Community Engagement in Health Care

Sites: Boston Healthcare for the Homeless, Family Van, Health Care Without Walls, Appendix II available upon request for site specific activities
Director(s): Nancy Oriol
Offered: Monthly
Location: HMS - Harvard Medical School (0)
Open to Exclerks: No (HMS only)
Description: The goal of this Community Engagement Clerkship is to transform the students' understanding of the principles of the social determinants of health from theoretical to actionable. This is a 4-week elective with two parallel but coordinated community-engagement activities. 1) An experiential component involving 4 weeks, fulltime immersion in a community organization; 2) A mentored didactic component of 5-10 additional hours of reading, discussion and reflection, under the direction of a Faculty Mentor. Our overall pedagogical approach is to combine deliberate apprenticeship to a community-based healthcare organization, with the intrinsic motivation and commitment of students interested in learning about the community context of health. IMMERSION COMPONENT: Students will be assigned to ONE of 4 community-based organizations: Health Care for the Homeless, The Family Van, Health Care Without Walls or Southcentral Foundation in Anchorage Alaska. The student will be integrated into the work of the assigned organization. The immersion activities will generally include: direct interaction with patients (25%); mentoring by the organization leadership(25%); structured interactions with program stakeholders (25%); and introduction to the organization CQI, outcomes assessment and research (25%). MENTORED ONLINE CURRICULUM COMPONENT: Students will be assigned a Faculty Mentor who will guide the student's review of the online curriculum and debrief their experiences with the community site. The online curriculum has 10 modules related to the principles and practice of community engagement. The modules include readings, videos and other didactic materials. The first week is required reading to prepare for working at the site, the second week is a selection of seminal works related to community health, thereafter the student choses one paper a night from the posted modules. Each week the student will write a reflection paper on their experiences integrated with their readings, share it with their site mentor and have a debriefing session with their faculty mentor. Students should contact Marcie Naumowicz ( for information and site availability.
Incorporation of Basic Science Content and Evidence-Based Medicine:
The basic science content is incorporated through readings in Social Medicine on the principle and practice of working in vulnerable communities. All students are required to read the scientific evidence that connects socio-economic vulnerability to adverse physical and mental health outcomes. These will include the pathophysiology of stress, micro- and macro-aggressions and their impact on health and well-being, and the emerging scientific literature on the physiology of physical and emotional resilience. The history of social determinants and their impact on health will also be reviewed, together with the barriers to what would seem logical, meaningful, and needed interventions (Marmot 2016). We will draw heavily on the evidence base of successful interventions in under-resourced settings that can be applied or extrapolated to the settings in which our students will work. In addition, the student will read, and discuss with the Faculty Mentor, the online modules listed below (one per week). In addition to the required module the student will choose 3 additional modules. The material will be covered through: self-study, written reflection and discussion with Faculty Mentor. Where appropriate to the topic of study, the student will also engage with Expert Consultants
Grade Criteria:
Satisfactory: Attendance and reliability Completion of all assignments
Unsatisfactory: Being unreliable/ inappropriate with patients or staff incomplete assignments