The Contribution of Citizens to Community-Based Medical Education in Japan: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Search Strategy
2.3. Inclusion and Exclusion Criteria
2.4. Data Extraction
2.5. Analysis
3. Results
3.1. Search Results
3.2. Study Characteristics
3.3. CBME Format
3.4. Kirkpatrick Outcome Levels and the Strength of the Findings
3.5. Synthesis of Findings on the Impact on Stakeholders in CBME
3.6. Kirkpatrick Outcome Level 1
3.6.1. Quantitative Assessment: Satisfaction with the Training, Overall Quality of the Training, Quality of the Teachers, Quality of the Contents, and Importance of the Training
3.6.2. Qualitative Assessment: Noteworthy Interaction with Citizens, the Distance between Medical Institutions, and the Motivation of Citizens and Professionals
3.7. Kirkpatrick Outcome Level 2A
3.7.1. Quantitative Assessment: Interacting with Patients/Citizens, Motivation for General Practitioners, Motivation for Specialists, Motivation for Working in Community Medicine, and Motivation for Working in Remote Areas
3.7.2. Qualitative Assessment: The Relationship between Professionals and Citizens, Strong Connections between Citizens for Health, and Motivation for Learning Rooted in the Expectations of the Citizens
3.8. Kirkpatrick Outcome Level 2B
3.8.1. Quantitative Assessment: Community Medicine, Remote Medicine, Citizens’ Lives, and Preventative Medicine
3.8.2. Qualitative Assessment: The Significance of Citizens’ Characteristics, Humanistic Relationships, and Community-Oriented Primary Care
4. Discussion
5. Limitation
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Criteria | Inclusion | Exclusion |
---|---|---|
Population | Medical students, residents | Other health care professionals (nurses, pharmacists, dentists, rehabilitators, care managers) |
Intervention | Clinical experience focusing on community-based medical education including citizens in communities | Clinical experience only in healthcare facilities |
Type of Study | Qualitative, quantitative, mixed-method | Non-empirical studies (editorials, news) |
Other | Abstract available Year of publication >1990 Conducted in Japan Including outcome of the participants categorized according to the Kirkpatrick model Full text available in English or Japanese | Abstract not available Full text not available in English or Japanese |
Variable | % | |
---|---|---|
Population Density | ||
Fewer than 50 | 4 | 19.0% |
50 to 150 | 8 | 38.1% |
150 to 1000 | 8 | 38.1% |
More than 1000 | 1 | 4.8% |
Rural (less than 150) | 12 | 57.1% |
Participants | ||
First year | 7 | 33.3% |
Pre-clinical years | 3 | 14.3% |
Clinical year | 10 | 47.6% |
Final year | 7 | 33.3% |
Medical Resident | 2 | 9.5% |
Variable | Number of Studies |
---|---|
Study Method | |
Quantitative method | 11 |
Qualitative method | 8 |
Mixed-method | 2 |
Study Design | |
Quantitative | |
Pre- and post-design | 6 |
Descriptive design | 3 |
Cross-sectional | 4 |
Qualitative | |
Descriptive analysis | 3 |
Thematic analysis | 4 |
SCAT (Steps for Coding and Theorization) | 2 |
Ethnography | 1 |
Data Resource | |
Quantitative | |
Questionnaire | 11 |
Qualitative | |
interview | 9 |
focus group | 2 |
direct observation | 1 |
e-portfolio | 1 |
Variable | Number of Studies |
---|---|
Duration of CBME | |
Three days | 2 |
One week | 9 |
Two weeks | 8 |
Four months | 1 |
Two years | 1 |
Study Place | |
Hospital | 17 |
Clinic | 15 |
Welfare facility | 17 |
Home care | 17 |
Community | 21 |
Variable | Number of Studies | |||
---|---|---|---|---|
Kirkpatrick Outcome Levels | Quantitative | Qualitative | Mixed | Total |
1: Reaction | 7 | 3 | 2 | 12 |
2A: Learning-change in attitudes | 8 | 4 | 2 | 14 |
2B: Learning-change in knowledge and skills | 6 | 7 | 2 | 15 |
3: Change in behaviors | 0 | 0 | 0 | 0 |
4A: Results-change in the system/organizational practice | 0 | 0 | 0 | 0 |
4B: Change in patient care outcomes | 0 | 0 | 0 | 0 |
Strength of Findings | ||||
Grade 1: No clear conclusions can be drawn; not practice | 0 | 0 | 0 | 0 |
Grade 2: Results ambiguous, but there appears to be a trend | 0 | 1 | 0 | 1 |
Grade 3: Conclusions can probably be drawn based on the results | 6 | 6 | 0 | 12 |
Grade 4: Results are clear and very likely to be true | 4 | 1 | 2 | 7 |
