Over the years, Community Based Education (CBE) program has gained popularity in the field of medicine. Its success as well is observable since many Institutions have shifted from the traditional approaches into CBE. The values of CBE in education, therefore, cannot be ignored if the health needs and interests of the community should be met.
The definition of Community Based Education is best defined by first understanding the meaning of a community. A community is a group of people with similar characteristics or people from a specific district or country in the context of social values and responsibilities. It is what makes a group of individuals a society. Based on the very definition of community, Community Based Education (CBE) therefore deals with community and the care of the people. Villani et al. (2000) define community-based education (CBE) as a form of instruction where students learn professional competences in a community setting primarily to build a sense of connection between the students and their communities. CBE is considered very crucial in enhancing independence between education and communities, which in turn helps in improving the quality of life among individuals and groups.
Another definition from John Hopkins University Community Based Learning (CBL) Group states that CBE is a pedagogical model that connects classroom-based work with meaningful community involvement and exchange (John Hopkins Working Group, 2013).Community-Oriented Education, on the other hand, is another medical education approach. Just like CBE, the approach focuses on a comprehensive approach to medicine that emphasizes health promotion, prevention, and rehabilitation at primary, secondary and tertiary levels.
Schmidt et al. (1991) believes that the main objective of COE is to graduate community-oriented
A physician who can serve his surrounding community by dealing with health problems.
Nevertheless, some differences exist between CBE and COE. According to Hays (2007), COE indicates the relevance of the program’s objectives to the health needs and interests of the community. The content, as well, should reflect these objectives. Another difference is that COE is primarily centred within the medical institution while on the other hand, CBE goes beyond the institution walls since its activities are attached to the surrounding community. CBE mainly focuses on learning activities in a particular community setting. CBE is also evidence-based. It utilizes more scientific methods as compared to COE. In this case, students get to learn the basic sciences with relevance to clinical practice which in the long run, equips the learner with efficient competency skills and experience to deal with the community needs.
In other words, CBE is one of the implementation approaches of the Community Oriented Educational Program. Owing to these many definitions, it is clear that there is no standard definition of the two concepts. This is illustrated by the fact that some scholars use the two terms interchangeably to mean the same thing. The two concepts, however, should work towards graduating the social and preventive physician rather than an individual and curative physician (Hays 2007).
From the many definitions of CBE, the community, in this case, is very important. The community provides a place to learn since it exposes learners to a vast array of issues for study and act. Other than simply basing the learning process in the community, CBE puts into consideration the interests and needs of the surrounding community. Due to its involvement in the community, CBE has the capacity of incorporating the emotional and social aspects of learning. (Hays 2007). This is mainly achieved through the interaction of various entities such as parents, schools and the community. Such interaction will foster collaboration which is very necessary for solving the problems faced by the community. Everyone will be involved in the entire educational process. Without community, therefore, the whole learning process would be futile.
CBE emphasizes real-world learning; it links between living and learning. CBE is research-oriented and puts into consideration the fact that young learners are likely to put their energies and attention on content that has personal meaning. More so, the content should build on what they already know and even allow learners to apply what they have learned in the real world. This further enables learners to be responsible for providing solutions to the inherent problems and needs faced in a particular community. The knowledge gain will also help in solving future day problems. Kreitzer et al. (2009) assert that CBE does not restrict itself merely on the intellectual abilities of a student, it involves the ability to gain an understanding of ideas and using the knowledge acquired in solving problems. CBE also facilitates interpersonal relationships and development.
The History and Evolution of CBE
To appreciate the benefits of CBE today in health care, it is extremely important to understand the historical context and evolution of CBE. The term CBE was first coined in Kingston, Jamaica meeting of the network-Towards Unity for Health (TUFH) around years ago. Conversely, the first prospects of CBE were initiated in the 1978 meeting of world health leaders in Alma Atta, Kazakhstan, Primary Health Care in their vision to improve the health care of the population by the year 2000. The main objective of the meeting was to identify the best educational program that would be responsive in meeting the needs and problems of the community they serve. The program needed to be was to be socially relevant and able to ensure health promotion in the community, clean water and proper sanitation for all. CBE, therefore, was established since it had prospects to meet the health conditions primarily within the local context. CBE, however, has developed with a series of models introduced frequently to enhance its sustainability and effectiveness in the community.
