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Although case management in higher education is a relatively new phenomenon, the challenges presented by COVID-19 have forced many institutions to deliver emergency services in an extremely rapid f...

Objectives. Evaluate the health impact of a novel financial education and coaching program in single mothers of low-income in Omaha, Nebraska. Methods. Employed, single mothers earning no more than 200% of the 2017 Federal Poverty Level (n = 345) enrolled in the study between April 2017 and August 2020 and were randomized to receive a novel financial education and coaching program, the Financial Success Program (FSP) or no intervention control. Demographics, biometrics, financial strain, health behaviors and healthcare utilization were assessed at baseline and the 12-month study visits. Results. Participants who completed the FSP demonstrated significantly reduced financial strain, an increased rate of smoking cessation, and a reduction in avoidance of medical care due to cost compared to participants in the control group. Conclusions. The FSP represents an effective model in promoting economic stability in vulnerable individuals through a reduction in financial strain. Health behavior changes including an increased rate of smoking cessation were demonstrated within the first 12 months of intervention.

Objective The objective of this study was to develop generic domains of competence (DoC) with associated competencies and milestones for physical therapist residency education. This work was intended to culminate in establishing validity evidence to support a competency-based assessment instrument that could be used by residency programs to evaluate resident achievement of the competencies, regardless of specialty area. Methods Employing the modified Delphi method, a residency education work group developed an evaluation instrument that included 7 DoC and 31 associated competencies with 6 milestones as rating scales for each competency. The instrument was distributed to mentors and residents in accredited physical therapist residency programs to establish validity evidence. Evaluations (measured by milestones) and demographics were collected at 3 time points (program entry, midterm, and final). Scores across these time points were compared using Kruskal-Wallis tests. Reliability was assessed with kappa statistics (interrater reliability) and alpha reliability coefficients (internal consistency). Construct validity was examined using confirmatory factor analysis via structural equation modeling. Results Overall, 237 mentors and 228 residents completed 824 evaluations (460 by mentors and 364 resident self-evaluations) across the time points. Scores significantly increased from entry through final time points. The interrater reliability of the associated behaviors ranged from moderate to substantial agreement (κ = 0.417–0.774). The internal consistency was high for all DoC at every time point (α reliability coefficients = .881–.955 for entry, .857–.925 for midterm, and .824–.902 for final). After confirmatory factor analysis with structural equation modeling was performed, a model that included 7 DoC and 20 associated competencies was proposed. Conclusions The residency assessment instrument developed demonstrates interrater reliability and validity evidence and therefore supports competency-based assessment of resident clinical performance across specialty areas. Additionally, the instrument aligns the physical therapy profession with other professions, such as medicine, dentistry, and pharmacy, that have transitioned to competency-based education. Impact This study outlines the benefits of moving to competency-based education for physical therapist residents, using a sound evaluation tool that evaluates residents across specialty areas. The instrument will allow for transition to competency-based education in physical therapist residency education programs.

The integration of cover crops within arable rotations is becoming increasingly popular due to their widely acknowledged benefits. Subsidisation of cover cropping is available to eligible farmers in the Republic of Ireland but not to Northern Ireland (NI) farmers. There has been little research focus on ROI and NI growers’ perceptions about the husbandry associated with cover crops and the benefits of growing them.Surveys to gauge farmer use and perception of cover crops were taken at two arable conferences, with 55 respondents in NI and 77 in ROI (132 respondents in total). Growers used cover crops mainly to improve and maintain soil structure in an overall bid to enhance soil health in ROI, whereas in NI it was predominantly for forage. The impact of subsidies provided by Ireland and its stipulated policy influences species choice, and farmers were more likely to plant cover crops after later harvested commercial crops, e.g. September. Compared to growers in NI, who were found predominantly to plant after crops harvested in August. In ROI, 63% of respondents receiving subsidies would continue to use cover crops if this monetary incentive ceased.

