Community-based Medical Education Research Articles

Community-based learning in medical education: A starting guide and lessons learned

Community-based medical education (CBME) addresses real-world health problems and is characterized by its emphasis on reciprocity and collaboration with community stakeholders. Limited evidence shows that CBME is an effective learning strategy to care for underserved communities. However, medical schools and nursing schools struggle to implement CBME in their curriculum. In this article, we present four practical examples of CBME from medical and nursing schools in Belgium and the Netherlands. By taking the lessons learned derived from these practical examples into account, all students can have an authentic learning experience within the community, which empowers community members and increases their health.

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.

Community Based Medical Education: What, Why and How?

Community based medical education has several definitions, but the core definition refers to learning that takes place is need based and in a community setting. Hence, community based medical education refers to medical education in which trainees learn and acquire professional competencies in a community setting based on the need of the community. This concept encourages medical colleges to produce not just highly competent professionals, but professionals who are equipped to respond to the changing challenges of healthcare through re-orientation of their education, research, and service commitments, and be capable of demonstrating a positive effect upon the communities they serve. Such social accountability of a healthcare cum academic institution demonstrates an impact on the communities served and thus, contribute to achieve a just and efficient healthcare service through mutually beneficial partnerships with other stakeholders. Community based medical education can make a difference in the country’s health sector by supporting a community based healthcare delivery system within the concept of National Health Policy and thus, contribute to the overall national efforts in achieving meaningful, self-sustaining quality of life and environment. Besides, it helps bring about change in current educational trait by imposing need-based, flexible academic strategies specific to the rural community and quality of the medical doctors by grooming them as empathetically responsive and active towards patients, professionally competent and ethically sound persons of the society. CBMJ 2024 January: vol. 13 no. 01 P: 119-129

BARRIERS TO STUNTING PRIMORDIAL PREVENTION THROUGH PROSPECTIVE BRIDE’S ADVISORY SERVICE: A QUALITATIVE STUDY USING SOCIAL ECOLOGICAL MODEL

Since the Faculty of Medicine and Health Sciences, University of Warmadewa, launched community-oriented medical education (COME), the stunting prevalence in Gianyar Residence decreased from 12.1% (2018) to 11.1% (2019). In 2021, it decreased to 5.1% which was lower than Bali province (10.9% in 2021) and much less than the Republic of Indonesia (24.4%). The PentaCOME (Pentahelix Community-Based Medical Education) project, the modification of COME, was the collaboration of the Indonesian Ministry of Education, Culture, Research, and Higher Education, the Warmadewa University, as well as PT. Sido Muncul is implemented to further lower stunting prevalence via the “Stunting Primordial Prevention Through Prospective Brides Advisory Service” initiative in Payangan District. The present study was intended to figure out barriers to implementing such initiatives. This is a qualitative study using in-depth interviews and focus group discussions (FGDs) in obtaining data. Purposive sampling was used to select informants who represented academicians (3), businessmen (2), community (9), government (3), and media (3) (i.e., Penta helix components). Twenty in-depth interviews and two FGDs involving academician, community, government, and media were conducted during the 1 September 2022 – 15 October 2022 period. Two coders transcribed and coded independently. The social-ecological model was used to categorize the codes. Informants described that they never heard about the ELSIMIL application (ELSIMIL stands for Electronic Siap Nikah dan Hamil which means ‘prepared to get married and pregnant application’) at the personal level. The “No pregnancy, no marriage” motto (i.e., social pressure to get pregnant before marriage among Balinese) was found a barrier at the interpersonal level. At the institutional level, key informants stated the prospective bride’s advisory service and ELSIMIL application campaign were not adequate. At the community level, the family support team community has been established, however, they could not fulfill their function properly due to the “no pregnancy, no marriage” motto. At the policy level, the traditional village assembly (i.e., “Majelis Desa Adat”) has not issued regulations regarding the prospective bride’s advisory service. A lack of cross-sector collaboration was also reported as a barrier to this initiative. A well-planned promotion could socialize ELSIMIL application among prospective brides. Advocacy to the traditional village assembly might diminish the “no pregnancy, no marriage” motto. Pentahelix collaboration needs to be established to achieve the “zero stunting for golden generation” goal.

Psychological safety and self-regulated learning through near-peer learning for the sustainability of rural community-based medical education: grounded theory approach.

