Print this page Email this page Users Online: 853 | Click here to view old website
Home About us Editorial Board Search Current Issue Archives Submit Article Author Instructions Contact Us Login 

 Table of Contents  
Year : 2014  |  Volume : 27  |  Issue : 1  |  Page : 47-50

Community-based medical education: Is success a result of meaningful personal learning experiences?

1 Professor, Division of Clinical Sciences, Northern Ontario School of Medicine, Sioux Lookout, ON, Canada
2 Associate Professor, Academic Director, Flinders University Rural Clinical School, Adelaide, South Australia
3 Senior Lecturer and Assessment Coordinator, Flinders University Rural Clinical School, Adelaide, South Australia

Date of Web Publication11-Jun-2014

Correspondence Address:
Prof. Len Kelly
Division of Clinical Sciences, Northern Ontario School of Medicine, Sioux Lookout, ON
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1357-6283.134311

Rights and Permissions

Background: Community-based medical education (CBME) is the delivery of medical education in a specific social context. Learners become a part of social and medical communities where their learning occurs. Longitudinal integrated clerkships (LICs) are year-long community-based placements where the curriculum and clinical experience is typically delivered by primary care physicians. These programs have proven to be robust learning environments, where learners develop strong communication skills and excellent clinical reasoning. To date, no learning model has been offered to describe CBME. Methods: The characteristics of CBME are explored by the authors who suggest that the social and professional context provided in small communities enhances medical education. The authors postulate that meaningfulness is engendered by the authentic context, which develops over time. These relationships with preceptors, patients and the community provide meaningfulness, which in turn enhances learning. Results and Discussion: The authors develop a novel learning model. They propose that the context-rich environment of CBME allows for meaningful relationships and experiences for students and that such meaningfulness enhances learning.

Keywords: Community-based medical education, community context, longitudinal integrated clerkships, meaningfulness, situated learning theory

How to cite this article:
Kelly L, Walters L, Rosenthal D. Community-based medical education: Is success a result of meaningful personal learning experiences?. Educ Health 2014;27:47-50

How to cite this URL:
Kelly L, Walters L, Rosenthal D. Community-based medical education: Is success a result of meaningful personal learning experiences?. Educ Health [serial online] 2014 [cited 2022 Dec 6];27:47-50. Available from:

  Background Top

Community-based medical education

Community-based medical education (CBME) refers to medical education, which situates the learner's clinical training in a community setting. It exposes students to patients who are managing their illnesses within their own family, social and community contexts. [1],[2],[3],[4] Primary care clinicians and other healthcare providers accept learners into their practice, professional community and local community, where they take on the role of delivering much of the curriculum and precepting learners. Essentially, learning occurs in the community. [3] Such programs typically include having the student follow the patient from office setting into hospital care and back home to community-based homecare. [5]

To date no learning model has been proposed to explain the level of success achieved by CBME initiatives. Developing a learning model to explain successful education programs for healthcare professionals seems like an afterthought. These programs are expanding internationally, and greater thoughtfulness around why this decentralized form of medical education works may teach us something about how we learn to be physicians. A learning model that identifies key components of a new learning environment can allow us to adapt to it and its challenges, as well as dissect failures when they occur. We may further learn important lessons about medical education, which can be transferred or adapted to new learning environments.

Longitudinal integrated clinical clerkships

One of the recent examples of CBME are longitudinal integrated clerkships (LICs). These year-long clinical placements were pioneered in Australia in the late 1990s. [3],[5],[6] Canada's newest medical school, the Northern Ontario School of Medicine, places students in rural communities for their third year of 'clinical clerkship'. To date, the outcomes of these LICs have been positive. Students gain strong communication skills and excellent clinical reasoning and management skills and are more likely to subsequently apply to primary care and rural training programs. [7] We suggest in our proposed learning model that CBME and longitudinal integrated programs provide medical students with some key elements that support meaningful personal learning experiences: An authentic professional and social community context for learning. The experience of community, both medical and social, sets up a rich environment for relationships, meaningfulness and, we propose, learning.

