Exploring early community exposure among first-year medical students in a peripheral Indonesian medical school: a qualitative case study

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Early Community Exposure (ECE) introduces medical students to real-world community and primary care contexts early in training, with the potential to foster empathy, professionalism, and contextual understanding of health. While ECE has been widely implemented, evidence remains limited regarding its impact on first-year medical students in newly established medical schools located in peripheral regions of Indonesia. This study explored how novice medical students experienced and interpreted their first exposure to community-based learning. Methods This study employed a qualitative exploratory case study design. Participants were first-year medical students who completed the inaugural ECE program at Universitas Borneo Tarakan, a newly established medical school in North Kalimantan, Indonesia. Using purposive and snowball sampling, 15 students participated in in-depth semi-structured interviews conducted between January and March 2025. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using a hybrid inductive–deductive approach informed by community-based education, experiential learning, and social cognitive theory. Strategies to enhance trustworthiness included member checking, reflexive journaling, and peer debriefing. Results Seven interrelated themes were identified: (1) meaningful experiences, (2) early learning transformation, (3) bridging theory and practice, (4) professional identity formation, (5) internalization of professional values, (6) adaptation and motivation, and (7) program optimization. Students described ECE as a transformative and humanistic learning experience that enhanced empathy, responsibility, teamwork, and confidence. ECE enabled students to contextualize preclinical knowledge within real community settings while fostering early professional identity formation. Challenges included limited time allocation, scheduling constraints, and accessibility issues for some community participants. Conclusions Early Community Exposure provided first-year medical students with a pivotal learning experience that integrated cognitive, affective, and professional development from the outset of training. Embedding structured reflection, mentorship, and institutional support may further strengthen the educational impact of ECE, particularly in peripheral and resource-limited settings. These findings highlight the value of early community-based learning in preparing socially accountable physicians. Early community exposure Community-based medical education Professional identity formation Qualitative research Indonesia Introduction Medical education has undergone a global shift from a predominantly biomedical model toward approaches that emphasize social accountability, contextual learning, and humanistic values. Contemporary medical graduates are expected not only to demonstrate scientific competence but also to understand the social determinants of health, communicate effectively with diverse populations, and respond to community health needs with empathy and professionalism. Community-based education (CBE) has been widely adopted as a curricular strategy to bridge theoretical knowledge with real-world health contexts by situating learning within communities and primary care settings [ 1 – 3 ]. Early Community Exposure (ECE) represents a structured form of CBE in which medical students, often during their first year, engage directly with patients, families, and community members under guided supervision. ECE aims to contextualize biomedical knowledge while fostering non-technical competencies such as communication, teamwork, reflection, and ethical sensitivity [ 1 , 4 – 7 ]. For novice learners transitioning into medical training, early exposure to authentic health care environments provides an opportunity to experience medicine as a social practice rather than a purely academic discipline. Existing evidence suggests that ECE contributes positively to students’ cognitive, affective, and professional development. Studies from high-income settings report that early patient and community contact enhances patient-centred communication, promotes interest in primary care, and supports long-term professional motivation [ 8 – 10 ]. In low- and middle-income countries, ECE has been shown to increase students’ awareness of health inequities, strengthen social accountability, and foster commitment to underserved populations [ 11 , 12 ]. Through engagement with community realities, students begin to recognize health as a multifactorial phenomenon shaped by socioeconomic, cultural, and environmental factors rather than solely by biological mechanisms. Beyond knowledge acquisition, ECE has been associated with early professional identity formation (PIF). Early immersion in clinical and community contexts enables students to observe professional role models, reflect on their own values, and internalize norms such as empathy, responsibility, and collaboration [ 9 , 13 , 14 ]. Experiential learning theory suggests that such authentic encounters promote deeper learning through reflection and meaning-making, while social cognitive theory highlights the role of observation, feedback, and environmental support in building self-efficacy and motivation [ 15 , 16 ]. These theoretical perspectives underscore the formative potential of ECE during the earliest stages of medical education. In Indonesia, the relevance of ECE is heightened by persistent disparities in health care access and workforce distribution across its geographically dispersed regions. Rural, border, and island areas continue to experience shortages of physicians and limited access to comprehensive health services [ 5 , 17 , 18 ]. In response, Indonesian medical schools have increasingly incorporated ECE to strengthen students’ understanding of primary care, cultural diversity, and community health needs [ 6 , 7 , 19 ]. Previous studies in Indonesian contexts have reported improvements in students’ communication skills, empathy, and awareness of social determinants of health, although challenges related to logistics, supervision, and curricular integration remain [ 20 – 22 ]. Recent national efforts to expand medical education into peripheral regions have led to the establishment of new medical schools intended to address regional workforce gaps. Universitas Borneo Tarakan (UBT), located in North Kalimantan, launched its medical program in the 2024/2025 academic year