Service learning in health administration programs.

Abstract

This article provides an introduction to service learning, a brief history/theoretical framework of service learning, followed by highlights of service learning projects as reported, using an electronic survey of members of the Association of University Programs in Health Administration (AUPHA). The AUPHA, which originated more than fifty years ago, has as one of it core components: to be a leader in transferring new pedagogical techniques and technology in health management education.

Introduction

Service learning is gaining popularity as a novel pedagogical tool to enhance learning in educational institutions across the country. As recent as 1998, the Wingspread Conference was held at the University of Michigan Center for Community Service. The purpose of the conference was to renew the civic mission of the American research university. Collaborators and sponsors of the conference included the University of Michigan Center for Community Service and Learning, the Association of American Universities, the American Association of Higher Education, the American Council of Education, the Association of American Colleges and Universities, Campus Compact, New England Resource Center for Higher Education, University of Pennsylvania Center for University Partnerships, the Johnson Foundation and the W.K. Kellogg Foundation.

Likewise, the Association of University Programs in Health Administration (AUPHA), a not for profit association of university based educational programs, faculty and provider organizations has embraced unique learning opportunities as components of its mission Components of the AUPHA mission are: to promote graduate and undergraduate curriculum reforms and faculty development which respond to the changing needs of the health services delivery system. The mission also aims to improve the health of communities and to be a leader in transferring new pedagogical techniques and technology to health management education. Thus, service learning is a timely mechanism to meet the new challenges in health care and the needs for curriculum reforms (Reed 2003).

By definition, service learning is an academic and community partnership that combines service and learning to meet the mutually defined needs of the partners (Shaffer, Mather and Gustafson, 2000). Hecht (1999) described service learning as an experiential teaching and learning method that provides students with the opportunity to apply both academic and non-academic skills in real-life situations--towards a common cause and identifiable goal in the community. Dell Carpini and Keeter (2000) distinguish service learning from both community service and traditional civic education by the integration of study with hands-on activity outside the classroom; typically through a collaborative effort to address a community problem.

In essence, most service learning projects have been designed to integrate community service into the curriculum--in order to enrich the students' learning of the course materials and to provide a community service. Additionally, the service learning projects have been designed to promote civic responsibility by working collaboratively with community agencies in health promotion / service delivery. The educational process often requires the active involvement of students in the training, development, overall implementation of the program. In this article, a survey of forty-three undergraduate health administration programs with membership in the Association of University Programs in Health Administration, was conducted to determine factors related to the frequency, design, implementation and evaluation of service learning projects. Strengths, weaknesses and benefits were also reviewed in relation to the survey. The results yielded five enlightening accounts of service learning experiences in the college / university setting.

History / Theoretical Framework

The idea of service learning was reported as having developed from an educational philosophy that encourages active learning to fulfill social responsibilities (Mueller and Norton 1998). According to Stone (2000), service learning has been a popular pedagogical tool since the mid-eighties. Service learning was designed to teach students social consciousness and pragmatic skills. It builds upon the tradition of activism that was popular in the sixties, but greatly subsided in the seventies and eighties. Heffernan (2001) presents various models of service learning to include discipline- based service learning and problem-based service learning (PBSL). Discipline-based service learning is model in which students are expected to have a presence in the community throughout the semester and reflect upon their experiences on a regular basis using content as a basis for their analysis and understanding.

Problem-based service learning (PBSL) is a model in which students (or teams of students) relate to the community much as "consultants" working for a "client". Students work with community members to understand the particular problem or need. This model presumes that the student will have some knowledge they draw upon to make recommendations to the community or develop a solution to the problem.

Kolb (1984) postulates that learning occurs in a cycle in which students engage in and then observe and reflect on experiences, assimilate reflections in a theory and then deduce implications for future action or theory. McCarthy (1987) on the other hand, indicates that learning has two dimensions: perception and processing. Four major phases are identified in the learning cycle based on these three dimensions: (1) experiences, (2) conceptualizing, (3) applying and (4) creating learning. All of the stages are significant and integral to the service learning process. Based on John Dewey's 1938 theory of experiential learning, service learning takes the student out of the classroom and into the community--which yields positive meaningful results for students and communities. Students become more involved in something important and learn that they can make a difference in the world (Meyers 1999).

Review of Literature

Service learning projects with students have ranged from preserving the natural environment to preventing teen pregnancy and sexually transmitted diseases (Abdus-Sabur 2000). Other accounts include medical students and Master of Public Health students being placed in public health agencies; math students starting a community benefit company (O'Donnell 2001) and geography students learning to solve environmental problems (Fearn 2001). According to Kulewicz 2001, Simon and McKinney 1998, conducted a study that showed the relationship between service learning and the education of student health care professionals and the delivery of community-based primary care. Service learning experiences encompassed community door-to-door family surveys, health assessments, health promotion activities, creation of a database with resources to meet the health care needs and health advocacy promotion. Through this program, more underserved community members had increased access to health promotion and disease prevention interventions, and unmet community health needs. General Assessment Measures Assessment measures for service learning projects have ranged from qualitative to quantitative methods, such as journal writing (Broderick and Allen 1999) and attitude surveys (Moore, Sandholtz 1999). Cairn and Cairn 1999 identified a comprehensive array of assessment tools which included journal writing, self assessments, research papers, instructor observation / site visits and evaluations by agency supervisors. Boud et al. (1985) noted that experience is not sufficient for learning. They suggest that structured reflection is the key to learning from experience.

