Community-oriented medical education: what is it?

Data Analysis of Physician Competence Research Trend: Social Network Analysis and Topic Modeling Approach

BACKGROUND

Studies on competency in medical education often explore the acquisition, performance, and evaluation of particular skills, knowledge, or behaviors that constitute physician competency. As physician competency reflects social demands according to changes in the medical environment, analyzing the research trends of physician competency by period is necessary to derive major research topics for future studies. Therefore, a more macroscopic method is required to analyze the core competencies of physicians in this era.

OBJECTIVE

This study aimed to analyze research trends related to physicians' competency in reflecting social needs according to changes in the medical environment.

METHODS

We used topic modeling to identify potential research topics by analyzing data from studies related to physician competency published between 2011 and 2020. We preprocessed 1354 articles and extracted 272 keywords.

RESULTS

The terms that appeared most frequently in the research related to physician competency since 2010 were knowledge, hospital, family, job, guidelines, management, and communication. The terms that appeared in most studies were education, model, knowledge, and hospital. Topic modeling revealed that the main topics about physician competency included Evidence-based clinical practice, Community-based healthcare, Patient care, Career and self-management, Continuous professional development, and Communication and cooperation. We divided the studies into 4 periods (2011-2013, 2014-2016, 2017-2019, and 2020-2021) and performed a linear regression analysis. The results showed a change in topics by period. The hot topics that have shown increased interest among scholars over time include Community-based healthcare, Career and self-management, and Continuous professional development.

CONCLUSIONS

On the basis of the analysis of research trends, it is predicted that physician professionalism and community-based medicine will continue to be studied in future studies on physician competency.

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

Introduction

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.

Methods

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.

Results

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.

Discussion

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.

The perceived usefulness of community based education and service (COBES) regarding students' rural workplace choices

BACKGROUND

Community Based Education and Service (COBES) are those learning activities that make use of the community as a learning environment. COBES exposes students to the public and primary health care needs of rural communities. The purpose of this study was to investigate students' perceived usefulness of COBES and its potential effect on their choice of career specialty and willingness to work in rural areas.

METHOD

A mixed method cross sectional study design using semi-structured interviews, questionnaires, and focus group discussions were used for health facility staff, faculty and students and community members.

RESULTS

One hundred and seventy questionnaires were administered to students and 134 were returned (78.8% response rate). The majority (59.7%) of students were male. Almost 45% of the students indicated that COBES will have an influence on their choice of career specialty. An almost equal number (44%) said COBES will not have an influence on their choice of career specialty. However, 60.3% of the students perceived that COBES could influence their practice location. More males (64.7%, n = 44) than females (57.8%, n = 26) were likely to indicate that COBES will influence their practice location but the differences were statistically insignificant (p = 0.553). The majority of students, who stated that COBES could influence their practice location, said that COBES may influence them to choose to practice in the rural area and that exposure to different disease conditions among different population groups may influence them in their career choice. Other stakeholders held similar views. Qualitative data supported the finding that COBES could influence medical students' choice of specialty and their practice location.

CONCLUSION

Medical students' 'perceptions of the influence of COBES on their choice of career specialty were varied. However, most of the students felt that COBES could influence them to practice in rural locations.

The effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in rural communities in Ghana

BACKGROUND

Career choices and placements of healthcare professionals in rural areas are a major problem worldwide, and their recruitment and retention to these areas have become a challenge to the health sector. The purpose of this study was to investigate the effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in a rural area.

METHOD

This cross sectional survey was conducted among 56 pioneering graduates that followed a Problem Based Learning/Community Based Education and Service (PBL/COBES) curriculum. Using a mixed methods approach, open-and closed-ended questionnaire was administered to 56 graduates. Cross tabulation using Chi-square test were used to compare findings of the quantitative data. All qualitative data analysis was performed using the principles of primary, secondary and tertiary coding.