with a strong emphasis on social accountability and community-oriented learning. As part of its foundational curriculum, ECE was introduced as a mandatory first-year activity to immerse students early in community and primary care settings. However, despite growing literature on ECE from established institutions, little is known about how first-year medical students in newly established, peripheral medical schools experience their initial community exposure. The first year of medical school represents a critical period of transition marked by identity exploration, emotional adjustment, and the formation of early professional values. Understanding how students interpret and make meaning of ECE during this phase is essential for optimizing curriculum design and support mechanisms. This study therefore aimed to explore the experiences and perceptions of first-year medical students participating in the inaugural ECE program at Universitas Borneo Tarakan. By examining students’ narratives, this study seeks to contribute empirical insights into the role of early community exposure in shaping learning, motivation, and professional identity within peripheral medical education contexts. Methods Study design This study employed a qualitative exploratory case study design to examine first-year medical students’ experiences of Early Community Exposure (ECE) within a newly established medical school. A qualitative approach was considered appropriate for capturing the complexity of students’ perceptions, emotions, and meaning-making processes associated with early community-based learning. The case study design enabled in-depth exploration of a bounded educational phenomenon situated within a specific institutional and sociocultural context. Research setting The study was conducted at Universitas Borneo Tarakan (UBT), a public university located in Tarakan, North Kalimantan, Indonesia. The medical program at UBT was established in the 2024/2025 academic year as part of a national strategy to expand medical education into peripheral and border regions. The curriculum was developed in collaboration with Universitas Gadjah Mada to ensure alignment with national accreditation standards. Tarakan is an island city characterized by geographic isolation, cultural diversity, and uneven health service distribution. These contextual features present unique challenges for healthcare delivery and provide a relevant setting for community-based medical education. At UBT, ECE was implemented as a compulsory first-year curricular component emphasizing experiential learning, social accountability, and early professional development. ECE activities included household visits, community health surveys, patient interviews, and group-based health promotion activities conducted in collaboration with local primary health centers and community health volunteers. Participants and sampling Participants were first-year medical students who had completed the ECE program. Purposive sampling was used to recruit students who were able to provide rich and reflective accounts of their experiences. Inclusion criteria were: (1) enrollment as a first-year medical student at UBT, (2) full participation in ECE activities, and (3) willingness to participate in an interview. Students who were unable to complete substantial portions of the ECE program due to illness or personal reasons were excluded. To enhance variation in perspectives, snowball sampling was subsequently used to recruit participants from different ECE groups and community placements. Sampling continued until thematic saturation was achieved, defined as the point at which no new concepts or insights emerged from additional interviews. A total of 15 students participated in the study. Data collection Data were collected through individual, semi-structured, in-depth interviews conducted between January and March 2025. Interviews were facilitated by the first author, a physician and medical educator with formal training in qualitative research methods. Prior to data collection, the interviewer engaged in reflexive practices to identify potential assumptions and biases related to early community-based education. A semi-structured interview guide was specifically developed for this study, informed by principles of community-based education, experiential learning, and social cognitive theory. The guide was designed to elicit rich accounts of students’ experiences and was refined through internal discussion among the research team. Topics explored included students’ perceptions of early community exposure activities, emotional responses, learning experiences, communication with community members, professional values, and perceived challenges. Open-ended questions and probing prompts were used to encourage depth and reflection. Interviews were conducted in Bahasa Indonesia, lasted between 45 and 70 minutes, and were audio-recorded with participants’ consent. All interviews were transcribed verbatim, and transcripts were reviewed for accuracy by a trained research assistant. To preserve contextual meaning, data analysis was conducted using the original Bahasa Indonesia transcripts. Selected quotations were later translated into English and back-translated to ensure semantic fidelity. An English-language version of the interview guide was prepared and provided as supplementary material. Data analysis Data were analyzed thematically following the six-phase approach described by Braun and Clarke. Analysis began with repeated reading of transcripts to achieve familiarization, followed by initial coding. A hybrid inductive–deductive approach was applied, allowing codes to emerge from the data while also being informed by theoretical constructs from community-based education, experiential learning, and social cognitive theory. Coding was conducted manually and supported by NVivo 12 qualitative data analysis software. Codes were iteratively compared and grouped into categories, which were subsequently refined into overarching themes representing shared patterns of meaning across participants. Themes were reviewed and refined through team discussions to ensure coherence, internal consistency, and alignment with the research aim. Trustworthiness Several strategies were employed to enhance the rigor and trustworthiness of the study. Credibility was supported through prolonged engagement with the data, triangulation of interview transcripts and reflexive field notes, and member checking, in which participants reviewed summaries of key findings. Dependability was strengthened by maintaining an audit trail documenting