"It's why I'm the doctor that I am": a qualitative study of the long-term outcomes of a longitudinal service-learning medical education program

Service-learning (SL) is widely used in medical education to promote structural competency and engagement with underserved communities. However, most SL evaluations focus on short-term outcomes, leaving limited understanding of whether these experiences shape physicians' perspectives and practice over time. This study examined the long-term impact of the Urban Medicine (UMed) Program, a longitudinal service-learning program, on graduates' professional development and commitment to health equity.

A retrospective qualitative study was conducted using semi-structured interviews with 35 UMed alumni who graduated from the University of Illinois College of Medicine between 2009 and 2020 and had at least four years of postgraduate clinical experience. Interviews were conducted via Zoom. Data were analyzed inductively using thematic coding, with codes and themes refined through iterative discussion among the research team.

Graduates described UMed as having a sustained influence on their professional identity, clinical practice, and commitment to underserved communities. Three major themes emerged: (1) sustained community engagement through the longitudinal community rotation reinforced graduates' sense of purpose and accountability to underserved populations; (2) structural competency training shaped participants' approaches to patient care by increasing attention to social determinants of health, advocacy, and systemic barriers to care across specialties; and (3) cohort relationships and mentorship fostered belonging and provided ongoing professional support that helped sustain equity-oriented commitments throughout training and practice. Participants also described continued collaborations with peers and community partners that influenced career decisions and professional trajectories.

Longitudinal service-learning programs may have durable effects on physicians' professional development and clinical practice. Sustained community engagement, structural competency training, mentorship, and cohort-based learning environments may help reinforce commitments to health equity and support physicians in addressing systemic barriers to care across diverse clinical settings.