Grade 5: Results are unequivocal | 0 | 0 | 0 | 0 |
CBME Setting, Participants/Duration/Population Density | Study’s Purpose | Findings | |
---|---|---|---|
Quantitative Method | |||
Okayama et al.(2004) [34] | Clinical and final grades/10 days/ 335 people/km2 | To examine the effects of a standardized program for medical facilities and clerkship contents introduced in 2001. | The trainees were motivated and had the confidence to talk with citizens in communities regarding medical and social issues. |
Takayashiki et al.(2005) [35] | Final year/10 days/ 335 people/km2 | To inquire as to the changes in medical students’ perceptions on the necessity of experience in community-based learning programs | The necessity of learning in communities was more likely to be recognized by students who had experienced CBME. |
Tani et al.(2009) [36] | Clinical year/5 days/ 66 people/km2 | To inquire as to the efficacy of the primary care practice | CBME increased the intensity of students’ interest in and passion for collaborating with citizens in communities as opposed to lectures. |
Okayama et al.(2011) [37] | Clinical year/10 days/ 335 people/km2 | To clarify which learning activities affect students’ attitudes toward community health care | Health education with citizens was associated with a positive change in both attitudes of “worthiness” (adjusted RR: 1.71, 95% CI: 1.10–2.66) and “confidence” (1.56, 1.08–2.25) for community medicine. |
Okayama et al.(2011) [38] | Clinical year/10 days/ 335 people/km2 | To explore the association between students’ evaluations of their community- based clinical clerkship, their attitudes toward community health care, and their career preferences | Evaluations of the programs (p = 0.014) and students’ attitudes (p < 0.001) were strongly associated with an increased preference for a career as a primary care physician after the clinical clerkship. |
Hashiba et al.(2011) [39] | First and pre-clinical years/3 days/ 129 people/km2 | To assess the impact of the student-led program on students’ notions about, appreciation of, and attitudes toward community- based medicine | The participants showed moderate-to-marked willingness to work in rural areas after their experiences interacting with citizens in communities. |
Iwasaki et al.(2011) [40] | Clinical and final years/5 days/ 108 people/km2 | To examine the changes in students’ thinking about an affinity for community medicine | Community-based medical programs enhance medical students’ understanding of and affinity for community medicine. |
Tani et al.(2014) [41] | Clinical and final years/5 days/ 66 people/km2 | To evaluate the effect of community-based clinical education on students’ attitudes toward community medicine and medicine in remote areas. | The intensity of students’ interest and their senses of fulfillment and passion for medicine in remote areas were significantly increased after CBME. |
Katsube et al.(2016) [42] | Clinical and final years/10 days/ 64.4 people/km2 | To clarify the learning and revising points regarding CBME in rural community hospitals | Based on the questionnaires, the medical students were satisfied with CBME in rural community hospitals. |
Tani et al.(2017) [43] | Clinical year/5 days/ 66 people/km2 | To examine the effect of community-based clinical practice on their attitudes toward remote medicine and their course after graduation. | Students demonstrated a significantly decreased desire to become general practitioners compared to becoming specialists; this was seen in the students that had a low intensity sense of fulfillment. |
Moriwaki et al.(2018) [44] | Clinical and final years/10 days/ 64.4 people/km2 | To investigate the change in medical students’ motivation through community-based medical education by surgeons | The medical students’ perceptions regarding rural medicine changed positively regarding the importance of rural medicine. |
Qualitative Method | |||
Yamada et al. (2010) [45] | First year/5 days/ 26 people/km2 | To inquire what medical students have actually learned from their involvement in communities | Medical students came to understand life on a remote island through their interactions with citizens. |
