Stakeholders' Expectations of Rural Community-Based Medical Education in Thailand

Author: Praphun Somporn

Somporn, Praphun, 2017 Stakeholders' Expectations of Rural Community-Based Medical Education in Thailand, Flinders University, School of Medicine

Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact with the details.


Thai Rural Community-Based Medical Education (RCBME) is being developed under CPIRD (Collaborative Project to Increase production of Rural Doctors) in order to maximise medical students’ interest in rural general practice, enhance early experiences in the rural community, and improve rural doctor retention rates. Although it is clearly evident that international RCBME outcomes and stakeholders’ experiences are successful in multiple countries, there are not enough studies to make any judgement on whether all stakeholder views are consistent across programs, regions, or countries, and no international comparative studies have explored whether context matters.

To understand this new context for RCBME and answer the research questions– “What should RCBME in the Thai context look like?” and “Does context matter?”– this study aims to explore the understanding and expectations of Thai stakeholders who will participate the first RCBME program development in Songkhla Province, in the lower Southern Region of Thailand, and considers how these attitudes and expectations align with, or differ from, stakeholders’ views in Western countries where RCBME programs are well established.

Worley’s symbiosis model was used as a conceptual framework, demonstrating four fundamental relationships between stakeholders and sectors in clinical education. These can be described into clinical, institutional, personal, and social axes. The symbiosis model was also utilised to evaluate the international evidence in the literature that outlined stakeholders’ perspectives regarding the success and value of RCBME programs.

A qualitative case study was conducted to explore in-depth the view of four stakeholder groups with a range of experiences in rural general practice. Purposive sampling resulted in 21 participants including four CPIRD medical students, six clinical educators, five policy makers, and six rural stakeholders who were health professionals and community members. Individual semi-structured interviews were conducted and transcribed. Themes were analysed within and across Worley’s symbiosis model.

The results can be categorised within the symbiosis model. Considering symbiosis in the clinical axis, Thai RCBME stakeholders expected the RCBME program to offer students authentic preparation for future roles as rural doctors. However, students were expected to be ready to participate actively in the apprenticeship relationships in the clinical environment and contribute to the legitimate work of their rural clinician preceptors. Through apprenticeship-style learning between students and rural health professionals, students were anticipated to develop their meaningful relationships with interprofessional clinical team members. Collaboration between urban and rural clinicians to deliver RCBME could enable each party to see the other side of clinical practice. Symbiosis in the institutional axis can be described that, through RCBME initiative and community placements, stakeholders from tertiary hospitals will meet the government expectations for transferring clinical learning to the rural areas. Stakeholders also expect RCBME to improve and sustain rural health service quality. In addition, stakeholders will in turn support rural health services to succeed with RCBME. In the personal axis, students were expected to develop their rural professional and personal identities, while rural clinician preceptors can be seen to shape student development through their role modelling and mentorship. However, stakeholders expressed concerns about students meeting their academic requirements and protecting the institution’s reputation for successful outcomes with regard to academic results in National Examinations. Recognising the social axis, RCBME students were expected to understand rural patients and rural context during their training period. Potentially, graduates who establish relationships with rural communities will meet the government expectations to support rural health service policy and increase rural doctor retention rates. Additionally, stakeholders expressed hopes that the implementation of RCBME in a rural location would assist in building capacity for rural communities.

Further synthesis of across-axis themes built on the results is presented to integrate stakeholder perspectives on what was critical to ensure the development of RCBME in Thailand. Three across-axis themes which emerged from the results demonstrate that context does matter. These themes include the dramatic shifts in Thai medical education paradigm, stakeholders envisioning ideal futures for themselves within Thai RCBME, and the urban – rural collaborations required to develop successful and sustainable RCBME in the Thai context. This study comprehensively describes Thai stakeholder views of RCBME and demonstrates that although some RCBME principles are universal, context does influence the expectations and capacity of stakeholders to contribute to RCBME. Further studies in regard to RCBME outcomes and stakeholder experiences in a new educational innovation in the Thai context should be conducted in order to confirm stakeholder expectations of the RCBME initiative described in this study.

Keywords: Rural community-based medical education, Stakeholder expectations, Thailand

Subject: Medicine thesis

Thesis type: Masters
Completed: 2017
School: School of Medicine
Supervisor: Lucie Walters