Impact of Community-Oriented Medical Education on Medical Students' Perceptions of Community Health Care: Qualitative Study

Abstract

Background: Physician maldistribution remains a global challenge, with Japan's rural regions facing critical health care shortages. Regional quota programs aim to attract medical students to underserved areas; however, their effectiveness in fostering long-term commitment is uncertain. Community-oriented medical education (COME) programs aim to address this issue by developing students' understanding and dedication to rural health care.

Objective: This study investigated the impact of an enhanced COME program, featuring increased early clinical exposure and faculty development, on first-year regional quota medical students' perception of community health care at Chiba University.

Methods: We conducted a cross-sectional qualitative study comparing 2 cohorts, 20 students enrolled from the existing COME course (April-December 2021) and 20 from the revised course (April-December 2022). The revised course included an additional day of community-based clinical exposure supervised by COME-trained attending physicians. Students' written reflections were analyzed using qualitative content analysis and categorized according to the Fink Taxonomy of significant learning, comprising 6 domains, including foundational knowledge, application, integration, human dimension, caring, and learning how to learn. Reflections were synthesized into higher-order themes crosswalked to the Fink domains.

Results: Demographics were similar between the 2021 and 2022 cohorts. In 2021, 311 learning codes were identified across foundational knowledge (n=128), application (n=91), integration (n=40), human dimension (n=16), caring (n=30), and learning how to learn (n=6). In 2022, codes increased to 385, with notable growth in caring (n=58) and human dimension (n=57), alongside increases in learning how to learn (n=15) and integration (n=45). Theme-based synthesis identified four overarching themes: (1) community health care as an interconnected, resource-constrained system; (2) patient-centered relationships and trust through communication and teamwork; (3) emerging professional identity and responsibility toward community service; and (4) developing a self-directed learning orientation for community practice. Qualitative analysis revealed that students gained a deeper understanding of patient-centered care, interprofessional collaboration, and social challenges in rural health care. The consistency in the foundational knowledge domain underscored a stable conceptual foundation, while the increase in affective and reflective domains reflected greater emphasis on interpersonal, value-oriented, and reflective learning in the revised cohort.

Conclusions: Enhancements of the COME program, including additional early clinical exposure and faculty development, were associated with improved students' perceptions of community health care. The increased focus on the caring and human dimension domains underscores the role of practical experiences in fostering collaboration, communication, and patient-centered care. The theme-based synthesis further suggests that the revised program prompted more frequent reflections on professional identity formation and self-directed learning while maintaining a stable foundation of community health care concepts. Mentorship by community hospital attendings, alongside structured clinical exposure, appears crucial in shaping medical students' understanding and commitment to rural medicine. Ongoing longitudinal evaluations are warranted to assess the sustained impact of COME programs on career trajectories in underserved areas.

Keywords: career perceptions; community education; community health care; community hospital; community-based medical education; community-oriented medical education; faculty development; physician maldistribution.