Early exposure to a primary care course: a co-created transformative approach in health systems science

As health systems science has become the third pillar of medical education (along with basic and clinical sciences), Thailand has been developing medical curricula to focus more on its health systems. Despite primary care being the driving force of Thailand's health systems, their integration into the curricula remains a challenge, resulting in medical students having limited exposure and understanding. To address this, a course was co-created by stakeholders to provide students with early exposure to and understanding of primary care mechanisms. Forty-one first- and second-year medical students designed their learning experience with faculty staff and hospital directors based on excursions at four community hospitals. The course included interactive lectures, a one-week excursion and knowledge-sharing sessions. The authors assessed the course's effectiveness using mixed methods: pre- and post-tests on health system concepts and reflective writings after completion of the course. The authors analysed the test scores through descriptive statistics and the writings through thematic analysis. The co-creation process was evaluated with focus group discussions among all stakeholders and visualised using a casual loop diagram (CLD). The test results showed an increase in the knowledge and understanding of primary care in health systems after the course. The reflective writings on encountering contextualised health challenges revealed an understanding of the importance of primary care and community engagement strategies; the emerging themes were the students' learning motivation as future physicians, interest in systems thinking and understanding of leadership in healthcare. The CLD revealed how co-creation, real-world exposure, reflective practice and faculty facilitation interacted to build student ownership, transformative learning and self-efficacy through reinforcing feedback loops. This study reveals how health systems, especially on a primary care level, can be effectively taught through engaging students in course co-creation. Fostering transformative learning is a starting point towards a socially accountable medical school.