Community-based Medical Education Programmes Research Articles

The Impact of an Undergraduate Community-Based Medical Education Program in a Japanese Urban City.

With an aging global population posing healthcare challenges, especially in community healthcare, training professionals for community healthcare remains a global educational challenge, including in Japan. While previous research shows increased student interest in community healthcare through practical experiences, the focus has primarily been on rural areas, leaving a gap in understanding urban-based community medical education. This study aimed to evaluate the impact of urban community-based medical education on students' understanding and attitudes toward community healthcare. This study was conducted at Kyushu University in Fukuoka City, the sixth-largest city in Japan. For fifth-grade medical students, a community-based medical education program is mandatory, with a one-week schedule that includes orientation, one day in a clinic, and three days in a community hospital. The program aimed to expose students to various healthcare settings, emphasizing outpatient care, inpatient management, home health care, home nursing, and rehabilitation. A self-administered questionnairereferencing the Model Core Curriculum for medical educationwas administered immediately before and after the program, and the differences in students' perceptions were assessed using the Student's t-test. Findings from 188 students completing both pre- and post-program questionnaires revealed significant improvements in perceptions of students' knowledge and skills related to community healthcare. After the training, there was a noteworthy positive shift in attitudes toward community healthcare and increased interest in primary care physicians as a career choice. Although students maintained a preference for urban areas, there was a notable inclination towards rural settings.The study highlights the program's success in enhancing students' understanding and positive attitudes toward community healthcare within an urban context. It challenges prior notions regarding work-life balance and urban-rural preferences in career choices. Urban community-based medical education significantly improved students' perceptions and attitudes toward community healthcare. It offers valuable insights for curriculum planners, emphasizing the need for continued research into sustained effects and broader applicability.

Efficient open recruitment and perspectives of host families on medical student homestays in rural Japan.

We devised and assessed open recruitment of host families for medical student homestays in a rural area of Hyogo Prefecture, Japan, so that program organizers would not have to depend on professional and personal connections. The duration of the homestays was one night and two days, and they were conducted in August 2016, 2017, and 2018. The purpose of this community-based medical education program was to promote interactions between medical students and residents of Tamba area. The study asked one family member from each host family to complete a questionnaire after the homestay, and their experiences were evaluated in the study. The questionnaire results were analyzed using a visual analog scale (VAS; 0-100 mm). Thirty-three host families participated in the homestay program over three years. Results showed that VAS scores were high for enjoyment of homestays (VAS; 92.4 ± 13.0), continuation of the homestay program (91.7 ± 12.7), continuation of participation in the homestay program (89.2 ± 16.2), and desire for the homestay students to work in the area in the future (95.4 ± 6.3). The recruitment of host families through advertising was an efficient method for this community-based medical education homestay program. The results indicate that it is possible to attract more host families through open recruitment, which will contribute to the sustainability of the homestay program. Further research, including a follow-up of the students who participated and whether they chose a rural area or Tamba to practice is needed in the future. Since this is an ongoing program, further research in a similar format can be conducted in the future.

Applying visual mapping techniques to promote learning in community-based medical education activities

BackgroundTeaching and learning Community-Based Medical Education (CBME) requires the active engagement of students in various activities to cover planned curricular content. CBME being multifaceted involves careful application and formation of links when attending to community health problems and public health issues. Students often depend on factual recall rather than ‘engaging in’, to counteract the broad and comprehensive nature of CBME. This study was conducted to assess the effectiveness of Visual mapping techniques as a learning tool in a CBME program for the subject Community Medicine and thereby assist medical undergraduate students in overcoming identified learning challenges.MethodologyAn interventional study was conducted where medical undergraduates were randomly assigned to two different groups (each group = 30). After sensitization, a broad theme was taught to both the groups as a part of community-based teaching (CBT), each week for a month. The students in the intervention group were given the assignment to draw visual maps using the mind mapping & concept mapping techniques, after each CBT session, while the control group had Question-Answer session with built-in discussion (Conventional method) by an equally qualified, experienced faculty with no mapping assignments. A surprise written examination was conducted on the topics taught, and scores of both the groups were compared. Feedback was obtained from the intervention group.ResultsMean score of the examination by the intervention group (29.85 ± 3.22) was significantly higher than and that of the control group (23.06 ± 4.09) (t = 7.14 and p < 0.05). The students shared that the assignment of drawing mind and concept maps for topics taught helped in attempting questions of the written examination by facilitating easy recall of the information learned. It aided to frame the answers to descriptive questions in a structured way with the use of keywords. However, identifying the concepts and establishing relationship between them was slightly challenging.Conclusion‘Visual mapping’ in the form of Mind and Concept mapping was found to be an effective learning tool for multifaceted CBME especially in promoting meaningful learning and facilitating rational thinking by the medical undergraduates.

