Sustained service: a community-driven framework for longitudinal service-learning.

This article was migrated. The article was marked as recommended. The sustained service four-year longitudinal framework for medical school service-learning is introduced and defined. Framework benefits include: students can engage deeply over time with both the people they serve and their colleagues, they are immersed in the social determinants of health in authentic contexts, and they grow in the expertise required to perform their service over time. The approach starts with a sophisticated community needs assessment that relies on systematic inclusion of community voices, community leader inputs, and systematic and data-saturated inputs. This needs assessment should result in a six to eight item list of the community's priority needs. All student service is then focused on the primary needs identified in the assessment. Goals of the framework are described: to make a difference with the community's priority needs; to grow the identity, skills and paradigms required of a community-responsive physician; and to strengthen student credentials through objective qualifications related to their sustained service. The culminating activity is a Capstone research project that focuses on the served population and gives students an opportunity to synthesize their experience. Initial results describing the community impact of service, the focus of service hours, and candid student reactions to the approach are presented. Discussions of findings and conclusions are offered.

"It Feels Like Being a Real Doctor:" The Virtual Family Approach in Medical Education.

This article was migrated. The article was marked as recommended. The majority of health outcomes are determined by social determinants of health (SDOH) while medical care is responsible for as little as 20% of health outcomes. This article is an introduction to the Virtual Family (VF) approach to case based instruction; a novel strategy for addressing SDOH in medical school. The VF theoretical framework is presented and practical considerations and challenges for implementation of the VF approach at three different medical schools are offered. VFs are defined as representations of families or social groups that are not real. "Virtual," in this instance, refers to people or things that do not physically exist. The VF approach allows students and educators to adjust the "lens" of a case's focus to view the relevant determinants. The VF approach is presented as an extension of the virtual patient approach. Theoretical support for the VF approach is argued drawing on principles from modeling and simulation, effective story design, establishing a sense of human presence, serious gaming, visual design, identity leveraging, and flow theory. Challenges and benefits of the approach are described. Measures of efficacy designed to match learning goals are proposed. The VF approach is presented as practical, accessible, economical, and potentially powerful.