Background Physical therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research. Objective The objective was to conceptualize a broad description of physical therapists’ clinical reasoning grounded in the published literature and to unify understanding for future work related to teaching, assessment, and research. Design/Methods The design included a systematic concept analysis using Rodgers’ evolutionary methodology. A concept analysis is a research methodology in which a concept's characteristics and the relation between features of the concept are clarified. Results Based on findings in the literature, clinical reasoning in physical therapy was conceptualized as integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management. Limitations Although a comprehensive approach was intended, it is possible that the search methods or reduction of the literature were incomplete or key sources were mistakenly excluded. Conclusions A description of clinical reasoning in physical therapy was conceptualized, as it currently exists in representative literature. The intent is for it to contribute to the unification of an understanding of how clinical reasoning has been conceptualized to date by practitioners, academicians, and clinical educators. Substantial work remains to further develop the concept of clinical reasoning for physical therapy, including the role of movement in our reasoning in practice.

Financial stress is implicated in poor health and decreased Quality of Life (QOL). The purpose of this project was to assess the 2-year effect of a financial education program on the health of single, low-income women. A total of 30 women were enrolled and 20 continued through follow-up. Two years following intervention, women demonstrated a $8,026 increase in mean annual income and significant improvements in health-related QOL and hopefulness. Half of the participants lost weight, and while not statistically significant, mean weight decreased by 2.2 pounds. Trends in decreased fast food consumption were observed. The results suggest that financial education has a significant, sustained effect on the health and health-related QOL of single, women of low income.

Objective The purpose of the study is to determine the immediate effect of Bowen Therapy in pressure pain threshold and postural sway of healthy individuals. Design Crossover, randomized, and double blinded study. Setting University. Participants Participants aged 18 years old or over, naive to Bowen therapy were recruited among university students. An a priori sample size calculation determined that 34 participants were needed. Methods Each participant attended two sessions and received Bowen Therapy and a sham procedure. The order in which Bowen or the sham procedure were administered was randomized. All participants had their postural control and pressure pain thresholds assessed in sessions 1 and 2 both at baseline and at the end of the session. Main outcome measurements Postural control was assessed using a force plate and centre of pressure antero-posterior and medio-lateral displacement, velocity and total sway area were calculated. Pressure pain threshold was measured at 10 different body sites on the paraspinal muscles from C1 to S1 using an electronic algometer. Result The results showed a significant increase in the anteroposterior displacement ( p = 0.04) and a significantly lower decrease in the mean velocity ( p = 0.01) of the centre of pressure and a significant increase in the pressure pain thresholds of two (out of ten; p ≤ 0.04) body sites in the group receiving Bowen Therapy compared to the group receiving the sham. No other significant differences were found. Conclusions The findings suggest that Bowen Therapy has inconsistent immediate effects on postural control and pain threshold in healthy subjects. Further studies are needed using symptomatic participants.

Although Irish winter wheat yields are among the highest globally, increases in the profitability of this crop are required to maintain its economic viability. However, in order to determine if efforts to further increase Irish wheat yields are likely to be successful, an accurate estimation of the yield potential is required for different regions within Ireland. A winter wheat yield potential model (WWYPM) was developed, which estimates the maximum water-limited yield achievable, within the confines of current genetic resources and technologies, using parameters for winter wheat growth and development observed recently in Ireland and a minor amount of daily meteorological input (maximum and minimum daily temperature, total daily rainfall and total daily incident radiation). The WWYPM is composed of three processes: (i) an estimation of potential green area index, (ii) an estimation of light interception and biomass accumulation and (iii) an estimation of biomass partitioning to grain yield. Model validation indicated that WWYPM estimations of water-limited yield potential (YPw) were significantly related to maximum yields recorded in variety evaluation trials as well as regional average and maximum farm yields, reflecting the model’s sensitivity to alterations in the climatic environment with spatial and seasonal variations. Simulations of YPw for long-term average weather data at 12 sites located at spatially contrasting regions of Ireland indicated that the typical YPw varied between 15.6 and 17.9 t/ha, with a mean of 16.7 t/ha at 15% moisture content. These results indicate that the majority of sites in Ireland have the potential to grow high-yielding crops of winter wheat when the effects of very high rainfall and other stresses such as disease incidence and nutrient deficits are not considered.

