Aprendizaje-servicio en la formación inicial de profesionales de la salud en contextos interculturales. El caso chileno

Service-learning as part of the initial training of health professionals in intercultural contexts. The Chilean case

En Chile conviven diversas culturas, lo que resulta en tensiones y barreras en la prestación y el acceso a servicios de salud. Sumado a esto, la formación de profesionales de la salud se basa en un modelo biomédico que reduce, fragmenta y cosifica el proceso salud-enfermedad. En este sentido, el objetivo del presente ensayo es reflexionar sobre el papel de la metodología aprendizaje-servicio (ApS) en la formación de profesionales de la salud en el contexto intercultural de Chile. Dada su naturaleza, la implementación del ApS en la formación de estos profesionales en el país podría ser útil para promover el reconocimiento de cosmovisiones sobre la salud y saberes y prácticas médicas diferentes a la medicina occidental en pro de una atención en salud intercultural realmente incluyente y accesible para grupos minoritarios como pueblos originarios y migrantes. Además, el aprendizaje activo y el pensamiento reflexivo derivados de la participación activa y culturalmente contextualizada en entornos reales que requiere el ApS podría contribuir a una transformación significativa de las prácticas en salud de los futuros profesionales de la salud, resultando en el desarrollo e implementación colectiva de planes y programas de salud con agentes de salud y usuarios de servicios de salud pertenecientes a estos grupos culturales minoritarios.

Chile is home to a rich diversity of cultures, resulting in tensions and barriers in the provision of and access to health services. Furthermore, the training of health professionals is based on a biomedical model that reduces, compartmentalizes, and objectifies the health-illness process. Therefore, the objective of this essay is to reflect on the role of the service-learning (SL) methodology in the training of health professionals within the intercultural context of Chile. Given its nature, implementing SL in the training of these professionals in the country could help promote the acknowledgement of worldviews on health and medical approaches and practices that differ from Western medicine, in support of truly inclusive and accessible intercultural health care for minority groups, such as indigenous peoples and migrants. Moreover, active learning and reflective thinking derived from proactive and culturally contextualized involvement in real-world environments required by SL could contribute to a significant transformation of future health professionals’ practices, leading to the collective development and implementation of health plans and programs alongside health professionals and health service users belonging to these minority cultural groups.

Reflection

Juan Carlos Beltrán-Véliz1 Ana María Alarcón2 Nathaly Vera-Gajardo3

1 Universidad de La Frontera - Scientific Technological Nucleus in Social Sciences and Humanities - Temuco - Chile.

2 Universidad de La Frontera - Faculty of Medicine - Public Health Department -Temuco - Chile.

3 Universidad Autónoma de Chile - Faculty of Education - Transdisciplinary Research Group on Knowledge Management and Learning (GITGECA) - Temuco - Chile.

Open access

Received: 13/05/2025

Accepted: 25/03/2026

Corresponding author: Juan Carlos Beltrán-Véliz. Núcleo Científico Tecnológico en Ciencias Sociales y Humanidades, Universidad de La Frontera. Temuco. Chile. E-mail: juan.beltran@ufrontera.cl.

Keywords: Health Education; Learning; Traditional Medicine (MeSH).

Palabras clave: Educación en Salud; Aprendizaje; Medicina Tradicional (DeCS).

How to cite: Beltrán-Véliz JC, Alarcón AM, Vera-Gajardo N. Service-learning as part of the initial training of health professionals in intercultural contexts. The Chilean case. Rev. Fac. Med. 2026;74:e120344. English. doi: https://doi.org/10.15446/revfacmed.v74.120344.

Cómo citar: Beltrán-Véliz JC, Alarcón AM, Vera-Gajardo N. [Aprendizaje-servicio en la formación inicial de profesionales de la salud en contextos interculturales. El caso chileno]. Rev. Fac. Med. 2026;74:e120344. English. doi: https://doi.org/10.15446/revfacmed.v74.120344.

Copyright: ©2026 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, as long as the original author and source are credited.

Abstract

Resumen

Introduction

Chile is regarded as a multicultural country where diverse indigenous cultures coexist, each with its own beliefs, behaviors, practices, and worldviews. This cultural diversity has been further enriched by a massive increase in migrants in recent years, accounting for 8.8% of the national population in 2022.1

In the Americas, one-third of the population faces barriers to accessing healthcare.2 In countries like Chile, this situation worsens due to factors such as illegal migration, migrants’ lack of knowledge of the healthcare system, and social integration issues within these populations.3-5 Consequently, the Chilean government has made efforts to guarantee access to healthcare services for all inhabitants, as stated in Law No. 19937 of 20046 and Law No. 20584 of 2012.7 In addition, Law 21094 of 20188 established that public universities must contribute to meeting the general needs and interests of society by collaborating on all policies, plans, and programs that promote the country’s cultural, social, territorial, artistic, scientific, technological, economic, and sustainable development from an intercultural perspective. In this context, service-learning (SL) is a pedagogical methodology that should be considered in the training of health professionals throughout the country.