Existing learning theories

As learners participate in medical education they change. Learning is both emotional and socially embedded. [8] It is not merely a knowledge acquisition process, but also a socialization process. [9] Upon entering clinical rotations and working regularly alongside clinical teachers seeing patients, learning is facilitated by the students becoming embedded in the subculture of medical practice and the culture of the local community.

Two existing learning theories are relevant to our discussion. Kolb's Experiential Learning Theory combines experience, observation and reflection as elements of medical learning in a clinical setting. Lave and Wenger's Situated Learning Theory describes the apprenticeship model of clinical experience as a participation in a set of social relationships. Learning, they propose, is dependent on participation in these relationships. Their Situated Learning Theory suggests that learning is a by-product of engaging in problem solving 'situated' in a real world environment, enhanced by social interaction and collaboration. [9] This apprenticeship learning model may explain how students adopt values and attitudes of their clinician preceptors and mentors as they seek to 'be' doctors rather than to 'do' medicine. How can experience and socialization in a learning theory best apply to CBME?

Community, relationships with clinicians and graded responsibility

In CBME, particularly longitudinal experiences, medical students are embedded within a small group of clinicians with whom they work closely and come to know well as their professional community. The close working relationships between learners and their clinical supervisors over time allows for the maturation of an apprenticeship relationship. [10] Students judged to be safe and respectful of patients are often able to take on more clinical responsibilities sooner in a known, safe environment. [10] While short term placements result in shared enthusiasm and social inclusion of students by preceptors, students in extended CBME programs describe developing a "sense of companionship". [11] We propose that a personal relationship between student and preceptor, which develops over time, can mature more rapidly in CBME programs, where there are fewer health professionals working closely together and working relationships are more consistent than in most tertiary hospital settings. By contrast, in tertiary care medical education center, students risk experiencing rapidly changing collections of health professionals known as 'negotiated knotworks' rather than teams. [12] This dynamic, depersonalized context risks students experiencing depersonalization themselves. [13]

In CBME, relationships between students and clinical preceptors quickly mature, facilitating preceptor awareness of the clinical growth of their learner. Students are taught and delegated tasks and begin to contribute meaningfully to the healthcare team. Clinical supervisors receive positive reinforcement through effective performance of these clinical tasks by students. [10] Students are likely to receive consistent instruction and feedback because of the continuity of supervision. This consistency of the apprentice relationships enhances entrustment of professional activities, [14] resulting in critical functional changes in the three-way relationship between the preceptor, student and patient during the consultation as students moved from passive to active members of the clinical team. [10]

CBME placements can provide students with a small group of primary care and specialty physicians, nurses and allied health professionals who can welcome a student as a novice member of their team. The student's sense of belonging is enhanced in rural areas where professional and social boundaries are less exclusive. [11] These relationships are enhanced on longer placements, [15] which may explain the success of LICs in community versus tertiary care settings. [7] Length of rotation, continuity of the clinical and teaching team and a welcoming professional environment are key components in this learning environment.

Community, relationships with patients and professional development

In CBME placements, students are introduced to individual patients and to the community in which these patients live. Many CBME programs have developed in areas of workforce need, such as rural locations and low socio-economic outer urban areas. [6],[16] Students are recognized as potential future workforce members and are welcomed into the town. [11] Patients are mostly very accepting of having a student involved in their care. [17],[18] Within the primary care context, students can be given the opportunity to see patients on their own before the general practitioner joins the consultation. This process enables students to develop a relationship with individual patients and contribute to their care. [19] Even in short CBME placements, students have opportunities to follow individual patients through different healthcare contexts (such as clinic to hospital to nursing home) from presentation, investigation, treatment and convalescence. Clinical preceptors are also able to provide students with an entrée into significant patient events such as birth and palliative care journeys. CBME students gain insight into the provision of care to people within the context of their lives, while students in the tertiary hospital setting risk understanding medicine as a context-void skill. Learning from real people with medical conditions who live within a student's own community, rather than about pathology in patients who are short term residents in the tertiary hospital setting, is likely to prevent them losing empathy and objectifying patients, a common outcome in traditional clinical clerkships. [13]

