Medical education in action: community-based experience and service in Nigeria.

Problem-based, student-centred learning at the Faculty of Health Sciences, Unilorin, Nigeria were incorporated in the overall objectives of producing students with a sense of service and a strong inclination toward broad community care and preventive medicine. The educational programme reflecting this concept was called COBES (community-based experience and service). Twice a year groups of between seven and fourteen students, each accompanied by two to three staff members, settled in a village or other community for 1 month. According to the Faculty's objectives, each group assessed the size of its community (population, areal map) at first. Malnutrition and infectious diseases were selected as the two health problems which were to be studied in depth during the first two COBES placements. Data were collected and analysed by the students from which deductions were made, and at the end of the placement a written report was required by the Faculty. Three learning situations and the experience gained from them by one group of students are reported: (1) What was our community? (2) The nutritional status of children, and (3) Guinea-worm infection. The educational benefits of the programme are discussed and the view of the students is brought out. A correct assessment of students' performances proved difficult. Other problems were related to the experimental situation of COBES, such as insufficient support of the programme by some staff members, the lack of programme structure and logistical shortcomings. The COBES programme, however, set a pattern of medical education which specifically suits Nigerian needs and probably those of other African countries.