SL encourages and stimulates students’ learning through three dimensions: an academic one, where direct contact with the real world enables students to learn more and better; another linked to service quality and making a tangible contribution to solving community problems; and one related to the opportunity to create a space for values-based training for students.9-11 However, despite the proven relevance of SL in the training of health science professionals,10–17 its use in Chile is still quite limited, as it is mostly monocultural and decontextualized,18,19 with teaching methods rooted in a Western Eurocentric culture and driven by positivist thinking.18,20

Positivist thought is based on Cartesian rationalism21 and empiricism,22 and is characterized by the reification of everything, including human beings.22 It is defined by methodological monism, causal explanation, and the domination and generalization of knowledge.22-24 From this perspective, any aspect of the health-illness process that can be observed, measured, verified, and quantified is suitable for research, whereas metaphysical aspects are not. This type of rationality underpins and promotes the hegemony of the “biomedical model” in the training of health professionals,25,26 which holds a reductionist and narrow view of health and illness,25,27 dividing human beings into body and mind.28 This approach overlooks the complexity of the individual by failing to consider their historical, social, and cultural context, while assuming and promoting health as a consumer good.29,30

In contrast to biomedical rationality, according to the worldview of indigenous peoples such as the Mapuche and the Aymara, the health-illness model involves relationships of balance and imbalance with natural, material, spiritual, and supernatural aspects.23,31–36 In this sense, for these peoples, the community environment and sociocultural, natural, and historical processes play a significant role in health.37,38 In the case of the Mapuche and Aymara peoples, health-illness models are based on the concept of good living, or küme mogen33 and suma qamaña34 respectively, in which the individual can coexist in balance and harmony with themselves, the community, nature, spiritual forces, deities, and other people, whether or not they belong to indigenous communities.23,33,34,39,40 Despite the relevance of these concepts to these indigenous peoples, the training of health professionals in Chile renders them invisible and delegitimizes them by excluding their medical knowledge and practices.19,38

Furthermore, access to healthcare from an intercultural perspective is practically nonexistent among migrants in Chile due to a lack of real recognition of their cultural identity.22 In this regard, it has been reported that they are up to 7.5 times more likely to be uninsured compared to the non-migrant population,3 and health policies benefiting these individuals are generally lacking.4 Current regulations in Chile establish that the Ministry of Health must formulate policies aimed at incorporating an intercultural health approach into health programs in municipalities with high concentrations of indigenous and/or migrant populations.22 However, these policies are developed from a functional perspective without questioning sociocultural asymmetries and inequalities,41 promoting the training of health professionals based on the biomedical model and, therefore, reinforcing the reproduction of medical practices that ignore said interculturality.

Consequently, this functional intercultural health approach subordinates and even overshadows the knowledge and health systems used by indigenous peoples and migrant groups,21,22,38,42-44 resulting in inequalities in the provision of health services to these individuals due to practices related to social and cultural segregation and exclusion.4,44,45 This is concerning given that patients’ social and cultural contexts are factors that healthcare professionals must take into account.44,46

To overcome these barriers, training programs for health professionals must acknowledge that other forms of medical knowledge exist alongside scientific knowledge, and this means renouncing any general epistemology.47 Therefore, health science professionals must acquire skills and competencies during their training to solve problems in complex scenarios, considering the influence of social and cultural realities, as well as traditional medical knowledge and systems on the health-illness process,48 particularly in multicultural regions such as Chile. Establishing links with community-specific health practices during the training of these professionals is essential48 to promote continuous and contextualized learning.49 This shift requires social, political, and cultural changes in the training of health professionals, alongside a transformation of teaching practices19,50 based on the hegemony of Cartesian thought and logical empiricism.20,21

In this context, SL is a useful and necessary tool for adapting teaching practices in health sciences programs to Chile’s intercultural landscape. This methodology allows health sciences students to forge a close connection with the real world in which they will practice by actively participating in the community, ensuring that their actions during clinical practice align with the social and cultural reality and the needs of the communities.9-11,51

Some studies on service-learning experiences among health sciences students

In recent years, SL has been discussed in national and international literature, demonstrating its effectiveness in the training of health professionals.

