Community-based or tertiary-based medical education: so what is the question?

This edition of Medical Teacher brings to our attention another insightful article from the Flinders University Rural Clinical School, led by Professor Paul Worley (Worley et al., 2004), enquiring as to what students actually do on their clinical rotations. Beginning with the premise that there is little published material exploring the learning activities undertaken by students in different learning environments, Worley and colleagues conducted a study that was able to compare three groups of students. These students were exposed to the same curricula material in three different environments, namely an urban teaching hospital, a remote secondary referral hospital and a rural community-based programme. Although Worley et al. admit to the small numbers of students within the study, and the generalisability of their results, the community students reported greater and more valuable patient contact, more effective time spent in clinical settings and an increased time being supervised by experienced clinicians, compared to the secondary and tertiary based students. The secondary hospital based students reported more time spent in lectures and tutorials than the tertiary or community-based students and the time spent in their clinical settings was valued less than the time spent learning at home. The impact is that this is yet another paper that demonstrates the value of communities as a credible alternative to the traditional teaching hospital. However it does raise other questions regarding medical education and community learning.