Impacts of Sustained Institutional Participation in Service-learning Perspectives from Faculty, Staff and Administrators Community-campus Partnerships for Health

The movement for greater civic engagement in higher education in the United States has taken hold across the core academic One manifestation of this movement has been dramatic growth in faculty and student participation in service-learning. Service-learning is an approach to experiential learning that is grounded in community-university partnerships, in which students provide services that simultaneously address community-identified concerns and meet key learning objectives (Seifer 1998). A key characteristic of service-learning is the 'reciprocal nature of both the service and the learning among all parties in the relationship' (Jacoby 1996). Community and university partners – including faculty members, students and community organisations – are engaged as co-learners and co-creators of knowledge (Jacoby 1996; Seifer 1998). Service-learning also aims to produce reciprocal benefits for community and university partners. The method equips students with skills and competencies that may be better taught through experiential learning than conventional classroom-based methods. While the specific learning objectives for service-learning vary by course and degree program, most service-learning experiences share the goals of teaching skills to work effectively with communities and support positive social change, and fostering attitudes of social responsibility and professionalism service objectives for service-learning vary, service-learning aims to benefit partnering community agencies by providing needed services that address client needs or support broader agency objectives such as capacity development and strategic planning (Cashman et al. 2004; Kushto-Reese et al. 2007). In addition to these immediate benefits to participating students and community partners, service-learning can have broader impacts. Service-learning may lay the foundation for future community-university partnerships by building trusting relationships that produce reciprocal benefits and by creating a context for academic and community partners to develop staff member skills and organisational infrastructure. In addition, sustained service-learning partnerships have been identified as effective in changing the attitudes, behaviours and beliefs of participants. For example, they can help enhance faculty members' understanding of the value of community-engaged scholarship (CES); encourage community-based careers among graduates; and enhance mutual understanding between partnering community organisations and universities. Ultimately, service-learning has been identified as a means of building the capacity and desire of academic and community partners to work together to address community needs and work for social justice A large body of empirical literature documents the short-term benefits of service-learning for students in a wide variety of disciplines and fields (Eyler et al. 2001). This literature has shown that service-learning positively influences students' personal and professional development, leadership …

member skills and organisational infrastructure.In addition, sustained service-learning partnerships have been identified as effective in changing the attitudes, behaviours and beliefs of participants.For example, they can help enhance faculty members' understanding of the value of community-engaged scholarship (CES); encourage community-based careers among graduates; and enhance mutual understanding between partnering community organisations and universities.Ultimately, service-learning has been identified as a means of building the capacity and desire of academic and community partners to work together to address community needs and work for social justice (Cashman & Seifer 2008;Community-Campus Partnerships for Health 2007;Freyder & O'Toole 2000;Gelmon, Holland & Shinnamon 1998b;Seifer 1998).
A large body of empirical literature documents the shortterm benefits of service-learning for students in a wide variety of disciplines and fields (Eyler et al. 2001).This literature has shown that service-learning positively influences students' personal and professional development, leadership and communication skills, intercultural understanding and sense of community responsibility.It has also shown that service-learning contributes to enhanced academic outcomes, including critical thinking skills, course content learning, the ability to apply classroom learning to real-world settings and the likelihood of completing one's academic degree program (Eyler et al. 2001;Prentice & Robinson 2010).
In comparison, there is very little empirical literature documenting the broader impacts of service-learning for both academic and community partners, such as those mentioned above.But the existing studies have demonstrated promising outcomes.Gelmon andcolleagues (1998a, 1998b) conducted a multi-methods assessment of the impact of the Health Professions Schools in Service to the Nation (HPSISN) program, a threeyear service-learning demonstration program implemented in 17 US health professions schools.They found that benefits for participating faculty members included enhanced relationships with students and community partners, new directions in teaching and scholarship, greater integration of their personal and professional lives, and increased understanding of community needs.Benefits for community partners included expanded services for their clients, greater access to grant funding, increased awareness of university assets and limitations, and enhanced volunteer and staff recruitment and retention.Sandy and Holland (2006) conducted 15 focus groups with longstanding community partners in service-learning, in which participants reported that sustained organisational participation in service-learning had multiple positive outcomes, including benefits to their clients from the interpersonal relationships they formed with students and receipt of services that enabled their organisations to both deliver core services to clients and take on new projects.They also reported that participating in service-learning supported reflective practices that enhanced staff and organisational development, created opportunities to learn from academic partners, helped their organisations to develop relationships with other community agencies participating in service-learning, and supported efforts to achieve organisational goals by creating a certain amount of prestige that was affirming and energising.Worrall (2007) conducted an interview-based study with participants from 12 community agencies with different durations of participation in service-learning.These agencies reported similar benefits, including that service-learning enabled them to deliver core services in the context of limited budgets, benefited their clients through the interpersonal relationships they developed with students and enhanced their perceptions of the academic institution.Finally, a number of studies have found benefits for participating academic institutions, including that servicelearning supports student recruitment and retention (Astin & Sax 1998;Roose et al. 1997;Vogel, Seifer & Gelmon 2010) and enhances community-university relationships (Gelmon, Holland & Shinnamon 1998b;Vogel, Seifer & Gelmon 2010).One likely explanation for the limited empirical research exploring the broad impacts of service-learning is that these outcomes may require a number of years to achieve, yet most evaluations of service-learning outcomes tend to be funded concurrently with three-to five-year grants to support the implementation or institutionalisation of service-learning (Gelmon et al. 1998a(Gelmon et al. , 1998b;;Holland 1997).This limits the outcomes that can be successfully evaluated, and may contribute to the strong focus in the literature on students' learning outcomes.In the present study, we had a unique opportunity to return to the HPSISN cohort studied by Gelmon and colleagues, 10 years after grant funding ended, to assess the broad impacts of long-term sustained institutional participation in service-learning.We interviewed service-learning leaders from each of the institutions, including faculty members, staff and administrators, to learn about the extent to which service-learning was sustained at their institutions, the factors that influenced sustainability and the impacts of long-term institutional participation in servicelearning for both academic and community partners.This article reports findings on the sustainability of service-learning at each school and the impact of long-term institutional participation in service-learning.For a description of the factors that influenced sustainability, see Vogel, Seifer and Gelmon (2010).

