14 Community Engaged Learning Opportunity (CELO): A Novel Approach to Community Engagement in Medical Education
ALEXANDER AMON RODGERS, MD, MPH, MBA, NOE RUBEN CHAVEZ, PHD, SHEBA GEORGE, PHD
Introduction
A new generation of medical trainees with an understanding of social determinants of health (SDOH) contextualized in community-engaged learning is key to producing a physician workforce that is more effective at addressing health inequities. This is particularly true of the physicians who will serve in health care systems with patients whose health outcomes are disproportionately shaped by structural/cultural determinants of health as well as systemic racial inequities, falling under the broad umbrella term of SDOH. Below, we describe a medical education course in which medical students in their first two years of training worked in teams to learn about social determinants of health in the context of prevalent and significant health concerns in the South Los Angeles communities around them. Community-engaged learning is important for medical students because such learning goes beyond classroom discussions and clinical training to connect students directly with community stakeholders in the communities where they live, study, and serve.
- First, we provide a brief background and discuss the common challenges of teaching SDOH components in medical education.
- Second, we introduce the institutional and community contexts of our medical program, which allows for the development of this unique course in medical education.
- Third, we describe the methodology of the course to make the process transparent for other educators to replicate.
- Fourth, we briefly highlight each of the six student projects and what community engagement yielded for them.
- Fifth, we briefly reflect on how this approach to community-engaged learning in medical education fits within the field of Community Psychology.
- Finally, as educators, we conclude with reflections on our experience of facilitating this course for the first time and lessons learned.
The Background of SDOH and Community-Engaged Learning in Medical Education
There is growing recognition in the field of medicine and public health that understanding and addressing SDOH and community-engaged learning are key to improving health outcomes and quality of care. (Doobay-Persaud et al., 2019; Lewis et al., 2020; Nour, Onchonga, Neville, O’Donnell, & Abdalla, 2024) Yet medical education, for the most part, has not caught up with this recognition since SDOH-related curricula still comprise a relatively small share of the total medical education curricular footprint (Solomon et al., 2025). While medical educational programs increasingly include some representation of SDOH and community-engaged learning related topics in their curricula, several studies based on nationally representative samples report on the variability of SDOH and community-engaged learning content, the level of prioritization in teaching this content, and the lack of consistent evaluation of these program elements (Campbell et al., 2022; Doobay-Persaud et al., 2019; Hunter & Thomson, 2019; Lewis et al., 2020; Nour et al., 2024; Sharma, Pinto, & Kumagai, 2018).
When it comes to SDOH and community-engaged learning training in medical education, medical students are exposed to these topics under varied terminology, for variable lengths of time, and using a variety of different approaches. Terminology such as population health (within health systems sciences), community-based care, or community-based service learning can all incorporate exposure to SDOH. The level of prioritization for such exposure can vary from a single lecture on the topic to year-long service-learning opportunities, to research theses. These variations notwithstanding, the dominant approach to teaching about SDOH and community-engaged learning within medical education in the 2010s and 2020s has been criticized for positioning them as a laundry list of “facts to be known” and likely addressed at an individual or interactional level (e.g., behavior-focused interventions, doctor-patient communication) rather than as “conditions to be challenged and changed” at the systemic and sociopolitical levels (Sharma et al., 2018).
There is a reason that medical education programs tend not to prioritize SDOH and community-engaged learning-related curricula, which have been referred to as the “broccoli of medical education”(Gonzalo & Ogrinc, 2019). Like broccoli, SDOH and community-engaged learning are deemed beneficial for students but not sought after by most students, and not a high-priority component of many medical programs. While this type of learning has increasingly been incorporated among the required components for licensing by the Liaison Committee for Medical Education (LCME), SDOH, and community-engaged learning concepts are minimally represented on NBME board and shelf exams (Lewis et al., 2020).
Additionally, few medical programs make space in their curricula to address such topics, and faculty often lack appropriate knowledge and skills to teach such materials. Therefore, students are left with the impression that this information is peripheral if not irrelevant, relative to building competency in basic science, organ systems, and clinical skills knowledge. Because students are not rigorously tested on this topic on certifying exams, they see SDOH and community-engaged learning and systems change as outside the realm of physician responsibility and not considered as “high yield” (Gonzalo & Ogrinc, 2019). Consequently, this learning is often not prioritized by both medical students and medical education programs alike. Despite these barriers, we were able to develop a community-engaged course focused on experiential learning in our new medical program at Charles R. Drew University.