Nakada et al. (2010) [46] | First year/5 days/ 26 people/km2 | To clarify what students learned on a rural island | Through CBME on a rural island, medical students felt and learned how closely nature and people relate in addition to learning about life on a remote island and the health conditions of the people on the island and recognizing the lack of study and self-realization. |
Uehara et al. (2011) [47] | First and pre-clinical years/5 days 184 people/km2 | To discover what medical students learn and accomplish in CBME in rural Japan | The CBME not only can increase students’ understanding of community medicine, but also functions as a motivating force by exposing them to the expectations of community people. |
Takamura et al. (2015) [48] | Final year/4 months/ 281 people/km2 | To clarify the challenges of the application of an integrated longitudinal clerkship in a rural community hospital | One of the most important outcomes of the LIC was an enhanced understanding of the community-based practice and the community itself, especially in a rural setting. |
Saiki et al. (2016) [49] | First year/5 days/ 1963 people/km2 | To explore how a longitudinal interaction with citizens can develop medical students’ communication skills and understanding of themselves as social entities. | Medical students developed an understanding of citizen-centered communication and of the human relationship and capacity to expand one’s world via social existence. |
Ohta et al.(2018) [50] | Resident/1 week/ 43.1 people/km2 | To clarify learning content in CBME on a rural island | A strong connection among the islanders, islander-centered care, and the differences between rural and hospital medicine were the main aspects remarked upon by those who had experienced deep relationships with the islanders. |
Yamada et al.(2018) [51] | First year/5 days/ 26 people/km2 | To investigate medical students’ changes in perception regarding their living | Medical students changed their perception regarding rural medicine and their learning approach to medical science. |
Ohta et al.(2019) [52] | Clinical and final years/10 days/ 64.4 people/km2 | To investigate the changes in perceptions of participants who completed a two-week CBME course. | The participants’ ratings regarding community care improved significantly from pre-to post-training. The participants realized the importance of community care and of having respect for individuals’ lifestyles. |
Mixed-Method | |||
Takamura et al. (2017) [53] | Resident/2 years/ 281.3 people/km2 | To explore the effects of introducing community members to medical education as active teachers. | The participants scored higher regarding their views on the importance of and their preferences for working with communities. 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. |
Ohta et al.(2019) [54] | First and pre-clinical years/3 days/ 126 people/km2 | To clarify the short-term learning experienced by medical students on rural islands in Japan | By interacting with various islanders, students developed an understanding of the different cultural backgrounds in which rural physicians worked, in addition to establishing their own ability to adapt to each. This experience motivated them to pursue studies on rural medicine upon their return to the mainland. |
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Ohta, R.; Ryu, Y.; Sano, C. The Contribution of Citizens to Community-Based Medical Education in Japan: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 1575. https://doi.org/10.3390/ijerph18041575
Ohta R, Ryu Y, Sano C. The Contribution of Citizens to Community-Based Medical Education in Japan: A Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18(4):1575. https://doi.org/10.3390/ijerph18041575
Chicago/Turabian StyleOhta, Ryuichi, Yoshinori Ryu, and Chiaki Sano. 2021. "The Contribution of Citizens to Community-Based Medical Education in Japan: A Systematic Review" International Journal of Environmental Research and Public Health 18, no. 4: 1575. https://doi.org/10.3390/ijerph18041575
APA StyleOhta, R., Ryu, Y., & Sano, C. (2021). The Contribution of Citizens to Community-Based Medical Education in Japan: A Systematic Review. International Journal of Environmental Research and Public Health, 18(4), 1575. https://doi.org/10.3390/ijerph18041575