Community-based education in the Institute of Medicine, Tribhuvan University, Nepal: a qualitative assessment

Background: Community-based education (CBE) involves learning activities that take place in a community setting. CBE is now recognized as an important addition to medical education, because the skills of graduates are needed more in communities than in urban and tertiary hospitals. The goal of CBE is to help the students understand social dynamics of health promotion and disease prevention and to impart a sense of social justice and cultural humility. Since its establishment in 1972, the Institute of Medicine (IOM) has provided community-based education in the medical and public health programs. Purpose: The objective of this study was to assess the organization and implementation of CBE in the IOM. This study also aimed to make recommendations based on the perspectives of students, faculty, education managers and administrative staff. Methods: The methods employed in this study were descriptive and exploratory using primary as well as secondary data collection. Primary data were collected using a qualitative approach – five focus group discussions with the students of Bachelor of Medicine and Bachelor of Surgery and Bachelor of Public Health programs, and 13 interviews with faculty members, field coordinators, administrative staff and office-bearers of the IOM. Additionally, observation of the infrastructure for implementing CBE activities was conducted. Secondary data were collected from the field reports of the students. The results were grouped into the following themes – organization of CBE, implementation of CBE and beneficiary perspectives. Results: The CBE has remained an important component of the undergraduate medical and public health curricula of the IOM since its establishment in 1972. The students and faculty members emphasized the importance of CBE in medical and public health education. The IOM has achieved the curricular objectives of the CBE by developing relevant guidelines and regularly conducting orientations and field activities. Conclusions: The organization and implementation of the CBE need to be made more effective and efficient by simplifying the administrative and financial procedures, specifying teaching communities, acknowledging the support of community and stakeholders, increasing the service components in students’ field practice, and engaging the communities in planning, implementation and evaluation of CBE.