Difficulties in improving psychological safety in medical education can be attributed to the hierarchy among medical professionals. Near-peer learning (NPL) can increase learning between students and residents, and improve psychological safety. Rural community-based medical education (CBME) can use an NPL framework to improve psychological safety and compensate for the lack of resources, leading to sustainability. This qualitative study aimed to clarify the effects of NPL on the psychological safety and learning of medical trainees in rural CBME. This study used a grounded theory approach. Thirty-eight medical students, 12 second-year residents, and eight family medicine residents participated in this study. Purposive sampling was used to address the research objectives, followed by ethnographic and semi-structured interviews. Three themes were identified: facilitating learning, change in perception, and change in learning. Rural NPL-based CBME drove learners' engagement in clinical practice through constant participation and reflection. Respecting and supporting learners' motivation and participation and effectively accepting them increased their sense of ownership and psychological safety. Furthermore, NPL supported participants in becoming self-regulated learners. Rural CBMEs lack healthcare and educational resources, but implementing NPL could make rural medical education sustainable, increasing the motivation of healthcare students and the number of medical staff working in rural contexts.

The Primary Healthcare Physician's Awareness and Engagement in Community-Based Medical Education: A Mixed Qualitative and Quantitative Study.

Community-based medical education (CBME) is an essential component of medical education, where primary healthcare physicians (PCPs) play a crucial role. This study explores PCPs' awareness and engagement in CBME and investigates the factors influencing their participation. This mixed study was conducted in two phases. In the first phase, a qualitative study was conducted using semi-structured interviews with PCPs as well as thematic analysis related to their awareness and engagement in CBME. In the second phase, a quantitative survey was conducted on 72 PCPs' pre- and post-training programs. Primary healthcare physicians had a positive attitude toward community-based medical education. The participants had an acceptable level of awareness and engagement, which increased substantially by (p-value = 0.03) and (p-value = 0.003), respectively. Logistical analysis indicated that non-Saudi physicians were more likely to participate in the CBME (p-value = 0.001). Professions and academic experiences influenced their willingness to engage and participate in CBME (OR = 7.5, p-value = 0.001) and (OR = 0.21, p-value = 0.001), respectively. The study findings highlighted the importance of increased awareness and the factors that enhance PCPs' engagement in CBME. This positive perspective of the PCPs will help build effective partnerships and facilitate the extension of the curriculum to apply CBME.

Implementation of Near-Peer Learning for the Sustainability of Rural Family Medicine Education.

Balancing educators and trainees in community-based medical education (CBME) is essential for practical education in family medicine and the quality of care. The number of educators and trainees can be flexible in rural family medicine education. Implementing near-peer learning (NPL), in which trainees learn from each other and enhance their clinical skills, is complementary to medical education in rural medical education, which lacks medical educators. The Department of Community Care at the Unnan City Hospital has experienced significant changes in staffing structure. The previous structure of two consultants and six senior residents was replaced by losing one consultant and adding three senior residents. Therefore, the balance between the numbers of educators and learners changed significantly. Traditional teamwork methods no longer ensure effective team communication and balance; currently, effective teamwork does not occur within a team. The increased burden on consultants could result in lower patient outcomes and decreased quality of education for students and residents, thereby affecting the nurturing of future generations. To overcome these difficulties, we implemented the NPL. The implementation was based on strengths, weaknesses, opportunities, and threats (SWOT) and stakeholder analyses. This technical report demonstrated that NPL in rural family medicine education benefits the quality of rural medical education.

Case Report-Driven Medical Education in Rural Family Medicine Education: A Thematic Analysis.

Case-based education (CBE) is a teaching method in which learners work on real-life cases to learn and apply concepts and skills they have been taught. Case report-driven medical education using the CBE framework can effectively facilitate student and resident learning, and entice them to become involved in actual clinical practice. Specific case report-driven medical education methods and learning outcomes are not clarified. This study aimed to clarify the specific learning processes and outcomes of case report-driven medical education in rural community-based medical education. Using a qualitative design based on a thematic analysis approach, data were collected through semi-structured interviews. The study participants were medical students and residents in training at a rural Japanese community hospital. Fifty-one case reports were completed and published in Cureus from April 2021 to March 2023. Participants learned about various difficulties related to volatility, uncertainty, complexity, and ambiguity (VUCA) in the medical care of various older patients, which increased their interest in family medicine. They appreciated the importance of case reports in academic careers and how their responsibilities as researchers increase with collaboration. Case report-driven medical education in community hospitals can drive medical students' and junior residents' learning regarding family medicine in the VUCA world.