BACKGROUND TO THE STUDY
This study was conducted with service-learning leaders at schools that participated in the HPSISN program.HPSISN provided The HPSISN grantees represented a broad spectrum of the characteristics of US health professions academic institutions.
They were dispersed across the major regions of the country and included large research institutions and small teaching institutions, as well as public and private, faith-based and secular, and rural and urban institutions.Grantees included schools of allied health, nursing, allopathic medicine, osteopathic medicine, pharmacy, public health and dentistry.There was also a great degree of diversity among participating community agencies because each academic institution selected community partners with the aim of addressing local health priorities.Community partners included local chapters of national organisations such as the American Red Cross, Boys and Girls Clubs of America and Planned Parenthood, and local agencies such as nursing homes, churches, senior centres and youth centres.Detailed descriptions of the HPSISN program and the outcomes over its three years of operation have been published elsewhere (Connors et al. 1996;Gelmon et al. 1998aGelmon et al. , 1998bGelmon et al. , 1998c;;Seifer, Connors & O'Neil 1996a;Seifer, Mutha & Connors 1996b).
More than 10 years later, HPSISN remains one of only a few national demonstration programs for service-learning in a single discipline or set of disciplines in the United States.As early adopters of service-learning, and given the support provided to HPSISN participants to implement high-quality servicelearning, a study with leaders of service-learning at the HPSISN grantee institutions represented an ideal opportunity to explore the impacts of long-term institutional participation in servicelearning.

