Academic journal article International Journal of Child Health and Human Development

Curricular Design: A Place-Based Strategy for Rural Medical Education

Academic journal article International Journal of Child Health and Human Development

Curricular Design: A Place-Based Strategy for Rural Medical Education

Article excerpt


There is a growing appreciation for the value of context to training, career satisfaction and retention of rural practitioners (1). Like -terroir" to a good wine, experiential learning in rural places brings flavor, nuance and meaning to rural education and practice.

A place-based strategy in rural medical education offers a promising remedy for the -placeless" uniformity and standardization characteristic of modern medical education, where the learner on graduating risks knowing everything in general and little in particular. From a place-based perspective, pedagogy for rural medical education is best anchored in the experience of rural places, complemented by facilitated reflection and deliberate learning from that experience, thus reclaiming -local knowledge and the educative value of experiences in local communities" (2).

Experiential place integration, an active developmental process described as integral to professional development and retention of rural physicians in practice, is framed around the principles of security, freedom, and identity (3). Well-designed place-based curricula in a safe setting and with appropriate learner autonomy should in theory promote indwelling knowledge, i.e. not simply knowing about rural practice in an objective sense, but knowing and understanding rural practice in a personal sense (4).

Critical to sustained professional development and physician retention is learning to live well as a physician in a rural place. For those who have not grown up in a rural community, learning in a rural place can be a truly enriching, cross-cultural and life-changing experience (5). For those learners who have grown up in such settings, the same training can promote the successful integration of that prior knowledge into an emerging professional identity as physician in a rural community, a decidedly different role than that of rural-born child or adolescent (6).


Place-based education is a label recently applied to a curricular and instructional approach designed to help students learn about their immediate surroundings by capitalizing on their lived experiences (7). It is not a new phenomenon, with origins in John Dewey's 19th century Lab School, but it has more fully emerged in the education literature over the past 15 years. It is learning rooted in what is local-the unique history, environment, culture, economy, literature, and art of a particular place. The community provides the context for learning and student work focuses on community needs and interests, and on community members (8).

Place-based education is -learning in place," learning from experience rooted in a specific context. It begins in a specific physical location, and from that starting point a curriculum is built with the resources, human and otherwise, available in that setting.

Although the value of learning in context can be debated, many rural physicians' shared experience of transitioning to rural practice after a medical education in the city certainly lends validity to the concept (9). This is -swamp learning" as opposed to learning in an -ivory tower," learning in a place that is messy and where the practitioner repeatedly encounters cases that are not in the book (10). Rather than learning about rural medicine through prescribed content in a classroom setting remote from a rural environment, the content emerges from day-to-day experience.

The evidence

There is a growing body of evidence in both K-12 and higher education for the effectiveness of place-based education, for students as well as communities (2). Unfortunately in medicine, the evidence is preliminary and scant (11-14). The experiences of rurally located medical educators themselves are infrequently published, and for those that are, the scale of experiments in place-based pedagogy is often too small for quantitative analysis. Conclusions as to their effectiveness will have to await more creative qualitative approaches (15). …

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