Social accountability in medical schools is defined by Boelen et al. (1995) as the ability to work in partnership with key stakeholders to impact greatly on the wellbeing of the people. Key stakeholders, in this case, include healthcare organizations, health insurance providers, policymakers, health professionals and civil society. In CBE, social accountability is important since it helps in identifying current and future health needs as well as challenges facing society. Other than identifying the challenges, social accountability aims to train future health professionals and more so propose working health models that would effectively promote the health status of the immediate community.
The El-Tal-El-Kebir story provides the best example of social accountability at work (Talaat et al. 2012). The story was initiated by the Faculty of Medicine to help the Egyptian people, especially from the district of El-Tal-El-Kebir. The establishment was motivated by residence’ inability to address poor health statistics in the region. The move was a success in proving that social accountability is important in mobilizing other sectors to work for the common good, improve community health. It is also a pointer and a challenge for others that medical schools to at all times develop health projects and research question formulation in association with the community.
In conclusion, a graduate of CBE can be said to have acquired social skills, leadership skills, decision-making skills, problem-solving skills and even the necessary clinical and managerial skills which are pertinent in healthcare provision for all. The need for social accountability is also ingrained in the students’ minds. All-round competencies are fostered through CBE.
Boelen C. & Heck JE (1995). Defining and measuring the social accountability of medical schools. Geneva: World Health Organization, 1995:3.
Hamad B (1991). Community Oriented Medical Education, What it is? MedicalEducation, 1991, 25: 16-22.
Hays, R. (2007). Community-Oriented Medical Education. Teaching and Teacher Education, 2007, 23, 286–293.
Kreitzer M.J. Kligler B. Meeker W.C. (2009). Health professions’ education and Integrative health are commissioned for the IOM Summit on Integrative Medicine and the Health of the Public. February 2009.
Magzoub M.E. Schmidt H.G (2000). A taxonomy of community-based medical education. Academic Medicine, 2000, 75 (7), 699-707.
Schmidt H.G. Neufeld V. R. Nooman Z. M. Ogunbode T. (1991). The network of Community-Oriented Education institutions for health sciences. Academic
Medicine, 1991, 66(5): 259-263.
Talaat W., El-Wazir Y. (2012). The El-Tal El-Kebir Story: An example of social accountability from Egypt. Medical Teacher 2012; 34:354-360.
Villani C J. & Atkins D (2000). Community-Based Education, School Community Journal, Vol. 10, No. 1, Spring/Summer 2000.
Module 1 Assignment 2a
Community-Based Education (CBE) Case Studies.
Deep insights about CBE could be fostered by analyzing and synthesizing the experiences obtained through the innumerable global case studies. For instance, the Experiences in developing and implementing a Community-Based Education strategy – a case study from South Africa and Egypt’s case study are perfect examples to use. The case studies provide diverse views and a broad definition of CBE, which is centralized at facilitating sustainability and social accountability. Such diverse views are worth considering since they inform various institutions not only on the prospects of CBE but also on the challenges likely to be experienced by implementing such an educational strategy.
The concept of CBE, according to Suez Canal University’s experience with the local community in Egypt case study is almost similar to that of WHO. In this case study CBE is made of activities that utilize the community extensively as a learning environment in which not only students, but also teachers, members of the community, and representatives of other sectors are actively involved throughout the educational experience (Bester, (2006). In the case study from Egypt, the definition of CBE is further expanded to go beyond community involvement to include empathy and dedication in the whole education process.
The duration of the community-based learning activities varies depending on the method used in each case study. For instance, in the Egypt case study, the all process took SIX years. The flow of events was chronological depending on the training being offered, as the years rolled by the student’s training intensified to managerial competencies, evaluation services, and quality improvement strategies (Talaat, 2012). For instance, in year one, the students attended training at Primary Health Care Centers (PHCC) two days every week in years one and two. The program would then proceed to community survey activities such as the survey on the nutritional habits among the Bedouins. In years two and three children screening for common health care problems were done, year four involved elective studies, and in the final years, the activities were focused on things affecting the community as a whole. At every step, students used problem-solving techniques whereby a problem was first defined, followed by clarification of vague presentations then the analysis of the signs and symptoms and finally setting of objectives and interventions.
