Inadequate access to health care, lack of health insurance, and significant health disparities reflect crises in health care affecting all of society. Training U.S. physicians to possess not only clinical expertise but also sufficient leadership skills is essential to solve these problems and to effectively improve health care systems. Few models in the undergraduate medical curriculum exist for teaching students how to combine needed leadership competencies with actual service opportunities.The Advanced Leadership Skills in Community Service (ALSCS) selective developed in response to the shortage of leadership models and leadership training for medical students. The ALSCS selective is designed specifically to increase students' leadership skills, with an emphasis on community service. The selective integrates classroom-based learning, hands-on application of learned skills, and service learning. More than 60 medical students have participated in the selective since inception. Short-term outcomes demonstrate an increase in students' self-efficacy around multiple dimensions of leadership skills (e.g., fundraising, networking, motivating others). Students have also successfully completed more than a dozen leadership and community service projects. The selective offers an innovative model of a leadership-skills-based course that can have a positive impact on leadership skill development among medical school students and that can be incorporated into the medical school curriculum.

A state-wide survey of the receptivity, policies, and implications of mandated employee influenza vaccinations among healthcare institutions serving the elderly in North Carolina found written policies uncommon and most of the mechanisms used to increase vaccinations voluntary. Efforts should be tailored to individuals, institutions, and healthcare systems to dramatically increase employee immunization rates.

IntroductionThis study examines the integration of community engagement and community-engaged scholarship at all accredited US and Canadian medical schools in order to better understand and assess their current state of engagement.MethodsA 32-question data abstraction instrument measured the role of community engagement and community-engaged scholarship as represented on the Web sites of all accredited US and Canadian medical schools. The instrument targeted a medical school’s mission and vision statements, institutional structure, student and faculty awards and honors, and faculty tenure and promotion guidelines.ResultsMedical school Web sites demonstrate little evidence that schools incorporate community engagement in their mission or vision statements or their promotion and tenure guidelines. The majority of medical schools do not include community service terms and/or descriptive language in their mission statements, and only 8.5% of medical schools incorporate community service and engagement as a primary or major criterion in promotion and tenure guidelines.DiscussionThis research highlights significant gaps in the integration of community engagement or community-engaged scholarship into medical school mission and vision statements, promotion and tenure guidelines, and service administrative structures.

Introduction: Standing order immunization policies (SOIPs) for influenza and pneumococcal vaccinations have been found to be among the most effective strategies for increasing immunizations rates. Despite their proven efficacy these policies have not been widely adopted and there has been limited attention focused on testing particular adoption/implementation strategies. This pilot research assessed the efficacy of a minimalist strategy to implement an SOIP.Methods: A convenience sample of 3 primary care outpatient clinics in North Carolina agreed to participate in this study and adopt and implement an SOIP for influenza and pneumococcal immunizations for their patients >65 years old. The adoption procedure included 1-hour training for clinic nurses and providers, the provision of appropriate forms, and 2 brief reminders of protocols during the study period. Chart audits of appropriate patients who had a clinic visit during flu season (October through February) at each clinic during the baseline year of policy implementation (1999) and the year after (2000) allowed calculation of influenza and pneumococcal immunization rates as primary outcome measures.Results: There was little evidence to indicate that these clinics made changes to implement a SOIP policy. Immunization flow sheet use, a critical process measure of SOIP implementation, was found to be less consistent than would be expected under a well-implemented SOIP. It was also found that, although influenza immunization rates did increase slightly in the 3 intervention clinics, the changes were not statistically significant. Pneumococcal immunization rate changes were also inconsistent across clinics and from baseline to post-intervention periods.Conclusions: This minimalist effort to implement the SOIP seems not to have had sufficient impact to significantly change clinic practices. Flow sheet use, as one critical measure of SOIP implementation, did not change over the course of the intervention period. We did not find the expected increase in influenza and pneumococcal immunization rates as a result of a newly adopted SOIP. Additional research on improved strategies to fully implement SOIPs is needed to insure effective adoption of this proven systems intervention. (J Am Board Fam Med 2008;21:38 -44.)