Does community-based education increase students' motivation to practice community health care? - a cross sectional study

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Abstract

Background

Community-based education has been introduced in many medical schools around the globe, but evaluation of instructional quality has remained a critical issue. Community-based education is an approach that aims to prepare students for future professional work at the community level. Instructional quality should be measured based on a program's outcomes. However, the association between learning activities and students' attitudes is unknown. The purpose of this study was to clarify what learning activities affect students' attitudes toward community health care.

Methods

From 2003 to 2009, self-administered pre- and post-questionnaire surveys were given to 693 fifth-year medical students taking a 2-week clinical clerkship. Main items measured were student attitudes, which were: "I think practicing community health care is worthwhile" ("worthwhile") and "I am confident about practicing community health care" ("confidence") using a visual analogue scale (0-100). Other items were gender, training setting, and learning activities. We analyzed the difference in attitudes before and after the clerkships by paired t test and the factors associated with a positive change in attitude by logistic regression analysis.

Results

Six hundred forty-five students (93.1%), 494 (76.6%) male and 151(23.4%) female, completed the pre- and post-questionnaires. The VAS scores of the students' attitudes for "worthwhile" and "confidence" after the clerkship were 80.2 ± 17.4 and 57.3 ± 20.1, respectively. Both of the scores increased after the clerkship. Using multivariate logistic regression analysis, "health education" was associated with a positive change for both attitudes of "worthwhile" (adjusted RR: 1.71, 95% CI: 1.10-2.66) and "confidence" (1.56, 1.08-2.25).

Conclusions

Community-based education motivates students to practice community health care. In addition, their motivation is increased by the health education activity. Participating in this activity probably produces a positive effect and improves the instructional quality of the program based on its outcomes.

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Most cited references 16

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Medical education in Japan.

Tadahiko Kozu (2006)

There are 79 medical schools in Japan--42 national, 8 prefectural (i.e., founded by a local government), and 29 private--representing approximately one school for every 1.6 million people. Undergraduate medical education is six years long, typically consisting of four years of preclinical education and then two years of clinical education. High school graduates are eligible to enter medical school. In 36 schools, college graduates are offered admission, but they account for fewer than 10% of the available positions. There were 46,800 medical students in 2006; 32.8% were women. Since 1990, Japanese medical education has undergone significant changes, with some medical schools implementing integrated curricula, problem-based learning tutorials, and clinical clerkships. A model core curriculum was proposed by the government in 2001 that outlined a core structure for undergraduate medical education, with 1,218 specific behavioral objectives. A nationwide common achievement test was instituted in 2005; students must pass this test to qualify for preclinical medical education. It is similar to the United States Medical Licensing Examination step 1, although the Japanese test is not a licensing examination. The National Examination for Physicians is a 500-item examination that is administered once a year. In 2006, 8,602 applicants took the examination, and 7,742 of them (90.0%) passed. A new law requires postgraduate training for two years after graduation. Residents are paid reasonably, and the work hours are limited to 40 hours a week. In 2004, a matching system was started; the match rate was 95.6% (46.2% for the university hospitals and 49.4% for other teaching hospitals). Sustained and meaningful change in Japanese medical education is continuing.

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Undergraduate medical education in Germany

Jean-Francois Chenot (2009)

The purpose of this article is to give international readers an overview of the organisation, structure and curriculum, together with important advances and problems, of undergraduate medical education in Germany. Interest in medical education in Germany has been relatively low but has gained momentum with the new "Regulation of the Licensing of Doctors" which came into effect in 2003. Medical education had required substantial reform, particularly with respect to improving the links between theoretical and clinical teaching and the extension of interdisciplinary and topic-related instruction. It takes six years and three months to complete the curriculum and training is divided into three sections: basic science (2 years), clinical science (3 years) and final clinical year. While the reorganisation of graduate medical education required by the new "Regulation of the Licensing of Doctors" has stimulated multiple excellent teaching projects, there is evidence that some of the stipulated changes have not been implemented. Indeed, whether the medical schools have complied with this regulation and its overall success remains to be assessed systematically. Mandatory external accreditation and periodic reaccreditation of medical faculties need to be established in Germany.

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A taxonomy of community-based medical education.

Ingo G. H. Schmidt-Wolf, M E M Magzoub (2000)

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.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Med Educ

Title: BMC Medical Education

Publisher: BioMed Central

ISSN (Electronic): 1472-6920

Publication date Collection: 2011

Publication date (Electronic): 11 May 2011

Volume: 11

Page: 19

Affiliations

[1 ]Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, 3311-1 Shimotsuke-city Tochigi, 329-0498 Japan

Article

Publisher ID: 1472-6920-11-19

DOI: 10.1186/1472-6920-11-19

PMC ID: 3114788

PubMed ID: 21569332

SO-VID: d650d6e2-c0c4-4e16-aa2b-c53109fd0a08

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Does community-based education increase students' motivation to practice community health care? - a cross sectional study

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Special Issue: Colleges as Anchor Institutions in their Local Community

Most cited references 16

Medical education in Japan.

Undergraduate medical education in Germany

A taxonomy of community-based medical education.

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