METHOD
We structured our inquiry according to an approach proposed by Gelmon and colleagues (2001).They defined the impact of service-learning in terms of the breadth of stakeholder groups that may be affected by it, including students, faculty service-learning staff, staff members of community agencies who are directly involved with service-learning and more broadly, the participating academic institutions, community agencies and communities served by these agencies.Because our study focused on the impact of long-term participation in service-learning by academic institutions, we assessed the impact on all of these stakeholder groups, with the exception of students, who are transient and therefore not involved in sustained service-learning activities.
This was a retrospective study, conducted from July 2007 through June 2008, involving interviews with service-learning leaders at the HPSISN grantee institutions.Our aims were to assess the extent to which service-learning had been sustained at each HPSISN department or school since grant funding ended a decade earlier, in 1998, in order to explore the factors that influenced sustainability and to learn about the impact of sustained institutional participation in service-learning.
We began by contacting the original HPSISN principal investigators at each of the 17 grantee institutions, to invite their participation in interviews for this study.As a number of these individuals had moved on to other institutions or organisations, this involved first identifying their current institutional affiliations and contact information.All consenting principal investigators participated in one-on-one telephone interviews.Interviews assessed the extent to which the HPSISN schools had sustained service-learning; the factors that influenced sustainability, including facilitators, challenges and strategies for success; and the impact of sustained institutional participation in service-learning for a broad range of stakeholders.In any case where the principal investigator was unable to answer all of the interview questionsfor example, if he or she had left the institution, or was no longer actively involved with service-learning -we asked for referrals to additional service-learning leaders at the institution who could answer these questions.These individuals were also interviewed by telephone, and interviews explored the same three topics.
Interviews ranged from 60 to 90 minutes in duration.
With the consent of the participants, all but one of the interviews were recorded and transcribed.Transcripts were analysed using an iterative process of thematic coding and memowriting, which identified major themes and the relationships between these themes (Miles & Huberman 1994;Morse & Richards 2002).Thematic codes were developed as a result of this process, and applied to all of the transcripts.To analyse the interview that was not transcribed, the lead investigator listened to the recording and took notes on the major themes that emerged.These were analysed along with the transcripts.For a more detailed description of the study methods, see Vogel (2009) and Vogel, Seifer and Gelmon (2010).This research was approved by the

Johns Hopkins Bloomberg School of Public Health Institutional
Review Board (IRB-1 Protocol #211).

Degree of Service-Learning Sustainability
Of the 16 grantee institutions represented in this research, 15 had sustained service-learning in some manner for the entire 10-year period since HPSISN grant funding ended.However, the degree to which these 15 schools continued to invest in service-learning varied significantly.Participants from three of these schools reported no organised departmental-or school-level investments in service-learning.They explained that service-learning was no longer integrated into the curriculum and did not receive any support through the allocation of resources, faculty or staff time, or supportive routines or policies.Rather, they explained that servicelearning was sustained through the independent efforts of a small number of dedicated faculty members who created service-learning experiences in the context of elective courses or co-curricular experiences.
In contrast, participants from the other 12 schools reported that service-learning remained integrated into required courses 10 years after HPSISN funding ended, and that significant resources continued to be invested in service-learning at the departmental level.Faculty time was allocated to servicelearning in a systematic fashion; service-learning was included in departmental planning processes; learning objectives continued to be developed specifically for service-learning experiences; and funding was allocated to support a full-or part-time servicelearning coordinator in the department.Within this group of 12 schools, there were sub-groups with additional levels of support for service-learning.Participants from 10 of these schools reported that there was support for service-learning in the institutional mission, and participants from nine schools described vocal leadership for service-learning among high-level administrators at the levels of the school and/or university.Participants from seven of these 12 schools described additional investments in service-learning at the levels of the school, college and/or university.These included, for example, funding for a service-learning centre and director at one or more of these organisational levels; stipends and/or release time to support faculty participation in service-learning; recognition for service-learning in hiring, promotion and tenure policies; and the creation of a steering committee to advise on service-learning in health professions education.
Interview participants from these 12 institutions shared reflections on the impact of their schools' and departments' longterm participation in service-learning.From their interviews, five main themes emerged related to the impacts of service-learning.
These were: 1) increased community engagement and CES, and increased valuation of both, among participating faculty members; 2) greater capacity for community-university partnerships among academic and community partners; 3) improved communityuniversity relations; 4) diffusion of service-learning and/ or principles of community-university partnerships to other departments and schools; and 5) recruitment of students seeking community engagement opportunities.Each of these themes is described in detail below.

