Gaining cultural competency at home

Medical students stay local for summer service learning

Michelle Pruchniewski spent part of the summer working as a medical assistant at the Worcester EcoTarium’s Summer Discovery Camp. She is pictured here with campers.

Many rising second-year medical students at UMass Medical School take advantage of the opportunity to participate in international summer service learning projects that broaden their cultural competency and expose them to health care related situations that deepen their understanding of a range of patients and patient care. But there is also a lot to be learned about culture locally. Thanks to the Summer Service-Learning Assistantship (SSLA) program sponsored by the Office of Undergraduate Medical Education, rising second-year medical students also have ample opportunities to participate in paid summer service learning projects right in their own backyards. The program is partially funded by the Massachusetts AHEC network, which supports students in the Rural Health Scholars Pathway.

Directed by Heather-Lyn Haley PhD, assistant professor of family medicine & community health and medicine, and Suzanne Cashman, ScD, professor of family medicine & community health, the program provides medical students with service opportunities at sites that benefit from the students’ unique skills and interests. Leveraging existing partnerships, Drs. Haley and Cashman match the learning objectives of individual students with sites that can fulfill those objectives.

Many of the students originally learned about the SSLA program through the first-year course Determinants of Health, which helps prepare these future physicians to act as advocates within a multidisciplinary team. The summer program provides students with a chance to get their feet wet in a community service organization by applying their first-year knowledge in non-clinical settings. The paid placements span five to six weeks over the summer, with students working about 30 hours per week.

This year for the first time, the students were required to develop their posters in the classic research poster format, adding a technical aspect to the summer projects that arms the students with a valuable new skill that they will use throughout their academic careers. The posters were displayed at a group presentation in late August.

Another important component of the SSLA program is periodic group sessions for reflective discussions with Haley and Cashman. These meetings are scheduled throughout the summer so that all students who are actively working at their SSLA assignment have an opportunity to attend at least two. At the sessions, students talk generally about their learning objectives and their sites, and specifically about the nature and context of their experiences, sharing insights germane to their future roles as physicians.

Students also discuss the various professions they are exposed to and interact with, which helps them begin to think about areas of specialty and different professional settings. The summer program is capped by a pot luck dinner that all the students attend. This final gathering is highlighted by small group discussions in which students review each other’s poster content and respond to final reflective questions.

For the 2012 summer, the program funded 16 students who worked in projects ranging from immersion in interpreter services at a community hospital to serving as a first-aid and medical information resource at a science camp. Below, three of the student participants—Melinda Palma, who worked at AIDS Project Worcester; Michelle Pruchniewski, who worked at the EcoTarium; and Linda Salstein, who worked at Veterans Affairs Medical Center in Northampton on Ward 8—talk about their projects.

Melinda Palma, AIDS Project Worcester
My main learning objective was to gain a better understanding for the services that AIDS Project Worcester provides to people living with HIV/AIDS in the Greater Worcester area. More specifically, I wanted to learn how AIDS Project Worcester implements their services and projects involving client case management, food assistance, support groups, testing and counseling; and financial support for housing and utilities.

I was given excellent opportunities to explore the many services and support that APW provides. I participated in grant writing to obtain funding for on-going projects involving women’s health and support for families affected by HIV/AIDS. I also worked in APW’s food bank, shadowed case workers, attended support groups and took part in HIV counseling and testing at APW and in the community.

AIDS Project Worcester is an amazing place. This experience has been eye-opening and has made me more informed about the varied and difficult social problems that people in Worcester face. From the beginning, the staff at APW saw this as a learning opportunity for me and they wanted me to experience as much as possible of what the agency does. I hope to bring more empathy and understanding to my future patients because of this experience and I feel that I can provide better care to HIV positive individuals as a result.

Michelle Pruchniewski, EcoTarium
My primary learning objective was to become more familiar with the resources and programs available through the EcoTarium and determine how they are promoting health education in Worcester. Since I was working at the Summer Discovery Camp, my focus was the EcoTarium's impact on Worcester's youth. However, I also wanted to discover for myself how the EcoTarium fits within the greater medical community.

I was the Summer Discovery Camp's medical assistant. All of the kids and counselors just referred to me as the "nurse," which I loved. My responsibilities ranged from helping counselors supervise and maintain the safety of the campers, to administering first aid to injured campers as needed, supervising sick campers in the camp health room, updating and maintaining the camp medical log and facilitating the distribution of medications by the camp director. In short, I patched up split open knees with band-aids, gave out ice packs like hot cakes and applied more bug spray and performed more tick checks than I can ever remember. It was so much fun! (It really was). I also had the opportunity to take advantage of the EcoTarium by exploring the grounds and participating in all of the camp activities that I wanted to.

Working at the EcoTarium was a blast and during my time there I was fortunate enough to run into a few members of the UMass Medical School community. It was wonderful to interact with them and especially their children, who were my campers. It made me feel like I was part of the greater Worcester community and an integral member at that. Many of the campers thought it was the coolest thing when they found out that I go to medical school. One camper came up to me and informed me that her mom said I'm not a nurse at all. I thought she was going to call me a fraud and start asking for my work credentials but instead just excitedly said, "You're a medical student!" I cannot accurately describe the feeling, but it made me feel proud that I had the approval of an 8-year-old and that I could be a role model for these children.

Linda Salstein, Veterans Affairs Medical Center in Northampton, Ward 8
My objective was to learn about the clinical presentation of post-traumatic stress disorder as well as current treatment for the disorder (both therapy and pharmacology).

Ward 8 is a post-traumatic stress disorder treatment unit. While there, I was observing psychiatric interviews and group therapy, and learning about all the other components of the program that are needed to create a successful therapeutic milieu for patients.

From this experience I was able to see how disabling PTSD can be for veterans and their families. PTSD is relatively common in returning veterans and something the medical community should look out for in patients. The psychiatrist with whom I was working also taught me a lot about interviewing skills and techniques. I am looking forward to practicing and applying these techniques in the future.

2012 Summer Service Learning Assistantship participants

Rachel Ackerman, Mass General Hospital Center for Community Health Improvement

Aditi Ahlawat, Family Health Center Worcester

Sarah Aker, Edward M Kennedy Community Health Center

Meghan Gibson,* UMass Memorial Pediatric Primary Care

Chelsea Harris, Office of Health Policy and Technology, Commonwealth Medicine

Katherine Hicks-Courant, Boston Public Health Commission

Liam Jette,* Barnstable County Dept of Human Services

Kristen Liska, Martha’s Vineyard Youth Task Force

Nicole Mushero, Worcester Elder Services

Melinda Palma, AIDS Project Worcester

Michelle Pruchniewski, Ecotarium

Peter Roman,* Clinton Hospital

Lisa Salstein, Bedford Veteran’s Administration Hospital

Komal Shah,* REACH North Adams

Emmy (Mary) Smith, WooFoods

Avinash Sridhar,* Martha’s Vineyard Tick Task Force

Carrie (Chong) Wu, Worcester Dept of Public Health/ UMass Injury Prevention Team
*Rural Health Scholars Pathway students