Development and evaluation of a community immersion program during preclinical medical studies: a 15-year experience at the University of Geneva Medical School

P Chastonay,^1,2 V Zesiger,¹ A Klohn,¹ L Soguel,³ E K Mpinga,^1,4 NV Vu,² L Bernheim<sup>5

1</sup>Institute of Social and Preventive Medicine, ²Unit of Development and Research in Medical Education, University of Geneva, Faculty of Medicine, Geneva, ³Nutrition and Dietetics Department, University of Applied Sciences, Geneva, ⁴Swiss School of Public Health, Zurich, ⁵Department of Neurosciences, University of Geneva, Faculty of Medicine, Geneva, Switzerland

Background: Significant changes in medical education have occurred in recent decades because of new challenges in the health sector and new learning theories and practices. This might have contributed to the decision of medical schools throughout the world to adopt community-based learning activities. The community-based learning approach has been promoted and supported by the World Health Organization and has emerged as an efficient learning strategy. The aim of the present paper is to describe the characteristics of a community immersion clerkship for third-year undergraduate medical students, its evolution over 15 years, and an evaluation of its outcomes.
Methods: A review of the literature and consensus meetings with a multidisciplinary group of health professionals were used to define learning objectives and an educational approach when developing the program. Evaluation of the program addressed students' perception, achievement of learning objectives, interactions between students and the community, and educational innovations over the years.
Results: The program and the main learning objectives were defined by consensus meetings among teaching staff and community health workers, which strengthened the community immersion clerkship. Satisfaction, as monitored by a self-administered questionnaire in successive cohorts of students, showed a mean of 4.4 on a five-point scale. Students also mentioned community immersion clerkship as a unique community experience. The learning objectives were reached by a vast majority of students. Behavior evaluation was not assessed per se, but specific testimonies show that students have been marked by their community experience. The evaluation also assessed outcomes such as educational innovations (eg, students teaching other students), new developments in the curriculum (eg, partnership with the University of Applied Health Sciences), and interaction between students and the community (eg, student development of a website for a community health institution).
Conclusion: The community immersion clerkship trains future doctors to respond to the health problems of individuals in their complexity, and strengthens their ability to work with the community.

Keywords: community immersion, community-based learning, community health, medical curriculum