Increased community engagement and community-engaged scholarship, and increased valuation of both
When asked about the impact of their institutions' long-term participation in service-learning, interview participants most often described the impact on their own professional activities.About half of the interview participants described how their personal leadership in service-learning early in their careers, through their roles in HPSISN, was a major factor in leading them to develop careers as community-engaged scholars.Many of the others said they were already committed to CES when they became involved in HPSISN, and that their ongoing leadership in service-learning during and after HPSISN, helped to support their development as community engaged scholars.
Participants described their involvement in a wide range of activities that fell under the rubric of CES, and which benefited a wide range of stakeholders, including their academic institutions, other academic institutions, their local communities and the CES movement more broadly.Half of these individuals mentioned writing books or chapters, or editing books, about servicelearning in their professions.A number described how they had provided technical assistance to colleagues at other academic institutions in the US and abroad to support them in implementing service-learning.Some of these participants served as principal investigators for grants that involved their institutions as mentors to other health professions institutions that were implementing service-learning for the first time.One participant described how she and a group of colleagues from her university developed a summer service-learning institute to train faculty from other health professions institutions.
In addition, a number of participants explained that their involvement in service-learning connected them with community agencies and government offices where they took on leadership roles or conducted research.For example, one participant, who eventually became the dean of her school, described how her leadership for service-learning led her to become involved in a host I did a study at [a hospital that was a service-learning partner], looking at implementing protocols in the urgent care department to screen for victims of violence.There was a protocol that everybody should be screened when they come into urgent care, so we did a study to see if that was true.
This study determined that screening for violence in fact was not taking place in all instances where it was warranted, and resulted in the development of a new screening protocol that was more effectively implemented.
Other participants described how service-learning helped them to develop an understanding that community engagement had a legitimate place within the activities of health professions faculty members and health professions academic institutions more broadly.In addition, they described how service-learning helped them to see the added value that community engagement brought to the core activities of academic institutions, including both research and teaching.Interview participants explained how this new perspective dramatically influenced their own professional activities, as it provided them with the lens they needed to integrate community engagement into their scholarly activities.For example, one participant said:

Greater capacity for community-university partnerships among academic and community partners
The second most commonly mentioned impact of long-term institutional participation in service-learning was that it contributed to building greater capacity for community-university partnerships of all kinds among participating academic institutions and community agencies.A number of interview participants described how their service-learning centres or participating faculty members capitalised upon service-learning partnerships to develop future community-engaged research, training and service opportunities.One of these interview participants explained: We have been able to leverage some of the [service-learning] projects … There's one [service-learning] team I can think of in which the faculty member has written a grant that speaks to the need that was identified by the community partner.The outcomes of that have been that now the faculty member has a grant to study obesity in this population, the community agency benefits because they didn't have to write the grant … and there are programs and interventions developed through that grant that benefit the community.
Another participant described how community and academic partners in service-learning had created relationships that enabled them to support each other's efforts to obtain grant funding: We applied for one of the regional medical education and public health

grants. And then [for the grant writing process] everybody [academic and community partners] comes together. And we have credibility with our [service-learning] partners … so people [in the community
partner agencies] will mobilize when there's a need to mobilize.And we, equally, will mobilize for them when they need our input on grant funding they're trying to get.
Just as often, participants noted how service-learning had created capacity among community partners to initiate partnerships with the university to address community health priorities.For example, one participant explained:

The community partners now seek us out because they have an issue that they think would be relevant for a course group or for students and faculty … [And] they're able to more effectively deal with the problems that they bring to us because they have the extra support of the bodies, as it were -students and faculty -and they have the intellectual capital of a university to help them see and deal with their problems differently.
They feel, very often, empowered by the process and not overwhelmed by having to address the issues, because now they have help.

Another participant said:
Usually the [grant] applications are initiated by the community partner, and we provide technical assistance … Our faculty members, to my knowledge, don't receive any money from those.But the [servicelearning] students then can be part of that.They write the students in as the people who are going to deliver the [services].

Improved community-university relations
Many interview participants said that sustained service-learning helped to change the way that the academic institution and community partners perceived and related to one another.One particularly important impact they described was that servicelearning led community partners to feel that the university could be trusted and, specifically, that the university's stated interest in addressing the needs of community partners was sincere.For example, one participant said: Sometimes people approach projects with universities with a sort of scepticism, because they feel like they're going to be the subjects or guinea pigs of some project, and that their needs are not going to be considered, just the student needs or the faculty needs.That's certainly not true in service-learning.And that's been our experience -that the community partners now seek us out … Question: Did community partners not seek you out before the servicelearning program?
Answer: Not to the extent that they do now.
Other participants from institutions where service-learning was only implemented within a single department, and not at the level of the school, college or university, described how these benefits were limited to the department engaged in servicelearning, and did not extend to the entire academic institution.

