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

Abstract

BackgroundCommunity-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.MethodsFrom 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.ResultsSix 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).ConclusionsCommunity-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.

Comparison of Medical Students' Satisfaction with Family Medicine Clerkships between University Hospitals and Community Hospitals or Clinics

“…Similarly, they gave high ratings to the utility of and need for being installed in community hospitals or clinics during their clerkship. These results were similar to those of previous studies on this topic 1213)…”

The impact of socially-accountable health professional education: A systematic review of the literature

“…Students training in rural areas also seem pleased with their experience (Satran et al 1993;Howe 2001); with several studies showing students report a stronger learning experience rurally than they would have in a metropolitan area (Worley et al 2004b;Birden & Wilson 2012;Couper et al 2011;Chang et al 2011;Okayama & Kajii 2011). Students also self-report that community placements highlight the importance of dealing with people rather than diseases, and the visual impact of the social environment on health (Howe 2001).…”

“…In addition, longitudinal rural placements have also been shown to increase the desire of students for general practice (Howe & Ives 2001;Amalba et al 2016) and rural community service (Howe & Ives 2001;Jinadu et al 2002;Amalba et al 2016;Worley et al 2004b;Okayama & Kajii 2011). There is also some additional evidence, based on rural patient feedback, that students undergo professional identity transformation in community-based, longitudinal learning environments (Hudson et al 2012).…”

Community-based nursing education in South Africa: A grounded-middle range theory

“…[18] One of the reasons for this could be that CBE arose as a "reaction" to the realization of the inadequacy of traditional education programs in preparing graduates with relevant knowledge and skills to meet the health needs of the community. [16,17,19,20] Another reason could be that CBE programs in South Africa were popularised by the sudden availability of external donor funds, particularly from the Kellogg Foundation as stated by Gwele in Mtshali [4] which resulted in a number of unconnected and unrelated CBE programs being implemented from 1995-2000. This preceded and almost precluded any form of professional and/or intellectual discourse on what CBE entails.…”

“…[12,15] More importantly, students' exposure to learning in diverse community-based settings prepares them for life after graduation and stimulates in them a special interest and motivation to work with communities, including remote, rural and under-resourced health care settings because these settings resemble those in which they underwent educational preparation. [15][16][17] CBE is a familiar concept in South Africa, with a number of nursing education institutions having community-based education programs. [4] However, literature shows that although CBE is a familiar concept, there is a lack of shared common understanding of what this phenomenon entails.…”