Three-year evaluation of a program teaching social determinants of health in community-based medical education: a general inductive approach for qualitative data analysis

BackgroundSocial determinants of health (SDH) are intricately intertwined with various social and economic factors. Reflection is essential for learning about SDH. However, only a few reports have focused on reflection in SDH programs; most were cross-sectional studies. We aimed to longitudinally evaluate a SDH program in a community-based medical education (CBME) curriculum that we introduced in 2018 based on the level of reflection and content on SDH in students’ reports.MethodsStudy design: General inductive approach for qualitative data analysis. Education program: A 4-week mandatory clinical clerkship in general medicine and primary care at the University of Tsukuba School of Medicine in Japan was provided to all fifth- and sixth-year medical students. Students underwent a 3-week rotation in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. After a lecture on SDH on the first day, students were instructed to prepare a structural case description based on encounters during the curriculum. On the final day, students shared their experiences in a small group session and submitted a report on SDH. The program was continuously improved and faculty development was provided. Study participants: Students who completed the program during October 2018–June 2021. Analysis: Levels of reflection were categorized as reflective, analytical, or descriptive. The content was analyzed based on the Solid Facts framework.ResultsWe analyzed 118 reports from 2018–19, 101 reports from 2019–20, and 142 reports from 2020–21. There were 2 (1.7%), 6 (5.9%), and 7 (4.8%) reflective reports; 9 (7.6%), 24 (23.8%), and 52 (35.9%) analytical reports; and 36 (30.5%), 48 (47.5%), and 79 (54.5%) descriptive reports, respectively. The others were not evaluable. The number of Solid Facts framework items in reports were 2.0 ± 1.2, 2.6 ± 1.3, and 3.3 ± 1.4, respectively.ConclusionsStudents’ understanding of SDH deepened as the SDH program in the CBME curriculum improved. Faculty development might have contributed to the results. Reflective understanding of SDH might require more faculty development and integrated education of social science and medicine.

A Qualitative Study on Barriers to Stunting Primordial Prevention during the PentaCOME Project

Introduction: The government of Gianyar district in Indonesia has successfully decreased the stunting prevalence from 12.1% in 2018, became 11.1% in 2019, and ended up with 5.1% in 2021, which was less than the stunting prevalence in Bali province (10.9% in 2021) and much lower than the national wide (24.4%). The PentaCOME (Pentahelix Community-Based Medical Education) project, the collaboration of the Warmadewa University, the Indonesian Ministry of Education, Culture, Research, and Higher Education, as well as PT. Sido Muncul, is intended to continuously lower stunting prevalence via “Stunting Primordial Prevention Through Future Brides and Grooms Accompaniment” initiative in Payangan District. The present study sought to determine barriers to implementing such initiative. Methods: This is a qualitative study. The data were derived from in-depth interviews and focus group discussions (FGDs). The key informants were purposefully selected to represent pentahelix model (i.e., academician, business, community, government, and media). Twenty key informants were interviewed during 1 September 2022 – 15 October 2022 period: three key informants were from academician, two from business, nine from community, three from government, and three from media. Two FGDs were conducted and attended by the representatives of academician, community, government, and media. The business representatives failed to attend both FGDs. The data were transcribed and coded independently by two coders. The codes were then categorised into the social ecological model. Results: At the intrapersonal level, informants described not knowing about ELSIMIL application (ELSIMIL stands for electronic “Siap Nikah dan Hamil” in Indonesian, which means electronic “Ready to Marry and Get Pregnant”). At the interpersonal level, we detected social pressure to get pregnant prior to marriage among Balinese (“no pregnancy, no marriage” motto). At the institutional level, key informants found the Future Brides and Grooms Accompaniment and ELSIMIL application campaign to be insufficient. At the community level, the family support team community has been engaged actively, however, they could not function adequately due to “no pregnancy, no marriage” motto. At the policy level, the traditional village assembly (commonly known as “Majelis Desa Adat” in Indonesian), which has not issued regulation regarding the future brides and grooms accompaniment, and lack of cross-sector collaboration were reported as barriers to this initiative. Conclusions: A well-developed promotion could improve the knowledge about ELSIMIL application among future brides and grooms. Advocacy to the traditional village assembly might slowly diminish “no pregnancy, no marriage” motto among Balinese hence enhance primordial prevention toward stunting. Cross-sector collaboration (known as pentahelix collaboration) needs to be empowered to achieve the “zero stunting for golden generation” goal accordingly.
 Key words: stunting, primordial prevention, ELSIMIL, PentaCOME, Bali

Has novel coronavirus infection affected the professional identity recognised by medical students? - A historical cohort study

