Impact of early, longitudinal community-based education on medical student self-efficacy: a qualitative study

Abstract

Background: The critical transition from preclinical theory to clinical practice in medical education is often hampered by a crisis of student confidence. Self-efficacy – belief in one’s capabilities – is paramount for effective patient interaction, yet how longitudinal, early community-based experiences during the preclinical phase foster this self-efficacy remains underexplored. This study investigated the impact of an early, longitudinal community-based education program, CFHC, which provides patient interaction from the first to seventh semester, on medical students’ self-efficacy for clinical clerkships. Methods: A descriptive qualitative study was conducted with seven first-semester clinical clerkship students (3 females, 4 males) at Universitas Gadjah Mada, Indonesia, who had participated in the longitudinal CFHC program. Data were collected via semistructured interviews, guided by the Social Cognitive Theory, and subjected to inductive thematic analysis. Rigor was ensured through peer coding, technical and peer review of the analysis, expert consultation, and member checking, with achievement of data saturation. Results: The analysis of student experiences yielded ten main themes and thirty subthemes, revealing a significant positive impact of the CFHC program on students’ self-efficacy. These themes were synthesized into four developmental variables (early exposure as a catalyst, adaptive communication as an enabler, reflective practice as a mediator, and professional growth as a transformational outcome). Two novel conceptual models were developed: the Longitudinal Clinical Immersion (LCI) framework, which maps the four key stages of student’s development from initial exposure to professional growth, and the Self-Efficacy Infinity Loop (SEIL) model, which explains the core psychological mechanism of how students convert experience into confidence through a reinforcing cycle of action and reflection. Conclusions: Early, longitudinal community-based education which provides patient interaction is a promising strategy for cultivating medical student self-efficacy. The LCI framework and SEIL model provide valuable conceptual tools for understanding and designing educational experiences that foster not only clinical skills but also the robust self-efficacy essentials for competent, compassionate, and adaptive future physicians. Integrating such programs is a valuable component of effective medical education.