Community-based Medical Education Research Articles

Faculty perceptions regarding community-based medical education: The case of KSA.

ObjectivesThere is great concern about the selection and quality of health college graduates and about their ability to respond to local community health needs. Community-based medical education (CBME) is a means of achieving educational relevance to community needs. In KSA, medical education has rapidly progressed in tandem with huge expansions in community health needs and expectations. This study aimed to assess the perceptions of the faculty members of the colleges of medicine and dentistry towards different concepts reflecting CBME.MethodologyThis analytical, observational and cross-sectional study used a self-administered questionnaire that was given to the faculty members of the colleges of medicine and dentistry at Taibah University, KSA.ResultsAs many as 136 faculty members responded, a response rate of 64%. The percentage of agreement was strongest among the faculty members of the college of medicine. The study findings also showed a relationship between different concepts of CBME and faculty teaching experiences by academic positions for applying CBME. There were significant differences in the social, cultural, and ethnic aspects of medical practice.ConclusionCBME is a means of achieving educational relevance to community needs and consequently serves as a means of implementing a community-oriented education programme.

Interprofessional Education in Medical Education: Can We Break the Silos?

For the last half-century, interprofessional education (IPE) has been identified and discussed as a critical educational process to facilitate collaboration in order to improve healthcare outcomes for healthcare participants. While the concept is not new, outcome-based research has provided few valid and reliable explanations of whether and how IPE can be effective in healthcare quality improvement. This challenge stems from the struggle to understand the epistemological meaning of IPE. The purpose of this literature review paper is to provide a synthesized understanding of IPE, its meaning, and to provide practical guidance for medical educators. The paper reviewed several key aspects of IPE. Professionalility was discussed to understand the historical background of IPE, followed by an explanation of the international trend of embracing the complexity of health care practice and the need for interprofessional collaboration. Additionally, several theoretical perspectives, such as general systems theory, social identity theory, and community of practice were reviewed to pinpoint what constitutes IPE. Several existing definitions were discussed with similar concepts (i.e., disciplinary vs. professional, and multi-, inter-, vs. trans-) to clarify the nature of knowledge and collaboration in IPE. Three concepts, including practice, authenticity of context, and socialization were proposed as key constructs of IPE, followed by appropriate timing of IPE, outcome research, directions for future research, and guidance for implementation. Community-based medical education practice, professional socialization within a community, and longitudinal system-based outcome research are recommended as future directions for research and practice.

Community Based Medical Education (CBME): A collateral benefit to the society!

Community Based Medical Education (CBME): A collateral benefit to the society!

A National Survey of Community-Based Medical Education in Japanese Medical Schools (second report)

A National Survey of Community-Based Medical Education in Japanese Medical Schools (second report)

The Impact of Community-Based Undergraduate Medical Education on the Regional Physician Workforce