Fostering student motivation towards community healthcare: a qualitative study

ObjectivesThis study investigated what kinds of experiences influence regional quota (chiikiwaku) medical students’ motivation to practice community healthcare (CH), and the mechanism of this influence, by focusing on their experiences...

Evaluation of Community Based Medical Education Program in Bezmialem Vakıf University Faculty of Medicine Education

Evaluation of Community Based Medical Education Program in Bezmialem Vakıf University Faculty of Medicine Education

Students' Perspectives of a Community-Based Medical Education Programme in a Rural District Hospital.

Background:The adoption of community-based medical education (CoBME) into the undergraduate medical curriculum is in line with the SPICE model for medical curriculum proposed by Harden and colleagues. Students are the consumers of medical education and are, thus, the ideal evaluators of the efficacy of their own course and learning environment. To evaluate the quality of the CoBME programme in Botshabelo District Hospital (BDH), this study investigated student’s perceptions of their experience during their CoBME training at BDH. In addition, suggestions on how to enrich students’ experience during the CoBME posting were obtained from the participants.Methods:This research was designed as a qualitative (ethnographic) study that used a structured questionnaire, to obtain written statements from 120 fourth-year undergraduate medical students describing their experience during their CoBME training at BDH. The structured questionnaire in the form of an evaluation form was self-administered, consisted of only open-ended questions grouped into 4 main sections and was distributed manually (hard copy) to the participants.Results:Of the 120 questionnaires distributed, 84 were returned, giving a response rate of 70.0%. When asked to indicate what they liked or disliked about their CoBME training, ‘Good educators/staff’ and the ‘Poor attitude of some doctors’ were the themes that scored highly (25.1% and 19.4%) in the ‘likes’ and ‘dislikes’ category, respectively. Some of the major challenges faced during the CoBME training at BDH included: exposure to new learning environment (14.2%), clinical practice context (12.6%), and language barrier (7.2%). Participants stated that they gained knowledge of how to perform certain clinical procedures and acquired core clinical skills in the areas of formulating management and managing some medical emergencies during their training at BDH. Increasing the duration of training (25.6% coverage) was suggested as a major way to enrich students’ experience during the training at BDH.Conclusion:Findings by this study reveal that CoBME is a valuable pedagogical tool to enhance learning in undergraduate medical education and that more work is required to improve the quality of CoBME training in BDH. We believe that the findings by this study will inform future planning of CoBME training programmes in BDH.

Community-based training of medical students is associated with malaria prevention and treatment seeking behaviour for children under 5\xa0years in Uganda: a study of MESAU-MEPI COBERS in Uganda

BackgroundFour university medical training institutions in Uganda have trained students at off-site health facilities under community-based education and Research Service (COBERS) programme for over 5 years. One of the major components of COBERS placement is for the students to provide health education in the communities about malaria as a major public health disease in Uganda. This study seeks to assess if targeted community-based medical education programme is associated with better prevention and treatment seeking behaviours in the management of malaria, a leading cause of morbidity and mortality of children under five in Uganda.MethodsA cross-sectional survey was done to compare communities around health facilities where medical students were placed at COBERS sites with communities around similar health facilities where medical students were not placed (non-COBERS sites). We randomly selected two villages near each health facility and consecutively selected 10 households per village for interviews using nearest-neighbour method. We used a structured questionnaire to interview household heads on malaria prevention and treatment seeking behaviour for children under 5 years. We performed univariate analysis to determine site and demographic characteristics and performed a multivariate logistic regression to assess association between dependant and independent variables.ResultsFive hundred twenty-three (66.8%) of the children under 5 years in COBERS communities slept under Insecticide Treated Nets (ITNs) the night before survey compared with 1451 (57.8%) in non-COBERS communities (AOR = 0.66, p = 0.017). 100 (60.0%) of children under 5 years in COBERS communities sought care for fever within 24 h of onset compared with 268 (47.0%) in non-COBERS communities (AOR = 0.71, P = 0.009).ConclusionThe presence of COBERS in communities is associated with improved malaria prevention and treatment-seeking behaviour for parents of children under 5 years. Further study needs to be done to determine the long-term impact of COBERS training program on malaria control and prevention in Uganda, along with other effects of COBERS.

