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Background@#The effects of community immersion programs and other forms of community-based medical education on students have been highlighted in the literature. However, the driving factors that generate these outcomes are not emphasized by many authors. @*Objective@#This study aimed to identify and explain the important contextual factors and mechanisms considered as driving factors of the outcomes of community immersion programs. Methodology: An exploratory qualitative inquiry that employed focus group discussions, in-depth interviews, and reflection papers was utilized. The realist approach provided the structure in eliciting and analyzing medical students’ perspectives on the driving factors of the program outcomes of community immersion. Data were analyzed through thematic analysis. @*Results@#The outcomes generated by the community immersion program are consistent with the literature as well as relevant to the course and social outcomes as identified by De La Salle Medical and Health Sciences Institute. Uncovered major driving factors for these program outcomes include: “perceiving things from a different perspective”, and “positive attitude towards community health”. Various contextual factors that trigger these driving factors were further unpacked that provide a backdrop to the community immersion program. @*Conclusion@#Factors that bring about the program outcomes of community immersion are evident in the experiences of medical students. Focusing on these factors may allow community preceptors and administrators to have clearer perspectives on the factors to focus on in teaching community medicine through community immersion. It is recommended that preceptors and administrators consider and nurture these factors during community immersion to be effective in teaching medical students in the community setting and in the provision of primary health services to communities.
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Community-based clinical clerkship, which involves travel outside the university or prefecture, was restricted or reduced due to the outbreak of the new coronavirus infection. What kind of shortage of learning this caused and how the shortage was compensated for were discussed in a special symposium at the 53rd Annual Meeting of the Japanese Society for Medical Education. As a result, two “essences” of community-based medical education emerged: 1) to recognize one’s role and responsibility in the future in the context of interprofessional practice, and 2) to look beyond the framework of medical institutions and view the whole scope of medicine with the patient at the center. It was concluded that online supplementary education should be utilized to enhance the value of practical training experience even in the post-Corona era. It was also supposed that this would lead to the “evolution” of community-based medical education itself.
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We provide “student-selected components (SSCs) “ for 3rd-year students at our school. They work with local NGOs and identify SDH that affect the underserved population including people in isolation, poverty and/or homelessness. Since most students are from privileged families, those encounters made a strong impression on students who create a short video to advocate for people they have met. We describe the process of developing this program and explain the models and theories that underpin this education.
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Background: There is an increasing demand for general practitioners capable of examining patients from a broad perspective. Although the training of such doctors is urgently needed, the accreditation system was only recently put into place.Purpose: Our aim was to identify factors that influence career decision-making among doctors who were interested in general practice but chose to be specialists, in addition to finding methods to improve general practitioner training in the future.Method: From April 2017 to April 2018, we conducted semi-structured interviews with five subjects to understand the process leading up to the selection of their current careers. The verbatim records were analyzed using the modified grounded theory approach.Results: The reasons given for choosing specialist careers included "attraction as a field of study", "being relied upon by other doctors", and "the sense of security from having a specialty". Cited barriers to entering general practice included "uncertainty about the future" and "criticism from specialists".Conclusion: Improving the training curriculum for general practitioners will require improvement of the quality of community-based medical education and the general practice board certification system, in addition to the implementation of general practice retraining for specialists.
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Objective: Community-based medical education (CBME) serves as a complement to university medical education, and it is practiced in several urban undergraduate and postgraduate curriculums. However, there are few reports on CBME learning content in rural Japanese settings.Materials and Methods: This research aimed to clarify learning content through semi-structured interviews and qualitative analysis of second-year residents who studied on a remote, rural island located 400 km from the mainland of Okinawa, Japan. Analysis was based on Steps for Coding and Theorization (SCAT).Results: Fifteen concepts were extracted, and four categories were generated: a strong connection among the islanders, the necessary abilities for rural physicians, islander-centered care, and the differences between rural and hospital medicine. In contrast to hospital medicine, various kinds of learning occurred in deep relationships with the islanders.Conclusion: Through CBME on a remote island, the residents learned not only about medical aspects, but also the importance of community health through the social and cultural aspects, whole-person medical care in a remote location, and the importance of reflection in their self-directed learning.
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Introduction: Recently, community-based medical education has become widespread in Japanese medical schools, but the current status is not clear on a national level. A second survey of community-based medical education at all Japanese medical schools was conducted. The first survey was done in 2011. Methods: Members of the Council made and distributed a questionnaire to medical schools in order to assess the situation of community-based medical education as of April 2014. Results: A total of eighty schools responded. The number of schools which had community medicine programs was seventy-eight. In the first survey, the number was seventy-three. Seventy-seven schools gave community-based clinical clerkships. Discussion: The number of medical schools that had curriculum about community medicine was more than indicated in the first survey. Further research about the contents or implementation system of community-based clerkships is needed.
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Background: The International Medical University (IMU) has an outcome-based curriculum defined by eight major curriculum outcome domains. The attributes, qualities and competencies expected of a health care professional form the basis for these outcome domains. Community service is an effective curriculum delivery tool widely practised by medical universities around the world. We present the results of a survey among IMU students to explore the effectiveness of community service as a curriculum delivery tool in enabling activities defined within the major curriculum outcome domains of IMU. Methods: A self-administered 6-point Likert scale questionnaire was used to survey student participants of 20 community service events held in a rural village between 2007 – 2012. The survey tool included questions on demographic data as well as the perception of the students on whether participation in the events enabled them to experience activities defined under the eight major curriculum outcome domains of IMU. The one sample Student t-test was used to test for statistical significance while regression analysis was done to look for significant predictors. Results: A total of 255 students were surveyed, of which 229 (90.5%) were medical students while the rest were nursing students. Most of the students were in the 3 rd (48.2%) and 4 th (43.8%) year of their studies and have completed the surgery, internal medicine and family medicine posting. Six out of the 8 curriculum outcomes domains were achieved through participation in the community service programme. Conclusion: Community service is an effective curriculum delivery tool for the outcome-based curriculum of IMU where activities defined in six out of eight outcome domains were achieved.
