Does community-based education come close to what it should be? A case study from the developing world: Students' opinions

Abstract

Context: There has been an increase in the number of medical schools implementing community-based educational (CBE) programmes. However, there are doubts whether CBE programmes are appropriately implemented. As a case study, the CBE programme of the Medical Faculty of Diponegoro University (MFDU) in Semarang, Indonesia was evaluated. Objectives: To acquire MFDU's students' opinions on their CBE programme as part of a comprehensive evaluation of that programme, and to generate recommendations for improvement of MFDU's CBE programme. Methods: Coles and Grant's model for curriculum evaluation was applied. This model recommends triangulation of data generated from comparison of the programme as designed “on paper”, as implemented “in action” by the faculty, and “as experienced” by the students. To assess the curriculum as experienced by the students, direct participatory observation was performed and focus group discussions were conducted to collect students' opinions. Results: Students specifically signalled: (1) frequent overlap of lectures given during the CBE clerkship and in the previous part of the curriculum, (2) mismatch between their activities in the community and the community's felt health needs, (3) greater benefits of the CBE programme for Primary Health Care (PHC) centres and students than for target communities, and (4) incidental defective co-operation between students and health providers or community health workers. Conclusion: Students' opinions yielded more in-depth information on the CBE programme evaluated and facilitated formulation of recommendations for improvement of that CBE programme.