Views of the students of the selected non-government medical colleges of Bangladesh regarding community based medical education (CBME) practice in their institutes

This was a descriptive cross-sectional study conducted in 2015, objective was to find out the views of the students of 3rd phase of non-government medical colleges regarding the community based medical education practice in their colleges. Data was collected from 507 students of 12 medical colleges by using self-administered structured questionnaires. Among the students 223 were from the Dhaka city and 284 from outside the Dhaka city. Almost 90 percent of the students mentioned that their institutes conducted RFST and Day Visit programe, and duration of Residential Field Site Training (RFST) programe ranges from 1-30 days with mean 9.45 and SD ± 6.34. Most of the students mentioned that they did not stay night in the community. About sixty percent of the students were satisfied with the RFST programe . During RFST programme most of the students 387 (77.7) visited upazila health complex, and 296 (59.4) participated in the conduction of survey. Most of the students visited institute of public health, EPI head quarter and MCH centre or clinic during Day visit programme. Most of them mentioned problems faced in RFST programme as: lack of transport support; lack own accommodation facilities; lack of security; and lack of cooperation from the authority of the different organizations. Suggestions given by the students for the further improvement of the practice of CBME programme in their institutes were mainly : realization of importance of CBME by college authority , teachers and students; College authority should be well motivated for conducting the CBME programme activities in their institute; College authority should build dormitories for the permanent solution of the residential problems and College authority should have the required amount of transport for this activities.Bangladesh Journal of Medical Education Vol.9(1) 2018: 21-25

Stakeholder views of rural community-based medical education: a narrative review of the international literature.

Rural community-based medical education (RCBME), in which medical student learning activities take place within a rural community, requires students, clinical teachers, patients, community members and representatives of health and government sectors to actively contribute to the educational process. Therefore, academics seeking to develop RCBME need to understand the rural context, and the views and needs of local stakeholders. The aim of this review is to examine stakeholder experiences of RCBME programmes internationally. This narrative literature review of original research articles published after 1970 utilises Worley's symbiosis model of medical education as an analysis framework. This model proposes that students experience RCBME through their intersection with multiple clinical, social and institutional relationships. This model seeks to provide a framework for considering the intersecting relationships in which RCBME programmes are situated. Thirty RCBME programmes are described in 52 articles, representing a wide range of rural clinical placements. One-year longitudinal integrated clerkships for penultimate-year students in Anglosphere countries were most common. Such RCBME enables students to engage in work-integrated learning in a feasible manner that is acceptable to many rural clinicians and patients. Academic results are not compromised, and a few papers demonstrate quality improvement for rural health services engaged in RCBME. These programmes have delivered some rural medical workforce outcomes to communities and governments. Medical students also provide social capital to rural communities. However, these programmes have significant financial cost and risk student social and educational isolation. Rural community-based medical education programmes are seen as academically acceptable and can facilitate symbiotic relationships among students, rural clinicians, patients and community stakeholders. These relationships can influence students' clinical competency and professional identity, increase graduates' interest in rural careers, and potentially improve rural health service stability. Formal prospective stakeholder consultations should be published in the literature.

Process of Developing of Community Based Medical Education Programme Curriculum in Puducherry, India

Process of Developing of Community Based Medical Education Programme Curriculum in Puducherry, India

Identifying approaches and tools for evaluating community-based medical education programmes in Africa

Background. The US President's Emergency Plan for AIDS Relief (PEPFAR)-funded Medical Education Partnership Initiative (MEPI) aims to support medical education and research in sub-Saharan African institutions. The intention is to increase the quantity, quality and retention of graduates with specific skills addressing the health needs of their populations. While many MEPI programmes include elements of community-based education (CBE), such as community placements, clinical rotations in underserved locations, community medicine, or primary healthcare, the challenge identified by MEPI-supported schools was the need for appropriate approaches and tools to evaluate these activities. This article outlines the process of identifying tools that, with modification, could assist in the evaluation of CBE programmes in participating MEPI schools. Methods. A literature search was carried out to identify approaches and tools that could be used in Africa to evaluate CBE programmes. The search included published, peer-reviewed literature as well as grey literature and websites. Evaluation tools considered appropriate were obtained from the articles or their authors for inclusion in a compendium of example CBE evaluation tools. All tools sourced through the search were entered into a CBE evaluation matrix, which included an analysis of the tool in relation to Kirkpatrick’s four levels of evaluation. Results. Out of 37 sources included as appropriate, 8 sets of CBE evaluation tools were obtained for the compendium. Most of the evaluations were quantitative, relied on Likert-type scales, and focused on measuring CBE activities and intermediate outcomes in terms of student learning. When categorised according to the level of the evaluation, the evaluations largely focused on levels 1 and 2 of the Kirkpatrick model, as measured through students’ reactions to and learning from the CBE programmes. Tools that focused on student assessment, rather than programme evaluation, were excluded from the final set. Conclusion. With the shortage of published literature on CBE evaluation, the findings of this literature review will assist African medical schools in developing appropriate evaluation approaches and tools.