Institutional and Community Contexts in South Los Angeles
To understand how we came to teach community-engaged learning, we need to briefly share the context of South Los Angeles and the birth of our institution, Charles R. Drew University of Medicine and Science. Los Angeles County is the largest county in the nation, with nearly 13 million residents residing within it. For administrative and planning purposes, the county is divided into eight geographic regions of approximately equal population size called service planning areas (SPAs). South Los Angeles, while slightly ambiguous in definition, is a term colloquially used to describe a collection of LA city neighborhoods (e.g., Watts) as well as unincorporated regions of LA city (e.g., Willowbrook) and even independent cities (such as Compton).
Most of the geographic regions people consider South LA lie within LA County’s Service Planning Area 6 (SPA 6), and for this chapter and other chapters in this textbook, we will use South LA and SPA 6 interchangeably. SPA 6 has a population of just over 1 million residents – a population comparable to the state populations of Rhode Island, Delaware, and North Dakota and South Dakota.
In 1965, Governor Jerry Brown appointed John McCone to chair a commission tasked with understanding the root causes of the deadly 1965 Watts riot. In the report, the commission cites several critical healthcare metrics about South Los Angeles as contributing to the uprising:
- an infant mortality rate 1.5 times greater than the county average,
- a “considerably shorter” lifespan,
- a population-to-physician ratio of 2,377 people/physician (the county ratio was three times lower), and
- a total of two hospitals in the area that met “minimum standards of professional quality” (California Governor’s Commission on the Los Angeles Riots, 1965).
Given the discovered findings, the commission recommended the construction of a new county hospital. This hospital would later be known as the King-Drew Medical Center. At the same time, Charles R. Drew University (CDU) was established directly across the street from the hospital with the intention of training healthcare professionals to provide care in South Los Angeles.
Two thousand and twenty-five marks the 60th anniversary of the issuing of the McCone commission report – and despite significant advances in medicine, public health, and health policy, the report remains uncomfortably relevant. The infant mortality rate remains consistent at 1.45 times greater than the county average. The average life expectancy in SPA 6 is 79.1 years, 3.3 years lower than the county average (Los Angeles County Dept of Public Health Office of Health Assessment and Epidemiology, 2017). While it’s difficult to ascertain the current population-to-physician ratio in SPA 6, 32.5% of adults report difficulty accessing medical care – the highest rate reported in the county. (Los Angeles County Dept of Public Health Office of Health Assessment and Epidemiology, 2017). Finally, in 2007, the King-Drew Medical Center, the seminal achievement of the McCone Commission, was shut down. While it was eventually replaced with the establishment of MLK Community Hospital in 2014, this transition represents a decrease of 406 fewer hospital beds in the South LA region. These statistics, being so resistant to change, support the conclusion that meaningful, sustainable change in South Los Angeles is both complex and challenging.
With a vision of “excellent health and wellness for all in a world without disparities,” CDU has continued to attract faculty, staff, and aspiring healthcare professionals with a shared goal of addressing these challenging disparities within lower-resource communities. In 2023, CDU launched its 4-year medical education program and is only the fourth medical program at a historically Black graduate institution in the United States. As a university, CDU has prioritized a focus on social and historical determinants of health across its programs, including in its brand-new medical education curriculum, because we train our students to provide care to the most under-resourced communities around us, like the ones in South Los Angeles.
Our student body also reflects this priority with 85% of the matriculating medical students reporting an intention to practice in an underserved community after graduation. It is significant to note that an overwhelming large percentage of our medical student body has lower financial resources and are first-generation. Likely, CDU’s graduates will ultimately make up a large proportion of the safety-net healthcare workforce throughout Southern California. The Medical Education Program aspires to cultivate excellent clinical leaders in the community, with the ability to critically engage the community around pressing health issues as a focus for leadership skill development. Within this program, Medicine and Society is a course taken throughout the four years of the medical program, which was designed to include a Community-Engaged Learning Opportunity (CELO) in the first two pre-clerkship years.