RESULTS

All 56 graduates answered and returned the questionnaire giving a 100 % response rate. 57.1 % (32) of them were male. Majority of them lived in towns (41.1 %) and cities (50 %) prior to medical school. A significant number of graduates (53.6 %,) from the cities, without any female or male predominance said COBES had influenced their choice of specialty. Again, a significant proportion of graduates from the towns (60.9 %,) and cities (67.8 %,), indicated that COBES had influenced them to work in the rural area. However, there was no significant difference between males and females from the towns and cities regarding the influence of COBES to work in the rural area. Qualitative data supported the finding that COBES will influence graduates willingness to work in the rural area

CONCLUSION

The majority of graduates from the towns and cities in Ghana, with a male predominance, indicated that COBES may have influenced their choice of specialty and willingness to practice in the rural areas despite their town or city based upbringing.

A critical hybrid realist-outcomes systematic review of relationships between medical education programmes and communities: BEME Guide No. 35

BACKGROUND

The relationships between medical schools and communities have long inspired and troubled medical education programmes. Successive models of community-oriented, community-based and community-engaged medical education have promised much and delivered to varying degrees. A two-armed realist systematic review was undertaken to explore and synthesize the evidence on medical school-community relationships.

METHOD

One arm used standard outcomes criteria (Kirkpatrick levels), the other a realist approach seeking out the underlying contexts, mechanisms and outcomes. 38 reviewers completed 489 realist reviews and 271 outcomes reviews; 334 articles were reviewed in the realist arm and 181 in the outcomes arm. Analyses were based on: descriptive statistics on both articles and reviews; the outcomes involved; the quality of the evidence presented; realist contexts, mechanisms, and outcomes; and an analysis of underlying discursive themes.

FINDINGS

The literature on medical school-community relationships is heterogeneous and largely idiographic, with no common standards for what a community is, who represents communities, what a relationship is based on, or whose needs are or should be being addressed or considered.

CONCLUSIONS

Community relationships can benefit medical education, even if it is not always clear why or how. There is much opportunity to improve the quality and precision of scholarship in this area.

Medical education in India: current challenges and the way forward

Medical education in India is suffering from various shortcomings at conceptual as well as implementation level. With the expansion in medical education, the doctor to patient ratio has increased but these numbers do not align well with the overall quality of medical care in the country. To address this issue, a comprehensive analysis of various associated factors is essential. Indian medical education is suffering from a maldistribution of resources, unregulated growth in the private sector, lack of uniform admission procedures and traditional curricula lacking innovative approaches. To achieve higher standards of medical education, our goal should be to re-evaluate each and every aspect; create an efficient accreditation system; promote an equal distribution of resources, redesign curricula with stricter implementation and improved assessment methodologies; all of which will generate efficient medical graduates and consequently better health care delivery, and resulting in desired change within the system.

Competence, commitment and opportunity: an exploration of faculty views and perceptions on community- based education

BACKGROUND

Community-Based Education (CBE) is an instructional approach designed and carried out in a community context and environment in which not only students, but also faculty and Health Professionals' Education (HPE) institutions must be actively engaged throughout the educational experience. Despite the growing evidence of CBE being an effective approach for contemporary HPE, doubts about its successful implementation still exist. This study has explored HPE structure, policies and curriculum from the point of view of faculty members to gain understanding about the prevailing practices and to propose recommendations that nurtures and promotes CBE.

METHOD

A purposive sample was drawn from three major cities of Pakistan- Karachi, Rawalpindi and Islamabad. Out of twelve HPE institutions present in these cities we selected six, which provided a sound representation of medical and nursing colleges around the country. At each institution we had two Focus Group Discussions; in addition we interviewed registrars of medical and nursing councils and two CBE experts.

RESULTS

The factors effecting implementation of CBE as perceived by study participants are categorized as: preparation of faculty members; institutional commitment and enthusiasm; curricular priorities and external milieu. Within each theme, participants recurrently described structural and curricular deficiencies, and lack of commitment and appreciation for community based teaching, service and research permeating at all levels: regulatory bodies, institutional heads and faculty members.

