Practical skills and valued community outcomes: the next step in community-based education

Objectives Community-based medical education (CBE) has clear value. However , there are aspects of CBE where improvement is possible. First, communitie s do not generally receive valued outcomes in exchange for participation in the CBE process. Secondly, students are usually not trained to influence h ealth in the community using methods that are realistic in busy clinical pr actice. Design A CBE rotation was designed to address these problems. Rotation acti vities were structured to facilitate development of a health programme desi red by the community while giving students practical skills for later use. Working with community residents and health staff, sequential groups of stu dents carried out, in turn, problem analysis, resource identification, plan ning and implementation activities aimed at establishing a community tuberc ulosis (TB) control programme. Setting The University of Natal in Durban, South Africa. Subjects Final-year medical students. Results At the end of the academic year, the TB control programme was appro ximately 60% in place, and 90% of TB patients cared for by the students wer e completing treatment. Overall, students rated the experience good for lea rning about health care in community settings and about methods for communi ty health programme development Student ratings were significantly higher f or those groups whose activities brought them into greater contact with com munity residents. The 'real-time' nature of planning the sequential student groups' work created logistical problems and, as an isolated activity, the rotation had little impact on student attitudes toward community-based car eers. Conclusions Expanding the goals for CBE is both feasible and important. Fur ther work should focus on refining designs for this next step in CBE.