Integrity: the key to quality in community-based medical education? (Part two).

Relationships do matter! In fact, medicine cannot be learned without them, and community-based medical education (CBME) curricula that ignore them or take them for granted do so at their students peril! Could these assertions provide a key to quality in CBME curricula? In a previous paper, I provided evidence for a simple model of four key relationships, the four Rs, to act as a framework to analyse CBME. These four Rs are the relationships between (1) clinicians and patients, (2) health service and university research, (3) government and community, and (4) personal principles and professional expectations. In this paper I describe a key to discerning quality in this model. This key is integrity - that coalition of soundness and interdependence that enables the quality of the whole to be greater than the sum of the parts. I will also discuss the implications of this model for CBME with particular reference to reform of student selection, curricular goals, course structure, and assessment. Whilst further research based on this model is needed, as a result of this synthesis of the current medical education literature, I propose that it is its capacity to produce clinical, social, institutional and interpersonal integrity in its graduates that makes community-based medical education such an attractive alternative. Relationships do matter!