Methods used in the development of the CELO Project
For their CELO projects, six groups comprised of ten medical students in each group were asked to complete the following six steps:
| Step | Topic | Description |
|---|---|---|
| 1 | Identify a health condition prevalent and significant to South Los Angeles | We divided the 60 students randomly into six groups of ten students each. The students discussed their interests and together decided on some potential health conditions for consideration. With input from faculty mentors and directors, the groups refined and focused their topics through further discussion and confirmation of the prevalence and significance of the health condition in South LA to select their final topic. |
| 2 | Develop a brief literature review and project plan | Each student, in their groups of ten, reviewed peer-reviewed articles/governmental reports in order to develop a collective literature review of twenty articles to identify key domains. They also wrote a collective proposal that described their topic and research question, the prevalence and significance of the issue in South Los Angeles, identified any relevant local or national health policies that might shape this issue, and a plan in which each group member would interview one of ten stakeholders. |
| 3 | Brief training in developing qualitative interviewing skills used in Social Science disciplines | Students were introduced to in-depth interviewing techniques and script development through in-class workshops. Unlike clinical interviews that are therapeutic and goal-oriented, qualitative in-depth interviews are open-ended and usually utilize a semi-structured script of questions. Using a semi-structured script allows the interviewer to cover known domains of inquiry but also the flexibility to follow the lead of the interviewee into new domains not identified in the questions, thus allowing for discovery. The students worked in their groups to develop and refine interview scripts with input from faculty mentors. Faculty mentors and directors provided feedback on how to refine and tailor interview questions to match the type of stakeholder (e.g., patient/family member, CBO, healthcare provider, policy person/researcher, government or community leader) they were interviewing. |
| 4 | Conduct in-depth qualitative interviews | Each group of students was required to collectively interview at least ten community stakeholders, and each group member was required to conduct at least one interview. The three stakeholder categories were consistent with the socioecological model as follows:
a) “patients/family/Community-based organizations” – those who received or facilitated health care, the community members most directly impacted by the topic of interest; b) “providers/health care teams” including social workers, community health workers, nutritionists, and care providers, etc. – those who provided health and social services to those directly impacted by the topic of interest; and c) “policy makers/researchers/governmental representatives” – those who made or implemented health policy or studied the topic of interest. Students were primarily tasked with identifying community-based organizations that addressed their topic of interest in South Los Angeles, as well as providers, patients, researchers, and policymakers. This allowed students to directly learn about who the key actors and decision-makers are for their topic of interest and directly probe them on the challenges and needs faced by such diverse community stakeholders. Faculty mentors and directors also supported the teams in identifying appropriate interviewees. |
| 5 | Summarize and analyze their interviews | Students used automated transcription software to transcribe their interviews. Each student analyzed the transcript of the interview they conducted for themes identified in the literature review and for new themes that emerged from their interviews. They analyzed the transcripts and created summaries with regard to what they learned in the interview, considering the broader questions being asked in their overall project.
Then, they were asked to form sub-groups based on the three stakeholder categories (i.e., patients, providers, and policymakers). All group members who interviewed a certain type of stakeholder were placed in one sub-group. Within each sub-group, they read each other’s summaries and created a summary analysis for each sub-group of stakeholders, identifying key themes that emerged across their transcripts. (For example, what did the three different types of providers (physician, dietician, and community health worker) interviewed say about the provision of health care in South LA around the selected topic? How did their views concur or differ? etc.). They also identified key quotes that illustrated their most interesting findings. Then each subgroup presented their findings to the other stakeholder subgroups and vice versa, so they could all learn about the differences in perspectives of those receiving/facilitating care, those providing care, and those creating policy or researching about the topic of interest. By pooling and analyzing their interview transcripts together in their subgroups and large groups, they were able to identify key themes and both patterns of similarities and divergences across their collective interviews, which is a main strength of qualitative interviews. |
| 6 | Develop a presentation | Finally, each of the teams worked together across the subgroups to develop a collaborative analysis and a collective presentation. They worked together to develop a comprehensive presentation that discussed:
a) the problem, its significance and relevance to South Los Angeles; b) how their literature review shaped their questions and identified gaps in our collective knowledge; c) What they learned about the issue and implications for South Los Angeles, some potential solutions to the identified problems, and future directions, and d) Reflections on their community stakeholder interview strategies and what they learned from their stakeholders, and what they learned about themselves in the process. The student groups presented their analyses and competed for first, second, and third place prizes with their final presentations. They were assessed by three judges from outside the program using the rubric provided in Appendix A. |
Faculty mentors and directors provided them feedback and support throughout the process, including in the selection and focusing of the topic, on their literature reviews and project proposals, their interview script development and revisions, in identifying interview participants, in their data collection and development of analyses, and culminating in their final presentations.