Purpose: As medical schools in the United States expand, many are adopting community-based models, often with goals of graduating students who will practice primary care, serve local communities, and care for underserved populations. The study’s purpose was to assess the impact of community-based medical education on the regional physician workforce. The Michigan State University College of Human Medicine (MSU-CHM) has immersed students in diverse communities across the state since its founding in 1966. The authors retrospectively evaluated the regional impact on the physician workforce in the six communities where centers of medical education were initially established. Method: American Medical Association Masterfile data from 2011 were used to obtain practice locations and specialty data for all MSU-CHM graduates from 1972 to 2006. Physicians were classified as practicing primary care or practicing in a high-need specialty. Using geographic information system software, practice locations were geocoded to the ZIP code level, evaluated for practice within a Health Professions Shortage Area (HPSA), and joined to Rural–Urban Commuting Area Code 2006 data to determine rurality. Fisher exact tests were used to compare the proportion of graduates from each campus practicing primary care, in high-need specialties, within 50 miles of their campus, in rural communities, in HPSAs, and in Michigan. Differences between campuses were further analyzed using binary logistic regression, to determine whether differences remained significant after controlling for pertinent demographics. Maps of the footprints of each campus were visually compared. Generalizability was assessed by comparing the footprints of all allopathic, nonmilitary U.S. medical schools with established regional campuses versus those without regional campuses, using Med School Mapper.1 Results: Three thousand one hundred seven (93.9%) graduates were analyzed. Twenty percent were practicing within 50 miles of their community-based campus in 2011. Saginaw and Flint graduates also clustered around Detroit and its surrounding suburbs, reflecting these communities’ urban character. Grand Rapids, the community with the strongest tertiary medical care focus, had the lowest proportions of rural (13% vs. 16%, P = .0108) and high-need specialty graduates, including primary care (52% vs. 57%, P < .0001). Upper Peninsula graduates were significantly more likely to practice in rural communities (45% vs. 16%, P < .0001) and high-need specialties (65% vs. 57%, P = .0449), consistent with the regional campus’ rural mission. Forty-three percent of all studied graduates were practicing in Michigan in 2011; 49% were practicing in HPSAs; and 44% were practicing primary care. Taken together, the proportion of MSU-CHM graduates in each Michigan county grossly reflected the state’s population. Nationally, U.S. medical schools with regional campuses had larger geographic footprints within their states or regions than single-campus schools (mean: 31 counties vs. 21 counties; P < .001). Conclusions: This case study suggests that distributed medical education campuses can have a significant impact on the long-term local and regional physician workforce. Students’ long-term practice choices may also reflect the patient populations and specialty patterns of communities where they learn. The results augment previous research demonstrating that graduates of regionally dispersed medical schools are more likely to practice primary care and practice in rural communities.2–4

Community-based medical education: To each, his own

This article was migrated. The article was marked as recommended. Community-based medical education plays an important part of medical education as learning occurs outside of the four-walled classroom, and exposure to real-life medicine is given. In Singapore, our medical education is progressively geared towards the incorporation of community-based medical education as part of our curriculum, albeit most of the programmes being voluntary. This is an article detailing the experiences of three Singaporean medical students' experiences with three different forms of community-based medical education.

The developing role of Community-Based Medical Education

This article was migrated. The article was marked as recommended. Not requied for this editorial.

Follow-up study of the regional quota system of Japanese medical schools and prefecture scholarship programmes: a study protocol

IntroductionGiven the shortage of physicians, particularly in rural areas, the Japanese government has rapidly expanded the number of medical school students by adding chiikiwaku (regional quotas) since 2008. Quota entrants...

Assessment of community-based training of medical undergraduates: Development and validation of a competency-based questionnaire.

The global shift toward competency-based education and assessment is also applicable to community-based training (CBT) of undergraduate medical students. There is a need for a tool to assess competencies related to CBT. This study aimed to develop a tool that uses a competency-based approach to evaluate CBT of medical undergraduates. A preliminary draft of the questionnaire was prepared by the investigators based on a conceptual framework. Using the Delphi technique, this draft was further developed by a specialist panel (n = 8) into a self-administered questionnaire. After pretesting with students, it was administered to medical undergraduates (n = 178) who had recently completed Community Medicine. Item analysis and exploratory factor analysis were performed under which principal component analysis was used. Reliability was assessed by calculating Cronbach's alpha, convergent validity by correlating the scores with Community Medicine university examination scores, and construct validity by describing percentage variance explained by the components. A 74-item questionnaire developed after the Delphi technique was further abridged to a 58-item questionnaire. Cronbach's alpha of 74 and 58-item questionnaires were 0.96 and 0.95, respectively; convergent validity was 0.07 and 0.09, respectively; and percentage variance explained by the components were 69.3% and 70.1%, respectively. Agreement between scores of both versions was 0.76. The authors developed a questionnaire which can be used for competency-based assessment in community-based undergraduate medical education. It is a valuable addition to the existing assessment methods and can guide experts in a need-based design of curriculum and teaching/training methodology.

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.

Health-profession students' teaching and learning expectations in Ugandan medical schools: pre- and postcommunity placement comparison.