Diffusion of service-learning and/or principles of communityuniversity partnerships to other departments and schools
Another commonly cited impact of long-term institutional involvement in service-learning was the diffusion of service-learning and/or the principles of community-university partnerships on which service-learning is built to additional departments and schools.Interview participants described how they provided leadership to encourage this.For example, one participant explained how, as a leader for service-learning in her department, she organised a series of colloquia about servicelearning on her campus that led to the diffusion of service-learning to other departments: Other interview participants described how their long-term leadership in service-learning led to system-wide changes at their institutions that led to the adoption of service-learning more broadly.For example, one participant said: We were able, after the [HPSISN] grant was finished, to continue to encourage [other] departments to come on board … So now, the college does have service-learning requirements for [all of] their students.
Other interview participants described how, although service-learning did not spread to other disciplines at their institutions, the partnership principles that underlie successful service-learning -including communication, equitable power sharing and reciprocal benefits -did diffuse to other departments and schools in their institutions, with positive results.For example, the following participant noted the influence of service-learning in a medical school on the way that the master of public health (MPH) program was designed:

I will say that this [service-learning] program has had an influence on
the MPH program … For example, the MPH practicum now needs to be more of value [to the community partners] and more collaborative.Another participant observed how a long-term commitment to service-learning in a school of nursing helped to create broad buy-in to principles of community partnerships among faculty and administrators, and this in turn helped to develop an environment that supported community-based participatory research: I think the service-learning effort really promoted the mandate, the philosophy, and the passion for community [-based] participatory research … Service-learning enhanced people's attitudes about doing research in that way: really in the community, with the community, and with applications back to the community -that we're going to improve the quality of life.

Recruitment of students seeking community engagement opportunities
Finally, a number of interview participants described how longterm institutional participation in service-learning had unforeseen benefits for student recruitment.They explained that students cited the opportunity to engage in service-learning as an important reason they chose to attend these institutions.These participants said that students valued service-learning for the opportunities it provided both to provide service as a structured part of their education and to learn through experiential methods in community settings.Some of these interview participants described how, based on this feedback from students, their service-learning centres and marketing departments had collaborated to create student recruitment materials that highlighted the service-learning opportunities available at their institutions.For example, the service-learning director at a medical school related: Service-learning is something that attracts a lot of students.Some people come here [because] they know that service-learning is part of the first year course and they want to be involved.Sometimes they've been involved in service a lot in their prior institutions or in their work before they came here, and they want to continue.So every year we send [information]

