Design, Implementation, and Evaluation of City as Text™ as a Place-Based Framework for Service-Learning in...

Service-learning is a required component of undergraduate medical education and is associated with empathy, civic responsibility, and commitment to underserved populations. However, traditional experiential learning models underemphasize inequities shaping community health. City as Text™ (CAT), a place-based pedagogy, extends experiential learning by explicitly engaging learners in spatial, historical, and community-informed inquiry. This study evaluates the self-perceived effectiveness of a CAT-based service-learning curriculum in pre-clinical medical education for fostering students' acquired knowledge of structural drivers of health, community perspective-taking, and professional identity formation (PIF), while strengthening their understanding of civic responsibility and community as a health resource.

A required CAT-informed service-learning curriculum was implemented for all first- and second-year medical students (n = 480) at McGovern Medical School. Students participated in faculty-led neighborhood explorations, engaged with community organizations, and completed structured reflective narratives. Qualitative analyses of reflections were conducted a priori codes based directly on curriculum objectives and clustered into four domains: acquired knowledge of structural drivers of health, community perspective-taking, (PIF), and higher-order critical thinking. Comparisons were made between MS1 and MS2 cohorts.

Student reflections demonstrated enhanced analysis of structural drivers of health, recognition of community organizations as essential health resources, and engagement in higher-order critical thinking. MS1 students emphasized civic responsibility and non-medical drivers of health, while MS2 students exhibited more integrative, systems-oriented reasoning and explicit professional identity reflection. Across cohorts, reflections shifted from deficit-based to asset-based perspectives, positioning communities as co-educators rather than observation sites.

Our data demonstrate that this service-learning curriculum promoted the strengths of CAT pedagogy and the values of civic medicine for pre-clinical medical students. CAT is a scalable pedagogy for service-learning in undergraduate medical education. Embedding learning within place, history, and community partnership promotes structural analysis, PIF , and equity-oriented thinking, preparing future physicians for socially accountable practice.