Objectives With the widespread use of DNA testing, police, death investigators, and attorneys need to be aware of the capabilities of this technology. This review provides an overview of scenarios where DNA evidence has played a major role in homicide investigations in order to highlight important educational issues for police, death investigators, forensic pathologists, and attorneys. Methods This was a nonrandom, observational, retrospective study. Data were obtained from the collective files of the authors from casework during a 15-year period, from 2000 through 2014. Results A series of nine scenarios, encompassing 11 deaths, is presented from the standpoint of the police and death investigation, the forensic pathology autopsy performance, the subsequent DNA testing of evidence, and, ultimately, the final adjudication of cases. Details of each case are presented, along with a discussion that focuses on important aspects of sample collection for potential DNA testing, especially at the crime scene and the autopsy. The presentation highlights the diversity of case and evidence types in which DNA testing played a valuable role in the successful prosecution of the case. Conclusions By highlighting homicides where DNA testing contributed to the successful adjudication of cases, police, death investigators, forensic pathologists, and attorneys will be better informed regarding the types of evidence and situations where such testing is of potential value.

Previous studies from regions that produce high proportions of global winter wheat have highlighted that difference in sink size influences the majority of variations in winter wheat yield. However, the potential for source limitation due to environmental differences in regions that consistently produce a large sink capacity (i.e. >20,000 grains/m2), such as Ireland, have not been widely studied. The aim of this study was to characterise the variation in growth pattern and yield components that contribute to variations in grain yield in regions of high yield potential, and to identify the periods of development that are most likely to influence yield in these regions. Monitor crops of winter wheat were grown at three sites with contrasting latitudes on the island of Ireland, during three growing seasons (2013–2015). Crops were assessed regularly for measurements of crop growth and development, including biomass accumulation, canopy development and light interception. Grain yield ranged between 10.7–15.8 t/ha at 15% moisture content, with a grand mean of 12.7 t/ha. Results indicated that variations in grains/m2 had a larger effect on winter wheat yield than variations in individual grain weight. Variability in grains/m2 was influenced by changes in spikes/m2 more than the number of grains/spike. While spikes/m2 at harvest was significantly related to the number of shoots/m2 at GS59, no significant relationship was observed between the shoots/m2 at the time of maximum tillers/plant and spikes/m2 at harvest. Furthermore, a significantly negative linear relationship was observed between shoots/m2 at the time of maximum tillers/plant and grains/spike. Therefore, high rates of tillering were not beneficial to yield formation in the majority of crops monitored. A strong effect of individual grain weight was observed at one site of the nine evaluated in the study, indicating that a partial source limitation of yield is possible in certain Irish environmental conditions. However, variations in grain yield of crops of winter wheat grown at different locations in Ireland in different seasons were primarily driven by variations in grain number, and therefore were generally sink-limited.

Background Residency training is recognized as a valuable form of professional development and pathway to specialization. Currently residency is voluntary for physical therapists, with less than 12% of DPT students choosing to apply upon graduation. Motivations that drive the decision to pursue residency are currently unknown as is the extent of similarity and difference in perspective among various stakeholders. Objective The purpose of this study was to identify the dominant perspectives on motivations to pursue residency held by various stakeholders. Design This study was conducted using Q Methodology, which incorporates aspects of quantitative and qualitative techniques into the examination of human subjectivity. Methods Program directors, faculty, and current residents from all accredited physical therapy residency programs were invited to complete a forced-choice sorting activity where potential motivations for residency were sorted by perceived level of importance. Principal component analysis was used to identify dominant perspectives, which were interpreted based on emergent themes in the cluster of motivations identified as most important. Results Four dominant perspectives were identified: (1) desire to provide better patient care, (2) preparation for specialty practice, (3) fast track to expert practice, and (4) career advancement. These perspectives provided context and utility to 2 broad meta-motivations: improved clinical reasoning and receiving mentoring. Both within- and between-group differences among stakeholders were identified. However, subsets from each role-group population were found to share similar perspectives. Limitations Results from this study may not apply to potential residents in all specialty areas, and the implications of having a particular perspective are unknown. Conclusions Identification of the dominant perspective on motivations for pursuing residency may aid in promoting participation, program development, matching residents to programs and mentors, and future research.

