Purpose In addition to addressing issues with individuals, physicians need to understand community resources as well as barriers and potential solutions in order to effectively intervene in health behavioral issues. The purpose of our study was to determine how well first-year medical students understand these community issues after an early clinical experience.
Methods Following a week-long community-based primary care experience, 103 first-year medical students were asked to write their responses to the following questions: What was the most important health-related behavioral issue leading to illness you observed? What barriers exist in the community to changing this behavior and how may these be overcome? Two raters independently examined responses for themes using qualitative methodology.
Results Obesity-related issues (48%) were the most prevalent reported, followed by smoking (39%). We chose to further analyze the data regarding obesity. Student-perceived community barriers included nutritional issues (51%) and accessibility to exercise areas/programs (9%). Twenty-four percent of student responses pertained to individual behavior such as lack of time and sedentary lifestyle rather than community issues. Potential solutions included education (33%), healthy food alternatives (27%), and community-based exercise areas/programs (26%).
Conclusions Students had a fairly good grasp of community barriers regarding obesity; however, they did not demonstrate an adequate knowledge of potential community-based solutions. Their main focus was on education rather than on development of community programs or collaborating with existing organizations such as schools, the workplace, or the state. Early teaching in areas of practice-based learning and systems-based practice may be useful in correcting this discrepancy.
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