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      What do medical residents learn on a rural Japanese island?

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          Abstract

          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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          Most cited references20

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          Social capital and self-rated health: a contextual analysis.

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            Ways to make people active: The role of place attachment, cultural capital, and neighborhood ties

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              Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems.

              Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient's preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches-one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option-and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems.
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                Author and article information

                Journal
                J Rural Med
                J Rural Med
                JRM
                Journal of Rural Medicine : JRM
                The Japanese Association of Rural Medicine
                1880-487X
                1880-4888
                29 May 2018
                May 2018
                : 13
                : 1
                : 11-17
                Affiliations
                [1 ]Unnan City Hospital, Japan
                [2 ]International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Japan
                Author notes
                Correspondence: Ryuichi Ohta, MD, Unnan City Hospital, 96-1 Daito-cho Iida, Unnan, Shimane 699-1221, Japan. E-mail: ryuichiohta0120@ 123456gmail.com
                Article
                2950
                10.2185/jrm.2950
                5981014
                e16e4e59-c3bd-4514-bf09-2cd67ae40092
                ©2018 The Japanese Association of Rural Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. (CC-BY-NC-ND 4.0: http://creativecommons.org/licenses/by-nc-nd/4.0/ ).

                History
                : 11 September 2017
                : 26 October 2017
                Categories
                Original Article

                community-based medical education,postgraduate,rural medicine,whole-person medical care,self-directed learning

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