Educational principles of community-based education.

Much of medical education remains teacher centered, as exemplified by the continued emphasis on lectures. Increasingly, however, the importance of the learner is being recognized and acknowledged in medical school curricula. The distinction between teaching and learning is also an issue for graduate medical education; accreditation bodies focus on programs and teaching, and credentialing bodies determine whether individuals have accomplished sufficient learning. The true mission of teaching is to facilitate learning, and adult learning is enhanced by four elements: respect, building on previous experiences, immediacy of application, and the opportunity to practice. These elements should be considered when designing educational experiences in the community. Educational planning includes five steps, represented by the mnemonic GNOME: goals, needs assessment, objectives, methods, and evaluation. Goals are broad aspirations, which are refined by the learners' needs to specific, measurable objectives. Methods are selected to match the objective, and evaluation determines whether the objectives were achieved. The results of the evaluation serve as another needs assessment, and the process continues until the goals are achieved. Throughout the process, the primary focus should be on the resident, with the program in a supporting role.