Students in CMBE placements witness and are influenced by leadership roles rural doctors and other health professionals have within their community. They learn about primary care from a broad societal perspective as their preceptors participate in public health programs, health promotion campaigns and advocate to change the social determinants of health within their communities. CBME placements see medical care as a part of the holistic picture of a person's health status and come to recognize how the social determinants of health impact on patient outcomes [Figure 1]. Hence, meaningfulness in the clinical role of the learner, the relationships with clinical team members and the community itself contribute to learning.
Figure 1: CBME Learning Model

Click here to view

  Conclusion Top

We propose that longitudinal clinical placements provide a breadth of experience, which enhances learning through the development of rich relationships (with preceptors, other healthcare providers, patients and the general community). These relationships can thrive in a community setting and engender meaningfulness, a term not typically associated with medical education. We suggest that this social, personal and professional context enhances learning through the provision of a uniquely meaningful personal learning experience, which matures a learner personally and clinically. A CBME theory needs to encompass the continuity and depth of relationship development as it applies to learning. Meaningfulness is the term we propose to describe the nature of this authenticity and its effect on learning.

  References Top

1.Mennen S, Petroni-Mennnin R. Community-based Medical Education. Clin Teach 2006;3:90-6.  Back to cited text no. 1
2.Kelly L. Community-based Medical Education: A teacher's handbook. Oxford UK: Radcliffe Publishing; 2011.  Back to cited text no. 2
3.Mahoney S, Ash J, Walters L. Urban Community Based Medical Education-General Practice at the core of a new approach to teaching medical students. Aust Fam Physician 2012;41:631-6.  Back to cited text no. 3
4.Stasser R. Community engagement: A key to successful rural clinical education. Rural Remote Health 2012;10:1543.  Back to cited text no. 4
5.Worley P, Silagy C, Prideaux D, Newble D, Jones A. The Parallel Rural Community Curriculum: An integrated clinical curriculum based in rural general practice. Med Educ 2000;34:558-65.  Back to cited text no. 5
6.Walters LK, Worley PS, Mugford BV. The parallel rural community curriculum: Is it a transferable model? Rural Remote Health 2003;3:236.  Back to cited text no. 6
7.Walters L, Greenhill J, Richards J, Ward H, Campbell N, Ash J, et al. Outcomes of longitudinal integrated clinical placments for students, clinicians and society. Med Educ 2012;46:1028-41.  Back to cited text no. 7
8.Brookfield S. Understanding and facilitating adult learning. Sch Libr Media Q 1988;16:99-109.  Back to cited text no. 8
9.Lave J, Wenger E. Situated Learning: Legitimate peripheral participation. New York: Cambridge University Press; 2007.  Back to cited text no. 9
10.Walters L, Prideaux D, Worley P, Greenhill J. Demonstrating the value of longitudinal integrated placements for general practice preceptors. Med Educ 2011;45:455-63.  Back to cited text no. 10
11.Walters L, Stagg P, Conradie H, Halsey J, Campbell D, D'Amore A, et al. Community engagement by two Australian Rural Clinical Schools. Australas J Univ Community Engagem 2011;6:27-56.  Back to cited text no. 11
12.Engeström Y. From teams to knots: activity theoretical studies of collaboration and learning at work. Cambridge: Cambridge University Press; 2008.  Back to cited text no. 12
13.Hafferty K, Franks R. The hidden curriculum, ethics teaching and the structure of medical education. Acad Med 1994;69:861-71.  Back to cited text no. 13
14.ten Cate O. Entrustability of professional activities and competency-based training. Med Educ 2005;39:1176-7.  Back to cited text no. 14
15.Walker JH, Dewitt DE, Pallant JF, Cunningham CE. Rural origin plus rural clinical school placement is a significant predictor of medical students' intention to practice rurally: A multi-university study. Rural Remote Health 2012;12:1908.  Back to cited text no. 15
16.Ash JK, Walters LK, Prideaux DJ, Wilson IG. The Context of clinial teaching and learning in Australia. Med J Aust 2012;196:475.  Back to cited text no. 16
17.Bleakley A, Bligh J. Students learning from patients: Let's get real in Medical Education. Adv Health Sci Educ 2008;13:89-107.  Back to cited text no. 17
18.Hudson JN, Weston KM, Farmer EE, Ivers RG, Pearson RW. Are patients willing participants in the new wave of community-based medical education in regional and rural Australia? Med J Aust 2010;192:150-3.  Back to cited text no. 18
19.Walters L, Prideaux D, Worley P, Greenhill J, Rolfe H. What do general practitioners do differently when consulting with a medical student? Med Educ 2009;43:268-73.  Back to cited text no. 19


