What Does “Community Training” Actually Mean?
‘Community training’ is an umbrella term that can mean different things at different medical schools: it’s helpful to go and look at each individual course and of course to talk with current students!
One helpful way to think about community training is through the lens of primary versus secondary and tertiary care. Primary care services are the NHS ‘front door’: healthcare centres which serve a small local population and make up the bulk of how people access care. It’s a common misconception that primary care is ‘just’ General Practice, but pharmacies, optometrists and community dentists are also part of primary care. Secondary and tertiary care centres, in contrast, are essentially hospitals: larger, specialist services that people travel to, having been referred from primary care.
Historically, medical training took place almost exclusively in secondary care (or in hospitals). This has been criticised for promoting a particular view of medicine that doesn’t recognise holistic, community factors influencing patients’ health beliefs and behaviours. Community training, in contrast, prioritises primary care placements to allow students to become embedded in these local health networks.
There’s more to community training than GP placements; after all, all medical schools now offer primary care provision. Community training approaches often focus on relationships with local communities and social justice, looking at how medical schools can give back to the people they serve. They also prioritise building relationships over time, such as through Longitudinal Integrated Clerkships, where students attend the same GP practice for a day a week (or more!) for a year, compared to traditional placement models of blocks of several months.
Many UK medical schools offer well established community based models, such as Kings’ Undergraduate Medical Education in the Community programme or the ScotGEM model of an integrated generalist degree focused on rural Scotland. More recently, the University of Hertfordshire’s new course will focus on building student relationships in an underserved region of the UK, to improve health services on a local community level.
When Do You See Your First Real Patient as a medical student – and does it matter?
One big plus of community training approaches to medical education is that they offer early patient contact, integrated throughout your degree. Traditional medical degrees typically offer no patient contact at all for the first two or three years, prioritising building scientific knowledge. Community training recognises that the role of a doctor is to apply science to support your patients, allowing you to build longer term relationships with a primary care service and patient cohort.
For example, the University of Hertfordshire’s course will offer early years clinical exposure from the first year, allowing you to build your understanding of local health needs. At the University of Bangor, the entire third year of the medical course runs as a Longitudinal Integrated Clerkship with a strong one to one relationship with your GP tutor. Of course, you will know best what learning style will suit you – but community training is a great way to have safe, supported early years clinical contact with strong mentorship, allowing you to develop as a future clinician.
How can Community Training help you develop as a better doctor?
As we shift to a prevention based, local community driven way of practicing medicine, community training is increasingly popular. Community training is probably the future of the NHS as we move away from hospital based care!
As a student, there are lots of advantages around a community training approach to medical education:
· Relationships: a community training approach means you return to the same clinics and communities, so you can build mentoring relationships and learn from tutors who know you well;
· Local knowledge: you will become embedded in the local communities you serve, making you better able to meet population health needs;
· Clinical knowledge: primary care services are generalist, seeing every patient and managing risk without the backup a huge hospital offers, meaning you get great clinical exposure;
· Making a difference: by spending longer in a community, you will have more time and knowledge to engage in things like Quality Improvement Projects to make your services even better.
How does Community Training help keep up with the changing healthcare needs of the population?
Healthcare is increasingly moving into the community and out of hospitals as a way to keep up with the changing healthcare needs of the aging population and meet NHS demand. Separately, of course, primary care has always been a strong part of the NHS and of how we manage health: it’s only relatively recently that we have prioritised hospitals over communities!
Community training recognises that many patients want to be cared for at home or in their local area, by healthcare professionals who know and understand them and their local geographies. Continuity of care – between the same doctor and patient, but also between families, geographies and communities – is key for better health outcomes. GPs who have worked in the same area for decades will often end up caring for multiple generations of the same family, with much deeper relationships as a result.
A Case Study in Community-Integrated Training
One exciting case study in community integrated training is the new medical school opening at the University of Hertfordshire. Herts’ remit is to address the concerning shortage of doctors in Hertfordshire, a large and varied county in the East of England, stretching from Cambridgeshire and Bedfordshire in the north to the outskirts of London in the south. By opening a new medical school focused on community-integrated training in the region, there is a fantastic opportunity to be part of a new generation of physicians helping this area to thrive.
Conclusions
Hands-on community training approaches are increasingly popular and likely to be part of your future in medicine wherever you study. If building relationships and bringing about change in the local community appeal to you, look for one of the many medical schools emphasising this in their teaching. Most medicine happens outside of hospitals!
