Global Research in Higher Education ISSN 2576-196X (Print) ISSN 2576-1951 (Online) Vol. 6, No. 4, 2023 www.scholink.org/ojs/index.php/grhe 15 Original Paper Integrating Service-Learning through Practice and Exploration in the Second Classroom of Medical School Students, Huzhou University, China Dong Jianxin 1* , Gao Yuhang 1 & Cheng Yiyuan 1 1 School of Medicine , Huzhou University, Huzhou, China * Dong Jianxin, Medical College, Huzhou University, Wuxing District, Huzhou City, Zhejiang Province, China Received: October 28, 2023 Accepted: November 7, 2023 Online Published: November 30, 2023 doi:10.22158/grhe.v6n4p15 URL:http://dx.doi.org/10.22158/grhe.v6n4p15 Abstract “Service-Learning” is a practical teaching method based on experience, and the “second classroom” of medical students also has strong practicality, and the two have a strong convergence. It is of great application value to explore the fusion mode of Service-Learning and the second classroom of medical students. This paper expounds the concept and connotation of Service-Learning and the second classroom, analyzes the necessity of their integration, and takes Huzhou University as an example to explore the application of Service-Learning in the second classroom of medical students in local universities in China from the aspects of motivation, ideas, practices and effects. The results show that the deep integration of service-learning with the second classroom of medical students is of great significance for improving the quality of talent training, expanding teaching resources and enhancing the effect of social welfare. Keywords Service-Learning, Second classroom, Medical student, Local university www.scholink.org/ojs/index.php/grhe Global Research in Higher Education Vol. 6, No. 4, 2023 16 Published by SCHOLINK INC. 1. Introduction At present, the functional orientation of the second classroom for medical students in many Chinese universities is limited to the general educational functions such as moral education and social training, and the integration of the second classroom for medical students with professional courses is not deep enough. Service-Learning applies theoretical knowledge to real situations to obtain practical experience (Mahasneh & Tawalbeh, 2012, pp. 415-425), so as to promote a deep understanding of theoretical knowledge and finally achieve the integration of knowledge, skills, emotions, attitudes and values (Lu & He, 2016, pp. 117-119). Integrating the concept of service-oriented learning can overcome problems such as one-sided education function, weak learning function and weak professionalism in the second classroom of medical students, effectively promote the deep integration of the first and second classrooms, and achieve a win-win situation between school teaching and education and social public welfare services. Taking the Medical School of Huzhou University as an example, this study has carried out many years of reform and exploration on the integration of Service-Learning into the second classroom system of medical students, and condensed relevant experiences and practices for the reference of similar colleges and universities. 2. Core Concept and Connotation Analysis 2.1 Connotation of Service-Learning Service-Learning advocates the combination of school curriculum and social service, which is an educational model with multiple characteristics such as diversity, synergy, reciprocity and reflection (Du, 2018, pp. 116-121). Service-Learning advocates the combination of teachers’ teaching, students’ learning and social problems, so that students can acquire professional knowledge, exercise social skills and improve moral level at the same time, and promote social development. It integrates one-way egoistic course learning with one-way altruistic social service, which is a two-way win-win model. Service-Learning is different from simple social service, its original starting point is “learning”, learning effect is the core goal, social effect is the “by-product” of learning practice process. Schools are required to focus on curriculum plans and social needs, carefully design projects, and comprehensively consider teachers’ teaching, students’ learning, and social needs, so as to achieve the integration of professional learning and social services. There is no consensus on its definition. Robert Sigmon (1979) believes that Service-Learning is an effective experiential teaching method. The American Association for Higher Education defines it as a way for students to learn and develop through planned social services (Liu, Wang & Ma, 2005). The National Youth Leadership Council defines it as: an instructional strategy that meets student learning goals and content standards, and a new model of philosophical, pedagogical, and community development. Barbara Jacoby (1996) defines it as: an experiential learning in which students engage in solving human and social problems. www.scholink.org/ojs/index.php/grhe Global Research in Higher Education Vol. 6, No. 4, 2023 17 Published by SCHOLINK INC. 2.2 The Connotation of the Second Classroom The second classroom is an important carrier for colleges and universities to cultivate the comprehensive literacy of college students and promote the all-round development of college students (Liu & Gao, 2022, pp. 106-111). The second classroom has five elements: From the time point of view, the second class uses the extracurricular time, does not occupy the first classroom time; From the content point of view, the second classroom is different from the first classroom, is the extension of the first classroom; From the perspective of requirements, the second classroom comes from but is not limited to the teaching material, generally does not need to test, but is an indispensable part of the complete education; From the form point of view, the second classroom is more vivid than the first classroom, the carrier is more abundant; From the perspective of learning space, its scope is very wide, both on campus and off-campus. The second class can not only strengthen the understanding of the theoretical knowledge of the first class, but also broaden students’ horizons, improve their practical level, cultivate their independent thinking ability, and enhance their social adaptability. In short, the second classroom is a kind of educational learning way to acquire knowledge and skills from extra-curricular carriers and comprehensively improve students’ comprehensive quality(Hu & Li, 2018, pp. 758-761). 