Medical education institutions that practice outcome-based education are also expected to play a role in responding to societal needs. In order to clarify the primary care education that society needs, we considered it desirable to create learning objectives by integrating the perceptions of community-based primary care physicians and the knowledge of university faculties from the standpoint of medical education, and to match these objectives with education and evaluation.
This strategy is also desirable from the perspective of implementing community-based medical education (CBME). CBME is not only about placing the education in the community, but also about teaching the concept of primary health care in primary care settings, so it is inevitable that the curriculum reflect the voices of the community10,11. Therefore, we have adopted a method of incorporating the opinions of community-based primary care physicians who are considered to be representative of the community.
The main focus of this curriculum revision is to clarify the learning objectives of the program, which combines general medicine/primary care clerkship and community medicine clerkship, in line with the needs of the community. As part of the general medicine/primary care training, students learn about the general practice skills that are required of doctors in all specialties and acquire the image of a general practitioner. In addition, from the perspective of the community medicine clerkship, students need to understand the public health, medical care, welfare, and nursing care activities required in the community, and learn the necessity of building community medicine and Community-based Integrated Care System in an integrated manner.1
In Japan, general medicine has just been officially recognized as a specialty in 2018, but as society demands more leaders in community medicine, there is an urgent need for further training of general practitioners12. Therefore, it is not hard to imagine that the improvement of general medicine and community medicine clerkship is expected to increase the number of young people who choose general medicine and community medicine as their future career.
Several studies have been conducted nationally and internationally on what experiences of medical students doing primary care clerkship leads to their choice of community or primary care careers. One qualitative study suggests that positive interaction with local residents and medical professionals, as well as contact with the attractive environment and culture of the region, can lead to a regional career13. In terms of quantitative data, a systematic review has shown that Longitudinal Integrated Clerkship(LIC) is the only intervention consistently associated with an increased in the proportion of students choosing primary care14. In fact, a previous study conducted in Japan failed to prove that community-based training significantly increases career choice in the community15.
According to the aforementioned systematic review, successful interventions were characterized by diverse teaching formats, student selection, and good-quality teaching. Therefore, the improvement of general medicine and community medicine clerkship provided to all medical students will indirectly serve as a foundation for the penetration and development of general medicine. From the viewpoint of fostering a large number of general practitioners, LICs are desirable, as mentioned above, and the first empirical trial of LIC in Japan is being conducted at Mie University School of Medicine16.
In terms of capturing the true needs of the community, it is most desirable to obtain information from a wide range of sources, including local medical providers, welfare, government, and residents. Obtaining information only from local community physicians may be considered to be a limitation. In addition, from the perspective of primary care physicians throughout Mie Prefecture, the target population of this study is very limited and does not cover all the needs of the Mie Prefecture. While the curriculum developed at Mie University can be used by medical schools around the world, it was developed based on feedback from community physicians in Mie University’s region, and each region where the university is located may have its own specific learning needs.