Dear Editor,

Worldwide, medical education faces lots of challenges, especially in resource-limited settings like Africa. African medical education did not synchronize with the significant global pedagogical changes. Socioeconomic and political instability are the main reasons behind this retardation. In addition, the outdated curriculum and lack of effective and sufficient teachers and school administrators have also played a role.[ 6 ] Several approaches have been suggested and applied to overcome the resource-limited settings in developing countries; one of them is Community-Based Education and Service (COBES). COBES is a program that invests the local community in the educational field, where not only medics but also educators, residents of the community, and delegates from other industries take an active role during the student’s learning journey.[ 7 ] It has gained widespread acceptance as an effective method in undergraduate medical schooling and is viewed as a learning opportunity to tackle local community health concerns.

COBES requires medical students to spend a defined amount of period assisting healthcare professionals in local health centers, primary care facilities, and other community-based venues such as schools, mosques, churches, and markets. The goal of COBES is to tackle the difficulties of teaching students in various situations and allow them to grasp the differences and deal with various challenges. It has gained positive feedback from both students and community residents due to its real and observed effect.[ 2 ]

Apart from dealing with social services problems, incorporating COBES in medical education has numerous benefits. First is the comprehension of the effectiveness of medical services in rural regions, which could gain further from promoting health and preventing illnesses than from therapeutic services.[ 3 ] The second is reducing disparities in healthcare availability by enhancing accessibility to healthcare facilities in rural regions.[ 1 ] Finally, it positively influences students’ decision to practice in rural areas after graduation, which could potentially reduce disparities in healthcare accessibility in these locations. According to a study conducted by Amalba et al.,[ 2 ] nearly 45% of the students reported that COBES would impact their selection of professional specialty, and 63% felt that COBES could influence their desire of where to practice; of those, most asserted the fact that it could influence their decision to work in a rural area and the exposure to various diseases among different demographics could impact their choice of profession. COBES has been recognized as a critical strategy for training physicians and other medical professionals who are ready and equipped to work in underprivileged areas.[ 8 ]

A REAL-TIME EXAMPLE

With the launch of the ground-breaking COBES program in 1978, the University of Ilorin in Nigeria is one of the leaders who took advantage of this program. It remains at the forefront of advancing community-based medical training in Nigeria, encouraging other nearby countries such as Uganda[ 5 ] and Ghana[ 2 ] to implement the strategy. At the University, COBES is an essential part of undergraduate medical education that provides students with the chance to participate in initiatives that promote health and clinical experience in a variety of community settings. It serves as a problem-solving, community-based, and student-centered learning environment that was designed with the extensive demand of creating students who have a strong desire to deliver preventative medicine and general community healthcare as well as a sense of service.[ 4 ]

During their COBES posting, students perform demographical surveys and develop a “community diagnosis” for which public health initiatives, such as vaccination campaigns, outreaches, and health education, are planned and activated. As a conclusion of these postings, certain recommendations for the village authorities are given. The postings get published yearly by the World Health Organization, emphasizing the acquisition of clinical skills in primary health care in addition to recognizing how the local culture influences how disease is understood and treated.[ 7 ]

Numerous related developments have been sparked by the COBES experience, such as the creation of an African Chapter of the “Network of Community Oriented Institutions for Health Sciences,” the 1989 African Inter-Ministerial Conference’s proposals for changes to medical education, and the launch of comparable programs at some Universities in Nigeria.[ 7 ] This is on top of initiatives created by medical students, such as the Glial Initiative, which aims to raise awareness and provide care for neurological disorders, and the Human for Human Foundation, which combats gender-based violence and promotes mentorship and education for girls, among other things. These initiatives help address some of the issues identified during the community-based experience.

