Fostering Reflective Practice Through Participant Observation: Medical Students' Learning During Community-Based Clinical Training in Japan.

Abstract

Background: Since 2011, the Department of Community Medicine at Tottori University has provided community-based clinical training for fourth-year medical students. However, conventional community-based training often remains observational and does not necessarily foster students' critical reflection or active questioning in clinical settings. To address this gap, ethnographic methods from medical anthropology were introduced in 2018, allowing students to engage in participant observation. After each weekly practicum session conducted at a community-based medical facility, students documented the questions that emerged and their reasoning in an electronic portfolio (ePF), receiving individual feedback from faculty.

Methods: A qualitative descriptive study was conducted using text data from the 2019 ePF entries of 107 fourth-year medical students. Descriptions of participant observation were analyzed using the text-mining software KH Coder. Co-occurrence network diagrams and textual analysis were used to extract thematic categories.

Results: Frequently used words included "observe," "think," "learn," and "feel." Cluster analysis revealed strong associations such as "question" with "have," "university" with "community," and "study" with "knowledge." Students commonly formulated action plans emphasizing active observation and critical questioning for future clinical training.

Conclusion: Participant observation enabled students to reflect on differences between community and university-based clinical settings. The exercise promoted the development of critical thinking and multiple perspectives, suggesting the value of incorporating anthropological methods into pre-clinical medical education.