Our immediate and future food security agenda requires sustainable phosphorus (P) management, and recovered P products such a struvite form part of the solution. Waste recovered struvite is generated from different waste streams and precipitation technologies. In this study, we compare P speciation and bioavailability of nine struvite products with traditional/granulated chemical fertilisers to investigate performance characteristics across soil types in the Irish ecoregion. Elemental-analysis/P-speciation of the struvites was examined by ICP-OES, 31P solid state NMR, PXRD and P-solubility tests. The fertiliser dose effect and bioavailability of the different struvite products were tested in 4-week and 3-month rhizotron experiments with perennial ryegrass (Lolium perenne). In addition to calculating plant-P offtake, bioavailability was assessed by Olsen-P and Diffusive-Gradients-in-Thin-Films (DGT). The struvites differed markedly in colour/appearance, texture, metal content and solubility. Struvites all had similar P-speciation, but minor impurity phases were detected. There was no significant difference between the struvite samples and triple-super-phosphate (TSP) with respect to either plant growth performance or P-bioavailability. The struvite products are produced from different wastewater streams/processes, yet possess a uniformity in overall fertilising performance within our experiments. Encouragingly, no appreciable agronomic difference in terms of yield was observed between the struvite and chemical fertilisers, which provides further evidence in support of struvite as a sustainable alternative to mined rock-phosphate derived products. Importantly the struvite samples analysed within this study contained both significantly fewer impurities than TSP and lower concentrations of toxic metals such as cadmium.

Background and Purpose.Given the complexity of the current health care environment, effective clinical reasoning skills are fundamental to making critical patient care decisions. The purpose of this study was to explore the clinical reasoning abilities of students across time in 1 professional Docto

BACKGROUND AND PURPOSEIf faculty members want to better understand student learning and the development of student reasoning abilities, avenues to gain insight into student thinking are needed. Sound teaching and learning strategies should be studied and shared to improve this educational process. In order to improve our ability as teachers, we must engage in inquiry into the process of teaching along with the evidence of student learning, the outcome of teaching.1 As described by Ernest Boyer, an inquiry driven approach consistent with the scholarship of teaching may best help us understand critical issues in the assessment of student learning.2Scholarship of teaching and learning projects allow educators to evaluate teaching strategies by using assessment of student learning as a primary source of evidence.2,3 To understand the development of a complicated ability such as clinical reasoning, one must investigate the evidence of student learning, as well as the teaching strategies linked to it. Shulman describes it well, saying:To prompt learning, you've got to begin with the processes-the inside from the inside out. The first influence on new learning is not what teachers do pedagogically but the learning that's already inside the learner.Bps36'Clinical reasoning is a multifactorial and complex phenomenon.4 Research in the health professions identifies clinical reasoning used in clinical practice as a collaborative and reflective process that involves contentspecific knowledge, engagement of the patient and family in understanding the clinical problem, and incorporation of critical contextual factors. All of these factors lead to deliberative decision making and sound clinical judgment.4,5 As defined by Christensen et al, clinical reasoning is the thinking and decision making process used for examination and patient management.6 The American Physical Therapy Association (APTA) recognizes the importance of clinical reasoning as a required practice skill.7 The Commission on Accreditation of Physical Therapy Education (CAPTE) requires that all physical therapist (PT) education programs develop and assess clinical reasoning skills as a professional practice expectation.8 Students must be able to utilize clinical reasoning to enhance patient care and minimize errors in practice.A nonnegotiable component or foundation for the development of clinical reasoning is the students' ability to engage in self-monitoring and critical self-reflection. The ability to monitor self, stop the action, bring different frames of perspective to the situation, see the context of the problem, and grapple with the uncertainty of the situation are skills that depend on self-monitoring and critical self-reflection.9'12 Learners are engaged in a life-long process of honing their skills to be attentive, mindful, and nonjudgmental. These skills go well beyond the traditional notions of analytical thinking and looking for the right answer or definitive piece of evidence that are far too often seen as the most important aspects of critical thinking.1'11,13Due to the multidimensional nature of clinical reasoning, assessment of this skill is challenging for educators and clinical instructors. There are few standardized tools available to evaluate student clinical reasoning abilities in physical therapy. Most of the existing assessment tools were developed for use in other health care professions and assess critical thinking rather than clinical reasoning.14 Some of these tools include the Health Science Reasoning Test and the California Critical Thinking Skills Test.15 While critical thinking is an important skill for all students, we argue here that clinical reasoning is a more robust concept, as it not only focuses on the mental processes, but also includes the connections between these processes and the behaviors that are shared between the patient, practitioner, and the environment.16The following tools and teaching strategies have been used with some success to assess clinical reasoning: the script concordance test, concept mapping, thinking aloud, quantitative standardized tests, reflection, interviews, and focus groups. …

