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BRIEF RESEARCH ARTICLE
Year : 2021  |  Volume : 65  |  Issue : 3  |  Page : 291-293  

Perceptions on the impact of a structured community-based training model in undergraduate medical training during the first phase of clinical exposure: A qualitative study from Kerala


1 Assistant Professor, KS Hegde Medical College, Nitte, Mangalore, India
2 Associate Professor, KS Hegde Medical College, Nitte, Mangalore, India
3 Associate Professor, Believers Church Medical College Hospital, Kuttapuzha, Thiruvalla, Kerala, India
4 Manager and Social Scientist, Institute of Health and Management, Rosanna, Victoria, Australia
5 Medical Social Worker, Institute of Health and Management, Rosanna, Victoria, Australia
6 Professor, Head of School of Medicine and Health, Institute of Health and Management, Rosanna, Victoria, Australia

Date of Submission16-Dec-2020
Date of Decision18-Feb-2021
Date of Acceptance31-May-2021
Date of Web Publication22-Sep-2021

Correspondence Address:
Shaliet Rose Sebastian
Assistant Professor, Department of Community Medicine, Believers Church Medical College Hospital, Kuttapuzha, Thiruvalla - 689 103, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_1265_20

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   Abstract 


The new competency-based undergraduate medical curriculum advocates early clinical exposure in medical training for adequate orientation to societal and patient needs. The present study aimed to explore the experiences of medical students about community-based training in rural hospitals during the first phase of clinical exposure. An exploratory qualitative study was conducted among 75 Bachelor of Medicine and Bachelor of Surgery students who underwent the training program as part of their undergraduate medical training using “most significant change” technique. The responses collected were analyzed using the inductive approach of thematic analysis. Majority of the participants opined that the program not only has enabled them to better understand their academic learning but also has provided a social learning experience. The student feedback throws light on the potential of such community-based learning programs to inspire the students to become a more humane version of themselves. This study observed that the remote hospital-based training has positively influenced the students.

Keywords: Community-based training, Kerala, medical students, qualitative


How to cite this article:
Sebastian SR, Mathew G, Johnson AK, Chacko A, Babu BP, Joseph MR. Perceptions on the impact of a structured community-based training model in undergraduate medical training during the first phase of clinical exposure: A qualitative study from Kerala. Indian J Public Health 2021;65:291-3

How to cite this URL:
Sebastian SR, Mathew G, Johnson AK, Chacko A, Babu BP, Joseph MR. Perceptions on the impact of a structured community-based training model in undergraduate medical training during the first phase of clinical exposure: A qualitative study from Kerala. Indian J Public Health [serial online] 2021 [cited 2021 Dec 7];65:291-3. Available from: https://www.ijph.in/text.asp?2021/65/3/291/326378



The rapid strides in healthcare and medicine have resulted in corresponding rapid changes in the content and process of medical education also. The existing research findings indicate that, by providing medical education in a rural setting, it is possible to bring up a new generation of medical professionals with a strong conviction and commitment to moral and ethical values and profound knowledge in clinical and communication skills.[1] Therefore, a total revamping of medical education is the need of the hour. The Medical Council of India has in its Vision 2015 document, proposed plans for undergraduate medical education (UGME) in which early clinical exposure and community-based training (CBT) are the major reforms to improve quality of medical education.[2] Early clinical exposure, and the accompanying knowledge and skills development enriches and contextualizes that learning and offers a wider variety of teaching and learning methods.[3]

CBT program is a vital part of UGME where teaching and training are carried out in the community outside the teaching hospital.[4] In India, the department of community medicine is responsible for conducting CBT program and is offered from the 1st year of Bachelor of Medicine and Bachelor of Surgery (MBBS) onwards. Rural hospital-based learning is an example of one such training program. The overall goal of the remote hospital posting in the 1st clinical year of MBBS curriculum is to provide an opportunity to learn outside the academic center, to sensitize students to health needs in different parts of the country, and to develop a perspective regarding providing healthcare in India.

Although studies investigating student feedback after community-based education programs have been done outside India,[5],[6] no literature has been found on similar studies conducted in the state of Kerala. This study aimed to explore the immediate perceptions of medical students about their CBT in rural hospitals in India during the first phase of clinical exposure.

This was a Phenomenological Research Study conducted among the first batch of 75 MBBS students who underwent the CBT program toward the end of their third semester. The study was approved by the institutional ethical committee. Consent was sought from mission hospitals that catered to needs of the poorest of the poor located in the various states of India. Out of the rural hospitals that gave consent to participate in student training, ten hospitals were randomly selected. The 75 study participants were randomly assigned to 10 groups of 8–9 students each and posted in each of the 10 rural hospitals located in Uttar Pradesh, Madhya Pradesh, Bihar, Maharashtra, Odisha, Uttar Pradesh, and Tamil Nadu accompanied by two faculty members for a period of 2 weeks. The student training was broadly classified into four: (a) hospital visit, which included observing cases in outpatient department and clinical case presentations; (b) community visits and morbidity survey; (c) exercises on basics of hospital administration; and (d) exercises on basics of planning and management. At the end of each day, the students were required to record their daily reflection in a Log Book. The presentations of students on their learning experience at the end of their posting were videotaped and transcribed based on “most significant change” approach.[7] The responses on participants' perceptions, feelings, and experiences collected via feedback were analyzed using the inductive approach of thematic analysis.[8] The data collected were independently transcribed and coded into themes and subthemes by three trained investigators to increase the quality of the results. The common themes and subthemes that emerged from the data were pooled together.

