Community Placements in Medical Education
Community placements aim to provide medical students with opportunities to learn about the social basis and context of health and healthcare by placing them with a wide range of organisations and groups which are situated in and work with their local communities. Where I work, in undergraduate medical education in the School of Medicine, Pharmacy and Health at Durham University (http://www.dur.ac.uk/school.health) , students are on placements with organisations such as mainstream and special schools, support groups for carers, parents, children and young people, services for people with mental, physical and emotional health and welfare needs, youth clubs, hostels, outreach and community development projects and organisations working with a variety of socially marginalised and vulnerable groups and individuals. Many of the organisations are in the charitable or ‘third sector’.
Community placements complement clinical placements and experiences and provide a concrete environment for student learning about the social aspects of health through engagement with ‘real’ social context. They have opportunities learn about how people ‘do’ and experience health outside the mainstream of formal health services. Placements may also help to promote medicine to difficult to reach and vulnerable groups who often engage with ‘third sector‘ community-based organisations but not health services, provide a context for students learning about cultural difference and development of cultural competence and ultimately, encourage them to work in difficult and deprived areas which traditionally are under-served by health services.
This learning is increasingly important because of changes in the nature of health, healthcare and the role and demands on doctors. The UK faces challenges posed by an aging population, increases in migrancy and cultural diversity, the prevalence of chronic disease and the influence of life-style factors on health. Doctors need to understand public health and their role in its protection and promotion. Health services are moving away from the provision of acute, primary care to a community base focused on long-term management of health and social care. Many doctors will need to work ever more closely with a range of healthcare and other professionals and communities to support networks of health and social care. These structural changes are accompanied by rising expectations that doctors will work in patient-centred ways, respectful of people’s views, needs autonomy and rights.
Developing practice, theory, evaluation and research
Community placements in the context of medical education are an exciting and innovative way of helping doctors of the future to understand and meet these challenges. But, underpinning theory remains relatively emergent rather than fully developed. There are challenges around assessment of placement-learning, the logistical organisational and administration of placements and reconciling partners’ investment, governance processes, policies and working practices.
I am visiting colleagues in Australia to explore how they are approaching these issues in the context of programmes based at Monash, Western Sydney and Newcastle universities which have well-developed community placement schemes.
Not only am I hoping to develop my knowledge, understanding and academic practice but to share this with colleagues across the UK making use the HEA and networks such as BeSST (http://besstnetwork.wordpress.com). Specifically, I am aiming to:
- Capture and describe emerging practice in contexts where placement learning associated with the social sciences in medical education is developing most rapidly;
- Explore its theoretical and empirical bases;
- Share and develop practice relating to specific challenges of the kind listed above;
- And, to develop a research agenda and practice about evaluating process and impact and identify areas for development in the future.