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Community-based medical education in action: primary care physicians’ perceptions

Afsaneh Yakhforoshha, Dr. Sonia Oveisi, Dr. Ramin Sarchami, Dr. Behrooze Mahmoodi-Bakhtiari


Introduction and objectives: During the last decade, in response to wide ranging changes in healthcare systems and physicians' roles, the medical curriculum has undergone some modification. To achieve high quality education, 2 strategies are suggested: (1) Community-based medical education and (2) Community-oriented medical education. During the process of curriculum planning, the planners need to identify the potential areas for improvement and to guarantee the quality of instruction. This study aimed to determine the viewpoints of medical graduates from Qazvin University of Medical Science (QUMS), Tehran, on community medicine internship and clerkship programs (CMICP) in order to assist better decision-making by policymakers.

Methods: In this qualitative study, the conventional content analysis approach was employed. Data were gathered from 20 primary practitioners of QUMS through individual semi-structured interviews and focus group discussions (FGD) which were continued until data saturation occured. The interviews were transcribed and analyzed immediately after the interviews. To analyze the data, one note was employed and to analyze the qualitative data, inductive method was used. The unit of analysis was selected and labeled using an open coding system. Then, the similar open codes were categorized in subthemes and finally the subthemes were organized into the main themes.

Findings: The results of data analysis identified 4 main themes including: planned curriculum, delivered curriculum, hidden curriculum and curriculum evaluation.

Conclusion: Many graduates suggest that, in addition to curriculum renewal, curriculum planners should identify mediated factors in CMICP to prepare graduates to practise in healthcare settings.




Primary Care Practice, Curriculum, Physician, Internship, Clerkship

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Lee, S.W. & Clement, N. (2014). The current provision of community-based teaching in UK medical schools: an online survey and systematic review. BMJ Open 4 (12) e005696.

Mash, B. & de Villiers, M. (1999). Community-based training in family medicine - a different paradigm. Medical Education 33 (10) 725-729.

Talaat, W., Khamis, N. & Aziz, A.A. (2011). Review Article:Ten Frequently Asked Questions on Community-Oriented/BasedMedical Education. Medical Journal of Cairo University 79 (2) 55-60.

Chenot, J-F., Kochen, M.M. & Himmel, W. (2009). Student evaluation of a primary care clerkship: quality assurance and identification of potential for improvement. BMC Medical Education 9 (1) 1.

Illing, J.C., Morrow, G.M., Rothwell nee Kergon, C.R., Buirford, B.C., Baldauf, B.F., Davies, C.L., Peile, E.B., Spencer, J.A., Johnson, N., Allen, M. & Morrison, J. (2013). Perceptions of UK medical graduates preparedness for practice: A multi-centre qualitative study reflecting the importance of learning on the job. BMC Medical Education 13 (1) 1.

Mirzazadeh, A., Bavarian, B., Labaf, A., Afshari, A., Nikoo, M., Meshkani, Z.S. & Khashayar, P. (2013). Curriculum gaps in teaching clinical skills to Iranian undergraduate medical students. Archives of Medical Science 9 (2) 309-313.

Tavakol, M. & Murphy, R. (2009). Medical education in Iran: an exploration of some curriculum issues. Medical Education Online 11, 5.

Byrami, H.J., Amini, A., Bakhshian, F., Pezeshki, M., Gasemiyeh, M. & Yatri, J. (2013). The Effectiveness of the Community Medicine Undergraduate Program in Medical Schools on Enabling Medical Graduates to Work in the Health Systems. Research and Development in Medical Education 2 (1) 7-13.

Jabbari, H., Farokhfar, M., Jafarabadi, M.A., Taqhipour, H., Bakhshian, F. & Rohane, S. (2012). Personal and organizational predictors of physicians' knowledge, attitudes and practices related to medical waste management in Mazandaran province (northern Iran). Waste Management & Research 30 (7) 738-744.

Jabbari-Birami, H,G.H. & Bakhshian, F. (2012). Evaluation of Family Physician Program Based on Family Health Indices. Knowledge & Health 7 (3) 124-128.

Ocek, Z.A., Ciceklioğlu, M., Gursoy, S.T., Aksu, F., Soyer, M.T., Hassoy, H., Ergin, I., Sayiner, A. & Kandiloğlu, G. (2008). Public health education in Ege University Medical Faculty: developing a community-oriented model. Medical Teacher 30 (9-10) 180-188.