Outcomes and Impact
In the following chapters, the six groups of medical students describe their CELO projects, lessons learned, and recommendations to address the challenges of their respective health issues. The topics of their projects included the following: 1) prevention of childhood obesity, 2) pediatric asthma, 3) food insecurity, depression, and the gut-brain axis, 4) substance use among the unhoused, 5) inequities in hypertension, and 6) reproductive justice in maternal and infant mortality.
| Group | Topic | Description |
|---|---|---|
| 1 – Hamideh et al | Prevention of childhood obesity | Focused on understanding the inequities in childhood obesity for Black and Latinx descent communities in South LA. Their interviews with diverse stakeholders, including physicians, dieticians, community advocates, and parents, highlighted varied factors interrelated with childhood obesity in South LA communities. Four common themes that emerged included improving culturally and linguistically grounded nutrition education, offering community support to improve access to health education and resources, improving the safety of environments for exercising and building community, and policy changes to make all these new resources possible. |
| 2 – Argueta et al | Pediatric asthma | Examined inequities in asthma rates in Black and Latinx children and adolescents in South LA communities. The students interviewed mothers of pediatric patients with asthma, children/youth with asthma, pediatricians, community advocates, and policy makers. The interviews highlighted the following themes:
a) disparities in exposure to indoor and outdoor air pollution, b) parental difficulties in the management of children’s asthma, c) access to emotional support and education in pediatric asthma, d) complex challenges in improving insurance coverage, and e) effective medication and treatment for pediatric asthma. Potential solutions, centered on funding for community organizations for parental support and education on pediatric management, policies for mitigating air pollution, education and access to healthy diets, and improving equitable access to specialized and quality treatment. |
| 3 – Peña-Garcia et al | Food insecurity, depression, and the gut-brain axis | Explored the role of food insecurity and healthy food deserts with depression and the gut-brain axis in South LA communities. The group interviewed diverse stakeholders, including a community member who experienced depression and food scarcity; a local farmer’s market manager; a community resident; providers, including a primary physician, a psychiatrist, and a dietician; a researcher; a public health advocate; and a policy maker. The main themes from their interviews underscored the significant scarcity of healthy foods in South LA, the extensive consumption of ultra-processed foods, limited access to culturally responsive mental health services, the need for integrating nutrition knowledge in medical education, and the need to increase knowledge of food and the gut-brain axis. This group’s work highlighted the interconnections among multiple factors influencing depression, supporting the application of biopsychosocial and ecological frameworks in developing solutions. |
| 4 – Lopez et al | Substance use among the unhoused | Tackled the problem of substance use in the unhoused in South LA by interviewing diverse experts. Like the other projects, this project applied a holistic lens to better understand the complexity of structural factors impacting substance use in one of the most marginalized and vulnerable populations. Particularly, the medical students sought to create a holistic model that captured the multifaceted challenges of systems change to provide support to the unhoused. Their SUPPORT model (Stigma, Understanding, Prevention, Policy, Outreach, Roof/Refuge, and Transformation) was intentionally created to ground their work in the community-centered approaches of Housing First and the decriminalization of the unhoused populations. |
| 5 – Deshields et al | Inequities in hypertension | Examined one of the most rampant health inequities faced by Black and Latinx communities, hypertension, which stems from multiple socio-cultural and economic factors, and is one of the leading causes of morbidity and mortality. The students focused on how nutrition interconnects with various factors, such as poverty, cultural practices, food systems, and education. They interviewed diverse stakeholders, including Black and Latinx patients, community activists, and healthcare providers with expertise in hypertension. The interview findings highlighted the importance of understanding the historical, cultural, psychological, and economic contexts of food practices. To address hypertension, interventions should engage diverse community members, such as community health workers, faith-based leaders, residents/patients, to develop culturally and linguistically responsive community interventions integrated within the medical education and patient-care systems. |
