Relationships: a new way to analyse community-based medical education? (Part one)

Relationships do matter! In fact, medicine cannot be learned without them, and community-based medical education (CBME) curricula that ignore them or take them for granted do so at their students' peril. As CBME is becoming more popular, there is a need to develop appropriate frameworks for describing quality in CBME to ensure that it remains a principle-driven, not format-driven, initiative. In this paper, I provide evidence for a simple model of four key relationships, the four Rs, in which the medical student must be immersed to facilitate high quality learning. These four Rs are the relationships between (1) clinicians and patients, (2) health service and university research, (3) government and community, and (4) personal principles and professional expectations. As a result of this synthesis of the current medical education literature, I propose that this model of clinical, social, institutional and interpersonal relationships is a valid framework for articulating the important principles in CBME, and that it describes why community-based medical education is such an attractive alternative. Relationships do matter!