3. The Necessity of Integrating Service-Learning into the Second Classroom of Medical Students 3.1 Social Service Is an Indispensable Part of Higher Education Teaching, scientific research and social service are recognized as the three functions of universities, which not only promote each other, but also complement each other. The purpose of “teaching” is to cultivate excellent talents, and the purpose of “research” is to help better production. In fact, whether it is training talents or assisting production, its ultimate goal is to better serve the society. From this point of view, serving the society is the ultimate goal and the most fundamental task of colleges and universities. On the contrary, knowledge comes from society, and the inspiration of research also comes from society. Only when knowledge and research are deeply integrated with society, can knowledge be deeply understood and reflected, and research propositions of more applied value be explored. Therefore, social services can better promote “teaching” and “learning”. From this point of view, social service is the initial link and original power of university work. In summary, from the beginning to the end, social service runs through every link of colleges and universities, and is an indispensable and important content in higher education (Jiang, 2023, pp. 96-98). www.scholink.org/ojs/index.php/grhe Global Research in Higher Education Vol. 6, No. 4, 2023 18 Published by SCHOLINK INC. 3.2 The Traditional College Second Classroom Is Not Effective At present, the effect of the second classroom is not good at both the university level and the student level (Xiao, Dong & Liu, 2022, pp. 56-61). The main manifestations at the university level are as follows: first, the university lacks systematic planning for the second classroom, mainly focusing on voluntary service and social practice, lacking unified norms and one-sided content; Second, the coverage of the second class is not extensive enough, the carrier capacity is limited, the lack of rigid requirements, and the full participation has not been realized. Third, the second classroom is relatively disconnected from the first classroom, and the two are not effectively integrated. The second classroom is strong in practice and service, but weak in learning. At the student level, the main manifestations are as follows: first, some students lack attention to social problems, have low enthusiasm to participate in the second class, and lack the ability to combine theory with practice; Second, the quantitative assessment and effect evaluation system of the second classroom is not perfect, and students are easy to breed negative psychology such as perfunctory coping; Third, students have blindness in the second classroom activities, and the acquisition of knowledge is not systematic. 3.3 The Second Classroom for Medical Students Is Complementary To Service-Learning The Outline for the Reform and Development of Medical Education in China emphasizes that both “teacher teaching” and “student learning” should be integrated into service. In the “Several Opinions on Further Strengthening the Practice of Educating People in Colleges and Universities”, it is also emphasized that higher education must be combined with productive labor and social practice, and theoretical education, innovative thinking and social practice must be unified. Medicine is a practical discipline that attaches great importance to service, and the second classroom in colleges and universities has obvious characteristics of practicality, service and sociality, etc. The second classroom in colleges and universities needs medical service as the carrier, and medical education also needs the second classroom to make up for the lack of practicality in the first classroom. Therefore, for medical students, Service-Learning and the second classroom have a very obvious complementary and promoting effect. www.scholink.org/ojs/index.php/grhe Global Research in Higher Education Vol. 6, No. 4, 2023 19 Published by SCHOLINK INC. 4. The Basis and Motivation of the Reform 4.1 The Basic Conditions The Medical School of Huzhou University is the only medical college in Huzhou City, Zhejiang Province, with 8 affiliated hospitals, 1 affiliated community health service center, 4 community practice bases and 56 internship hospitals. The Medical School of Huzhou University has two master’s degree authorization points in nursing and clinical medicine, and offers three undergraduate majors in clinical medicine, nursing and stomatology, and the clinical medicine discipline entered the top 1% of ESI in the world in November 2020, with more than 2,500 full-time students. The School attaches great importance to the cultivation of practical medical talents at the grassroots level. The Medical School of Huzhou University attaches great importance to the training of practical medical talents at the grass-roots level. As early as 2007, it took the lead in training rural community general practitioners in Zhejiang Province, and has been established as one of the three community general practitioners training bases in Zhejiang Province. In 2012, it was selected as the first batch of national pilot universities for excellent doctor education and training program. Focusing on the training needs of practical medical talents at grassroots level, the college attaches special importance to the construction of the second classroom for medical students. At the same time, the college has in-depth cooperation with local governments and social organizations, with abundant resources and carriers, and good basic conditions for carrying out the second classroom (Yao, Fang & Xu, 2021, pp. 113-116). 