  [Figure 1]

This article has been cited by
1 Community partnerships in medical education: Narratives of medical students
Alexandra M. Cardoso Pinto, Ethan Malone, Nydile Ramesh, Simisola Onanuga, Nikitha Benny, Christine Pettitt, Richard J. Pinder, Shyam Sundar Budhathoki
Public Health Challenges. 2022; 1(4)
[Pubmed] | [DOI]
2 Strengthening Breast Cancer Screening Mammography Services in Pakistan Using Islamabad Capital Territory as a Pilot Public Health Intervention
Ayesha Isani Majeed, Assad Hafeez, Shahzad Ali Khan
Healthcare. 2022; 10(6): 1106
[Pubmed] | [DOI]
3 The Uncertainty of COVID-19 Inducing Social Fear and Pressure on the Continuity of Rural, Community-Based Medical Education: A Thematic Analysis
Ryuichi Ohta,Yoshinori Ryu,Chiaki Sano
Healthcare. 2021; 9(2): 223
[Pubmed] | [DOI]
4 The Contribution of Citizens to Community-Based Medical Education in Japan: A Systematic Review
Ryuichi Ohta,Yoshinori Ryu,Chiaki Sano
International Journal of Environmental Research and Public Health. 2021; 18(4): 1575
[Pubmed] | [DOI]
5 Creating a Pipeline for Minority Physicians: Medical-Student-Led Programming
Vishnu R Muppala,Rohan S Janwadkar,Alicia Rootes,Nirmala Prakash
Cureus. 2021;
[Pubmed] | [DOI]
6 Perceptions and Attitudes toward Community Health and Interprofessional Education in Students with and without an Additional Community Medicine-Focused Program
Dana Jungbauer,Michael Glasser,Martin MacDowell
Medical Science Educator. 2021;
[Pubmed] | [DOI]
7 Development of a community orientation program (COP) as a community-based medical education method for undergraduate medical students: an experience from India
Bayapa Reddy Narapureddy, Shakeer Kahn Patan, C. Sravana Deepthi, Sirshendu Chaudhuri, K. R. John, Chandrasekar Chittooru, Surendra Babu, Khadervali Nagoor, Devika Jeeragyal, Jawahar Basha, Theo Nell, Ravi Shankar Reddy
BMC Medical Education. 2021; 21(1)
[Pubmed] | [DOI]
8 Encontros e desencontros entre projetos pedagógicos de cursos de Medicina e Diretrizes Curriculares Nacionais: percepções de professores
Carlos Alberto de Oliveira,Eliana Martorano Amaral,Eliana Goldfarb Cyrino,Reinaldo José Gianini
Interface - Comunicação, Saúde, Educação. 2021; 25
[Pubmed] | [DOI]
9 How rural immersion training influences rural work orientation of medical students: Theory building through realist evaluation
Amie Bingham,Belinda O’Sullivan,Danielle Couch,Samuel Cresser,Matthew McGrail,Laura Major
Medical Teacher. 2021; : 1
[Pubmed] | [DOI]
10 C4Tech: Virtual connections between the classrooms, clinicians, and community clinics to bridge the gap between research and practice
Paige L. McDonald,Gregory C. Weaver,Jacqueline S. Barnett,Howard O. Straker
Medical Teacher. 2021; : 1
[Pubmed] | [DOI]
11 Medical students’ perceptions of ‘community’ in a longitudinal integrated clerkship
Shalini Gupta,Stella Howden
Education for Primary Care. 2020; : 1
[Pubmed] | [DOI]
12 A road less travelled: Undergraduate midwifery students’ experiences of a decentralised clinical training platform
Olivia B. Baloyi,Gugu G. Mchunu,Charlene Williams,Mary-Ann Jarvis
Health SA Gesondheid. 2020; 25
[Pubmed] | [DOI]
13 Veterinary student experiences in a community- and competency-based primary care rotation: A case study
MKatie Sheats,Traci Temple,Dan Spencer