| 6 – Watat et al | Reproductive justice in maternal and infant mortality | Examined the inequities in maternal and infant mortality in South LA. The students explored the birthing and postpartum experiences, including depression, of minoritized women. The students applied a Reproductive Justice framework to explore the structural roots of the inequities experienced by women, such as systemic racism and economic instability. The diverse stakeholders they interviewed – patient mothers, healthcare providers, researchers, and maternal health advocates- informed a three-tiered framework of potential solutions – 1. Improved patient-care and advocacy, 2. Improving healthcare systems and processes, and 3. Reproductive justice to advance maternal equity. The framework promotes a humanized, justice-centered, culturally rooted, trauma-informed, centering mothers’ voices, and empowering approach. |
How the CELO Curriculum aligns with Community Psychology
The mission of our university is focused on social justice and community engagement, reflecting two core principles of community psychology. CDU was founded in 1966, while the field of community psychology in the United States started in 1965. Both the university and the disciplinary field emerged in the context of powerful civil rights movements fighting against racial oppression and driving attention toward solving the complex social determinants of health and well-being. In their projects, our medical students learned directly from community representatives about the various social determinants and inequities affecting the South LA communities’ experiences on a diversity of health issues. They utilized the socio-ecological or biopsychosocial model to organize the diversity of community stakeholder interviews, representing the different ecological levels or settings, from community residents or patients, caregivers, community advocates, to healthcare professionals, researchers/academics, and policymakers. These projects contribute knowledge on the limited scholarship in community-engaged medical education and aim to advance community interventions for prevention and promotion of health equity in under-resourced communities. The principles of community psychology can aid in further improving our healthcare education and practices in a community-engaged manner.
Conclusion
Reflections on Lessons Learned and Future Directions
We end with some reflections on the process of implementing this community-engaged approach in medical education. Through this process, we learned that it was possible to teach medical students about community-engaged ways of inquiry. Many of them became invested in the health conditions of the communities around them, engaging with both individual stakeholders and community organizations/leaders, and learning techniques of inquiry that were unfamiliar to them and not traditionally taught in medical education. As teachers, it was a joy to see them develop and grow through this experience.
Several factors enabled us to pilot this curriculum successfully. Being in a large metropolitan area allowed a diversity of views to be captured in the stakeholder interviews. This context and ecology allowed our students to learn from diverse perspectives. An intentional engagement of stakeholders across the socioecological spectrum by medical students to obtain a holistic understanding of their selected health issue counters the predominant narrative in medicine that the doctor-patient interaction begins and ends within the clinical walls. It was valuable to use qualitative open-ended interviewing methods to expand epistemological tools available to medical students – to teach them that meaning-making is subjective and collaborative. This allowed for an expansion of what is acceptable evidence, beyond the gold standard of randomized clinical trials, to include their own reflexivity and lived experiences on data collected from a range of stakeholders. Finally, our curriculum benefited from the general support of the university community:
1) the absolute commitment and support of our institution and the medical program administrators who believed in the importance of this education,
2) the commitment of our students to equip themselves to be the best healthcare providers for the communities they aim to serve; and
3) the dedication of our interdisciplinary faculty (clinicians and social scientists/ community leaders) who brought wisdom and passion to this endeavor.
With that said, there are several challenges (noted in previous sections) that may result in difficulty for another medical education program to reproduce a similar curriculum and results. This type of learning, using questions to explore ideas inductively and without clearly defined answers, is very different from the rest of a typical medical curriculum. Medicine, being a profession that inherently carries high risk and a low tolerance for error, results in training that prioritizes knowledge that is extremely well-defined, reproducible, and evidence-based, with little room for subjectivity or reflexivity. Consequently, we learned that championing this type of learning, which contrasted with most medical educational goals, was quite challenging. First, it was difficult to implement this learning among medical students, who are overwhelmed with the many other requirements of medical education, when the knowledge from this learning is not tested by medical accrediting bodies.
