Dear Editor,
In 1995, World Health Organization (WHO) defined the accountability of medical colleges for community needs as: "Conducting education, research and services to meet the health needs and health priorities of the community, region or nation they are committed to serving it" (1). In order to address the gap between community needs and the curriculum of medical students, medical schools have approached to novel places for providing appropriate trainings for the next generation of physicians. To fill this gap, several strategies such as the Community-Based Medical Education (CBME) have already been deployed (2-4). In fact, traditional hospital-oriented methods have been unable to train committed physicians to serve underdeveloped regions in the era of clinical education (5). In this regard, several studies have indicated that only a small proportion of patients (less than 10%) are referred to hospitals and only about 1% of them are admitted. Accordingly, we would be unable to limit the provided clinical education to hospitals and in the meanwhile train competent physicians for serving remote areas (6).
In Iran, there are rural health centers that provide the most basic health services to the community. If the patient's problem persists or there is a need for specialized services, such patients are referred to higher level caring centers such as urban hospitals. These rural health centers may play an important and promising role in medical education. Medical students should shift from classes and specialized hospitals to rural health centers during the final years of medical school. Some students may spend some of their service time at clinics in less developed areas following graduation. Due to the different social, economical and environmental conditions, a variety of diseases occurs in rural areas. Such diversity of medical problems present an opportunity for medical students to expand their knowledge and integrate their previous trainings with what they learn in the field.
Another advantage of rural educational-health centers is that medical students may feel more liable about the underprivileged parts of their society. Unfortunately, the establishment of educational-health centers is not going to be simple and requires a targeted effort to address administrative, financial and humanistic barriers. A lack of trained educators at these centers and students’ accommodation and transportation are some of the limitations that need to be overcome. More studies are needed to assess local conditions and different aspects of implementing this project.
It seems that it is time for a fundamental change in the clinical medical education curriculum to better prepare medical students for practicing at rural areas. Consecutively, establishment of such healthcare and educational centers may meet the standards for accountability of medical schools set by the WHO.