Evaluating community-based medical education programmes in Africa: A workshop report

The Medical Education Partnership Initiative (MEPI) supports medical schools in Africa to increase the capacity and quality of medical education, improve retention of graduates, and promote regionally relevant research. Many MEPI programmes include elements of community-based education (CBE) such as: community placements; clinical rotations in underserved locations, community medicine, or primary health; situational analyses; or student-led research. CapacityPlus and the MEPI Coordinating Center conducted a workshop to share good practices for CBE evaluation, identify approaches that can be used for CBE evaluation in the African context, and strengthen a network of CBE collaborators. Expected outcomes of the workshop included draft evaluation plans for each school and plans for continued collaboration among participants. The workshop focused on approaches and resources for evaluation, guiding exploration of programme evaluation including data collection, sampling, analysis, and reporting. Participants developed logic models capturing inputs, activities, outputs, and expected outcomes of their programmes, and used these models to inform development of evaluation plans. This report describes key insights from the workshop, and highlights plans for CBE evaluation among the MEPI institutions. Each school left the workshop with a draft evaluation plan. Participants agreed to maintain communication and identified concrete areas for collaboration moving forward. Since the workshop's conclusion, nine schools have agreed on next steps for the evaluation process and will begin implementation of their plans. This workshop clearly demonstrated the widespread interest in improving CBE evaluation efforts and a need to develop, implement, and disseminate rigorous approaches and tools relevant to the African context.

How social accountability can be incorporated into an urban community-based medical education program: an Australian initiative.

Medical schools play a role in ensuring that their outcomes ultimately have positive effects on the health status of communities. We describe an initiative that translates this broad intent into meaningful activities that foster positive attitudes to social accountability among medical students in the context of an already full curriculum. Faculty members from an urban community-based medical education program undertook broad consultation with its community groups. Medical students then undertook activities designed to assist in the well-being of socio-economically disadvantaged adolescents through near-peer counselling and health education. Early evaluation from medical students, secondary students, community organisations and faculty indicates that the activities undertaken to-date have been of value to stakeholders. This initiative is intended to develop one model for incorporating social accountability into the medical curriculum with sustainable activities that benefit the community and medical students. Further research and evaluation of the impact of this initiative on both the community group involved and on medical students is essential.

Developing Symbiotic Clinical Educators: Using Program Logic to Evaluate a Clinical Education Course

Developing health professional clinical educators able to meet the shifting health care requirements of this century is a current government priority. To change practices in the clinic, those who teach need to change and that is best achieved by specific curricula designed for faculty development. Principles revealed during an investigation of a successful community-based medical education program underpin the Master of Clinical Education (MCE) course, a new faculty development curriculum. After six years, it is timely to evaluate whether the educational goals of the MCE course are being met. The MCE faculty employed an independent research officer to conduct the study. A two-phase approach used semi-structured interviews and content analysis to develop and assess outcomes against an outcomes logic model. The program achieved all short-term goals: understanding the symbiotic model; commitment to self as teacher; and changes in the way to give feedback. It achieved two of three medium-term goals: belief of transformation; and relationship development. One medium-term goal was not met: developing a sense of community. This evaluation of the MCE course shows the program develops clinicians as committed educators and also as change agents who see building relationships as the key to operating effectively within complex health services and systems.