PurposeThe benefits of community-based medical education for both students and teachers are becoming increasingly clear. However, there is paucity of information about the importance of incorporating students’ thoughts in the community-based education curriculum and the impact it has on their intentions to work in rural communities. The purpose of this study was to assess the teaching and learning expectations before and after placement of health-profession students going for community placement for the first time and make suggestions for improvement of the community-based programs.MethodsThe study was a cross-sectional survey with both structured and unstructured questions. Participants were recruited from four medical schools in Uganda targeting 100% participation of health-profession students going for community placement in 2014. In total, 454 and 305 participants responded to self-administered questionnaires before and after community placement, respectively; and they were from different programs and years of study.ResultsStudents’ learning expectations before placement, in ranking were: community engagement, interpersonal skills, community diagnosis, clinical skills, lifestyle practices, and patient management. After placement, the order of ranking was: interpersonal skills, community engagement, community diagnosis, lifestyle practices, clinical skills, and patient management. Most of the students had prior rural exposure and expected to do community engagement. However, after community placement they indicated having developed interpersonal skills. The various health-profession students were able to harmoniously work together to achieve a common purpose, which they find difficult to do in a classroom environment.ConclusionHaving student teams comprised of different health programs and years of study going for community placement together promoted peer-to-peer mentorship and enhanced team building during community placement.

Putting communities in the driver's seat: the realities of community-engaged medical education.

"Community" has featured in the discourse about medical education for over half a century. This discourse has explored relationships between medical education programs and communities in community-oriented medical education and community-based medical education and, in recent years, has extended to community-engaged medical education (CEME). This Perspective explores the developing focus on "community" in medical education, describes CEME as a concept, and presents examples of CEME in action at Flinders University School of Medicine (Australia), the Northern Ontario School of Medicine (Canada), and Ateneo de Zamboanga University School of Medicine (Philippines).The authors describe the ways in which CEME, which features active community participation, can improve medical education while meeting community needs and advancing national and international health equity agendas. They suggest that CEME can redefine student learning as taking place at the center of the partnership between communities and medical schools. They also consider the challenges of CEME and caution that criteria for community engagement must be sensitive to cultural variations and to the nature of the social contract in different sociocultural settings.The authors argue that CEME is effective in producing physicians who choose to practice in rural and underserved areas. Further research is required to demonstrate that CEME contributes to improved health, and ultimately health equity, for the populations served by the medical school.

Policy issues related to educating the future Israeli medical workforce: an international perspective.

A 2014 external review of medical schools in Israel identified several issues of importance to the nation’s health. This paper focuses on three inter-related policy-relevant topics: planning the physician and healthcare workforce to meet the needs of Israel’s population in the 21st century; enhancing the coordination and efficiency of medical education across the continuum of education and training; and the financing of medical education. All three involve both education and health care delivery.The physician workforce is aging and will need to be replenished. Several physician specialties have been in short supply, and some are being addressed through incentive programs. Israel’s needs for primary care clinicians are increasing due to growth and aging of the population and to the increasing prevalence of chronic conditions at all ages. Attention to the structure and content of both undergraduate and graduate medical education and to aligning incentives will be required to address current and projected workforce shortage areas. Effective workforce planning depends upon data that can inform the development of appropriate policies and on recognition of the time lag between developing such policies and seeing the results of their implementation.The preclinical and clinical phases of Israeli undergraduate medical education (medical school), the mandatory rotating internship (stáge), and graduate medical education (residency) are conducted as separate “silos” and not well coordinated. The content of basic science education should be relevant to clinical medicine and research. It should stimulate inquiry, scholarship, and lifelong learning. Clinical exposures should begin early and be as hands-on as possible. Medical students and residents should acquire specific competencies. With an increasing shift of medical care from hospitals to ambulatory settings, development of ambulatory teachers and learning environments is increasingly important. Objectives such as these will require development of new policies.Undergraduate medical education (UME) in Israel is financed primarily through universities, and they receive funds through VATAT, an education-related entity. The integration of basic science and clinical education, development of earlier, more hands-on clinical experiences, and increased ambulatory and community-based medical education will demand new funding and operating partnerships between the universities and the health care delivery system. Additional financing policies will be needed to ensure the appropriate infrastructure and support for both educators and learners.If Israel develops collaborations between various government agencies such as the Ministries of Education, Health, and Finance, the universities, hospitals, and the sick funds (HMOs), it should be able to address successfully the challenges of the 21st century for the health professions and meet its population’s needs.