Subject(s)
Education, MedicalABSTRACT
<b>Background: </b>Although community-based training is included in medical undergraduate education in Japan, little assessment of the outcomes of community-based education programs has been performed. The aim of this study was to investigate the outcomes of a community-based education program using a mixed method.<br><b>Methods: </b>The study design utilized both qualitative and quantitative methods (mixed method). The subjects (n = 278) were fifth-grade medical students who were involved in the program from 2008 to 2010 inclusive. We collected two types of data: a six-item pre-and-post questionnaire (quantitative) and an open-ended questionnaire (qualitative) to evaluate the impressions this experience left on the students.<br><b>Results: </b>Pre-and-post questionnaires were completed by 263 (95%) of 278 subjects; on all items, the scores of the post- data were significantly higher than that of pre- data (P < 0.001). From the responses given by 139 respondents (total 181, 77%) in the open-ended questionnaire survey, 10 themes were extracted: 1. Inter-professional cooperation; 2. Role and cooperation among university hospitals, community hospitals, clinics, and welfare facilities; 3. Patient-centered medicine; 4. Trust-based relationships; 5. Competency in general medicine; 6. Professionalism; 7. Medical management; 8. Communication; 9. Common diseases; and 10. Long-term care.<br><b>Conclusions: </b>We found that medical students gained four major perspectives from their experiences: Inter-professional cooperation, trust based relationships, roles of community hospitals and clinics, and patient-centered medicine, respectively. Our findings suggest this program contributed significantly to their understanding of community medicine.
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The collapse of community medicine has becomes a serious social problem in Japan, and a variety of measures have been implemented to counter it. In medical education, the model core curriculum has been revised, and many universities have started programs for community medical. We have had a community-based medical course at the Kinki University School of Medicine since 2005. This study examined the changes in students' consciousness about and affinity for community medicine during our program.<br>1)Questionnaires were completed by 494 students taking part in community-based medical training from April 2006 through July 2010. Results from before and after training were compared.<br>2)The questionnaire had 3 parts. The first part concerned medical activities with community residents. The second part concerned medical activities with housebound elderly persons. The third part concerned the students' future plans.<br>3)Many students gave themselves high scores for activities with community residents and housebound elderly persons. More students preferred hospitals in regional towns. A few students chose rural areas.<br>4)In an introduction to community medicine, it is important to first foster cordial relations with community residents. Cultivating problem-solving skills is the next challenge.<br>5)Community-based medical programs enhance medical students' understanding of and affinity for community medicine. Furthermore, some students will choose community-based medicine as a specialty.
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Education in community medicine has become increasingly important. At Jichi Medical School, community-based clinicalclerkships began in 1998. This study examined the effects of a standardized program for medical facilities and clerkshipcontents introduced in 2001. A self-administered visual analogue scale questionnaire was given to 308 fifth-yearmedical students to examine their opinions about this program, community medicine, and the future. Results from beforeand after the introduction of the standardized program were compared. After the program had been introduced, significantlymore students agreed that the clerkship program was “meaningful” and should be continued. Furthermore, significantly more students agreed that “physicians enjoy working in the community, ” “talking with people, patients, and public officials is not difficult, ” and “ I will become a general physician or a specialist in the future.” These resultsshow that the standardized program is effective for education in community medicine.
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In Japan, it is necessary to develop the community medicine (community health care) because of the current of the medical practice. Since 1998, the community-based clinical clerkship (the two weeks' program) has been introduced to the all 5-grade medical students in Jichi Medical School. The aim of this program is to learn not only the knowledge and skill for the community medical practice, but also the attitude included the pleasure, enjoyment and worth to do it. The program contains as many activities of the community medicine as possible other than the out-patient or the in-patient managements. The most of medical students give good evaluation to the program. After the program, many of the medical students became to have the motivation to work in the rural area. In the undergraduate medical education, a community-based clinical clerkship will be more necessary in terms of the development of the community medicine.
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In clinic-based training, medical students take part in various activities, including watching or assisting in clinical procedures and participating in home visits, vaccinations, industrial inspections, health education, and elderly service adjustment meetings. Through these experiences students gain a practical understanding of the importance to primary care of a close patient-physician relationship; consideration of the life and background of patients and families; continuity of care; a suitable relationship between a primary-care clinic and a hospital or specialist; a team approach with other medical staff, such as nurses, community health nurses, helpers, and social workers; and medical and welfare resources of the community. These concepts are difficult to teach effectively in a large university or private hospital. On the basis of my experiences, I would like to comment on the policy of clinic-based training and problems in expanding such training.
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As undergraduate medical education in Japan has been changing, the role of university hospitals is reassessed in this paper. It is essential for medical students to acquire basic knowledge and skills before clinical training. During this term it is necessary for them to learn in university hospitals. However following clinical trainings, especially primary care, lifestyle-related diseases, and clinical clerkship in home medical care, are not performed sufficiently under the present condition in university hospitals. In this training term, we have to introduce community-based medical education under closer cooperation with medical facilities.