From the bush to the big smoke - development of a hybrid urban community based medical education program in the Northern Territory, Australia

The Northern Territory (NT) of Australia is a unique setting for training medical students. This learning environment is characterised by Aboriginal health and an emphasis on rural and remote primary care practice. For over a decade the NT Clinical School (NTCS) of Flinders University has been teaching undergraduate medical students in the NT. Community based medical education (CBME) has been demonstrated to be an effective method of learning medicine, particularly in rural settings. As a result, it is rapidly gaining popularity in Australia and other countries. The NTCS adopted this model some years ago with the implementation of its Rural Clinical School; however, urban models of CBME are much less well developed than those in rural areas. There is considerable pressure to better incorporate CBME into medical student teaching environment, particularly because of the projected massive increase in student numbers over the next few years. To date, the community setting of urban Darwin, the NT capital city, has not been well utilised for medical student training. In 2008, the NTCS enrolled its first cohort of students in a new hybrid CBME program based in urban Darwin. This report describes the process and challenges involved in development of the program, including justification for a hybrid model and the adaptation of a rural model to an urban setting. Relationships were established and formalised with key partners and stakeholders, including GPs and general practices, Aboriginal medical services, community based healthcare providers and other general practice and community organisations. Other significant issues included curriculum development and review, development of learning materials and the establishment of robust evaluation methods. Development of the CBME model in Darwin posed a number of key challenges. Although the experience of past rural programs was useful, a number of distinct differences were evident in the urban setting. Change leadership and inter-professional collaboration were key strengths in the implementation and ongoing evaluation of the program. The program will provide important information about medical student training in urban community settings, and help inform other clinical schools considering the adoption of similar models.

Primary Care Physicians' Attitudes to Community-Based Medical Education and the Wave Model as a New Teaching Method in Ambulatory Care Settings

Purpose: In order to expand and improve community-based medical education(CBME), we attempted to delineate the characters of the primary care physicians interested in medical education and their opinions on the new medical teaching method for ambulatory care settings, Wave model. Methods: Through mailed questionnaires, we asked the Seoul members of the family physician association and the internal medicine physician association about their interest and opinions of CBME and the Wave model. Results: We received 186 replies from the total 1088 questionnaires(17.1%) sent out. Many of the primary care physicians(141/186; 75.8%) had no experience with CBME. However, 127 (68.7%) were interested in CBME and 121(65.4%) answered that they were interested in teaching students in their clinic. There were 128(69.2%) affirmative responses to the Wave model, which was much higher than that to the observation-centered method, 53(30.3%)(p＜0.0001). Primary care physicians who have affirmative attitudes to adopting the Wave model would select this model as their CBME program(p＜0.0001). Primary care physicians willing to teach students tend to be males(p=0.0085) and younger in age(p=0.0003), have examination rooms for student-patient contact(p＜0.0001), and possess positive attitude to adopting the Wave model(p= 0.0018). Conclusion: There are many primary care physicians eager to participate in CBME. They view the Wave model as an effective teaching method. Factors associated with the desire to work as a preceptor include being male and younger in age. having examination rooms for student-patient contact, and possessing a positive attitude to adopting the Wave model.

Parallel Rural Community Curriculum: is it a transferable model?

The chronic shortage of doctors in rural Australia has been well documented. Enabling medical students to undertake positive rural experiences during their undergraduate course is a well-supported long-term strategy to provide a sustainable solution to this problem. The Parallel Rural Community Curriculum (PRCC) was developed by Flinders University, South Australia, in 1997 to enable senior medical students to undertake an entire clinical year based in rural general practice in the Riverland region of South Australia. The academic success of this program has been widely acknowledged. Many institutions are planning to use this model as a basis for their own curriculum reform. However, questions have been asked as to how well this program would translate into another region. Due to the success of the Riverland program, Flinders University decided to commence a second PRCC program in 2002, this time in the Greater Green Triangle (GGT) region of South Australia and Victoria, Australia. This new program was developed collaboratively by the GGT University Department of Rural Health and the Flinders University Rural Clinical School. The mean student rank improved by an average of 17 places out of a class of 90 students. Partnership development took time. General practitioners (GPs) initially showed significant anxiety particularly in regard to their teaching capacity, time commitment of students and the infrastructure demands on their practices. Specialists' engagement was a challenge, requiring a significant change to their teaching paradigms. Horizontal and vertical integration of teaching was complex and required ongoing effort to maximize efficiency. The community had high expectations of the workforce outcome and these needed to be tempered with realistic expectations about the length of time required to train doctors, and an understanding of workforce mobility. The initial evaluation of the GGT PRCC suggests that the Riverland PRCC is translatable. Successes, including student performance, GP acceptance and community ownership have been replicated in the GGT community-based medical education program. A key to the success has been the recognition of the crucial role of partnerships in an environment where, for clinicians, clinical service provision and other personal needs take precedence over teaching roles and responsibilities.