Evaluating primary care as a base for medical education: the report of theCambridge Community-based Clinical Course

Background Medical students receive increasing amounts of their clinical ed ucation in a primary care setting. The educational possibilities of such at tachments are still being explored. Aim To report the evaluation of a small, radical innovation to provide stud ents with a long-term community attachment which integrated with hospital-b ased education. Method Between 1993 and 1998, 13 medical students completed 15-month attach ments with a single general practice in England. The course offered them ex perience in the major clinical specialties throughout this period. Students were exposed to specialist as well as generalist education in the context of patients with whom they could establish a continuing relationship. The i nnovation was evaluated by its feasibility, by students' examination result s, by analysis of clinical experience, through formal student feedback and by cost. Results The course was practicable in a particular setting with academic le adership. The students all passed their exams. They had wide, appropriate c linical experience even though the attachment was to a single practice. Whe n they returned to the hospital environment, students did not feel themselv es at a disadvantage compared with traditional students. The costs of the c ourse are controversial: placement costs were higher than in the hospital, but those for facilities were lower. Conclusion It is possible to run a course like this successfully. It remain s the most radical attempt to share clinical education in the UK between pr imary and secondary/tertiary care. Further research is required into provid ing long-term clinical attachments in NHS primary care settings.