Using HIV clinics to improve quality of community-based medical education

Using HIV clinics to improve quality of community-based medical education

Why Does Cuba 'Care' So Much? Understanding the Epistemology of Solidarity in Global Health Outreach

Cuba currently has more than 38,000 health workers providing emergency relief, long-term community-based care and medical education to some of the most vulnerable communities in the world. This current outreach to 76 countries positions Cuba as a leader in global health outreach. This has been well documented and praised by many scholars and policy makers alike. While many acknowledge the importance and impact of the Cuba’s global effort, there is very little understanding as to why Cuba makes such a large global health commitment in the first place. I argue that solidarity is in fact a mixture of national pride, self-interest and humanistic outreach. Ultimately, it is a calculated effort to overcome current structures of inequity and exploitation on a global scale by expanding new opportunities for health professionals dedicated to providing care in marginalized communities.

Community-based medical education: Is success a result of meaningful personal learning experiences?

Community-based medical education (CBME) is the delivery of medical education in a specific social context. Learners become a part of social and medical communities where their learning occurs. Longitudinal integrated clerkships (LICs) are year-long community-based placements where the curriculum and clinical experience is typically delivered by primary care physicians. These programs have proven to be robust learning environments, where learners develop strong communication skills and excellent clinical reasoning. To date, no learning model has been offered to describe CBME. The characteristics of CBME are explored by the authors who suggest that the social and professional context provided in small communities enhances medical education. The authors postulate that meaningfulness is engendered by the authentic context, which develops over time. These relationships with preceptors, patients and the community provide meaningfulness, which in turn enhances learning. The authors develop a novel learning model. They propose that the context-rich environment of CBME allows for meaningful relationships and experiences for students and that such meaningfulness enhances learning.

Community-based Medical Education

Community-based Medical Education

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.

Commitment of medical graduates educated with and without community-based medical education towards community health care: A study from Malaysia.

Context: Community-based medical education (CBME) has become widely accepted as an important innovation in undergraduate medical education. In curriculum featuring CBE, students are acquainted with the community early in their studies however; the impact of this training can be judged best to see them practice the required aspects of CBME. Malaysia is a multiracial country with a very strong community dependant life style. Main national health problems have called for a change in health profession education from traditional hospital based health care to community-based delivery system. There are three major university medical schools that practice either community oriented or community based medical education in undergraduate medical curriculum. Universiti Sains Malaysia (USM) has a community based medical education (CBME) curriculum as compared to a community oriented education curriculum (COE) adopted by Universiti Malaya (UM) and a more traditional curriculum practiced by Universiti Kebangsaan Malaysia (UKM) Objective: To determine whether medical graduates from USM with a community-based medical education in its curriculum for more than 25 years are inspired to have stronger commitment towards community health as shown during their on-job practice of medicine compared to other graduates from UM and UKM, who have adopted community-oriented medical education. Methods: A questionnaire-based pilot study with 12 items (variables) was designed to obtain supervisor’s opinion on commitment of interns towards the health of community they serve. The questionnaire was administered to a randomized group of 85 specialists supervising the internship training program in five major disciplines including internal medicine, surgery, orthopedic, gynecology and obstetrics and pediatric medicine. The data received from 62 respondents from four major disciplines was analyzed utilizing SPSS version 12.0.1. Result: The responses received from 62 supervisors on 9 out of 12 variables were directly related to community commitments of interns. It was shown that the USM graduates who were taught through a CBME curriculum have performed better than the graduates from UM and UKM who followed a COE curriculum. p-value (< 0.001) was highly significant and consistent with higher mean score in those variables. Conclusion: The graduates taught through a CBME curriculum (USM) performed better in community commitments towards patients care compared to graduates from COE curriculum (UM) and a traditional curriculum (UKM).