Abstract
University-administered student run free clinics provide health care and enabling services to community members experiencing limited access to care, simultaneously offering direct educational experiences to students interested in careers in medicine. Programs vary in size and scope and are dependent on university and community commitment that considers the needs of the targeted patient population. This descriptive chapter illustrates Stanford University's Cardinal Free Clinic's inclusion of critical service-learning pedagogy within student didactics and experiential learning. The chapter is shared from an administrator's perspective to benefit higher education institutions considering establishing or expanding their SRFC program. While the environment and social context are essential to understand, the inclusion of community cultural wealth awareness, social identity exploration, and active self-reflection within the program will be highlighted. This chapter may benefit administrators interested in including elements of critical service-learning pedagogy in their programs.
TopIntroduction
Student-run free clinics (SRFC) create opportunities for student clinical and service-learning experiences and are considered a pipeline to careers in primary care and/or community medicine. While SRFC clinic locations are considered medical student service-learning sites, they are led by a social justice perspective that seeks to decrease social health inequity. Moskowitz et al. (2006) described the increase in underserved urban communities and the rise in the unhoused population that had necessitated more health professionals in underserved areas that, unfortunately, have created a disparity between the level of healthcare need and a sufficient healthcare professional workforce. The authors asserted “One such exposure to underserved populations can be accomplished through service learning in student-run health clinics; these clinics serve as an opportunity for health sciences students to use their developing clinical skills for the benefit of underserved populations” (Moskowitz et al., 2006, p.255). Since 1990, Stanford University’s School of Medicine’s Cardinal Free Clinics (CFC) program (Cardinal Free Clinics, n.d.) has operated student-run free clinics located in the San Francisco Bay Area within communities similarly described by Moskowitz.
The history of the CFC program includes steady growth while responding to the needs of the local community and targeted patient population. This chapter will describe how critical service-learning pedagogy is embedded in the CFCs with the intention of how student volunteers self-reflect about their social identities’ influence in their didactic and experiential clinic experiences. Mitchell’s (2008) review of the literature differentiates between traditional and critical service learning whereby, critical service learning includes the presence of a social change orientation, working to redistribute power, and developing authentic relationships. While the ability and form of service-learning approaches is dependent on the institution, community partners, and social context the CFC program’s orientation will be described as actively remaining cognizant of heroic discourse and savior complex leadership (Kim & Mauldin, 2022) in which service learning program participants interpret their voluntarism as heroic that will save the community they are serving. Community cultural wealth typology (Yosso, 2005) negates this discourse indicating that marginalized and underrepresented communities possess several forms of capital that should be included in frames of thought. Student exploration of community cultural wealth typologies (Yosso, 2005) and social identity (Tajfel, 1974) within an SRFC program produces opportunities for active student reflection as they participate in the CFC program.
Key Terms in this Chapter
Social Identity: A component of an individual’s self-concept that derives from their knowledge of their membership within a social group(s) in combination with the emotional importance disposed to that membership ( Tajfel, 1974 ).
Cardinal Free Clinics: The name of Stanford University's School of Medicine’s student run free clinics program ( Cardinal Free Clinics, n.d. ).
Experiential Learning: Learning that occurs when an individual is responsible to process knowledge, skills, and/or attitudes in a learning environment in which they have active participation ( Hoover & Whitehead, 1975 ).
Heroic discourse: demonstration of an individual’s reliance on themself as the savior that contradicts social justice principles ( Kim & Mauldin, 2022 ).
Stanford University: Founded in 1885, the R1 research university is located in the San Francisco Bay Area, California. The university is composed of seven schools: School of Business; School of Sustainability; School of Education; School of Engineering; School of Humanities and Sciences; School of Law; and the School of Medicine ( Stanford University, n.d. ).
Didactic: Direct teaching of facts and information to students as receptors of knowledge usually in classrooms ( Smerdon et al., 1999 ).
Critical service-learning pedagogy: The method and practice of service-learning that includes a social change orientation, working to redistribute power, and developing authentic relationships ( Mitchell, 2008 ).
Community cultural wealth typology: The typology includes six capitals: aspirational, familial, linguistic, resistant, navigational, and social. The typology asserts these capitals exist within marginalized groups and should be viewed as assets and resources ( Yosso, 2005 )