Background Subcutaneous injection into an elevated skin fold poses a risk of "bilateral exposure" injury whereby the needle pierces the opposite side of a skin fold and subsequently enters the tissue of the health care worker (HCW). Methods Retrospective review was conducted examining the Exposure Prevention Information Network (EPINet) needlestick surveillance data. Data from 2,402 injuries occurring during subcutaneous injection were included for analysis. Descriptive data, statistical comparisons, and a logistic regression model reporting relative risk are provided. Results Eighty-five bilateral exposure injuries were identified between 2000 and 2009, representing 3.5% (n/N=85/2,402) of all injection-related percutaneous injuries. 65.4% Of the variance in bilateral exposure injury occurrence is explained through examination of the following: (1) manual elevation ("pinching") subcutaneous tissue prior to injection; (2) thin/emaciated patient; (3) injection of insulin; (4) injection of heparin; (5) injection of enoxaparin (Lovenox); (6) if a safety device was used; and (7) whether the health care worker was wearing gloves at the time of the injury (χ 2 7 = 424.2; P Conclusion Manual tissue elevation should be avoided to minimize the risk of bilateral exposure injuries.

Background and Purpose. Critical thinking, knowledge, skill, and self-reflection are the hallmarks of clinical reasoning in physical therapy. Teaching and measuring a highly complex entity such as clinical reasoning is a challenging task and often requires multiple pedagogies and assessments. Knowledge and skill are frequently assessed by educators, but critical thinking and skills of reflection are not. Previous studies have used standardized tests to assess clinical reasoning skills of physical therapist students. These studies report conflicting findings potentially due to the fact that neither test was designed to test critical thinking of allied health practitioners. The Health Sciences Reasoning Test (HSRT) was designed specifically for health science students with questions written in a health care context.Participants. In 2008, 63 students, 37 from a public East Coast university and 26 from a private Midwest university were recruited to complete the HSRT.Method. The students completed the HSRT at 3 points in their education: upon entry to the program, prior to final affiliations, and again just prior to graduation.Outcomes. Analysis indicated a statistically significant change for the total score as well as the deductive and analysis subscales. Post-hoc analysis indicated these differences occurred between times 1 and 2 for the total score as well as both subscales. There was a significant difference between the 2 schools after adjusting for variance in initial test scores. The Midwest school's mean score (24.85) was greater than the east coast school's (22.42), and this difference was significant F^sub l^ = 12.65; P Conclusion. The HSRT was able to detect change in critical thinking scores. This finding, coupled with those of a previous study in which the HSRT was able to detect differences between experts and novices, indicate the HSRT may have validity and therefore may be a useful tool for assessing the critical thinking skills of physical therapist students.Key Words: Assessment, Clinical reasoning, Critical thinking.INTRODUCTIONThe Commission on Accreditation of Physical Therapy Education (CAPTE) requires physical therapist education programs to develop and assess students' clinical reasoning skills.1 While clinical reasoning skills have always been an important component of physical therapist education, this mandate, coupled with direct access and the move to a doctoring profession, increases the importance of teaching and assessing clinical reasoning skills of physical therapist students.Clinical reasoning refers to the thinking and decision-making process used during examination and management of patients.2 It is a complex mechanism that requires basic scientific knowledge, clinical competence, the ability to self-reflect, and critical thinking skills. Critical thinking is the disciplined, intellectual process of applying skillful reasoning as a guide to belief or action and involves the cognitive abilities of analysis, interpretation, inference, evaluation, and explanation.3 The relationship between critical thinking and clinical reasoning is poorly understood and the terms are often interchanged. Clinical reasoning can be conceptualized as critical thinking within a specific domain or a particular point of view of a field, in this case the field of physical therapy. Physical therapists apply the components of critical thinking about and within the field of physical therapy, which has a certain point of view. This point of view is based on the objects, events, and investigations we consider in our area of expertise.4 The result of this critical thinking within our domain of practice and within the point of view of the field can be considered clinical reasoning. If one accepts this postulate then the skills required for critical thinking (ie, analysis, interpretation, inference, evaluation, and explanation) would be considered inherent in the clinical reasoning process but would be used contextually within the domain of physical therapy. …

Using data from the California Board of Registered Nursing Surveys of 1997, 2004, 2006 and 2008, this study explores demographic, human capital, and work environment changes in the Hispanic RN population and compared these changes to those occurring among non-Hispanic Whites. Results find several significant differences between the two groups. The most important finding is that Hispanic RNs enter and leave the profession at younger ages than their non-Hispanic White counterparts. There is an abrupt decrease in the proportion of Hispanic RNs after age 50, while the proportion non-Hispanic White continues to increase until age 65. Decided action is needed to increase recruitment and retention of Hispanic RNs in order to increase nurse-patient concordance and abate the looming nurse shortage.

