Community-based participatory medical education in rural Japan: analysis of medical student learning needs through...

Objective: Rural Japan is facing rapid aging, depopulation, and shortages of physicians. Community-based medical education (CBME) was introduced to cultivate future physicians in rural and underserved regions. The impact of participatory clerkships, in which students actively join healthcare teams should be defined. Methods: From 2015 to 2017, fifth-year medical students (n=132) from a Medical University completed clerkships at a rural hospital. The students participated in outpatient clinics, inpatient wards, home care, and case conferences alongside residents and attending physicians. Daily reflection sheets were collected and analyzed qualitatively, and the learning needs were categorized into four domains. Results: A total of 486 comments were analyzed. Most learning needs concerned general clinical knowledge and skills (65%), followed by patient communication (10.2%); community-specific medicine (14%); and other reflections, including self-attitude (10.7%). Students emphasized medical interviewing, clinical reasoning, and basic procedures as core areas for further learning in general clinical knowledge and skills. Conclusion: Participatory CBME in a rural hospital provides rich opportunities for clinical learning, equivalent to those in urban university hospital rotations, while fostering awareness of rural practices and community care. Our findings suggest that participatory clerkships effectively enhance both clinical competencies and motivation for rural practice.