#16 Community Engagement: How the Community Teachers Tomorrow’s Health Professionals

August 30, 2022 | By Molly Heublein

With Aisha Queen-Johnson, MSW

Aisha Queen-Johnson, MSW of UCSF School of Medicine PRIME-US @UCSF_CCE highlights the power of community engagement (CE) in health professions education to allow for bidirectional opportunities  to understand the lived experience of individuals and communities to reduce health inequities.  We cover how to partner with community groups, best practices for choosing projects where learners can engage with the community, and key features of the CE curriculum.  Listen to hear key tips on how to bring this amazing opportunity to advance understanding and innovations in health by learning from the incredible people that make up the community in which we live and work.

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Credits

• Producer/Host/Writer/Reviewer: Era Kryzhanovskaya MD; Molly Heublein MD
• Show notes/CME: Isabel Valdez, PA
• Infographics and Cover Art: Charlotte Chaiklin MD; Isabel Valdez, PA
• Editor:  Clair Morgan of Nodderly (audio)
• Guest: Aisha Queen-Johnson, MSW

CME Partner: VCU Health CE

Show Segments

• Intro, disclaimer, guest bio
• Guest one-liner/ Best piece of advice
• Picks of the Week
• Case from Kashlak
• Definitions
• Benefits
• Roadblocks and challenges
• Key components of a successful community engagement curriculum
• Aligning with community partners
• Creating and maintaining partnerships
• How to select a project
• Instructional strategies
• Case 2- student directed community engagement
• Vision for the future
• Take home points
• Outro

Community Engagement Pearls

1. Community engagement is an important element in clinical training that addresses health inequities by providing the opportunity to understand the lived experience of individuals and their communities. This allows us to better understand how people live, work, what their support structure is, and the impact of these entities on health.
2. Community engagement needs to be bidirectional–partners must have input on project goals and clear communication around expectations of time, responsibilities, and outcomes.
3. When teaching learners in a community engagement project, we should include training on cultural humility, how to make healthy community assessments, and create space for critical reflection–giving plenty of time for learner’s responses as well as the community partners’ reactions.
4. Community engagement programs are most successful when there is appropriate institutional buy-in, community partner representation, faculty/staff with expertise and time to establish long-term relationships in the community, and time set aside in the learner’s curriculum.  

Community Engagement Show Notes 

Background

Community engagement (CE) is an important element in clinical training that addresses health inequities by providing the opportunity to understand the lived experience of individuals and their communities and better understand how they live, work, and their support structures.  CE helps the learner understand the social factors that contribute to the well-being of individuals and communities.  Community engagement is a bridge between the expertise and knowledge of institutions and communities, which can become an effective partnership for building and promoting healthy community living long-term. Community engagement curricula are focused on competencies around assessment of a community, relationship-building, and defining social determinants of health (Khazanchi 2021). 

Community Engagement vs Service-Learning

The terms community engagement and service learning could be interchangeable but Ms. Queen-Johnson sees community engagement as a bidirectional, broad continuum of community experiences ranging from one touchpoint of outreach to long term engagement of creating and implementing policy changes or program innovations. Alternatively, service learning can be a one-direction entity.   Community engagement identifies learning objectives around a topic or population with whom the learners are working.  Community engagement also includes the key component of critical reflection, wherein the learner identifies new content that resonates with them after they have completed their engagement. It challenges learners to think about how they have changed or may act in the future.  Service-learning takes community service one step further  (Tiako 2021). 

Benefits for the Learners and Community

• Witness the barriers and facilitators to health from the individuals’ lived experiences 
• Learn from first person expertise and community wisdom
• Explore the resources that support the individual and community 
• Identify real, tangible, and innovative solutions that address health inequities (Bandy 2011)

Roadblocks

Time is a major constraint that can affect consistent participation in community engagement, particularly because there is much to do in medical education.  Ms. Queen-Johnson suggests being clear about availability to help identify a project in which one can participate. 

Communication is another roadblock that could affect community engagement projects, particularly with expectation and scope of work. She recommends establishing a clear communication strategy with your team and community partners wherein you have outcomes and benchmarks of success to revisit throughout the project.

Key Components of a Successful Curriculum

• Build relationships and establish trust over time by providing time and space for team members to get to know one another 
• Be transparent with why you are interested in a particular topic or community
• Establish clear understanding of each individual’s responsibility 
• Provide ample time for reflection throughout the project
• Ensure that the project is mutually beneficial (Marjadi 2021)

Aligning the Missions of the Institution and the Community

To acquire the institution’s buy-in and support the development of curriculum that addresses social determinants of health, Ms. Queen-Johnson suggests creating opportunities for learners to hear from community experts about successful innovations in the community (Khazanchi 2021).  Ms Queen-Johnson recommends using examples of community engagement successes to advocate for more community engagement opportunities.  She emphasizes the importance of the student-voice for pushing institutions to include CE to improve understanding the lived experience of individuals affected disproportionately by poor health outcomes.  Highlight the resiliency of community improvement efforts that have made addressing health more successful. 

