COMMUNITY-ORIENTED MEDICAL-EDUCATION - WHAT IS IT

The pressing need for this communication has emerged from the author's experience in conducting educational workshops, seminars and meetings for the orientation of health professionals in community-oriented medical education. Many questions are raised and many statements made which clearly indicate that the term 'community-oriented medical education' (COME) is still misunderstood. It carries a different meaning for different people. Many give it their own meaning and attach to it their own interpretations. This has resulted in wide propagation of the wrong concepts to the detriment of promoting the approach. (It is worth nothing that 'community medicine' has over the years suffered the same fate. Is it because both terms include the word 'community', which often has a poor image for much of the medical profession?) An attempt is made here to clarify the situation by a process of questions and answers, the questions being those frequently asked as such or posed in the form of statements. They are by no means exhaustive. Seven major such questions are addressed with reference to personal experience and the literature. (1) What do we mean by COME, community-based education (CBE) and community-based learning (CBL)? (2) COME is third-grade medical education producing third-grade graduates and 'barefoot doctors'. (3) COME produces community health doctors/specialists. (4) COME is not scientifically based (based only on soft sciences) and basic sciences are neglected. (5) Graduates from COME programmes are not competent in dealing with patients as they spend most of their time in the community. (6) If it is community-oriented education, then what about the hospital? Is it not part of the community? (7) COME is expensive and requires more resources than traditional approaches?