Community and Interns' Perspectives on Community-Participatory Medical Education: From Passive to Active Participation.

BACKGROUND AND OBJECTIVES: The use of community-based medical education as a method of learning primary care is now common worldwide. However, in many cases community participation remains passive. This study sought to explore the effects of introducing community members into medical education as active teachers. Medical education taught directly by community members might be a key to comprehensive community-based learning.

METHODS: This study was conducted in Japan at two postgraduate programs in community hospitals. We asked 10 community groups and 10 interns to join our 2-year "participatory" community curriculum continuously. Questionnaires completed by 10 interns and 77 community members were analyzed quantitatively. Audio-recorded and transcribed interview data from 10 interns and 39 community members were read iteratively and analyzed qualitatively.

RESULTS: Community members who participated in groups with the interns gave higher scores on approval of and willingness to participate in such experiences. Interns scored higher on their view of the importance and preferences to work with the community. In the qualitative analysis, health-oriented behavior, social connectedness, and shaping community orientation among doctors emerged as important for community members. Important themes that emerged from the interns' interviews were: taking responsibility for shared understanding, community-oriented focus, valuing community nurses, and tension from competing demands.

CONCLUSIONS: Interaction between interns and community members had positive effects for both. Community-participatory medical education could present a further step in the evolution of community-based medical education, one that is closest to community. Finding a balance between the time dedicated to working at the hospital and in the community proved to be essential to the success of this curriculum.