4.2 The Reform Motivation Although the resources of the second class of medical students in the college are rich, they have not been effectively integrated with the main teaching work of the college. Firstly, the management system is not standard, which is manifested as incomplete system, non-integration of resources, unsystematic planning and lack of evaluation mechanism. It is urgent to establish a mature and perfect management system for the second classroom of medical students from the aspects of training programs, management institutions, rules and regulations, credit recognition and platform construction. Second, the education effect is not ideal, manifested as: the integration with the first classroom is not close, the participation of teachers is not active, the engagement of students is not wide; emphasizes practicality and service, not learning. It is urgent to transform the relatively single education function of the traditional second classroom, making it closely connected with the medical courses, and effectively promoting the in-depth integration of the first classroom and the second classroom. Based on the above problems, the college began to explore the integration of Service-Learning into the second classroom of medical students, in order to achieve the integration of learning and service, as well as the win-win situation between the school and the society. www.scholink.org/ojs/index.php/grhe Global Research in Higher Education Vol. 6, No. 4, 2023 20 Published by SCHOLINK INC. 5. The Overall Framework and Ideas The overall framework and ideas of The Medical School of Huzhou University to promote the integration of service learning into the second classroom reform of medical students can be summarized as follows: a platform, two main lines, three functions, four in one, five communities and N carriers. A platform: closely combine professional background, fully integrate the second classroom resources, to build an integrated Service-Learning platform; Two main lines: take teaching and public service as the two main lines to achieve a win-win situation between school talent training and social public welfare needs; Three functions: Focusing on the three functions of talent training, scientific research and social service, vigorously carry out practical teaching, medical ethics education, student research and public welfare services; Four in one: integrating university student work, teaching work, local service work and scientific research competition work, forming a multi-functional complex with full cooperation of multiple departments. Five major associations: the establishment of New medical Association, Nursing Association, Dental Association, Qhuang Association and Youth Health Peer Association five college student associations, combined with departments, majors and courses to carry out targeted second classroom activities based on service-oriented learning, forming an effective supplement to the first classroom teaching. N carriers: Further integrate social resources, build a group of activity carriers based on projects, maximize the coverage of students, and formalize, normalize, scale and systematize the second classroom education. 6. Practice Methods and Paths In order to further promote the in-depth integration of service-learning and the second classroom of medical students, since 2017, the School has carried out a series of reforms in terms of management mechanism, credit system, departmental linkage and teaching methods, and the specific methods and paths are as follows: 6.1 Mechanism Reform Organize the Student Affairs Office, Teaching Affairs Office and the departments to set up the second classroom management steering Committee and the Service-Learning expert guidance team of the medical school, hold thematic meetings and academic seminars regularly, and establish and improve the management mechanism of the second classroom for medical students and the Service-Learning teaching system. 6.2 Credit System Reform Systematically sort out the content system of the second class for medical students, modify the training plan, formulate and introduce credit management measures for the second class for medical students, incorporate the activities of the second class into the credit system management system, take the credit system as the starting point and professional-oriented, carry out assessment and evaluation regularly, fully mobilize the enthusiasm of medical students to participate in the second class, and improve the www.scholink.org/ojs/index.php/grhe Global Research in Higher Education Vol. 6, No. 4, 2023 21 Published by SCHOLINK INC. quality of Service-Learning. 6.3 Linkage Reform The departments of learning, teaching, scientific research and external liaison work together to promote the participation of professional teachers in the second classroom, the embedding of professional courses into service projects, and the integration of professional practice into social practice, so as to open up the way for the deep integration of the first classroom and the second classroom, further enhance the professionalism and learnability of the second classroom, and effectively build the second classroom into an effective extension and supplement of the first classroom. 6.4 Reform of Teaching Methods In the traditional practice activities of “service as the core”, curriculum, service and reflection are combined into the PBL teaching concept to fully mobilize students’ learning initiative and put what they have learned into practical use. The specific mode is as follows: 1) Select and train a group of Service-Learning tutors to provide teacher’s guarantee; 2) Carry out service-oriented learning youth leadership training to train a group of student backbone; 3) The backbone of students will lead ordinary students to carry out learning practice activities in accordance with the steps of “raising questions—searching materials—group discussion—consulting teachers—application practice—reflection and improvement”. 