Ms. Queen-Johnson notes communities have experienced how the institutions “take away” from the partnership so it is important to invest people, time and resources in community partnerships in order to establish policies and procedures about how to work together, promote well-being of the community in which we work and live, and communicate openly about goals and outcomes. We need to identify leaders in the institution that will help community engagement partners navigate opportunities for service.  

Creating and Sustaining Partnerships

It is important to have faculty or staff that can maintain the relationships with a given project when trainees or learners cycle in and out. This enables the faculty to sustain community relationships and sets up the learners for success by setting expectations early as to the best practices of community engagement. The learners support the work that is already identified as important; learners at all levels (students, trainees, early faculty) with different skill sets and schedules can then be matched to support the projects, efforts and policies of the community.

Suggestions for Selecting Projects

• Identify the community partner and topic that is interesting 
• Reflect on and understand your interests in the community 
• Research the individuals doing the work of interest in the community 
• Assess and gather data on the community/topic 
• Interview the community leaders
• Highlight the assets of the community, not only the deficits or problems.
• Interview other organizations or programs in community engagement to learn about their successes and challenges.

Didactic and Reflective Exercises

Cultural Humility and Community Engagement

Cultural humility is a valuable framework to teach learners before they participate in a community engagement project.  Melina Tervalon and Jann Murray-Garcia developed a cultural humility framework focused on a lifelong commitment to self reflection and learning (1998). Ms. Queen-Johnson relates that one can never be fully culturally competent but suggests remaining curious and aware of the power dynamics that occur in the individual encounter or with a community partner. Encourage learners to find respectful ways to partner and be accountable for the relationship outcomes agreed upon.

Best Practices in Community Engagement

Community Campus Partnerships in Health is an organization that has identified best practices where they detail steps to take before partnering with community members. In an ideal world, learners in all health professions would learn these skills.

The Practice of Reflection

Ms. Queen-Johnson underscores the benefits of critical reflection, either as individuals or group-setting, as well as the importance of dialogue with the community members with whom the project was completed.  Reflection is a key way of assessing the depth of the relationship built from the shared experiences. It serves as an opportunity to find the “Aha” moment for the students  (Van de Heuvel,  2014). She also suggests implementing an opportunity for the community to reflect on what they learned about the learners and the institution.  

Drivers for Community Engagement: The Student Voice and Institution Leadership

Ms. Queen-Johnson encourages students in their want of opportunities for experiential learning while also asking institutions to promote these learning experiences. She recommends partnering with organizations or initiatives that are already in place and finding faculty mentors that will support the work the learners are doing.  At the beginning of the project, Ms. Queen-Johnson advises to be familiar with the limitations and the resources needed. Also, spend time with community partners to gain resources, increase project members/participation, and set small benchmarks of success to measure along the way of the project (Chandratre, 2021).

Ideal Community Engagement Curriculum

According to our expert, an ideal curriculum would include longitudinal, interprofessional experiences with organizations where there is a focus on advocacy and uplifting the voices of marginalized communities while also highlighting the expertise of the community.  She envisions an experience where not only do students learn ways to address the health inequalities but also explore ways to reform health systems and institutions and clinical encounters to make them more inviting and equitable. She adds that community leaders and the community voice should co-lead the curriculum.

Take Home Points

Community engagement highlights the voices and experiences of those affected by health disparities by keeping them in the center of the dialogue which is essential in developing solutions to problems in healthcare. 

Deconstruct knowledge hierarchy and power imbalances to address racist systems that have been proven to be very detrimental in their impact on health outcomes.

Improving health is best done in partnership, not in silos or alone.

Approach community partners with cultural humility, respectful communication, and agreed upon goals. 

Resources

Community Campus Partnerships in Health 

AAMC Center for Health Justice

Links

Picks of the Week:

Daring Greatly book by Brene Brown 

Peaky Blinders  show on Netflix *trigger warning: violence, strong language and sexual content*

Wildwood Whispers book  by Willa Reece

Goal

Listeners will understand the key aspects of community engagement curricula or service based learning in health professions education.

Learning objectives

After listening to this episode listeners will…

1. Define community engagement and service learning in health professions education, contrasting this to clinical learning.
2. Distinguish best practices for creating and selecting community engagement projects with community needs and wants in mind
3. Explain key components of instructional strategies (e.g. didactic and reflective practices) that underpin every service learning curriculum

Disclosures

Aisha Queen-Johnson, MSW reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Queen-Johnson A, Heublein M, Kryzhanovskaya E, Valdez I “#16 Community Engagement: How the Community Teaches Tomorrow’s Health Professionals . The Curbsiders Teach Podcast. http://thecurbsiders.com/teach August 30, 2022.