analytic decisions and code development. Confirmability was addressed through reflexive journaling and peer debriefing with researchers not directly involved in data collection. Transferability was facilitated through detailed descriptions of the research context, participants, and educational setting. Ethical considerations Ethical approval was obtained from the Research Ethics Committee of the Faculty of Health Sciences, Universitas Borneo Tarakan (Approval No. 15/KEPK-UBT/2025). All participants provided written informed consent prior to participation. Participation was voluntary, and students were assured that their academic standing would not be affected by their decision to participate or withdraw. Confidentiality was maintained through the use of pseudonyms, and all data were stored securely on password-protected devices accessible only to the research team. Results Fifteen first-year medical students participated in the interviews. Analysis of their narratives revealed seven interrelated themes (Table 1 ) that illustrate how students experienced, interpreted, and internalized Early Community Exposure (ECE). Collectively, these themes portray ECE as a formative learning experience that shaped students’ cognitive understanding, emotional engagement, and emerging professional identity. Meaningful and engaging learning experiences Students consistently described ECE as a meaningful and enjoyable experience characterized by a supportive and welcoming atmosphere. Interactions with supervising physicians, community members, and peers fostered a strong sense of belonging and psychological safety. Students reported feeling accepted by healthcare providers and trusted by patients, which enhanced their confidence and willingness to engage actively in learning. Patient involvement was particularly salient. Students emphasized the importance of listening attentively and building rapport, describing these encounters as emotionally impactful and personally validating. The informal and non-pressured learning environment was perceived as distinct from classroom-based instruction, allowing students to engage more authentically and comfortably with real health contexts. Early learning transformation through authentic experience ECE was widely perceived as students’ first authentic encounter with medical practice. Hands-on activities, such as interviewing patients and conducting basic health assessments, were described as transformative learning moments that made abstract concepts tangible. Students reported that experiential learning enhanced retention and understanding, with practical experiences described as more memorable than theoretical instruction alone. Several students reflected that ECE prompted early exploration of professional interests, including preventive medicine and health education roles. These reflections suggest that early exposure not only supports skill acquisition but also encourages self-discovery and career-related reflection at an early stage of training. Bridging theory and practice Students highlighted ECE as an effective bridge between preclinical theory and real-world application. Applying recently learned concepts—such as blood pressure measurement and cardiovascular physiology—within community settings reinforced their understanding and revealed the complexity of clinical realities. Students noted that real patient encounters rarely followed textbook patterns, prompting them to adapt, think critically, and appreciate contextual variability. This integration of theory and practice strengthened students’ perception of curricular relevance and helped them recognize the value of foundational sciences when applied in authentic settings. Early professional identity formation Participation in ECE contributed to the early development of students’ professional identity. Students described gaining new perspectives on the role of physicians, moving beyond task-oriented views toward a more relational and community-engaged understanding of medical practice. Observing role models and interacting directly with patients prompted reflection on personal strengths, limitations, and professional aspirations. Motivation to pursue a medical career was reinforced through these experiences. Students articulated emerging ideals of what it means to be a good doctor, emphasizing empathy, communication skills, responsibility, and ethical conduct. Internalization of professional values ECE facilitated the internalization of core professional values. Students frequently described empathic responses to patients’ life circumstances, often engaging in perspective-taking and emotional reflection. A sense of responsibility toward patients and communities emerged as students felt accountable for contributing meaningfully during activities. Teamwork and collaboration were also emphasized, with students highlighting shared responsibilities and peer support as central to positive learning experiences. Exposure to diverse community members fostered cultural openness and adaptability, reinforcing the importance of respectful and inclusive practice. Adaptation, confidence, and motivation Many students reported initial anxiety prior to community engagement, particularly related to communication skills and fear of making mistakes. However, these concerns diminished as students adapted to the environment and received support from peers, facilitators, and community members. Gradual increases in confidence were attributed to repeated exposure, positive feedback, and normalization of early discomfort. Motivation was sustained through a combination of intrinsic factors—such as personal growth and patient interaction—and extrinsic elements, including group activities and social engagement. These experiences contributed to increased enthusiasm and resilience during the program. Suggestions for program optimization Despite overall positive experiences, students identified areas for improvement. Time constraints and scheduling inconsistencies were perceived as limiting the depth of engagement. Students suggested extending the duration of ECE activities and improving advance communication and briefing processes. Participants also proposed greater student involvement in program organization through student-led committees, which they believed could enhance ownership and efficiency. Accessibility concerns, particularly for elderly community members, were highlighted as an important consideration for future program planning. Table 1 Themes, subthemes, and representative quotations from first-year medical students’ experiences of Early