DISCUSSION
A commonly cited challenge for the CES movement, particularly at research-intensive universities, is that the institutional culture does not recognise community engagement as a sufficiently scholarly activity (Calleson, Jordan & Seifer 2005).Our findings provide evidence that service-learning can help to support a shift towards an institutional culture that recognises and supports community engagement.Interview participants described how their participation in service-learning helped them to develop an appreciation for community engagement as a legitimate scholarly activity, and moreover, one that could advance the educational and societal goals of academia.They reported that this change in orientation to community engagement dramatically influenced their future professional activities as faculty and, in some cases, as administrators.Participants also described how service-learning led to institution-wide changes that supported CES, including greater capacity for community-university partnerships; improved community-university relations; the diffusion of service-learning and/or its partnership principles within the institution; and the recruitment of students seeking community engagement opportunities.These findings suggest that service-learning can be an effective strategy to foster an institutional culture that is more embracing of community engagement, by serving as a 'stepping stone' to other forms of community-university partnership, including partnerships for teaching, research and scholarly practice.
A comparison of the immediate outcomes of HPSISN reported by Gelmon andcolleagues (1998a, 1998b) with the outcomes of this research conducted 10 years later provides evidence for the added impact of long-term sustained institutional participation in service-learning, both for faculty activities and for the institutional culture.In interviews with academic partners in service-learning, Gelmon and colleagues found that faculty reported new directions in teaching and scholarship, greater integration of their personal and professional lives, and increased understanding of community needs.The findings from the present study suggest next steps that built upon the new directions described in the study by Gelmon and colleagues.Specifically, interview participants related how, over the prior 10 years, they had had committed careers as community-engaged scholars and implemented communityengaged projects that successfully addressed important community needs.In addition, participants described the diffusion of servicelearning and its principles of community-university partnerships to other departments and schools, and the benefits of service-learning for recruitment of students seeking community-engagement opportunities.
These research findings have implications for the activities of funding agencies, academic administrators and faculty members who wish to support greater community engagement in higher education institutions.They suggest that funders wishing to foster greater community engagement in higher education should include service-learning in their grant portfolios.They also point to the benefits of an incremental approach to encouraging community engagement, beginning with service-learning, which can lay the foundation for more resource-intensive communityuniversity partnerships such as community-engaged research.
Academic institutions may also find that service-learning is a promising first step towards additional partnerships because of the immediate benefits it produces for community partners, students and participating faculty members, and the infrastructure for partnerships that it builds.Finally, increasing numbers of faculty members wish to engage in scholarship that has practical benefits for communities.These findings suggest that servicelearning is an effective way for them to begin to learn about the scope of community-engaged scholarship, the range of available community partners, and the needs and priorities of their local communities.While participation in service-learning may create an extra time burden for faculty members in some institutions, participants in this research identified multiple professional and personal rewards.
This study had a number of limitations that are important to keep in mind when considering the findings.We purposefully selected participants from the HPSISN program in order to explore the experiences of a cohort of institutions that had sustained service-learning for over a decade, and that had implemented rigorous principles of service-learning.However, the experiences of the HPSISN cohort, which was comprised only of health professions schools, may not be generalisable to other academic disciplines.In addition, the HPSISN grantees received technical assistance on key aspects of implementing high-quality service-learning that may have contributed to the positive impacts identified in this research.
In addition, because only university-based participants in service-learning were interviewed, longer term impacts on communities could not be directly assessed.While some impacts for community partners were described, the university-based participants in this research tended to focus on impacts for faculty and academic institutions.Community partners would likely provide different perspectives that focus more heavily on the outcomes for their agencies, clients and communities.
Future research on the impact of sustained participation in service-learning is needed in other academic settings and with participants from community agencies that are long-term service-learning partners.Research that includes academic and community partner perspectives on the impacts of the same sustained service-learning partnerships may uncover convergences and divergences, with implications for understanding how best to maximise the benefits of service-learning for everyone involved.
Finally, studies that rely on retrospective interview data, such as this one, include a number of limitations.When asking participants to reflect on events over a period of time as long as 10 years, recall bias limits the ability to unambiguously assign impacts to particular events, or to identify whether the longterm impacts that participants described occurred due to events that took place in year 5 versus year 10.Future retrospective research on the impacts of long-term sustained service-learning can be enhanced through mixed-methods approaches that use a combination of data sources, such as interviews, documents and observations.Such approaches may help to identify the timing of key events and investments in service-learning and assess their short-and long-term impacts (Vogel 2009).A related challenge inherent in this study design was the inability to establish clear direction of causality.Academic institutions with a pre-existing bent towards community engagement were more likely to have participated in the HPSISN program.The influences of long-term sustained institutional participation in service-learning and the organic evolution of an institutional culture already predisposed to community engagement may be impossible to disentangle.
Future research into the sustainability and impact of servicelearning in higher education would benefit from comparative approaches that assess these outcomes in a set of institutions with variable baseline degrees of institutional support for community engagement and CES.

