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Community diagnosis as a transformative learning approach to enhance medical students' community orientation and
Keisuke Hasebe1,2, Kiyoshi Shikino3, Kenjiro Kawaguchi4
1Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan. m11072kh@gmail.com.
Background:
The impact of community diagnosis as an educational strategy on the community orientation of medical students and their understanding of the social determinants of health (SDH) necessitates additional investigation. This study aimed to evaluate the effectiveness of an experiential community diagnosis program in improving the community orientation of medical students, along with their knowledge and attitudes toward SDH.
Methods:
A mixed-methods approach was employed, involving 14 medical students from a regional quota program participating in community diagnosis activities in a rural area from April to September, 2024. Quantitative assessments utilizing the rural self-efficacy scale and the Assessing Student Competence and Knowledge of Social Determinants of Health (ASCK-SDH) tool were conducted pre- and post-intervention and analyzed using the Wilcoxon signed-rank test. Qualitative data were collected through focus group interviews and analyzed using content analysis based on Fink's taxonomy.
Results:
All the participants completed the assessments. Significant improvements were observed in rural self-efficacy (pre: median, 45; IQR, 8; post: median, 52.5; IQR, 7; p = 0.001; effect size, 0.851) and ASCK-SDH scores (pre: median 26, IQR 4; post: median, 31; IQR, 1; p, 0.001; effect size, 0.856). The content analysis identified 15 categories and 64 subcategories as follows: Application (n = 20), Integration (n = 34), Human Dimension (n = 110), Caring (n = 8), and Learning How to Learn (n = 43). Among these, developing professional identity in community healthcare (n = 19) and fostering curiosity in community healthcare (n = 5) were the most frequent under Learning How to Learn and Caring, respectively.
Conclusions:
The experiential community diagnosis program significantly enhanced the community orientation, understanding of SDH, and professional identity of the medical students. These findings support the broader integration of community diagnosis into medical education curricula to enhance student preparedness in addressing complex community health challenges.
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