| Summary: | The sustained service four-year longitudinal framework for medical school service-learning is introduced and defined. Framework benefits include: students can engage deeply over time with both the people they serve and their colleagues, they are immersed in the social determinants of health in authentic contexts, and they grow in the expertise required to perform their service over time. The approach starts with a sophisticated community needs assessment that relies on systematic inclusion of community voices, community leader inputs, and systematic and data-saturated inputs. This needs assessment should result in a six to eight item list of the community's priority needs. All student service is then focused on the primary needs identified in the assessment. Goals of the framework are described: to make a difference with the community's priority needs; to grow the identity, skills and paradigms required of a community-responsive physician; and to strengthen student credentials through objective qualifications related to their sustained service. The culminating activity is a Capstone research project that focuses on the served population and gives students an opportunity to synthesize their experience. Initial results describing the community impact of service, the focus of service hours, and candid student reactions to the approach are presented. Discussions of findings and conclusions are offered.
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