Background In 2007 and 2008, 115 patients were found to be either certainly or presumptively infected with the hepatitis C virus through the reuse of contaminated medication vials at two southern Nevada endoscopy clinics. A subsequent joint investigation by federal and state agencies found multiple breaches of infection control protocols. There was also strong anecdotal evidence that among clinic staff, unsafe patient care conditions often went unreported because of a general fear of retaliation. At the request of the Nevada legislature's Legislative Committee on Health Care, a study was conducted to examine Nevada RNs' experiences with workplace attitudes toward patient advocacy activities. This article presents the study findings and reviews how one public health tragedy led to the creation of effective health care policy. Methods A study questionnaire was developed and tested for reliability and validity. Questionnaires were then sent to an initial sample of 1,725 Nevada RNs, representing 10% of all RNs in the Nevada State Board of Nursing database with active licenses and current Nevada addresses. Results The response rate was modest at 33% (564 respondents). Of those who responded, 34% indicated that they'd been aware of a patient care condition that could have caused harm to a patient, yet hadn't reported it. The most common reasons given for nonreporting included fears of workplace retaliation (44%) and a belief that nothing would come of reports that were made (38%). Conclusions The study findings underscore the need for a shift in organizational culture toward one that encourages clear and open communication when patient safety may be in jeopardy. These findings were ultimately used to support the passage of whistleblower protection legislation in Nevada. Keywords Las Vegas hepatitis C outbreak, patient advocacy, whistleblower.

Background The goal in studying expertise is not merely to describe ways in which experts excel but also to understand how experts develop in order to better facilitate the development of novices. The study of novice progression helps us to understand what successful versus unsuccessful learning looks like. This understanding is critical, as autonomous practice places increased demands for advanced clinical judgments and the ability to assume professional responsibilities. Objectives The purpose of this study was to explore the experiences, learning, and development of promising novice therapists throughout their first year of practice in the United States. Design and Methods A longitudinal, multiple-site qualitative case study method was used for within-case and across-case analysis. A purposive sample of 11 promising new graduates from 4 physical therapist education programs participated. Investigators followed the graduates throughout their first year of practice. Data sources included: (1) semistructured interviews conducted at baseline and every 3 months thereafter for 1 year, (2) reflective journals completed at regular intervals, and (3) review of academic and clinical education records and résumés. Results Four themes emerged: (1) the clinical environment influenced the novice physical therapists' performance, (2) participants learned through experience and social interaction and learning was primarily directed toward self, (3) growing confidence was directly related to developing communication skills, and (4) therapists were engaged in professional identity formation and role transitions. Conclusions The findings suggest there are common experiences and themes that emerge as novice physical therapists develop. Although research has been conducted on expertise in physical therapy, few longitudinal investigations have explored the development of therapists across transitions from graduate to novice to expert practitioner. This study explored and described the learning and development of graduates during their first year of practice.

Physical therapy educators are challenged to emphasize the importance of social responsibility as a vital curricular element of professional development. Through reflection, students are able to identify core values, beliefs, and attitudes as part of the professional development process. The purpose of this study was to explore student perceptions and values of a community engagement experience based upon frequency of participation. This qualitative research report investigated student perceptions of the community experience following participation. Data collection tools included an open-ended questionnaire and focus group interviews. Comparisons were made across data for participants who engaged in the activity one time versus multiple times. Data analysis revealed participation in the community engagement experience had a positive impact on most participants. One time only participants demonstrated increased self-awareness, contemplating change, and capacity to serve while more than one time participants described a deeper understanding of community, impact on others, and professional transformation. Student involvement in community engagement activities combined with structured reflection provided meaningful insight into participants' personal beliefs. The results suggest incorporation of community-based learning experiences into academic curriculum may be beneficial in the students' preliminary understanding of social responsibility.