Impact of community-oriented medical education on medical students’ perceptions of community healthcare: A qualitative study (Preprint)

BACKGROUND Physician maldistribution remains a global challenge, with Japan's rural regions facing critical shortages of healthcare providers. Regional quota programs have been implemented 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 healthcare. OBJECTIVE In this study, we investigated the impact of an enhanced COME program, featuring increased early clinical exposure and faculty development, on the career perceptions of first-year regional quota medical students at Chiba University. METHODS We conducted a cross-sectional survey comparing two cohorts of first-year regional quota medical students: 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 clinical exposure supervised by COME-trained attending physicians. Students' written reflections were analyzed using qualitative content analysis and categorized according to Fink's Taxonomy of Significant Learning, which includes six domains: Foundational Knowledge, Application, Integration, Human Dimension, Caring, and Learning How to Learn. RESULTS In 2021, 311 learning codes were identified, distributed across Foundational Knowledge (128), Application (91), Integration (40), Human Dimension (16), Caring (30), and Learning How to Learn (6). In 2022, codes increased to 385, with notable growth in Caring (58) and Human Dimension (57), alongside increases in Learning How to Learn (15) and Integration (45). Content analysis of students' reports revealed enhanced understanding of patient-centered care, collaboration, and the challenges of rural healthcare. The consistency in Foundational Knowledge underscored a solid base of community healthcare principles. CONCLUSIONS Enhancements of the COME program, including additional early clinical exposure and faculty development, significantly improved students' perceptions of community healthcare. The increased focus on Caring and Human Dimension aspects, as identified in the content analysis, underscores the role of practical experiences in fostering skills such as collaboration, communication, and patient-centered care. These findings suggest that mentorship by community hospital attendings, alongside structured clinical exposure, plays a crucial role in shaping medical students' understanding and commitment to rural medicine. Continuous evaluation and refinement of COME programs are essential to mitigate physician shortages in underserved regions.