Our teaching philosophy is to inspire students to be lifelong learners and focus their personal inquiry on the care of their patients, whether it be in the classroom or at the bedside during authentic patient encounters. We motivate and challenge students to learn to care for patients, not only to provide care for their medical conditions, but also to regard their humanity, and their physical and psychosocial well-being. Moreover, we continually strive to train future physicians to be compassionate communicators with their patients and consider non-biological factors, such as environmental, social, economic, cultural and personal beliefs, in the delivery of excellent health care.

We launched our Learning Communities (LC) program in July 2020, in the midst of a pandemic. While many medical schools across the country have already implemented some form of a learning community, JABSOM’s innovative program integrates Hawaiian cultural values and practices while demonstrating a strong commitment to learning about and serving our diverse communities.

The JABSOM LC program is comprised of six groups of students-faculty, assigned to a moku. A moku is a large division of land within a mokupuni (island). The six LC groups correspond to the six moku on the island of Oʻahu: Waialua, Wai‘anae, ‘Ewa, Kona, Ko‘olaupoko, and Ko‘olauloa. Each moku is further divided into two smaller groups, mauka (mountain) and makai (ocean). Most of the learning and activities are facilitated by a faculty mentor within these smaller mauka and makai groups of 6-7 students and are also overseen by a moku director. The groups will stay together during their entire four year training. The small, longitudinal groupings foster connections amongst students and faculty and allow for in-depth discussion about a variety of topics including implicit bias, wellness, resiliency, health system sciences, and culture and community. One of the first topics we discussed was implicit bias and racism in medicine. This discussion involved studnets taking a project implicit test to identify any white-black implicit bias. Then in a small group discussion we discussed our own personal implicit bias and techniques to counteract personal implicit bias. Additionally we had discussions on racism in medicine and how it has affected medicine historically and what we could do to improve this moving forward.

The goals and objectives of JABSOM’s LC are consistent with Pilinahā or the Four Connections indigenous framework for health (connection to past and future, connection to self, connection to place and connection to community) developed by Kokua Kalihi Valley Comprehensive Family Services. Specific LC activities encourage connection to self through self awareness and wellness activities and connection to past and future, by exploring and sharing their culture as related to their genealogy and family. During their first week of orientation, students participate in a sense of place activity that helps them recognize and develop their own professional identity before understanding how to connect to their classmates, and later patients, as well as their community. Students then connect to place and community through a scavenger hunt of their moku searching for a traditional cultural site (connection to past), place where children play (connection to future) and a healthcare facility. In the gastroenterology/nutrition subunit, students have a session on how food insecurity can significantly impact patient’s health and how many people in Hawaii are food insecure, which has worsened since the pandemic. The students then explored the food resources within their moku, other resources available to patients including meals provided by schools and SNAP. Finally, the students took a trip to their Moku to shop for a large family on a limited budget as a lesson in health inequities and understanding resources in their community.

Since launching in July 2020, all 299 JABSOM students have participated in LC activities with a focus on activities for the 1st and 2nd year students. Thus far, 95% of 1st years and 83% of 2nd year students reported that the LC program helped them feel connected to the JABSOM community and 86% of 1st years and 73% of 2nd years felt the LC program helped them feel connected to their moku community. The students also felt that the LC faculty were valuable to their well-being (98% of 1st years and 92% of 2nd years) and that the LC program helped them understand the importance of wellness in their personal and professional life (91% of 1st years, 65% of 2nd years)

Student comments reflect positive response to the curriculum including the implicit bias activity results. Additionally, after participating in the food insecurity project, students were noted to have profound reflections about the activity and how they can incorporate that into their future practice as physicians. Finally, faculty had significant realizations by participating in the learning community program. Ex: “…never received the type of enriching faculty development support that I have with this program.” See “Outcomes-Supportive evidence” for more details.