Students' perceptions of the relative advantages and disadvantages of community-based and hospital-based teaching: a qualitative study

Aims To obtain the perceptions of first-year clinical medical students of t he relative advantages and disadvantages of community-based and hospital-ba sed clinical teaching. Methods A qualitative study. A purposive sample of first-year clinical medi cal students who had experienced both community-based and hospital-based te aching was invited to participate in individual semistructured interviews o r focus groups. Interviews and focus groups were audiotaped and transcribed to facilitate content analysis of the data. A total of 24 students partici pated in individual interviews and a further 18 took part in focus groups. Results Respondents identified advantages and disadvantages specific to tea ching in each setting. Chief advantages of hospital-based learning were per ceived to include learning about specialties and the management of acute co nditions, and gaining experience of procedures and investigations. Communit y-based learning was perceived as particularly appropriate for learning abo ut psychosocial issues in medicine, for increasing students' awareness of p atient autonomy and for improving communication skills. In addition, aspect s of organization and of teaching methods employed by community tutors, alt hough not site-specific, were viewed as conducive to a positive educational experience. Students perceived some areas, such as clinical skills acquisi tion, to be equally well learned in either setting. Discussion As community-based teaching forms a greater proportion of the un dergraduate medical experience, medical educators must find ways of determi ning the specific advantages that community and hospital settings can contr ibute to undergraduate learning and of using these resources effectively to develop comprehensive and integrated curricula. Innovations in teaching me thods may also be necessary to provide an effective educational experience and promote active learning.