Introduction: The pandemic caused by the novel coronavirus (COVID-19) has produced dramatic changes in the learning environment for clinical practice in medical education, and the impact on medical students has been significant. However, few program evaluation studies involving professional identity, now emphasised in medical education, have compared current with pre-COVID-19 programs. Here, we compared the professional identity recognised by medical students in the years before and during COVID-19. Methods: Medical students who participated in clinical practice were evaluated using the Japanese version of the Professional Self-Identity Questionnaire (PSIQ), a 9-item inventory rated using 7-point Likert scales. They answered on the first day of a 4-week clinical practice module within a community-based medical education (CBME) program and at graduation in 2018-2019 (pre-COVID-19 pandemic) and in 2019-2020 (during-COVID-19 pandemic). We compared the mean difference in total PSIQ score of the 2019-2020 students to those of the 2018-2019 students as a historical cohort using an unpaired t-test. Results: Participants were 104 medical students in the 2018-2019 academic year and 92 in the 2019-2020 academic year. PSIQ was increased at graduation. Mean difference in total PSIQ score was statistically higher for the 2019-2020 students (13.5 ± 9.4) than for the 2018-2019 students (10.3 ± 8.1) (t =2.6, df =195, p = 0.01). Conclusion: Although clinical practice was restricted by COVID-19, this had some positive impact on the strengthening of professional identity recognised by medical students. This finding may have been influenced by the imprinting of professional norms and changes in society.

Stakeholder Participation and Cross-Sectoral Cooperation in a Quality Circle on Community-Based Teaching: Results of a Qualitative Interview Study.

Community-based learning in family medicine practices is an increasingly important part of the medical curriculum internationally. It is widely regarded as one solution to healthcare system needs, such as training and retaining a workforce willing to work in primary care. However, the perspectives of community-based medical educators and representatives from university-based medical education are rarely integrated. To improve teaching quality and promote exchange between those two sectors of medical education, the Institute for General Practice and Interprofessional Care at Tübingen University started a quality circle in family medicine teaching involving stakeholders from both sectors in 2018. The study aims to describe how the participants of this specific QC describe the cross-sectoral cooperation and participation of stakeholders in the quality management of community and university medical education. After an observed meeting of the quality circle, semi-structured interviews were conducted with n=12 participants of the quality circle. Interview transcripts were analyzed using grounded theory. According to the participants, the quality circle provides a dynamic continuity which allows participants to navigate known barriers to transsectoral collaboration in the quality management of community-based medical education. The quality circle is perceived as an instrument for quality improvement that offered continuity and direction. At the same time, it allows for enough freedom and flexibility for the involved stakeholders to creatively work together on quality management and be inspired by their experiences. The quality circle has the potential to facilitate collaboration between the two teaching settings, form a creative community, and give medical students an active role in educational quality management.

Teacher’s view on current practices of ‘community based medical education’ related activities in undergraduate medical education of Bangladesh, 2021

‘Community-based medical education’ (CBME) consists of learning activities in the community settings where students, teachers and community members are actively engaged in the learning process of medical education relevant to community health needs. This cross sectional study was aimed to explore the current practices of CBME related activities in undergraduate medical education of Bangladesh. Data were collected from 108 teachers of eight medical colleges of Bangladesh from January to December of 2021 using a pretested self-administered questionnaire and analyzed by SPSS version 16. In this study, 61.1% were female teachers. Most of the teachers (69.4%) were agreed that CBME related activities motivate students to serve at community settings. About 74% teachers revealed that CBME develop student’s positive attitude towards community people. Maximum (51.9%) teachers were satisfied for infrastructure of residential field site training (RFST) sites. The accommodation, transport and security of RFST sites were satisfied to 38%, 45.4% and 47.2% teachers respectively. About 31.6% teachers mentioned that poor set up of service place for CBME activities and 23.7% teachers revealed that less participation of community people as important constraints for CBME related activities. Conduction of CBME related activities as per curriculum objectives and motivation of local health authority were most important suggestions to overcome the constraints of CBME related activities mentioned by 12.6% and 11.3% teachers respectively. This study recommended to motivate the stakeholders, increase duration for RFST, and ensure necessary infrastructures, adequate transport, security, resource and supervision for effective CBME related activities. Bangladesh Journal of Medical Education Vol.13(2) July 2022: 26-34

Family Adoption Program, A Way Forward to Community Based Medical Education…. Challenges Ahead

Medical education in India is based predominantly on hospital environments and specialist services covering a narrow spectrum of health problems, with especially dependent on technology. A significant reorientation is needed in medical education, to allow students to understand people in their social contexts in a more holistic way, rather than seeing them merely as parts of a biological machine.1 National Medical Commission (NMC) in their recent notification included Family Adoption Program (FAP) in the undergraduate curriculum to provide a learning opportunity towards community-based health care to Indian Medical Graduates.2 The NMC documented its vision as “to provide for medical education system that improves access to quality and affordable medical education, ensures availability of adequate and high-quality medical professionals in all parts of the country; that promotes equitable and universal health care that encourages community health perspective and makes services of medical professionals accessible to all citizens; that promotes national health goal.”

