JMIR Publications

ABSTRACT

Background:

Japan faces a significant healthcare delivery challenge due to physician maldistribution, with insufficient numbers of physicians practicing in rural areas. This issue impacts healthcare access in remote areas and affects patient outcomes. Educational interventions targeting students’ career decision-making have the potential to address this problem by promoting interest in rural medicine. We hypothesized that community-based problem-based learning (PBL) using real-patient videos could foster students' understanding of community healthcare and influence their career trajectories toward underserved areas.

Objective:

This study aims to investigate the impact of community-based PBL on medical students’ understanding and engagement with rural healthcare, focusing on their knowledge, skills, and career orientation.

Methods:

Participants were 113 fourth-year medical students from Chiba University who were engaged in a transition course between preclinical and clinical clerkships from October 24 to November 2, 2023. The students were randomly divided into 16 groups (7–8 participants per group). Each group participated in two 3-hour PBL sessions per week over two consecutive weeks. Quantitative data were collected using pre- and post-intervention questionnaires, comprehension tests, and tutor-assessed rubrics. Additionally, qualitative data were gathered from students’ reflective essays and semi-structured interviews. Statistical analysis included mean ± SD, median, IQR, and p-values for quantitative outcomes, while thematic analysis was employed for qualitative data.

Results:

Of the 113 participants, 63% were male and 37% female. Post-intervention, students' comprehension test scores improved significantly (pre-test: 4.1 ± 1.2, post-test: 4.9 ± 1.1, p < 0.001). The rubric-based assessments showed increased knowledge application (pre: 6.5 ± 1.1, post: 8.2 ± 0.9, p < 0.01). Thematic analysis revealed key themes such as “empathy in patient care,” “challenges in home healthcare,” and “professional identity formation.”

Conclusions:

Community-based PBL with real-patient videos effectively enhanced medical students’ understanding of rural healthcare and motivated some students to pursue careers in underserved areas. This approach holds potential as an educational strategy to address physician maldistribution.