CONCLUSIONS
A challenge for research on the broad impacts of servicelearning is that evaluations of service-learning tend to be funded concurrently with three-to five-year grants to support implementation.Yet many of the promising potential impacts of service-learning for faculty members, academic institutions, community agencies and communities -such as increased CES among faculty, greater capacity for community-university partnerships and additional partnerships for research, teaching and service -may require a number of years to develop.In this study, we had a unique opportunity to explore the long-term impacts of service-learning at a group of 15 institutions that had sustained service-learning for over a decade.Our findings produced evidence that long-term sustained institutional participation in service-learning can increase faculty community engagement and CES and enhance faculty attitudes regarding the scholarly value of community engagement; increase capacity for communityuniversity partnerships among academic and community partners; diffuse service-learning and related principles of communityuniversity partnerships to other departments or schools; and enhance recruitment of students seeking community engagement opportunities.These findings suggest that sustained institutional participation in service-learning can be effective in fostering a greater culture of community engagement in academic institutions and serve as a stepping stone to other forms of community engagement.
financial and technical support to 17 health professions schools to establish service-learning partnerships with community agencies to address unmet health needs and integrate service-learning into the curriculum.Each funded institution provided matching support, in cash or in-kind, over the three-year grant period.In addition, faculty, students and community partners received technical assistance and participated in professional development to support a high level of rigour in the partnership process and the pedagogical components of service-learning.HPSISN was a program of the Pew Health Professions Commission and the National Fund for Medical Education, and was supported by The Pew Charitable Trusts, the Learn and Serve America Higher Education program of the US Corporation for National and Community Service, and the US Health Resources and Services Administration.
Of the 17 HPSISN grantee institutions, 16 agreed to participate in this study.Twenty-three individuals participated in interviews -16 of the 17 HPSISN principal investigators and seven additional individuals identified through snowball sampling.The overall sample included faculty members, service-learning staff members including directors and other staff, and administrators such as department chairs and deans.
of local community activities: I was appointed by the Governor to the state board of nursing to represent professional nursing education.I think I'm recognized in the community as being involved with different kinds of social issues.I'm [also] on the board of directors of [a local] hospital.Another participant explained how her participation in service-learning led to a community-engaged research partnership, with important implications for local health:

[
Service-learning] provides a home for me … to this day that allows me to understand how I can give back [as a health professional].And I got hooked.And then I started thinking more broadly about what the role of the university was in educating students to think more broadly about community responsibility … That really made me cross multiple boundaries as a faculty member and as a citizen in my own local community.Another participant described how his early leadership role in service-learning through HPSISN provided him with a framework for understanding community-engaged research and teaching as scholarly activities.This framework shaped his future professional activities: [Service-learning] helped provide a more academic, or intellectual, base in some of the issues of community-based participatory research and community-based service-learning … I think it clearly helped inform a lot of the work that I did while at [the university] … and then with the [foundation].And it definitely helped a lot in terms of my work as dean of curriculum at [another university].So I would say that it's definitely had a profound impact on the work that I do … It's a sensitivity.It's a lens to look at problems.And I think it's a perspective that's been greatly informed by those initial experiences.
think that for the most part [the university] has, at least in our local community, made a name for itself [through service-learning], in terms of a certain level of integrity when it comes to working with community.So, you know, 'it's a good partner to have.They will deliver when they say they're going to do X, Y, Z.'Another participant observed that community members saw community-engaged scholars on campus in a new light, which reflected the principles of equity, collaboration and cultural humility that are central to service-learning partnerships:The way we're perceived by people off campus [now is] as people who want to work with people, who … understand and want to understand local issues.That we're not just looking down our noses and thinking we know best for everybody.Some participants indicated that these improvements in community perceptions of the university and communityengaged faculty members had led to a greater willingness among community partners to engage with the university.The following exchange with one participant exemplified this theme: Question: What's been the impact of service-learning from 1998 to the present on community partners?Answer: One of the major ones is a sense of trust in the university.

Faculty
would say, 'Well, we can't do service-learning in our course.This is a humanities course,' or, 'I teach a 70-student section of general biology.How would I get service into my course?' … Part of what I did at that time was to help people try to get an understanding of what service-learning was all about … And then the students did campuswide colloquia and presentations about the service-learning that they were involved in … Part of it was trying to just introduce the idea that service-learning is something that nearly everybody can do … Faculty who participated in some of those discussions went back, and [created new] service-learning activities … There were some things in music that were being done with students in after-school programs.The art faculty and students did some things in the low-income housing community … Business department faculty and students, especially during income tax preparation time, worked with the senior centers and worked with seniors to help them prepare for tax season.

[
Another impact was] the creation of a community advisory group for the MPH program, which was modeled directly on what we were doing [for service-learning].So a lot more attention to getting people involved in a collaborative way, much as we have with the medical school [service-learning] curriculum.
that tells where the students went and what they did [for service-learning] … to every newly admitted student … [And] every summer I get a few people who say, 'Thank you.I'm looking forward to starting in September and I saw that you're going to [a particular community agency], and I would like to go there because I've been working with that population.'