Original Research

Psychological safety and self-regulated learning through near-peer learning for the sustainability of rural community-based medical education: grounded theory approach


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Ryuichi Ohta
1 PhD, Director *

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Takuji Katsube

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Chiaki Sano
3 PhD


1, 2 Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-cho, Unnan, Shimane Prefecture, Japan

3 Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Shimane Prefecture, Japan

ACCEPTED: 11 August 2023

early abstract:

Introduction: Difficulties in improving psychological safety in medical education can be attributed to the hierarchy among medical professionals. Near-peer learning (NPL) can increase learning between students and residents, and improve psychological safety. Rural community-based medical education (CBME) can use an NPL framework to improve psychological safety and compensate for the lack of resources, leading to sustainability. This qualitative study aimed to clarify the effects of NPL on the psychological safety and learning of medical trainees in rural CBME.
Methods: This study used a grounded theory approach. Thirty-eight medical students, 12 second-year residents, and eight family medicine residents participated in this study. Purposive sampling was used to address the research objectives, followed by ethnographic and semi-structured interviews.
Results: Three themes were identified: facilitating learning, change in perception, and change in learning. Rural NPL-based CBME drove learners’ engagement in clinical practice through constant participation and reflection. Respecting and supporting learners’ motivation and participation and effectively accepting them increased their sense of ownership and psychological safety. Furthermore, NPL supported participants in becoming self-regulated learners.
Conclusions: Rural CBMEs lack healthcare and educational resources, but implementing NPL could make rural medical education sustainable, increasing the motivation of healthcare students and the number of medical staff working in rural contexts.