UC San Diego

Physician workforce shortages in California are projected to grow rapidly in the next ten years, particularly in inner-city and rural regions. In response to this anticipated need, the University of California's medical schools are increasing enrollment and working to implement and evaluate new programs and curricula to prepare graduates to work with medically underserved communities. In this dissertation I examine the origins and development of one of these programs, a health education outreach program known as Healthy Minds Healthy Bodies. By means of participant-observation, interviewing, and video-analysis, I observe how over the course of three-and-a-half years this program transitioned from a student-led, volunteer- based health education service project to a required course for first-year medical students participating in a new underserved medicine learning community. With this transition of purpose and institutional status came other unforeseen changes in, and contradictions between, the practices, tools, and procedures that medical students used to carry out the operation of the program. This also coordinated with a shift in the atmosphere of the training sessions, which became more formal, less interactive, more evaluation-focused, and less simulation-based. These changes were connected to evolving and at times conflicting expectations, goals, and objectives for Healthy Minds Healthy Bodies. I apply cultural-historical activity theory as a tool for analyzing these organizational contradictions, which allowed me to not only investigate the origins of the tensions, but also to imagine future trajectories for the program. I argue that the original objective of the program was volunteer community service and that as it became a required elective course experiential learning emerged as a new objective. Separately, these were competing interests; however, I suggest it might be possible to synthesize these orientations in the form of service-learning. Expanding the program's motivating object into service- learning could create synergy and coherence for the multiple actors and systems involved, as well as help to address contradictions within the program