CHALLENGES AND SOLUTIONS

Certain challenges exist that need resolution to maintain viability and efficacy while trying to implement COBES programs to offer medical education a great deal. First, securing sufficient infrastructure and resources to support COBES efforts is one of the main problems, especially in impoverished areas where there might not be sufficient healthcare facilities. Second, students’ effective participation in COBES events may be restrained by logistical concerns such as lodging and transportation. Finally, to guarantee conformity with academic standards and learning objectives, the integration of COBES into current medical curricula necessitates considerable planning and coordination, which could be challenging. This is on top of certain staff members’ inadequate support for the program.[ 4 ] Despite these obstacles, COBES programs offer a wealth of opportunities for creativity and cooperation in medical education. Therefore, worldwide implementation of such programs in resource-limited settings establishes a medical education curriculum that is tailored to global demands.[ 4 ]

To overcome the challenges faced in implementing COBES programs, some measures need to be taken. First is infrastructure improvement in resource-limited settings. Sufficient infrastructures and resources could be secured through public-private partnerships to build new or upgraded existing facilities. Mobile clinics equipped with basic medical facilities could be used to reach remote areas. Telemedicine and digital health platforms could be used to extend services to underserved areas. Second, logistical concerns could be improved to ease students’ participation. This could be achieved by partnering with local communities to provide lodging for students during COBES, which could save costs and increase students’ community engagement. To solve transportation issues, environmentally suitable means of transportation, such as bicycles or motorcycles, could be considered; this could help overcome barriers like fuel scarcity. Third, COBES could be integrated with academic standards and learning objectives. It could be a flexible curriculum that involves modular coursework or elective rotations that students can tailor to their interests and career goals. In addition, faculty members could be trained, supported, provided with resources for curriculum development, and mentored to ensure consistency and quality across COBES sites. There could also be collaborations between medical schools, healthcare institutions, and community organizations to establish COBES experiences that meet educational objectives while addressing local health needs. Finally, to promote staff support, incentive mechanisms such as recognition, professional development opportunities, or financial incentives could be used to motivate faculty and staff to support COBES activities actively. This is in addition to organizing workshops, seminars, or peer learning sessions to raise awareness about the benefits of COBES and platforms for sharing best practices and overcoming challenges. Students could also be empowered to take on leadership roles in COBES planning and implementation, thereby fostering ownership and commitment among both students and faculty.

CONCLUSION

The community-based medical education is crucial to enhance the educational level as well as resolve healthcare inequities in areas with unstable socioeconomic and political environments. This letter is focused on the role of COBES in building the next generation of medical doctors, with a particular focus on its global implementation in resource-limited settings.

Ethical approval

The Institutional Review Board approval is not required.

Declaration of patient consent

Patient’s consent was not required as there are no patients in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.

References

1. Amalba A, Abantanga FA, Scherpbier AJ, van Mook WN. The Role of Community-Based Education and Service (COBES) in undergraduate medical education in reducing the mal-distribution of medical doctors in rural areas in Africa: A systematic review. Health Prof Educ. 2020. 6: 9-18

2. Amalba A, Van Mook WN, Mogre V, Scherpbier AJ. The perceived usefulness of community based education and service (COBES) regarding students’ rural workplace choices. BMC Med Educ. 2016. 16: 130

3. Bligh J. Tomorrow’s doctors: Extending the role of public health medicine in medical education. Med Educ. 2002. 36: 206-7

4. Bollag U, Schmidt H, Fryers T, Lawani J. Medical education in action: Community-based experience and service in Nigeria. Med Educ. 1982. 16: 282-9

5. Chang LW, Kaye D, Muhwezi WW, Nabirye RC, Mbalinda S, Okullo I. Perceptions and valuation of a community-based education and service (COBES) program in Uganda. Med Teach. 2011. 33: e9-15

6. Gukas ID. Global paradigm shift in medical education: Issues of concern for Africa. Med Teach. 2007. 29: 887-92

7. Hamilton JD, Ogunbode O. Medical education in the community: A Nigerian experience. Lancet. 1991. 338: 99-102

8. McAllister L, McEwen E, Williams V, Frost N. Rural attachments for students in the health professions: Are they worthwhile?. Aust J Rural Health. 1998. 6: 194-201