Methodology

An electronic survey of forty-three health care administration programs with membership in the Association of University Programs in Health Care Administration was conducted to determine information relative to the frequency, design, implementation and evaluation of service learning programs. The eighteen item open ended survey included items on demographics, faculty--student ratio, course, course objectives, program design, agency type, strengths, weaknesses, student benefits, community benefits and modes of evaluation.

Results

Of the forty-three colleges / universities surveyed, ten programs (23.3%) of the programs completed the survey. Of the ten programs that responded, five (50%) reported the inclusion of service learning in their curriculum. States represented by the responding colleges were: California, Kentucky, North Carolina, Pennsylvania, and Utah. The results of the study will be presented in a descriptive format using the following categories: Course Type / Related Course Objectives, Faculty--Student ratio, Service Design, Agency Type, Strengths, Weaknesses, Student Benefits, Community Benefits and Mode of Evaluation.

Objectives Some of the course types, in which service learning projects were reported, included: Problems of the Aged, Long Term Care, Ambulatory Care, Strategic Management and Marketing, Health Policy and Planning, Health Care Services for the Mentally Ill and Leadership and Direction in the Administration of Health Services. While objectives of the experience were most often linked to the objectives of the course, some objectives were generic and related to gaining an appreciation for the service learning experience and providing a needed service to the community. Selected courses and related course objectives are as follows: Problems of the Aged and Long Term Care--To gain and understanding of the problems of the aged and to understand the difficulties; Long Term Care Management -To provide management / planning assistance to long term care agencies; Health Policy and Planning- To gain exposure and understanding on how to plan for health needs and develop policies by conducting community health needs assessments; Health Care Services for the Elderly and Mentally Ill--To gain sensitivity in working with the disabled, mentally, chronically ill or elderly persons; Planning and Marketing Health Services- To complete a marketing plan to health service delivery.

The faculty-student ratio for the service learning projects ranged from 1:10 to 1:25. Some of the faculty members reported working actively along side the students during the entire service learning project, while others observed, and yet others reported allowing the students to "volunteer" with the agency on their own. In the absence on classroom faculty, community workers supported and monitored the student. Mechanisms for feedback to the campus faculty included time reports, letters on agency letterhead and other evaluative means. Generally, the service design consisted on students committing up to twenty (20) hours per week to fulfill the course objectives in the designated health agency. The design of the service delivery included: Students volunteering with public health agencies to teach health concepts to inner city youth in a fun way; The use of a mobile health unit to conduct screenings, market programs and conduct modified community needs assessments--in the general and elderly population; The matching of student teams with health and human service organizations to provide a market plan, develop brochures and develop web sites; Students conducting background research using clinical and marketing literature to formulate a market plan for non-profit health agencies; The development of management consulting reports for health care agencies; The development and implementation of surveys related to employee turnover; The marketing of senior citizens services to increase enrollment using brochures and other marketing tools; The development and implementation of a quasi--needs analysis for Meals on Wheels.

Agency types reported for the service learning programs included: youth health centers, public health facilities, schools, long term care agencies, hospitals, skills nursing facilities, assisted living facilities, home health agencies, rehabilitation centers, hospices, physicians offices, and surgi-centers. Numerous strengths and weaknesses of the service learning programs were reported. Some of the highlights were as follows: Strengths- Hands--on experience and a chance to see how public health works; Support to underserved communities ;Better understanding of service and special circumstances of working with the disabled, elderly and chronically, mentally ill for students ;"Real World" experience for students--via interaction in managers and community agency. Weaknesses -Service arrangements did not tie in all of the class concepts; Service logistics difficult to coordinate; Time limits based on class / student schedules; More time required for planning service learning than for traditional classes; Students could fake hours worked; Students complain they are too busy with family; Difficult to find projects that are appropriate for undergraduate students--either the projects are too demanding or not rigorous enough

Despite the weaknesses of the service learning experiences, student and community benefits were identified as follows: Student Benefits Appreciation of knowledge gained in the real setting; Better understanding of industry studies; Possible contacts for job and internships; Intergenerational collaboration; Learned real world problem solving-Community Benefits-Assistance with programs / service Volunteer workforce ;"Free" assistance for marketing / planning; Energetic young people involved in the agencies; Increased knowledge about health promotion; Elevation in general knowledge of service offerings. Though service experiences varied in type and scope, efforts were made to adequately assess the fulfillment of the objectives of the each course. Modes of assessment were reported as follows: Faculty observation; Commitment to perform the service; Feedback from community coordinators ;Test questions related to the service experience; Reflection journals; Integrated class discussions; Term papers / Written reports ;Presentations (in-class and/or community based)

Discussion / Limitations

While the sample size and return rate for this survey was less than optimal, the information provided by the responding colleges and universities was invaluable in providing insight relative to the design/implementation and evaluation of service learning programs. A more extensive survey could also be used to determine which evaluative methods yield the most comprehensive and targeted results. Even so, based on the information provide a service learning guide could be developed to minimize the frustrations (weaknesses) associated with the implementation of service learning programs.