For example, in Colombia, Sánchez-Reyes & Bolaños-Martínez12 describe how this methodology contributed to the understanding of theory and the profession among psychology students. In Spain, Morin-Fraiñe et al.13 incorporated SL into a community nursing course, finding that this methodology improved student competencies in community care, health promotion, ethical commitment, and teamwork. In France, Le Roux et al.14 and Leblanc et al.,15 who evaluated a community-based learning program on health promotion for health sciences students implemented at a university in Paris and one in Lyon, respectively, reported that students considered the program a useful tool for increasing their awareness of prevention and health education issues. In the United States, Manson & Dunens16 demonstrated that SL is an effective pedagogical model in introductory public health courses, as it facilitated the achievement of student learning outcomes related to understanding the biological, behavioral, environmental, socioeconomic, and other factors that impact human health and contribute to health disparities.

In Chile, Maldonado-Rojas & Toro-Opazo,9 in a study conducted among medical technology students, found that SL improved knowledge acquisition in disciplinary modules and strengthened professional and social commitment. Lucero-González et al.,51 conducted a study with students of occupational therapy, physical therapy, and nutrition, and reported that this methodology effectively promotes the development of teamwork-related competencies and fosters dialogue about specific contexts, reinforcing students’ perception of their professional role in relation to community needs. Muñoz-Huaracán et al.,11 in a study involving health sciences students with one or more LS experiences, reported that activities carried out using this methodology contributed to the development of conflict resolution skills based on values of solidarity and empathy.

Also in Chile, Henríquez-Melgarejo et al.,10 in a study conducted with nursing students, reported that SL is essential for the development and improvement of the competencies and community engagement skills necessary to enhance their professional practice. Núñez-Vergara et al.,17 in a study involving nursing, physical therapy, nutrition, and dietetics students, found that SL not only contributes to professional development but also to students’ civic and social engagement.

Considering the above, the objective of this essay was to reflect on the role of the SL methodology in the training of health professionals within the intercultural context of Chile.

Development

Methodology

Based on the background, problem, and objective presented above, this reflection focuses on three main aspects: 1) training from a functional intercultural health perspective, 2) training from a critical intercultural health perspective, and 3) SL and intercultural dialogue. For this purpose, articles reporting empirical and theoretical evidence on these topics published in scientific journals indexed in Web of Science (WoS), Scopus, SciELO, Redalyc, and ERIC, specialized books, and relevant Chilean regulations were consulted in March 2025. Furthermore, based on the comments received during the peer-review stage of the article, this literature search was updated in March 2026.

Most of the reviewed literature was published within the last five years at the time the searches were conducted. Only documents published in Spanish, English, or Portuguese were included.

Training from a functional intercultural health perspective

To address health professional training from a functional intercultural health perspective, it is first necessary to discuss the concept of cultural diversity. It refers to the different ways cultures are expressed and the possibility of building cultural connections and expressions from a shared level through dialogue, collaboration, and mutual respect,52 which is why it is recognized as an inherent aspect of humanity.53

According to Lerín-Piñon,54 interculturality in health is understood as the various perceptions and practices related to the health-illness-care process involved in care strategies, health prevention actions, and disease resolution within multiethnic contexts. However, this definition is reductionist, as it fails to consider the individual as a relational and harmonious whole, nor does it incorporate their cultural and social aspects.

On the other hand, according to Cevallos & Amores,55 interculturality in health is defined as the capacity to plan and act in a balanced manner among different cultural practices, beliefs, and knowledge regarding health and illness, life and death, and biological, social, and relational aspects. Thus, intercultural health must be promoted from a critical, dialogic, and participatory perspective. However, this conception of intercultural health is not consistent with the functional approach to intercultural health currently in place in Chile,56 which remains a merely folkloric, rhetorical, and discursive construct that promotes the perpetuation of market-driven medical practices based on the biomedical model, while subordinating and even rendering invisible the medicinal knowledge and practices of indigenous peoples and migrant groups, completely ignoring interculturality.21,22,25,42-44

Studies conducted in Chile on this topic have demonstrated that health professionals are unfamiliar with the medical knowledge and practices of indigenous peoples, are reluctant to work collaboratively with these communities, and, given the language barrier, face serious communication problems with community health workers and indigenous patients.22,57,58 For example, authors such Galdámez-Zelada et al.59 and Santibáñez et al.60 point out that when providing health services to indigenous peoples like the Mapuche, most health professionals do not adapt their medical practices to the patients’ health worldview and instead dismiss traditional Mapuche medicine as “lacking scientific validity.”58,60