We also received feedback from several students at the end of the year, noting that our choice to randomly assign students into groups of ten resulted in project topic selection that did not adequately align with the interests of some individuals in the groups. Another challenge we faced was assisting students in successfully identifying potential stakeholders to interview. Students who were assigned to interview healthcare providers faced the greatest challenge, which we suspect is due to healthcare providers typically having impacted schedules.
Subsequent Changes and Future Directions
With these strengths and challenges in mind, we made several changes to the curriculum between the pilot year and the second year of running the course. Instead of randomly assigning students into groups of ten, we developed a sorting process that allowed for better alignment of individual student interests with small group interests. In the first phase of topic identification, we asked all 60 students to get accounts on a digital whiteboard (https://miro.com/index/), which allowed them to share ideas for topics virtually as well as provide input to the topic ideas posted by their colleagues. Once they put their ideas online, the directors of the course categorized their ideas by main topics and sub-topics.
In the second phase of idea refinement and topic selection, students voted for their top three main topics of interest. The directors picked the six topics most voted for and implemented a Google survey with those topics that the students ranked from 1 – 6, which allowed the use of an algorithm to place each student into one of six topic groups with ten students in each group, based on their ranking of topics. With input from faculty mentors and directors, the groups refined and focused their topics through further discussion. We believe that this change allowed for better alignment of the interests of individuals placed in each group.
We also adjusted the timeline of the curriculum to allow for more time for the students to identify and conduct their stakeholder interviews. Additionally, the faculty team developed a repository of potential stakeholders – particularly healthcare providers – for students to interview, depending on selected topics.
In conclusion, we hope this curriculum provides an example of how medical education programs could incorporate community-engaged ways of learning into their curricula. We hope that this effort contributes to existing scholarship on community-engaged medical education and advances academic and community efforts to motivate future collaborations between community psychologists, medical researchers, and healthcare professionals. Furthermore, we hope these projects and student reflections on what they learned can motivate more medical education and interdisciplinary approaches in community psychology, public health, and community health to engage various community representatives more fully in not only learning about the health issues in communities but also taking action to inform interventions and policies guided by diverse voices and lived experiences. To solve the growing health inequities, our medical systems and training of future healthcare providers should move beyond the individual, treatment, and pathology focus of biomedical frameworks, to develop and implement more approaches centered on ecological, prevention, and strengths-based/wellbeing perspectives.
We extend our deepest gratitude to the patients, family members, health care providers, researchers, policy makers, community leaders, and organizational stakeholders who generously shared their time, experiences, and insights with our medical students. Your willingness to participate in interviews and contribute critical information made this work possible and profoundly enriched each project.
We also sincerely thank the editors who guided the development of this compendium, as well as the many reviewers who provided careful, thoughtful, and iterative feedback on each chapter. Your engagement strengthened the quality, clarity, and rigor of every contribution.
We acknowledge the medical student authors whose dedication, collaboration, and perseverance shaped the heart of this work. Your commitment to designing and implementing each project and to thoughtfully addressing reviewer comments significantly enhanced the final manuscripts and reflects the best of scholarly teamwork.
Finally, we would be remiss to not mention the many allies who have supported this effort. Your unwavering support, both material and intangible, was essential to the success of the Community Engaged Learning Opportunity (CELO) that led to this publication. We thank our CDU Medical program and Dr. Dean Deborah Prothrow Stith and Associated Dean Dr. Arthur Gomez for giving us precious real estate in the program to focus on community-engaged learning. We thank the sponsors of cash prizes for the winning teams of the presentation competition – Dr. Lance Williams and The Russell Stoval Foundation, Professor Aziza Lucas-Wright Varnado and The New Vision Church of Jesus Christ, and Dr. Stephen Greene, a member of the first graduating class of CDU physicians. We thank Drs. Schetema Nealy, Noe Chavez, Lance Williams, and Professor Aziza Lucas-Wright Varnado, the CELO faculty mentors who guided our students through these projects. We also thank Drs. Lola Ogunyemi, Homero Del Piño, and Lejeune Lockett for dedicating their time and effort as judges for the students’ presentation competition.
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