Strengths and Challenges for Medical Students and Residents in Rural Japan

In Japan, family medicine training is driven by community-based medical education (CBME) and is often provided in rural community hospitals and clinics. Although CBME's positive relationship to family medicine in rural community hospitals is proven, the learning processes of medical students and residents in rural community hospitals needs investigating. The objective of this study was to reveal medical students' and residents' changing motivations and learning behaviors, as well as the factors underpinning their transition between medical schools or tertiary hospitals and rural community hospitals. Over 2 years, the researchers conducted one-on-one interviews with 50 medical students and 30 residents participating in family medicine training at a rural community hospital, and analyzed the difficulties the participants encountered and how they overcame them. The interviews were audio recorded and transcribed verbatim. We used grounded theory in the data analysis to clarify the findings. Three key themes emerged: educational background, changing environment, and factors driving the learning cycle. Participants had difficulties in overcoming differences between their previous education and their CBME, particularly regarding expected roles and the variety of medical issues. They overcame their difficulties through cognitive apprenticeships and legitimate peripheral participation enhanced by daily reflection. In rural community hospitals, participants struggled to adapt to the wider practice range and the more interactive relationship with educators. Cognitive apprenticeships and legitimate peripheral participation, supported by constant reflection between learners and clinical teachers, can facilitate learning, leading to more effective learning and practice of family medicine in rural areas.