CONCLUSIONS

The factors highlighted by our study and many others suggest that CBE could not perpetuate effectively within HPE. To enhance the effectiveness of CBE approach in a way that mutually benefits local communities as well as HPE institutions and health professionals, it is important that reforms in HPE must be strategized in a holistic fashion i.e. restructuring and aligning its polices, curriculum and research priorities.

The CanMEDS initiative: implementing an outcomes-based framework of physician competencies

BACKGROUND

Outcomes-based education in the health professions has emerged as a priority for curriculum planners striving to align with societal needs. However, many struggle with effective methods of implementing such an approach. In this narrative, we describe the lessons learned from the implementation of a national, needs-based, outcome-oriented, competency framework called the CanMEDS initiative of The Royal College of Physicians and Surgeons of Canada.

METHODS

We developed a framework of physician competencies organized around seven physician "Roles": Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar, and Professional. A systematic implementation plan involved: the development of standards for curriculum and assessment, faculty development, educational research and resources, and outreach.

LESSONS LEARNED

Implementing this competency framework has resulted in successes, challenges, resistance to change, and a list of essential ingredients for outcomes-based medical education.

CONCLUSIONS

A multifaceted implementation strategy has enabled this large-scale curriculum change for outcomes-based education.

Defining generic objectives for community-based education in undergraduate medical programmes

RATIONALE

The availability of a framework for the definition of generic objectives for community-based education (CBE) programmes may assist in the rational design of objectives for specific CBE programmes.

STRATEGY

Factors impacting on community health from the perspective of a developing country were collected. Potential assistance from medical students to communities to improve their health status was determined. Competencies required in students to execute tasks in the community were defined and eventually educational objectives to develop these competencies in the students were established.

METHODS

Factors impacting on community health and activities of medical students in CBE programmes were identified by review of literature and Internet resources. Competencies desired for execution of tasks by students and educational objectives to develop these competencies were defined by us and checked against pertinent literature. A draft table representing the 4 elements of the framework was discussed by an international group of experts for external validation.

MAIN OUTCOMES

A total of 26 factors impacting on community health were identified and clustered in 5 domains. Twenty-one generic objectives for CBE programmes were defined to develop the required competencies in students. Analogues of each of these 21 objectives were found in at least 1 publication specifying objectives for specific CBE programmes but none of these publications stated any objective not covered by our list of generic objectives.

CONCLUSION

It proved possible to develop a framework to define generic objectives for CBE programmes. An example was elaborated from the perspective of a medical school in a developing country.

The development and evaluation of an integrated community-based, patient-centred learning activity at the University of Hong Kong

OBJECTIVE

To develop and evaluate the Patient Care Project (PCP), an integrated patient-centred, community-based learning activity, implemented at the University of Hong Kong since 1992.

DESIGN

The PCP, a required course in the first 2 preclinical years, is structured into four learning cycles over 9 months. Each cycle consists of a patient interview followed by a debriefing group tutorial. In-depth interviews with the same patient allow students to explore the impact of disease and patients' illness experience, as well as the contribution of the wider determinants of health to their condition. The debriefing tutorial frames empirical observations into theoretical models and its format reinforces habits of problem-based learning. The programme was evaluated using survey questionnaires completed by students, patients and tutors.

PARTICIPANTS

324 first- and second-year medical students.

RESULTS

Students, participating patients and tutors all rated the PCP positively in end-of-course evaluations. Specifically, 68% of students commented that the PCP had met all or most of its stated objectives, while there was nearly unanimous agreement among patients that students demonstrated understanding and empathy in the visits and interviews. Tutor appraisal of student performance also indicated the attainment of all stated aims and objectives overall.

CONCLUSIONS

The PCP is a valuable contribution to community-based learning and the promotion of the patient-centred clinical method.

The first sunrise: an experience of cultural immersion and community health needs assessment by undergraduate medical students in New Zealand

CONTEXT

Cultural factors in health and illness, and an awareness of community health needs analysis, are important issues for medical education. Both have received relatively little recognition in the medical education literature. This paper describes the development of an educational attachment to remote predominantly Maori rural communities in New Zealand. The twin purposes of the programme were to encourage students to adopt broad public health approaches in assessing the health needs of defined communities, and to increase their awareness of the importance of cultural issues.