The partners involved in the Suez- Egypt case study mostly involve those working under the ministry of health. These include physicians from the ministry and the FOMSCU faculty and students. Other partners included Suez Canal University Schools as Veterinary Medicine, Agriculture, and Education (Talaat, 2012). It is also important to include the major stakeholders such as the people from the TEK community, WHO and the American University in Cairo. These groups were very instrumental in enhancing sustainable development in the underserved areas of the community. The spirit of social accountability for community empowerment was cherished by the partnership from the various sectors (Talaat, 2012).
Formative assessment was the major assessment method used in assessing the students at the PHCC level. The formative assessments at PHCC were done every week. The checklist specifically aimed at assessing the knowledge, skills, and attitude of the patients. The family visits, as well, were evaluated with the help of periodic progress reports. The electives, as well, were assessed through the presentation, defence, and reports. The summative evaluation was used at the end of the program (Maklady et al. 1998).
The case study from South Africa also provides important insights into CBE experiences. South African health programs have evolved. The case study provides the historical changes the government has undertaken in its pursuit to provide comprehensive health coverage to all citizens in the country. The initiative was gradually narrowed down to having a community based primary care. According to Cilliers et al. (2005), the government, through the health care policy initiated CBE mainly to provide appropriate community-based training to medical students to facilitate the provision of appropriate primary health care services. Several studies and research were performed, and they all positively provided support for the implementation of CBE programs to address health issues. The Ukwanda Rural Clinical School provided an ample setting to carry out the activities of the program (Bester, (2006). The community-based learning activities took six years.
According to Hosny (2013), the main participants or partners in this program were sub-specialists from tertiary hospitals, local specialists and family physicians from the local district hospitals. The partnership was solidified by the presence of Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) Mullan et al. (2012). The roles of these partners were to formulate a list of common clinical presentations. They were to attend a series of curriculum planning workshops which pioneered the need for social accountability. Another task for these members was to identify appropriate evaluation methods to be used in the process.
The assessment of students was also done in unique ways. Local family physicians, sub-specialists from the rural district hospital as well other stakeholders served as examiners and provided the assessment at the end-of rotation clinical examination Bester, (2006). The assessment method employed in this case study was a structured interview. The introduction of patient portfolios made it possible to track student progress during the learning process.
In conclusion, these case studies are crucial in understanding CBE as a whole even though they are only but representation from various parts of the globe. The studies provided does not only provide the strategies used in CBE, but it also informs on the creative ways of approaching and interacting with a given community as well as providing the drawbacks associated with the strategy. It is from such experiences also that concerned institutions get to know what should be done in the future to improve healthcare services and the quality of life of all individuals in the community.
Bester, J. (2006). The development of a theory to inform an interdisciplinary teaching and learning framework for the Stellenbosch University Faculty of Health Sciences. 2006. Unpublished document. Bester (2006)
Cilliers F., Mji G. (2005). Community-Based Education at the Faculty of Health Sciences at Stellenbosch University. 2005. Unpublished document
Ezzat, E.S. (1995). Role of community in contemporary health professions education. Medical education, 29(supplement 1), 44-52.
Hosny S., Kamel M.H., El-Wazir Y. & Gilbert J. (2013). IntegratingInterprofessional Education in Community-Based Learning Activities: a Casestudy. Med Teach. 2013;35Suppl 1:S68-73.
Maklady F. & Talaat W. (1998). Research document on the graduate’s competencies in the Faculty of Medicine, Suez Canal University in collaboration with the Eastern Mediterranean Regional Office of theWorld Health Organization. Geneva: WHO. Pp. 82–85.
Mullan F., Frehywot S., Omaswa F. et al. (2012). The Medical Education Partnership Initiative: PEPFAR’s effort to boost health worker education to strengthen health systems. Health Affairs. 2012; 31(7); 1-12.
Talaat W. & El Wazir Y. (2012). The El-Tal El Kebir Story: an example of social accountability from Egypt. Medical Teacher, 2012, 34, 354-360.
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