Community-Based Education, Primary Care and Social Accountability

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Community based education(CBE) helps young health professionals to appreciate the medical field and at the same time improves access to universal health care, observes  Dr. Elsie Kiguli-Malwadde, the ACHEST Director of Medical Education and Development.

  Dr. Kiguli-Malwadde, who is also the Secretary General of The Network Towards Unity for Health(TUFH) said this while delivering a presentation on the importance on CBE during a virtual conference hosted by  TUFH in partnership with the Faculty of Medicine, Public Health, and Nursing – Universitas Gadjah Mada, Indonesia.

The conference, under the theme “Community-Based Education, Primary Care and Social Accountability, was held virtually on July 5.2021. It was attended by about 300 participants from Asia, Africa, America, Australia, and Europe. The audience comprised of lecturers, health practitioners  as well  as students.

Dr. Kiguli-Malwadde defined CBE as medical education which places the learners clinical training in a community setting.

“It exposes learners who are managing their patients within their own family, social and community contexts. This gives them contextual learning so that the students appreciate the environments they would be working in after graduation. Learners become part of the social and medical communities where learning takes place. When you take the students to the community they understand their communities and  patients better,” she explained.

She said the objective of  CBE is to  improve the universal accessibility of health care.

“When we have students going out of the faculty to go to their communities, then they take basic health care to the communities and there are more people that access health. When you look after one individual in the community, that individual has a family and you’re reaching out to the entire household,” she said

The other objective is to train undergraduate health professional students in diagnosis, management and if possible solutions of community health problems

“For example, at Makerere University, when we send students in the community, they identify a problem, e.g lack of access to water, which might be the cause of health problems among young children if they are presenting diarrhea at  health centers.”

The general objective of CBE is to expand the students’ notion of community health problems through their learning, service and research, thereby improving the health of the community.

“If they are imbedded in the community, they learn about wellness, not just disease. When we are in the hospitals, we meet people that are sick, and the students learn about disease and pathology. But in the communities, they learn about wellness, how people live and integrated with them and understand them better,” explained Dr. Kiguli-Malwadde.

CBE is often delivered in 2 ways. The first one is the longitudinal clinical integrated clerkship, where  students  spend a longer time with communities, and are involved in sustained relationships with their patients and health professionals and integrate various learning topics. For example, in Stellenbosch University in South Africa  students spend the whole of their fourth year in the community working at a health center near the community, with a family physician. By the time they leave, they know that community  well, they have worked with them and know how to manage their patients within their locality, making it contextual. “This gives an integrated approach to health provision in that you are not just seeing  a patient with diabetes coming to the health centre but you follow them up in the community to see what they eat, where they live and work,” said Dr. Kiguli Malwadde, adding that this is taking root in other countries.

The second model of delivery are short CBE placements. This is   done in many universities in East Africa. Medical students take community placements for a period of 5-10 weeks and keep following up annually, over their five-year course of study.  

The outcomes of CBE are good.Research has found that students that do CBE have strong communication skills, better clinical reasoning and management skills and are more likely to subscribe to primary care and rural training programs. They also gain recognition as the future health professionals and are confidence to diagnose patients on their own, among other benefits.  “They are learning from real people with medical conditions rather than just pathology in patients who are in a short-term residents in a tertiary hospital setting. This prevents them from losing empathy and objectifying patients,” said Dr. Kiguli-Malwadde.

However, there are challenges on sustainability, the high costs in running the model, student assessment and faculty recruitment and retention.

Listen to the full discussion here: https://www.youtube.com/watch?v=yZZwb1tjpxs

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