Resident Education in Community Psychiatry: A Model of Service-Learning

In 1995 the Health Professions Schools in Service to the Nation launched a program of community-based education called service-learning. The foundation of this innovative form of education is the development of a partnership between health professions schools and the communities in which they are located. The aim is to achieve a collaborative balance between serving the identified unmet health care needs of the community and meeting defined educational objectives for the student or resident, such as embracing a personal ethic of service, cultivating critical thinking skills, and promoting a context for reciprocal learning.

Training psychiatric residents to be more knowledgeable about and responsive to the health care needs of the underserved is an educational goal of the University of Florida's community psychiatry program. Models of service-learning, integrated into the curriculum of the community psychiatry program, offer the opportunity to achieve this end. Upper-level psychiatric residents have the opportunity to engage in a service-learning experience by volunteering to work in an inner-city, shelter-based psychiatric clinic for the homeless mentally ill population in Jacksonville.

The University of Florida's community psychiatry program partnered with the Northeast Florida Area Health Education Center, an organization committed to training health care professionals to treat medically underserved populations, and approached the administration of the I. M. Sulzbacher Center for the Homeless, located in downtown Jacksonville. The purpose of the preliminary discussions was to determine the need for psychiatric care among those who frequent this large, 300-bed center for homeless persons. In these initial meetings it was made clear that access to mental health care and addiction services among the local homeless population was a profoundly unmet need. Hence the University of Florida's psychiatric clinic for the homeless was developed under the direction of the department's community psychiatry program, beginning in June 2000.

The clinic was designed to operate one full day each week in conjunction with the primary care clinic already established at the center. On clinic days, some 15 to 20 patients are seen for initial psychiatric evaluation, follow-up assessments, or medication management. During the first ten months of operation, over 650 clinic visits by homeless persons seeking mental health care were recorded.

Using the principles of service-learning, a balance between service and learning is emphasized. To promote a personal ethic of service among residents, participation in the clinic is voluntary. Upper-level residents are informed of the community need, the design of the clinic, and the minimum service commitment of two months. The department supports the resident's involvement but does not require participation. In addition, a faculty member is present throughout the clinic day and reviews each patient's chart with the resident. This interaction fosters critical reflection on community-specific issues such as lack of accessible health care for the poor, the local causes of homelessness among persons with mental illness, and the apparent obstacles in the community for those attempting to break the cycle of homelessness.

Finally, an emphasis on reciprocal learning is achieved through ready access and close proximity to the case managers and shelter providers who are intimately involved in the day-to-day needs of persons referred to our clinic. These individuals serve as informal faculty and teachers for the residents.

Preliminary feedback has been uniformly positive from both the psychiatric residents and the community. Commitments by the residents to staff the clinic are secured many months in advance. The homeless center has approached the department to determine whether the clinic can be held more than a single day each week. Long-term evaluation will include measuring the knowledge and attitudes of the residents through self-assessment tools and obtaining feedback from the center staff to ensure that identification of and response to the heath care needs of the homeless clientele is ongoing and appropriate.