Abstract
BACKGROUND: Japan's 2022 Model Core Curriculum (MCC) recommends community-based clinical clerkships spanning at least three consecutive weeks to foster generalism competency, although empirical evidence supporting this guidance remains limited. METHODS: We used an explanatory sequential mixed-methods design. Fifth-year Chiba University medical students (n = 112) completed a three-week community-based clinical clerkship from September to November 2024. Self-assessed attainment of the 18 MCC generalism learning objectives was measured pre- and post-clerkship. Daily reflection sheets (n = 1680) were deductively coded to analyze the learning processes using content analysis. RESULTS: Mean self-assessment scores increased significantly for all the objectives (p < 0.001), with effect sizes ranging from small (d = 0.37) to very large (d = 1.40). Content analysis of the reflection sheets yielded 539 reflection codes across 16 objectives, with all the students contributing. The most frequently coded objectives were "primary care at home" (106 codes from 58 students), "geriatric stage" (79 codes from 44 students), "primary care in the community" (64 codes from 42 students), and "end-of-life care" (62 codes from 43 students). CONCLUSIONS: A three-week community-based clinical clerkship produced significant self-assessed gains across all 18 generalism learning objectives and generated 539 reflection-based learning units, including 16 objectives, confirming that students actively engaged with the full breadth of generalism in practice. These findings should be interpreted as indicating perceived growth rather than objective competence, given the reliance on self-assessments, and exposure opportunities varied across clerkship sites. Further multi-site studies are needed to clarify whether 3 weeks is the optimal duration.