METHODS

During a one week attachment, 51 students from the Wellington School of Medicine were hosted in six small communities in the East Cape region of New Zealand. Students gained an insight into the health needs of the communities and were encouraged to challenge their own attitudes, assumptions and thinking regarding the determinants of health and the importance of cultural factors in health and illness. The programme included both health needs assessment and cultural immersion. Students made visits with primary health care professionals and were also introduced to Maori history and cultural protocol, and participated in diverse activities ranging from the preparation of traditional medicines to performing their own songs in concert.

CONCLUSIONS

The students evaluated the course extremely highly. Attachments of this sort provide an opportunity for students to appreciate how cultural values have an impact on health care, and how they also make the teaching and learning of topics such as community health needs analysis an enjoyable and dynamic experience.

A taxonomy of community-based medical education

The authors propose a classification of community-based education (CBE) as it is implemented all over the world. To create this taxonomy, they used reports in the literature of 31 active programs in many locations. A CBE program is an instructional program carried out in a community context, outside the academic hospital. The authors distinguish between programs that are developed primarily to provide services to an underserved community; programs that have a research focus; and programs that have as their primary goal the (clinical) training of students. These three major types can be subdivided in six minor types, among them community development programs, health intervention programs, and simple community-exposure programs. The ultimate goal of creating the taxonomy is to contribute to the development of a theory of CBE and provide a more systematic way to study CBE. In addition, the proposed taxonomy clearly demonstrates the various ways in which medical schools, their staffs, and their students can become involved with the communities served. CBE is not a unitary concept but a set of attempts to contribute to the quality of life in a particular community and, at the same time, create conditions for students to acquire hands-on understanding of the nature of the problems to be faced in future professional practice, and to develop relevant skills. The taxonomy also enables those involved in the development of CBE programs in their medical schools to see alternative approaches, which will help them choose the approaches that fit their particular educational goals. Last, it demonstrates the intricacies involved in the implementation of CBE, in particular the complexity of building a learning environment that is productive for students and, at the same time, responsive to community needs.

Measuring instructional quality in community-orientated medical education: looking into the black box

OBJECTIVES

Decentralizing medical education to community settings has raised issues of instructional quality. The need to evaluate community-based instruction accents the need to adopt a systems perspective, moving beyond factors known to comprise general clinical teaching effectiveness to include factors that focus on instruction as a process. Application of evaluation models using traditional input-output analysis can be flawed. This approach--dubbed the 'black box'--typically examines inputs and outputs, but often ignores throughputs.

DESIGN

In this article we open the black box, using theory to examine the underlying processes that define community-based medical education. We first describe the components and processes of an instructional model that is framed by the philosophy of quality and grounded in experiential learning theory. Without examining the critical processes at work inside the black box - i.e. how students come to acquire clinical knowledge and how behaviours are influenced - it is difficult to assess which programme features contribute to success. Tensions created by the absence of consensus on the outcomes of instruction and the challenge of developing adequate measures are highlighted.

SETTING

State University of New York at Buffalo.

SUBJECTS

Clinician-teachers, learners and patients in the environment.

RESULTS AND CONCLUSIONS

We conclude with describing a tool for evaluating community-based instruction that is guided by the context of our model.

Establishing community-orientated medical schools: key issues and steps in early planning

OBJECTIVES

To describe briefly the process of early planning and establishment of community-based medical schools with highlights of the key issues and milestones.

DESIGN

After outlining some basic concerns and provisos for the Dean and suggested strategies for setting the stage (preparing the ground) for the innovation, three phases of early planning and action steps within each are listed to serve as a guide and a general checklist.

SETTING

University of Gezira, Sudan and UAE University, AL-Ain.

CONCLUSION

As the curriculum with its implications constitutes the driving force for establishing the schools, it has been given due emphasis and greater share in planning. The communication is concluded with further advice to founding Deans through the proposition of a five-star Dean.