7. Main Achievements of the Reform Since the implementation of the reform, the school has greatly improved the quality of talent training, the expansion of teaching resources and the effectiveness of social welfare services, and the pilot effect of integrating service learning into the second classroom of medical students is very obvious. The key results are as follows: 7.1 The Quality of Personnel Training Has Been Significantly Improved First, students’ academic performance has steadily improved. In the Service-Learning program, students’ ability to discover, think and solve problems was significantly improved. In the past three years, 62% of students participating in service-oriented learning programs have won professional scholarships. The pass rate of CET-6 reached 83%; The entry rate of postgraduate entrance examination reached 78%; The passing rate of nurse practitioners is 100%; The passing rate of licensed doctors reached 96.85 percent, and the employment rate of fresh graduates remained above 97 percent. Second, students’ ability to innovation has been significantly improved. Students who participate in Service-Learning projects have significantly better indicators of innovation and entrepreneurship than ordinary students. In the past 5 years, 18 national college student innovation and entrepreneurship projects have been approved, 37 provincial projects, 113 school-level projects, more than 300 papers have been published, and 67 prizes have been awarded in provincial and above discipline competitions. Third, students’ sense of social responsibility has been significantly enhanced. Students deeply feel the www.scholink.org/ojs/index.php/grhe Global Research in Higher Education Vol. 6, No. 4, 2023 22 Published by SCHOLINK INC. society in the service, deeply understand the sacred mission of saving the dead and helping the wounded, and the sense of social responsibility is significantly enhanced. Students have actively participated in the fight against the COVID-19 epidemic and voluntary blood donation and other public welfare services, and a large number of advanced models have emerged. In the past three years, they have won more than 210 outstanding honors or advanced titles. 7.2 Teaching Resources Have Been Greatly Expanded First, the project funding is more abundant. The college has established long-term cooperative relations with more than 20 government departments or institutions, developed more than 20 Service-Learning projects such as youth and health peer education project, emergency rescue popularization training project, and obtained a total of more than 2 million RMB of external support funds, providing financial support for the sustainable development of Service-Learning. Second, project mentors have been expanded. In the school, more than 40 Service-Learning tutors have been trained from the professional faculty group. Off-campus, more than 50 off-campus part-time tutors have been trained from cooperative agency. It basically meets the teacher demand of Service-Learning. Third, the venue resources are more abundant. The College has established more than 30 Service-Learning project venues and bases, such as the Nightingale Education Hall, the Red Cross Life Education Base, and the emergency rescue modular teaching, research and training Center, providing a rich carrier for Service-Learning. 7.3 Fruitful Social Welfare Services In recent years, it has provided more than 600 rounds of rural and community health services, carried out Red Cross emergency rescue training for more than 60,000 people, provided health services for more than 10,000 people for the elderly, offered medical guidance services to more than 500,000 people in medical institutions, assisted voluntary blood donation with a cumulative blood collection of 1.652 million milliliter, and benefited more than 600,000 people, which was highly praised by society. 8. Conclusion The local universities in China, represented by Huzhou University, have always attached great importance to the practical education function of the second classroom, but lack the effective connection with the first classroom. In order to make up for the shortcomings, in recent years, more and more medical colleges and universities have begun to promote the integration of Service-Learning into the practical inquiry of medical students in the second classroom, which has achieved good results. Through systematic top-level design, the School of Medicine of Huzhou University has coordinated and promoted the mechanism reform, credit reform, joint reform and teaching method reform. The traditional second classroom activities have been upgraded, the Service-Learning project has been promoted rapidly, and good results have been achieved in the quality of talent training, the expansion of teaching resources and social welfare services. Its related experience has certain reference and www.scholink.org/ojs/index.php/grhe Global Research in Higher Education Vol. 6, No. 4, 2023 23 Published by SCHOLINK INC. promotion value in similar universities. Funding 2023 Humanities and Social Science Research Project of the Ministry of Education: Research on the Construction of local medical students’ practical Education Community under the background of New medical Science (23JDSZ3018); 2022 “Four New” education and teaching reform research and construction Project of Huzhou University: Construction of “Multiple Integration” Practice Education System for Medical Students in Local Universities under the Background of New Medicine (JG202242). References Barbara, J. (1996). Service-learning in higher education: concepts and practices. San Francisco, Calif.: Jossey-Bass Publishers, 1996. Du, Z. (2018). The moral Function and Enlightenment of Service Learning in America. Journal of Pingdingshan University, 33(04), 116-121. Hu, B. 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