In the case of the migrant population, there are currently no policies or programs in Chile that guarantee access to health services from an intercultural perspective.59,61,62 Although a regulatory framework exists, there are no specific clinical guidelines for providing adequate health care to migrants,61,63 a situation exacerbated by administrative, language, social, and cultural barriers.5,64 Another aspect to consider is that the limited training in intercultural health that health professionals receive during their undergraduate education focuses on recognizing indigenous peoples as individuals eligible to receive health services,7,59,65,66 instead of focusing on modifying attitudes, behaviors, and actions in clinical practice to align with these peoples’ worldview of health.67,68

Health professional training within intercultural contexts in Chile has been addressed by several authors. For instance, in a study conducted among health sciences students (dentistry, nursing, medicine, nutrition, physical therapy, pharmacy, and obstetrics) in the final phase of their training or during internships, Álvarez-Cruces et al.69 reported that students identified cases of discrimination, prejudice, exclusion, apathy, and disrespect against foreign patients during their practice, which could foster negative observational learning that perpetuates these behaviors toward this population.

Another example is the study by Álvarez-San Martín et al.70 conducted among nursing students in southern Chile, which found that, in addition to having a low level of cultural knowledge and skills, they also exhibited ethnocentric biases. Finally, in a recent study involving 106 health sciences students from three locations in Chile, Álvarez-Cruces et al.20 reported that the training of health professionals in the country focuses on theoretical and scientific aspects, neglecting experience-based learning. The problems identified by these studies make it difficult for these professionals to practice their profession considering the social and cultural context of their patients, resulting in poor healthcare delivery.

Consequently, this training is rooted in a functional intercultural health approach, given that it does not consider the underlying causes of health inequities and cultural, social, and economic asymmetries, nor does it question the principles of the biomedical model on which the Chilean health system is based. Furthermore, this intercultural health approach masks the deficiencies and inequalities of the health system, preventing the provision of an appropriate, high-quality health service that could improve the health of members of indigenous peoples and other cultures,42 making it highly compatible with the neoliberal model operating in Chile.38,41,71 As a result, this intercultural health approach fails to create an inclusive health system that considers the cultural, social, historical, and political dimensions of indigenous peoples or minority groups such as migrants.

In summary, the current health professional training model in Chile reproduces and perpetuates healthcare practices anchored in a biomedical model based on an ethnocentric Western culture, promoting decontextualized, dehumanizing, and reductionist intercultural health training. Concurrently, training is centered on a neoliberal model, increasing social and cultural inequalities and inequities between the dominant culture and minority populations such as migrants and indigenous peoples.

Training from a critical intercultural health perspective

Training for health professionals based on a critical intercultural health approach in Chile must be conceived as a political, social, ethical, and epistemological project that considers the health-related knowledge and wisdom of the country’s minorities. Thus, it is necessary to question, deconstruct, and transform the power relations, conditions, and mechanisms that the Chilean state has created through the functional intercultural health model, which perpetuate social inequality, racism, subalternity, discrimination, and social and cultural asymmetry.41,42,66,72 To this end, permanent spaces for dialogue and negotiation must be created to bring together the country’s cultural minority groups and the dominant Western culture, under conditions of respect, legitimacy, equity, equality, and dignity, where the diverse worldviews on medicine and the health-illness process are recognized and upheld. It is also necessary to promote intercultural health through the active and collective participation of members of indigenous and minority cultures in the planning, implementation, and management of health policies, programs, and projects with shared or mutually binding objectives.

However, a transformation of health professional education from its foundations is also required through strategies such as formulating and implementing local and national educational policies aimed at promoting the recognition of interculturality;73 designing curricula and teaching practices tailored to the social and cultural reality in which future professionals will practice; democratizing university governance systems and training processes; and ensuring better recognition and greater awareness within training programs of the real needs and worldviews of the different communities across Chile. Consequently, this critical stance on health will place the medical knowledge, practices, and insights of other cultures at the same level of importance as Western health knowledge, contributing to reducing the inequalities and asymmetries in access to healthcare faced by members of these communities,42,59 recognizing them as subjects of rights rather than merely passive individuals and recipients of state benefits.42

SL and intercultural dialogue

The theoretical foundation of SL is the “educational experience” proposed by Dewey.74 According to Dewey’s pedagogical model, student learning is facilitated by their active and collaborative participation in real-world contexts, adapting to social and cultural circumstances. This educational “experience” promotes reflective thinking and, as a result, in-depth learning.75-77 Training health professionals based on this “educational experience” will enable the development of projects designed to resolve real needs and problems. However, in an intercultural country like Chile, educational experience in health implies recognizing and incorporating the medical knowledge, practices, and experiences of minority cultural groups.