Community-oriented medical education in Glasgow: developing a community diagnosis exercise

OBJECTIVES

Recent NHS changes have included an increasing emphasis on primary care settings, and hence community needs assessment. This has led to suggestions that medical education should become more community-oriented if today's medical students are to become effective medical practitioners. Recent curriculum reforms in a number of medical schools frequently involve a more student-centred approach, which encourages students to learn by intellectual discovery and critical thinking. We describe one such exercise in community diagnosis that has been developed in Glasgow's new undergraduate medical curriculum.

DESIGN

The exercise has been developed as three teaching sessions, each with specific learning objectives. The first session explores the strengths and weaknesses of routine statistics, and reveals the lack of information regarding individual's and community's health and health care needs. The second session is a community-based rapid participatory appraisal arranged by general practitioners. Students interview patients, carers, and local key informants and health care professionals about their perceptions of health and health needs. In the final campus-based session, students combine and present their findings. Development included two pilot exercises involving detailed evaluation.

SETTING

University of Glasgow.

SUBJECTS

Medical students.

RESULTS

Students valued the contrasting perspectives and information provided by different sources. After completing the three sessions, most students and tutors considered it an interesting, enjoyable and educational experience.

CONCLUSIONS

This innovative community-oriented teaching programme gave students some insight into how health, morbidity and mortality are measured, why these might vary between different communities, and how different community members' perspectives might differ regarding perceived health and social needs.

Orienting medical education to community need: a review

The literature on community-oriented medical education is reviewed. In response to major changes in the origin, expression and place of management of much illness, many medical schools are turning their attention increasingly to the community from whence to derive their curriculum and wherein to effect their teaching. The traditional hospital base of teaching is eroding, necessitating new, innovative approaches to medical education. Becoming community-oriented, or using community-based learning, offers potential benefits for the schools, the students, and the public. The experience of others demonstrates the necessity of enlisting community representatives as partners in the process of change. Institutional barriers are significant and careful planning is needed to overcome them.

Community-based medical education: feasibility and cost

The General Medical Council has issued a call for an increase in community-based medical education, and many medical schools are enhancing the community component of their curricula. This paper uses the experience of a community-based junior medical firm to explore the potential costs, and highlight some of the unresolved problems, which a major transfer of education to the community might engender. Community-based medical education is not a cheap option. The cost of this programme for the academic year 1992-93 was 266,494 pounds, or 60 pounds per student session. This compares with the Service Increment for Teaching and Research (SIFTR) provision of 41,140 pounds per student per annum, or (excluding the 25% of SIFTR which is supposed to cover research costs), 64 pounds per student session. There are a number of possible ways of funding community-based education, including a diversion of SIFTR toward departments of primary health care. As this would have serious implications for the financial viability of some medical schools, an urgent discussion about the future funding of medical education is required.

A survey of medical undergraduate community-based teaching: taking undergraduate teaching into the community

This article summarizes the findings of a survey investigating the extent to which medical schools in the United Kingdom have developed community-based undergraduate teaching: the types of courses being run and their content; whether they are being evaluated; and how the students are assessed. Courses have been categorized under four main headings: (1) based in general practice, for teaching about general practice as a clinical specialty or using practice patients for teaching general medicine and basic clinical skills; (2) community-oriented, led by GP or community tutors; (3) specialist teaching led by hospital consultants; and (4) agency-based teaching. Twenty-eight schools responded to a written request for information and details of 83 courses were received.

Problem-management questionnaires as a student learning tool in environmental medicine

Environmental medicine can be defined as the science and art of medicine applied to the interaction between environment and health. In support of the WHO Health for All strategy, the educational programmes encourage closer links between epidemiology, clinical practice and environmental protection, and utilize problem-based learning. For tuition, problem-management questionnaires are a worthwhile tool to assist student learning. Examples are given and a model answer for one of these is appended. Their development, use and evaluation are described. They can be readily prepared from different clinical and environmental problems, and they help to meet identified needs in community-oriented medical education.