiastically, but he was surprised by how much the opportunity to dance has meant to kids who did not even have a safe outdoor place to play,much less a functional gymnasium.

"Here are kids of different ethnic groups who would never have much to do with each other, holding hands and having fun, getting exercise, learning good life habits, and even getting to be good dancers," he said. In addition, teachers reported that many kids in the program were able to concentrate and focus in the classroom better than ever before.

The students awarded their own plaques to Fieldston and his colleagues, thanking them for the program. And Fieldston was especially moved to find that at a recent fundraiser, some of the students' families, many of them living below the poverty line, thought enough of the program to make donations.

Still, Fieldston said no one has gotten more out of the program than he has.

"Being a pediatrician, it's been very valuable to me to be with kids in their own natural environment; seeing them in a hospital is not natural for them," he said. "And understanding their community and understanding the challenges really opened my eyes. I think, for all the residents involved, it really improved our ability to relate to them and to effectively practice medicine."

Education Is Picking Up

George Washington School of Medicine students Zahra Al-Lawati, Ramneek Rana, and Pascale Lepinasse clearing brush at Washington Parks Riverside Center as part of the school's community service day

All medical student and resident outreach need not be directly health-related, however. Often, just the willingness to lend a hand—or two—is all that is needed to make a difference, as shown by the recent efforts of more than 300 first- and second-year students at The George Washington University School of Medicine and Health Sciences. They picked up trash, painted,moved furniture, organized classrooms, pulled weeds, and performed countless other odd jobs at 11 Washington, D.C., public schools, two homeless shelters, and one city park for the school's annual Community Service Day.

"Doctors are dedicated individuals in a service-oriented profession," said Sarah Freeman, a spokesperson for the school and project. "Sometimes it's valuable to look into the community and see where and what kind of help is needed.With public schools about to open and the city preparing for winter with diminishing resources, this was what was needed. And we were there to help."

As with other outreach efforts, participants reported getting as much out of the experience as they put in.

"I spoke with a number of students about the project, and what seemed to come up again and again was how great it was to meet the people they are going to be serving, seeing them as real people, outside the exam room, having that interaction and making that personal connection," Freeman said. "They found that very valuable."

Many students also reported forging better relationships with their fellow students as a result of the project, as well as being moved by the appreciation they received from the people they met.

Freeman said she has seen a steady increase in interest in community outreach projects at George Washington. "Forging a commitment to service is certainly a trend here," she said. "I hope it is everywhere."

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