Along these lines, another of Dewey’s concepts that is fundamental to SL is “democratic citizenship” because this methodology also attempts to train professionals capable of contributing to their community.78 Thus, the use of SL in the training of health professionals would not only generate active learning based on direct experience but foster a vocation of service toward the community. In Chile’s case, it would promote the establishment of social bonds between these professionals and members of indigenous peoples and migrant groups, strengthening the inclusion of their health knowledge and practices in health service delivery within communities with a high proportion of indigenous and/or migrant populations.

SL is a highly relevant methodology in the training of healthcare professionals in intercultural contexts because it brings together aspects that are typically treated separately in universities: 1) university functions, 2) theory and practice, 3) the classroom and real-world experience, 4) training and commitment, and 5) cognition and emotion.79

In light of the above, and based on the methodology proposed by Musa et al.,80 Figure 1 proposes an SL model intended to be used in the training of health professionals in Chile. This SL model contemplates four phases for its implementation: planning and analysis (identification and analysis of the needs and opportunities to be incorporated into SL activities); implementation and participation (consisting of two steps: i) community participation from a situated perspective and ii) articulation based on dialogue regarding the participation of future health professionals and the community in real and intercultural contexts); evaluation and reflection (critical evaluation and reflection by the instructor in charge of implementing the SL activities, with the aim of adjusting or improving the design and/or SL activities); and exchange and dissemination of the experiences achieved in SL with those obtained in other contexts where SL activities were also implemented; this exchange of experiences may involve both students and instructors. It should be noted that Phase 2 requires continuous monitoring by the instructor in charge to address any questions or problems that may arise.

Figure 1. Phases of the proposed service-learning model.

SL: service-learning.

Source: Elaboration based on Musa et al.80

This SL model will allow future health professionals in Chile to strengthen their learning, professional development, and social commitment from a collaborative and democratic perspective,81 as well as link theoretical knowledge with the health insights and practices specific to the sociocultural context in which they will provide their services.82,83 It will also enable them to form and consolidate moral values and develop professional skills and competencies for the relevant and contextualized resolution of problems that arise during their clinical practice in communities with indigenous or migrant populations, contributing to a better satisfaction of the health needs of these individuals.9,84,85 Furthermore, the use of SL in the education of health sciences students will promote greater social awareness of the intercultural context in which they will work through active and collaborative participation in culturally contextualized medical practices,86-89 resulting in situated learning.90,91

Finally, intercultural dialogue92 is an element that must be taken into account in the development of the proposed SL model. This type of dialogue does not focus on confronting arguments about a common issue, but rather seeks to understand and put oneself in the other’s place to discover new ways of thinking, doing, feeling, and perceiving reality.92-95 In the context of health professional training in Chile, this dialogue would facilitate reciprocal relationships between health professionals, health agents, and health service users belonging to indigenous and migrant communities by recognizing that there are traditional medical knowledge and practices different from Western medicine that are also legitimate and should be viewed from a comprehensive and complementary perspective.96

Conclusions

The training of health professionals in Chile is based on an intercultural health approach that serves the neoliberal model, as it does not question the causes of social and cultural asymmetries and inequalities in access to healthcare; hence, this approach is defined as “functional” in this essay, as it promotes a consumption-centered healthcare model that renders invisible the worldview of the health-illness process and the medical knowledge and practices of the country’s cultural minority groups. Therefore, health sciences programs must generate permanent spaces for interaction and negotiation within the community between future health professionals and members of minority cultural groups, such as indigenous peoples and migrant population to create bonds between academia and communities and develop joint health plans and programs.

A highly useful tool for achieving this in culturally diverse countries such as Chile is SL, as the implementation of this methodology in health professional training would yield several important benefits for both students and the community, namely, linking curricula to the real-world environment in which future professionals practice, fostering situated learning; identifying and analyzing community needs; articulating ancestral and Western medical knowledge and practices from an intercultural perspective; and developing and strengthening skills such as collaborative work, leadership, professional, ethical, and social commitment, reflective and critical thinking, understanding and empathy, problem-solving, situated evaluation, resilience, assertive communication, autonomy, and innovation, among others.

Conflicts of interest

None stated by the authors.

Funding

None stated by the authors.

Acknowledgments

None stated by the authors.

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