Education in the Health Professions. 2020; 3(2): 54
[Pubmed] | [DOI]
14 Post-Modern Yapilandirmaci Uygulamalara Bir Örnek Olarak Topluma Dayali Tip Egitimi
Aybegüm Yörümez Dursun,Yesim Senol
Tip Egitimi Dünyasi. 2019;
[Pubmed] | [DOI]
15 Community-based nursing education
Sevim Ulupinar,Emine Gürel,Emine Senyuva,Hülya Kaya
Journal of Human Sciences. 2019; 16(3): 700
[Pubmed] | [DOI]
16 Realist approach to evaluating an interprofessional education program for medical students in clinical practice at a community hospital
Junji Haruta,Yu Yamamoto
Medical Teacher. 2019; : 1
[Pubmed] | [DOI]
17 The Contextual Curriculum
Brett Schrewe,Rachel H. Ellaway,Christopher Watling,Joanna Bates
Academic Medicine. 2018; 93(11): 1645
[Pubmed] | [DOI]
18 Block versus longitudinal integrated clerkships: students’ views of rural clinical supervision
Martin Witney,Vivian Isaac,Denese Playford,Leesa Walker,David Garne,Lucie Walters
Medical Education. 2018;
[Pubmed] | [DOI]
19 Community Preceptors’ Motivations and Views about Their Relationships with Medical Students During a Longitudinal Family Medicine Experience: A Qualitative Case Study
Charo Rodríguez,Emmanuelle Bélanger,Peter Nugus,Miriam Boillat,Marion Dove,Yvonne Steinert,Leonora Lalla
Teaching and Learning in Medicine. 2018; : 1
[Pubmed] | [DOI]
20 ‘Fostering transformative learning, self-reflexivity and medical citizenship through guided tours of disadvantaged neighborhoods’
E. Marshall Brooks,Mary Lee Magee,Mark Ryan
Medical Education Online. 2018; 23(1): 1537431
[Pubmed] | [DOI]
21 Medical students, early general practice placements and positive supervisor experiences
Margaret Henderson,Susan Upham,David King,Marie-Louise Dick,Mieke van Driel
Education for Primary Care. 2018; : 1
[Pubmed] | [DOI]
22 The development of a community-based medical education program in Korea
Jung Eun Yoo,Seo Eun Hwang,Gyeongsil Lee,Seung Jae Kim,Sang Min Park,Jong-Koo Lee,Seung-Hee Lee,Hyun Bae Yoon,Ji Eun Lee
Korean Journal of Medical Education. 2018; 30(4): 309
[Pubmed] | [DOI]
23 Transition to practice: can rural interprofessional education make a difference? A cohort study
Susan Pullon,Christine Wilson,Peter Gallagher,Margot Skinner,Eileen McKinlay,Lesley Gray,Patrick McHugh
BMC Medical Education. 2016; 16(1)
[Pubmed] | [DOI]
24 Do primary health centres and hospitals contribute equally towards achievement of the transversal clinical competencies of medical students? Performance on the Objective Structured Clinical Examination (OSCE) in competency acquisition
Jorge Soler-González,Miquel Buti,Jordi Boada,Victoria Ayala,Eduard Peñascal,Toni Rodriguez
Atención Primaria. 2016; 48(1): 42
[Pubmed] | [DOI]
25 Studentsæ Perspectives on Integrating a Social Service Program into a Medical Humanities and Social Science Curriculum
Pyeong Man Kim,Soo Jung Kim,Wha Sun Kang
Korean Medical Education Review. 2015; 17(3): 140
[Pubmed] | [DOI]
26 Exploring resilience in rural GP registrars – implications for training
Lucie Walters,Caroline O. Laurence,Joanne Dollard,Taryn Elliott,Diann S. Eley
BMC Medical Education. 2015; 15(1)
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Article Figures

 Article Access Statistics
    PDF Downloaded2446    
    Comments [Add]    
    Cited by others 26    

Recommend this journal