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The Impact of Preclinical Curriculum Based Serving-Learning on Osteopathic Medical Students’ Understanding of the Social Determinants of Health
Touma, O. [1]
Lacaze, M. [1]

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A729–731. doi: Subito , type of study: cohort study

Full text    (https://www.degruyterbrill.com/document/doi/10.1515/jom-2025-2000/html)

Keywords:

cohort study [86]
health determinants [6]
learning [100]
medical students [647]
osteopathic medicine [2025]
preclinical curriculum [1]
programs [126]
USA [1656]

Abstract:

Context: Burrell College of Osteopathic Medicine was established in 2016 with the intent to prepare culturally competent physicians who are dedicated to serving the Southwest United States, particularly its Native American and Hispanic populations. To enhance this mission, in 2023 the college introduced a mandatory, longitudinal service-learning component into the curriculum as a pilot program through a course named Mission Medicine. Students are placed at one of seventeen “community venue sites,” committing to at least four hours per month. These sites range from migrant education initiatives or delivering nutritional education within the Las Cruces Public School District and McKinney-Vento program for students facing homelessness to the Aprendamos Interventions Team working with children with intellectual disability and the Mesilla Valley Hospice and Palliative Care. Despite a historical interest in service-learning and the recognition that it adds immense value to medical education (1,2,3,4), the integration of a required service-learning component represents a significant departure from standard practices. Current literature predominantly features elective or volunteer-based models (5,6), leaving a gap with respect to mandatory (7), sustained preclinical community engagement and its outcome on medical student development; particularly regarding the understanding of the Social Determinants of Health (SDoH). Objective: To determine whether mandatory, longitudinal preclinical curriculum based service-learning significantly impacts osteopathic medical students’ understanding of the Social Determinants of Health. Methods: This study involved a cohort of 218 first-year medical students at the Burrell College of Osteopathic Medicine, Las Cruces campus. Participating students completed two sequential surveys. The first survey was completed in December of 2024 prior to being assigned to their community venue site and the second survey in May 2025 at the end of their first year of medical school. A third survey will be available for completion at the end of the cohort’s preclinical years, to assess the effects of the entirety of their longitudinal community based service-learning commitment. The students were told of the study in person as well as via school email when the link to participate was sent out. The surveys were designed using a 5-point Likert Scale ( 1= strongly disagree, 2 = somewhat disagree, 3 = neither agree nor disagree, 4 = somewhat agree, 5 = strongly agree) to assess students’ enthusiasm for the integration of community based service-learning into the curriculum, perceived preparedness for serving diverse populations, and confidence in identifying SDoH related to patient and community member health disparities. There was also the opportunity for students to respond to the question, “How has your experience at your community venue site impacted your personal understanding of the Social Determinants of Health?” Aggregated data was statistically analyzed using Qualtrics and GraphPad with unpaired t-tests to determine significance between surveys. Qualitative feedback was thematically analyzed in addition to quantitative findings to determine anecdotal impacts on the students’ learning. Understanding of the SDoH are crucial in osteopathic medicine because they can significantly influence a patient’s overall mental, physical, emotional, and spiritual health. Applying a whole-person approach to medicine necessitates an understanding of the SDoH and their interconnectedness with a patient’s well-being in order to have an effective, patient-centered approach towards health equity. Results: The survey data was collected from the same student group at two different time points (Survey 1: n=137; Survey 2: n=86). Three general themes were analyzed via various questions: enthusiasm about community-based learning integration into the curriculum, perceived preparedness for serving diverse patient populations, and impact on understanding of the SDoH. Statistical analysis using unpaired t-tests revealed the following results: for enthusiasm towards community-based learning, Survey 1 had a mean of 4.20 (SD=0.82) and Survey 2 had a mean of 4.22 (SD=0.85), which was not significantly different (t=-0.16, df=176.38, p=0.875). Similarly, for preparedness to serve diverse populations, Survey 1 showed a mean of 3.96 (SD=0.92) compared to Survey 2’s 3.74 (SD=1.06), which also did not reach statistical significance (t=1.58, df=161.36, p=0.117). In contrast, when assessing the difference in student’s confidence about identifying the SDoH that are contributing to health disparities in the populations at their community venue site, there was a statistically significant difference measured (t = 3.0050, df = 222, p=0.003) with Survey 1 showing a mean of 3.90 (SD=0.82) compared to Survey 2’s mean of 4.25 (SD=0.87). In response to the open-ended question “How has your experience at your community venue site impacted your personal understanding of the Social Determinants of Health?” students reported enhanced empathy and compassion, directly attributing their improved understanding of the SDoH to their community venue site experiences. Notable themes included the differentiation between theoretical learning of SDoH and real person interactions, increasing awareness of community resources or lack thereof, and a more nuanced understanding of family dynamics that influence patient care. Conclusion: Preliminary evidence suggests that mandatory pre-clinical service-learning significantly improves medical students’ understanding of the SDoH. While enthusiasm for preclinical community based learning remained stable, students reported decreased feelings of preparedness to serve diverse patient populations possibly indicating initial overestimation or recognition of previously unknown preparedness gaps. Specific qualitative feedback highlighted students’ greater understanding of socio-economic factors influencing healthcare access and outcomes, encounters that challenged preconceived notions, and an increase in empathy for future patient and community member interactions. As this is a pilot program, more longitudinal data is required to comprehensively assess the long-term efficacy of including required service-learning into osteopathic medical students’ preclinical curriculum. This may also be affected by community venue site placement, so future analyses will also compare responses from both within and between those placements. In addition, attrition attributed to students being at the end of the academic year likely impacted the data completeness.

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