Summary

The benefits of service learning reported in this study were quite similar to the benefits of service learning reported by noted authors. Astin and Sax 1998 indicated that service learning augmented the undergraduates' academic growth, life skill development, and awareness of civic responsibility. Gray et al. 1998 noted that a Rand Report credited service learning for an increase in students' knowledge, development of and comprehension of responsibilities of living in a democratic society, and heightened awareness of the critical social needs of the community. Finally, The Center for Health Professions /The Community--Campus Partnership for Health at the University of California (San Francisco), along with many other university programs, has also recognized the need for service learning. The Partnership has thus planned workshops related to effective curricular models; strategies for development of service learning program. Such efforts will be ongoing, in an attempt to "standardize" or provide effective models for service learning in health administration programs.

References

Abdus-Sabur, R. "D.C. Hosts National Youth Service Day". National Cities Weekly 23 (May 2000): 3.

Astin. A. W. and Sax, L. J. "How Undergraduates are Affected By Service Participation". Journal of College Student Development 39 (1998): 251-263.

Boud, D., Keogh, R., and Walker, D. (Eds). Reflection: Turning Experience into Learning. London: Kogan, 1985, pp. 7-8.

Broderick, P., and Allen, R. "The Definitive Handbook". Teaching Pre K--8 30 (September 1999): 90-92.

Cairn, R. and Cairn, S. "Service Learning Makes the Grade". Educational Leadership 56 (March 1999): 66-68.

Dell Carpini, M. and Keeter, S. "What Should Be Learned Through Service Learning". PS, Political Science and Politics 33 (Sept 2000): 635-637.

Dewey, J. How We Think: A Restatement of the Relation of Reflective Thinking to the Educative Process. Lexington: Health, 1933, p. 9.

Fearn, M. "Service Learning in Geography". Journal of College Science Teaching 30 (May 2001): 470-473.

Gray, M. J., Ondaatje, E. H., Fricker, R., Geschwind, S., Goldman, C. A., Kagnoff, T., Robyn, A., Sundt, M., Vogelgesang, L., Klein, S. P., Campbell, N. and Rosenblatt, K. "Coupling Service and Learning in Higher Education: The Final Report of the Evaluation of Learn and Serve America" Higher Education Program, Santa Monica: Rand Education, 1998.

Hecht, D. "Peer Help Through Service: Learned Helplessness". Social Policy 30 (Fall 1999): 34-41.

Heffernan K. Fundamentals of Service Learning Course Construction. Rhode Island: Campus Compact, 2001, pp. 2-7, 9.

Kolb, D. A. Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs: Prentice Hall, 1984.

Kulewicz, S. J. "Service Learning: Head Start and a Baccalaureate Nursing Curriculum Working Together". Pediatric Nursing 27 (Jan / Feb 2001): 37-43.

McCarthy, B. The 4MAT System: Teaching to Learning Styles with Right / Left Mode Techniques. Barrington: EXCEL Inc, 1987.

Meyers, S. "Service Learning in Alternative Education Settings". The Clearing House 73 (November/December 1999): 114-117.

Moore, K. P., and Sandholtz, J. H. "Resigning Successful Service Learning Projects for Urban Schools. Urban Education 34 (November 1999):480-498.

Mueller, C., and Norton, B. "Service Learning: Developing Values and Social Responsibility" in Billings, D.M and Halstead, J. A. (eds). Teaching in Nursing: A Guide for Faculty. Philadelphia: W.B. Saunders Company, 1998.

O'Donnell, B. "A Personal Journey: Integrating Mathematics and Service Learning". Mathematics Teaching in Middle School 6 (April 2001): 440-446.

Reed, L. (Ed.). Health Services Administration Education. Directory of Programs. Washington, D.C.: The Association of University Programs in Health Administration, 2003.

Schaffer, M., Mather, S., and Gustafson, V. "Service Learning: A Strategy for Conducting a Health Needs Assessment of the Homeless". Journal of Health Care of the Poor and Underserved 11 (November 2000): 385-399.

Stone, E. "Service Learning in the Introductory Technical Class: A Perfect Match?" Journal of Technical Writing and Communication 30 (2000): 385-398.

Sherryl W. Johnson, Albany State University 

Sherryl W. Johnson, Ph.D., is an Associate Professor of Management: Health Care Administration