Hashmi, N.R. & Daud, S. (2010). Medical education: views and recommendations by final year MBBS students of a private medical college in Lahore. Journal of the College of Physicians and Surgeons Pakistan 20 (2) 93-97.

Jalili, M. & Mirzazadeh, A. (2008). A survey of medical students' perceptions of the quality of their medical education upon graduation. Annals of the Academy of Medicine Singapore 37 (12) 1012-1018.

Ahmadi, S., Ghaffari, R. & Ghaffarifar, S. (2015). The Need to Reform the Health Care System in the Implementation of the Family Physician Curriculum in Iran. Research and Development in Medical Education 4 (2) 109-110.

AL-Alaboud, L. & Kurashi, N. The effects of breast cancer early detection training program on the Knowledge, Attitudes, and Practice of female PHHC Physicians. Middle East Journal of Family Medicine 4 (1) 31-37.

Joolaee, H. & Alizadeh, M., Fallahzadeh, M.H. & Sayadi, M. (2011). Evaluation of clinical skills of family physicians in Fars province by means of observed structured clinical evaluation. Strides in Development of Medical Education 7 (2) 92-98.

Faulx, D. (2012). The Social Determinants as part of the Medical School Curriculum. Washington: University of Washington.

Amouei, A., Tirgar, A., Ahmadi, M.H., Ghadimi, R., Hosseini, S.R., Sajadi, P., Tabar, A. N-A. & Dadashpoor, M. (2015). The role of health care apprentice program on the level of medical students knowledge and skills. Future of Medical Education Journal 5 (2) 18-21.

Okayama, M. & Kajii, E. (2011). Does community-based education increase students' motivation to practice community health care? - a cross sectional study. BMC Medical Education 11 (1) 1.

Ali, A. (2012). Community-oriented medical education and clinical training: comparison by medical students in hospitals. Journal of the College of Physicians and Surgeons Pakistan 22 (10) 622-626.

Gopalakrishnan, S. & Kumar, P.G. (2015). Community medicine teaching and evaluation: scope of betterment. Journal of Clinical & Diagnostic Research 9 (1) JE01-JE05.

Moghaddam, H.Z., Ghasemi, R.I., Ghoushkhanei, H., Afshari, R. & Marouzi, P. (2013). Knowledge of social accountability in medical education among faculty members at medical sciences of Mashhad University. Future of Medical Education Journal 3 (3) 20-23.

Hunt, J.B. & Bonham, C. (2011). Understanding the goals of service learning and community-based medical education: a systematic review. Academic Medicine 86 (2) 246-251.

Poncelet, A.N., Mazotti, L.A., Blumberg, B., Walmsley, M.W., Grennan, T. & Shore, W.B. (2014). Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system. The Permanente Journal 18 (2) 50.

Schiekirka, S., Reinhardt, D., Heim, S., Fabry, G., Pukrop, T., Anders, S. & Raupach, T. (2012). Student perceptions of evaluation in undergraduate medical education: A qualitative study from one medical school. BMC Medical Education 12 (1) 45.

Holmes, D., Tumiel-Berhalter, L., Zayas, L.E. & Watkins, R. (2008). "Bashing" of Medical Specialties: Students' Experiences and Recommendations. Family Medicine 40 (6) 400.

Kerr, J.R., Seaton, M.B., Zimcik, H., McCabe, J. & Feldman, K. (2008). The impact of interest How do family medicine interest groups influence medical students? Canadian Family Physician 54 (1) 78-79.

Cronholm, P.F., Margo, K., Bazelon, G., Bream, K., Bennett, I.M. & Brg, F.K. (2009). Student attitudes: potential barriers to implementing a community medicine field activity. Family Medicine 41 (1) 22-27.

Williamson, M.A. (2014). Change in Students Perceptions of Peer and Faculty Attitudes to Rural Medicine following the Introduction of a Rural Health Rotation. International Journal of Family Medicine doi:10.1155/2014/124708.

Koju, R. (2013). Community Based Medical Education-Necessity Realization and Practice. Kathmandu University Medical Journal 11 (3) 189-190.

Ahmady, S. & Lakeh, M.A. (2015). Exploring the practical themes for medical education social accountability in Iran. Gastroenterology and Hepatology from Bed to Bench 8 (1) 28-32.

Hafferty, F.W. (1998). Beyond curriculum reform: confronting medicine's hidden curriculum. Academic Medicine 73 (4) 403-407.



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