Diane Calleson

Community-Engaged Scholarship: Is Faculty Work in Communities a True Academic Enterprise?

Since Ernest Boyers landmark 1990 report, Scholarship Reconsidered: Priorities of the Professoriate, leaders in higher education, including academic medicine, have advocated that faculty members apply their expertise in new and creative ways in partnership with communities. Such community engagement can take many forms, including community-based teaching, research, clinical care, and service. There continues to be a gap, however, between the rhetoric of this idea and the reality of how promotion and tenure actually work in health professions schools. The Commission on Community-Engaged Scholarship in the Health Professions was established in October 2003 with funding from the W.K. Kellogg Foundation to take a leadership role in creating a more supportive culture and reward system for community-engaged faculty in the nations health professions schools. The authors prepared this article to inform the commissions deliberations and to stimulate discussion among educators in the health professions. The authors define the work that faculty engage in with communities, consider whether all work by faculty in community-based settings is actually scholarship, and propose a framework for documenting and assessing community-engaged scholarship for promotion and tenure decisions. They conclude with recommendations for change in academic health centers and health professions schools.

Complementary and Alternative Medicine Use by Primary Care Patients with Chronic Pain

OBJECTIVES To describe the characteristics and attitudes toward complementary and alternative medicine (CAM) use among primary care patients with chronic pain disorders and to determine if CAM use is associated with better pain control. DESIGN Cross-sectional survey. SUBJECTS Four hundred sixty-three patients suffering from chronic, nonmalignant pain receiving primary care at 12 U.S. academic medical centers. OUTCOME MEASURE Self-reported current CAM usage by patients with chronic pain disorders. RESULTS The survey had an 81% response rate. Fifty-two percent reported current use of CAM for relief of chronic pain. Of the patients that used CAM, 54% agreed that nontraditional remedies helped their pain and 14% indicated that their individual alternative remedy entirely relieved their pain. Vitamin and mineral supplements were the most frequently used CAM modalities. There was no association between reported use of CAM and pain severity, functional status, or perceived self-efficacy. Patients who reported having at least a high school education (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.02-1.19, P = 0.016) and high levels of satisfaction with their health care (OR 1.47, 95% CI 1.13-1.91, P = 0.004) were significantly more likely to report using CAM. CONCLUSIONS Complementary and alternative therapies were popular among patients with chronic pain disorders surveyed in academic primary care settings. When asked to choose between traditional therapies or CAM, most patients still preferred traditional therapies for pain relief. We found no association between reported CAM usage and pain severity, functional status, or self-efficacy.

Health professional faculty perspectives on community-based research: implications for policy and practice

Community-based research (CBR) has become central to the understanding and elimination of health disparities within the USA and across the globe. The authors sought to determine the perspectives of health professional faculty on the factors affecting their involvement in CBR and the extent of community participation in that research. Faculty from 18 health professional schools in the USA identified by their deans as being leaders in CBR completed a written survey. Respondents reported that between 5 - 10% of faculty in their schools were involved in CBR. Public perception of the university, familiarity with community-based organization leaders and institutional leadership were cited as the most significant factors contributing to a schools involvement in CBR. Long-term community relationships, recognition in tenure and promotion policies and access to funding were cited as factors that support faculty in conducting CBR. The authors conclude that a more significant investment of public and private funds, the development of interdisciplinary institutional structures for community partnerships and a more inclusive definition of scholarship are needed to achieve a central role for CBR in efforts to understand and eliminate health disparities.

An Evaluation of a Positive Youth Development Program for Adolescents with Chronic Illness

PURPOSE Youth with chronic illness often struggle transitioning to adulthood and adult medical care. This article examines the outcomes of a group mentoring program called The Adolescent Leadership Council (TALC) that brings together high school participants and college mentors, all with chronic illness. TALC uses a positive youth development (PYD) approach, emphasizing strong relationships between youth and adults in an environment where youth can learn important life skills and take a leadership role. METHODS A pre-/postprogram participant survey was conducted for high school participants using a loneliness scale and a transition readiness survey. An alumni survey was conducted with all high school and college mentor graduates to assess educational-, vocational-, and health care-related outcomes. RESULTS Program records review and the alumni survey indicated that TALC was consistent with the PYD program model. Twenty high school students participated in the pre-/postprogram outcomes evaluation, which demonstrated a decrease in loneliness from 46 to 38.5 (p < .001) and an increase in health care self-advocacy from 3.8 to 4.2 (p < .001). Thirty-four alumni participated in the alumni survey. All high school and college mentor alumni had graduated from high school and college, respectively, and all were either currently in school or working. The majority of alumni were seeing adult providers for medical care. CONCLUSIONS The TALC program applies the principles of PYD to support positive educational, vocational, and health care outcomes for youth with chronic illness. Program development using the PYD perspective is an important new approach for supporting adult development of youth with chronic illness.

Recognizing the value of community involvement by AHC faculty: A case study

Physicians seek connections to their communities. Some health care and academic leaders believe that facilitating the creation of more such community connections is one way to reverse the trend of waning social and political legitimacy for the U.S. medical profession. For academic health centers (AHCs), such connections can maintain local and state support crucial to their long-term success. Multiple barriers exist to such involvement, especially for physicians in AHCs, where work done beyond direct patient care, administration, and research rarely contributes to the tenure and promotion process. The authors present a case study to show how one department in an AHC, beginning in the late 1990s, has been overcoming these barriers to incorporate the scholarship of community engagement into its mission and structure. The case study incorporates theoretical underpinnings to crystallize the following lessons that the department has learned so far: (1) If academic departments wish community service to be a central part of their mission, they need ways to institutionalize community engagement within organizational structures. (2) Community engagement can be scholarly. (3) If faculty members are to be recognized for their service activities, measures are necessary to determine what constitutes “excellence” and “scholarship” in community service. (4) Scholarship of community engagement goes beyond performing service activities in the community.

An innovative home-based interdisciplinary service-learning experience.

Abstract The University of North Carolina Mobile Student Health Action Coalition (UNC MSHAC) at Chapel Hill, North Carolina is a voluntary service-learning program in which interdisciplinary teams of graduate level health professional students provide monthly home visits to isolated, community-dwelling elders with complex medical and social issues. Students are mentored by UNC clinical faculty and retirees from the local community. Together, mentors and students generate action plans to improve the health and well-being of the participating elders. We report here the qualitative and quantitative results from our program evaluation demonstrating UNC MSHAC as an effective, service-learning model that compliments curricula, is satisfactory to students, and is a vehicle for academic institutions to serve elders in the local community.

Effectiveness of Mailing “Bathing Without a Battle” to All US Nursing Homes

Abstract An educational CD-ROM/video program was developed to educate nursing home staff about two research-based techniques for reducing agitation and aggression during bathing of persons with Alzheimers disease, including person-centered showering and the towel bath. This educational program was distributed free of charge to all 15,453 USnursing homes in the Centers for Medicare and Medicaid Services database. The dissemination, use, and short-term outcomes were evaluated by extrapolating data collected by long-term care surveyors in three states; usage was further assessed by tracking the number of nursing home staff who registered for the continuing education credits associated with the program. The programs quality and content was evaluated by actual program users, who rated the program after completion. Short-term learning outcomes were assessed by examinations built into the CD-ROM. Evaluating a national innovation presented a set of unique challenges; yet, to date, our findings have revealed mostly favorable short-term outcomes in terms of its dissemination, usage, and educational value. The long-term outcomes of this educational program continue to be monitored.