Among the 75 study participants, 25 were males and 50 were females. The student responses have been categorized into themes as follows:


   Eye Opener Top


The students were thankful for the opportunity to get acquainted with the rich culture of the rural areas in which they were posted. The most striking students' quotes are as follows:

  • “Made me re-evaluate my priorities and goals”
  • “Changed my perspective toward life”
  • “To work for the poor and help them in whichever way we can.”



   Understood the Patient Perspective Top


Each student accompanied a patient from the point of their entry into the hospital to the time they left the hospital. Thus they got a chance to get closely acquainted with the experiences of the patients and bystanders in the hospital. A few students' quotes are as follows:

  • “We were able to see the people in their environment and understand their difficulties”
  • “Patients come with a lot of anxiety and all they require is a bit of care and consideration from the doctor.”



   Realized the Need for Healthcare Especially the Preventive Aspect Top


The students interacted with the community and participated in focus group discussions, health education sessions, and health surveys. This close interaction with the community made them realize the need for “preventive medicine” in the community. Some student realizations are as follows:

  • “Realized the need to reach out into the community and the need for low cost health care”
  • “The need for more health care professionals is evident”
  • “Enabled me to analyze the need of the society and my role in providing it.”



   Doctors as “Role-Models” Top


Many students opined that the Doctors they met during their training changed the perception they had in their minds about a “Doctor.” According to the students, these doctors will be their role-models hereafter. A few student quotes are as follows:

  • “The simple lifestyle of doctors inspired me. Learned to be happy with whatever I have and see the brighter side of things”
  • “Undeterred faith, determination, tireless effort, and commitment to the profession would enable each of us to leave behind a unique impression”
  • “The greatest challenge would be to be a doctor who could tackle any clinical situation confidently, even in a resource-limited setup.”



   Learning beyond Books Top


The students observed the setting up of Doctor patient rapport and felt inspired by the experiences that the Doctors shared with them. They received opportunities in assisting procedures and attending ward rounds. The responses of the students on their academic learning are shown in [Figure 1]. Some of the striking reflections were as follows:
Figure 1: The student feedback on academic learning during their rural community-based training.

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  • “No amount of books could have replaced a first-hand experience as this”
  • “I saw the doctors talk affectionately to patients and understood the importance of good communication skills.”



   Challenges in Providing Healthcare Top


Although the government provides healthcare facilities for the people, the lack of awareness regarding the same has led to nonutilization of opportunities. The challenges in providing healthcare as observed by the students are ignorance (20%), superstitious beliefs and taboos (40%), and shortage of materials and workforce (40%).

This study brings forward the reflections of 75 students after attending a 2-week long CBT at 10 rural mission hospitals in India. The study participants were able to closely experience the living conditions of the people in the rural areas. Most of the study participants opined that the training has had a positive influence on their attitude toward primary care. Living among the rural population enabled the study participants to have a better understanding of their sociocultural needs. A similar research conducted by Orbell and Abraham found that such experiences gave insight into the social and psychological problems of “real people.”[9] Majority of the study participants opined that the program has enabled them to not only better understand their academic knowledge and clinical skills but also has provided a social learning experience. Our study findings support the published evidence that early clinical and rural experience has a strong formative influence which enables to foster an empathetic and socially responsive career orientation.[10] Our study observed that the training program provided a scaffold for the students to observe and learn from the consultants at the rural hospitals to tackle any clinical situation confidently, even in a resource-limited setup.

This study observed that the rural hospital-based training has positively influenced the students who underwent the program. The author suggests the implementation of similar structured experiential learning programs to improve the learning experience in undergraduate medical training. Further research and follow up is needed to assess the extent to which the students imbibe the lessons learnt into their life when they start practicing as doctors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Curran V, Rourke J. The role of medical education in the recruitment and retention of rural physicians. Med Teach 2004;26:265-72.  Back to cited text no. 1
    
2.
Vision 2015. Medical Council of India. Available from www.mciindia.org/tools/announcement/MCI_booklet.pdf. [Last accessed on 2020 Jun 05].  Back to cited text no. 2
    
3.
Abramovitch H, Shenkman L, Schlank E, Shoham S, Borkan J. A tale of two exposures: A comparison of two approaches to early clinical exposure. Educ Health (Abingdon) 2002;15:386-90.  Back to cited text no. 3
    
4.
Deutsch S, Noble J, editors. Community-based Teaching: A Guide to Developing Education Programs for Medical Students and Residents in the Practitioner's Office. Philadelphia: ACP Press; 1997.  Back to cited text no. 4
    
5.
Okayama M, Kajii E. Does community-based education increase students' motivation to practice community health care?–A cross sectional study. BMC Med Educ 2011;11:19.  Back to cited text no. 5
    
6.
Widyandana D, Majoor G, Scherpbier A. Preclinical students' experiences in early clerkships after skills training partly offered in primary health care centers: A qualitative study from Indonesia. BMC Med Educ 2012;12:35.  Back to cited text no. 6
    
7.
Dart J, Davies R. A dialogical, story-based evaluation tool: The most significant change technique. Am J Eval 2003;24:137-55. [doi: 10.1177/109821400302400202].  Back to cited text no. 7
    
8.
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol 2006;3:77-101.  Back to cited text no. 8
    
9.
Orbell S, Abraham C. Behavioural sciences and the real world: report of a community interview scheme for medical students. Med Educ 1993;27:218-28.  Back to cited text no. 9
    
10.
Littlewood S, Ypinazar V, Margolis SA, Scherpbier A, Spencer J, Dornan T. Early practical experience and the social responsiveness of clinical education: Systematic review. BMJ 2005;331:387-91.  Back to cited text no. 10
    


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