Explaining the Effective Dimensions and Components for Community-Based Medical Education from the Perspective of Family Physicians of Ilam University of Medical Sciences: A Qualitative Study

Explaining the Effective Dimensions and Components for Community-Based Medical Education from the Perspective of Family Physicians of Ilam University of Medical Sciences: A Qualitative Study

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.

Attitudes and Motivation Toward Community-based Medical Education Among Students Enrolled in a Regional Quota Program at a Japanese Medical School

Attitudes and Motivation Toward Community-based Medical Education Among Students Enrolled in a Regional Quota Program at a Japanese Medical School

Development of a community orientation program (COP) as a community-based medical education method for undergraduate medical students: an experience from India

BackgroundIntra-regional cultural and linguistic differences are common in low- and middle-income countries. To sensitise undergraduate medical students to the social and contextual determinants of health to achieve the ‘health for all’ goal, these countries must focus on innovative teaching methods. The early introduction of a Community Orientation Program (COP) as a Community-based Medical Education (CBME) method could be a game changing strategy. In this paper the methods, evaluation, and implication of the COP in an Indian setting are described.MethodsThe curriculum of the COP was developed based on the analysis, design, development, implementation, and evaluation (ADDIE) model for educational intervention. In this learner-centric and supervised educational program, the key aim was to focus on developing students’ communication skills, observation power and enhancing their motivation for learning through collaborative learning. To meet the objectives of the COP, a situated learning model under the constructivism theory was adopted.ResultsBetween 2016 and 2019, 557 students were trained through the COP by visiting more than 1300 households in ten villages. To supplement the students’ observations in the community, more than 150 small group discussions, a health education programme for the community and summary presentations were conducted. The students’ feedback indicated the need to improve the clinical examinations demonstration quality and increase the number of instruments for clinical examinations. More than 80% of students felt that the program would assist them to improve their communication skills, their understanding of the various socio-demographic factors associated with the common diseases, and it will enable them to respect the local culture during their clinical practice.ConclusionsEarly initiation of the COP as a CBME method in the undergraduate medical curriculum in an Indian setting has shown promising results. Further evidence is required to adopt such a program routinely for under-graduate medical teaching in the low- and middle- income settings.

Community based medical education: A learning experience of Pakistani Undergraduate Medical Students at Medical Camps.

Objective: To determine impact of community based Medical Education on learning of undergraduate medical students. Study Design: Non-comparative, Prospective study. Setting: Irfania Ophthalmic Medical Camp, Lahore. Period: July 2019. Material & Methods: 70 students participated in a 4 hour interactive session, where they took a focused history, performed relevant clinical examination, and counseled patients regarding their disease. At the end, feedback was collected using a pre-tested questionnaire. Data obtained was analyzed using SPSS version 23, with mean ± SD determined for continuous variables and frequency with percentage for categorical variables. Results: Majority of the participants were female fourth year medical students. 97.1% found the camp system more efficient for learning, while 94.3% thought it should be included in future ophthalmic curricula. 81.5% of the participants were of the opinion that the camp had had a positive impact on their communication skills regarding taking focused history and counseling patients. Conclusion: In a country like Pakistan with a high burden of ophthalmic diseases and a developing medical curriculum, medical camps are essential for training and skill learning for undergraduate medical students, and should be included in the medical curriculum.

Effect of Residents-as-Teachers in Rural Community-Based Medical Education on the Learning of Medical Students and Residents: A Thematic Analysis.

Residents-as-teachers (RaT) is a theoretical framework emphasizing the significance of the similar learning background of teachers and learners. In Japan, community-based medical education (CBME) is a practical approach to teaching family medicine. This study aimed to investigate the impact and challenges of RaT on the learning of medical students and residents in CBME at a rural community hospital in Japan. Over the course of a year, the researchers conducted one-on-one interviews with three residents and ten medical students participating in family medicine training at the hospital. The interviews were recorded and transcribed verbatim. Grounded theory was used in the data analysis to clarify the findings. Three key themes emerged from the research: lack of educational experience with RaT, effectiveness of RaT, and challenges of RaT. Although participants were prejudiced against RaT, they felt its implementation could facilitate the establishment of beneficial relationships between learners and teachers. They were also able to participate in medical teams effectively. The findings suggest that the increased participation of senior doctors in RaT could strengthen its learning effects. RaT in rural CBME should be applied in various contexts, and its effectiveness should be further investigated both qualitatively and quantitatively.