Japan ranks among the top countries in the world in terms of life expectancy, and as the proportion of its elderly people increases, issues about longevity and way of life for the older population have become increasingly problematic. Further, many health-care professionals have been sent from Japan to work in developing countries. From both a domestic and international perspective, health-care professionals need to develop multi-skilled abilities that are adapted to the residents in their communities. However, few programs for early clinical exposure to community settings have been reported for students in the health sciences (i.e., health-care professional students). At Gunma University, implementation of its off-campus program is the first structured approach in this direction. Analysis of the educational effect of this program may provide with information that will help it include community-based education in the health sciences curriculum.
Regarding cluster 1, students’ overall impression of off-campus classes was considered “favorable.” Since our study results showed a combined use of experience-related terms (“actually/watch/learn/hear”) and terms about the community (“local residents/community-based clinical care settings”), we considered that the off-campus classes were highly evaluated and favorably accepted by the students. We expected the community-based learning to be different from university classroom education, and students who participated in the off-campus classes achieved different types of learning in community settings. This was deemed a favorable outcome since the students obtained a good impression of community intervention. Other reports [7
] have also noted that community-based medical education programs were rated favorably by students.
Cluster 2, which consisted of “work of staff member” and “role,” was different from the other clusters. It was expected that this cluster would reveal favorable intervention effects, whereby the program would enable students to visualize their futures working in the community by seeing health-care professionals or medical staff actually doing such work. However, the results suggested that university classroom education and the professional roles required in community settings are poorly matched. Community-based education for medical students reportedly motivates the students in understanding the health-care needs of the community and its residents, and at the same time students can learn from health-care professionals working in actual clinical settings [9
]; hence, it is expected that the off-campus program at Gunma University will contribute to the education and development of health-care professionals able to work in the community. In contrast, Worley et al. [10
] reported on students’ academic performance in tertiary and regional hospitals and found that the effects of community-based clinical practice were no different from those of general practice in hospitals. Their study content, which focused on examination performance by medical students, differs from that in the present study. However, it is expected that an educational approach that enables students to improve their professional knowledge and skills with links to related subjects in other specialty areas will become increasingly adopted in the future.
Regarding cluster 3, the following terms were commonly used: “communication with local residents,” “interaction,” “significant,” “important,” and “necessity.” Martini et al. [11
] reported that a community-based curriculum strongly affects students’ career choices. It was also revealed by Howe et al. [12
] that physicians’ choosing of careers in community-based settings is closely related to their experience of community-based medical education. Our results suggest that the students became aware of the significance of community interactions and started to become interested in community work. This psychological change is considered an important experience for students during their school years; thus, it is suggested that the students achieved effective learning through the off-campus classes.
Cluster 4 indicated that the students “enjoyed” and were “proactive” in community care settings, though they may have felt some confusion with respect to the actual situation. Some written passages related to these terms—for example, “I didn’t know what I should do, so I was confused” and “I wanted to study in on-campus classes, not to become confused in these settings”—led to the above interpretation. O’Sullivan et al. [13
] identified improvement in communication skills and promotion of active learning as relative advantages of community-based clinical education. The present study also found favorable outcomes in that the students enjoyed community-based learning through active participation in the off-campus classes. It is hoped that such off-campus learning experiences will have a synergistic effect on in-campus learning in the future.
Four factors acted as limits in clarifying the effectiveness of off-campus classes in the present study. The first is variety in the content of different classes: every class has its own particular content, and students’ learning may have been influenced by participation in different classes. The second factor is variety among the students: students’ learning and their grades or schools may be closely related, and since community exposure is multi-factorial this alone cannot exert a major effect on the future roles of health-care professionals. The timing of the off-campus exposure may also have an impact on the trainees’ career choices. In this study, we were unable to exclude the influence of such timing, so this needs to be addressed in future studies. Third, only 116 of 163 students submitted the self-assessment worksheets, so it is possible that the results were biased. No attempt was made to obtain information from the 47 students who failed to complete their assessment sheets; future trials would need to collect data from such students. Fourth, no statistical evaluation of the inter-rater agreement was made in this study; every result was judged only by discussion among analyzers. We expected that in this way, we would be able to evaluate every mined term or category statistically to support the results or conclusions.
Seabrook et al. [14
] found that a community-based program was beneficial for both community organizations and schools. Members of community organizations were able to obtain information regarding the university curriculum, and schoolteachers had the opportunity to learn about current medical issues and their application in the community. It was reported by Meyer et al. [15
] that community-academic partnerships contribute to the overall health of the community, and Calleson et al. [16
] demonstrated the importance of the balance between community needs and university requirements for knowledge. The present study was conducted to investigate students’ learning; future studies should investigate outcomes by focusing on the local community, including residents and medical staff members.