Community Exposure Theme Subthemes Representative quotations Meaningful experiences Sense of belonging; patient involvement; positive atmosphere; enjoyable activities “I felt welcomed by the doctor… it was as if they truly accepted us.” (S11) Early learning transformation Practical skills; first-hand experience; reflective learning; career exploration “This became our first learning experience for what lies ahead.” (S14) Bridging theory and practice Curriculum relevance; application of knowledge; clinical complexity “It became clearer when linked with real hypertension cases.” (S8) Professional identity formation Motivation; role perception; self-awareness “This strengthened my resolve to pursue medicine.” (S2) Professional values Empathy; responsibility; teamwork; cultural openness “My empathy just emerged naturally.” (S14) Adaptation and motivation Anxiety; confidence building; peer support “At first I was nervous… but it turned out I didn’t need to be afraid.” (S11) Program optimization Time management; organization; accessibility “If the duration were longer, it would be even better.” (S6) Discussion This study explored first-year medical students’ experiences of Early Community Exposure (ECE) in a newly established medical school located in a peripheral region of Indonesia. The findings demonstrate that ECE functioned as a formative learning experience that integrated cognitive learning, emotional engagement, and early professional identity formation. Students perceived ECE not merely as an introductory curricular activity, but as a transformative encounter that shaped how they understood medicine, patients, and their future professional roles. Principal findings ECE was experienced as meaningful, engaging, and humanistic, fostering a sense of belonging and psychological safety. Students described early patient interactions as emotionally impactful and confidence-building, reinforcing the value of authentic learning environments. These findings align with previous studies demonstrating that early exposure to real clinical and community contexts promotes deep learning and empathy development among novice medical students [ 8 – 10 ]. ECE also served as an effective bridge between preclinical theory and real-world practice. Students reported that applying recently learned concepts in community settings enhanced understanding and retention while revealing the complexity and unpredictability of health problems. This supports evidence that early experiential learning strengthens contextualization of knowledge and counters the fragmentation often observed in preclinical curricula [ 9 , 23 ]. Intentional alignment between foundational sciences and ECE activities therefore appears essential to maximize educational benefit. A key contribution of this study is its insight into early professional identity formation (PIF). Students articulated evolving perceptions of what it means to be a physician, emphasizing empathy, responsibility, teamwork, and ethical awareness. Early patient and community contact allowed students to observe professional role models and reflect on their own values, consistent with existing literature on PIF in medical education [ 13 , 14 , 24 ]. These findings suggest that ECE can serve as an early catalyst for identity development, particularly when supported by reflective opportunities and mentorship. Theoretical interpretation The findings can be interpreted through the lenses of experiential learning theory and social cognitive theory. From an experiential learning perspective, ECE provided concrete experiences that encouraged reflection, conceptualization, and application—key processes for meaningful learning [ 15 ]. Students’ descriptions of memorable, hands-on encounters support the notion that learning is enhanced when knowledge is constructed through experience rather than passive reception. From a social cognitive perspective, students’ gradual transition from anxiety to confidence reflects the role of environmental support, peer collaboration, and positive feedback in developing self-efficacy [ 16 ]. Observing clinicians, interacting with patients, and receiving affirmation from peers and facilitators contributed to increased motivation and engagement. These findings highlight the importance of supportive learning environments, particularly for novice learners navigating unfamiliar professional contexts. Implications for medical education The findings have several implications for curriculum design and implementation. First, integrating ECE early in the curriculum can support holistic development by simultaneously addressing cognitive, affective, and professional domains. Second, structured reflection should be embedded within ECE to help students process emotional experiences and consolidate professional identity development. Third, mentorship and peer-support mechanisms are essential for mitigating early anxiety and fostering confidence and resilience. Institutionally, adequate logistical planning and collaboration with community health centers are critical to ensuring sustainable and equitable ECE implementation. Students’ suggestions for extended program duration, clearer scheduling, and greater student involvement in organization reflect growing learner agency and align with calls for student–faculty partnerships in curriculum development [ 25 ]. In peripheral and resource-limited settings, such partnerships may enhance program relevance and responsiveness to local health needs. Strengths and limitations This study provides in-depth, contextually grounded insights into early community exposure in a newly established medical school located in a peripheral Indonesian region—an underrepresented context in the medical education literature. The qualitative case study design enabled rich exploration of students’ lived experiences, while methodological rigor was supported through reflexivity, triangulation, and member checking. Several limitations should be acknowledged. The study was conducted at a single institution with a relatively small cohort, which may limit transferability. Participants’ accounts may have been influenced by social desirability bias, given their early stage of training. Additionally, the study captured short-term perceptions following ECE; longitudinal research is needed to examine the sustained impact of early community exposure on professional identity, career choices, and clinical competence. Conclusions Early Community Exposure (ECE) provided first-year medical students at Universitas Borneo Tarakan with a pivotal and multifaceted learning experience that extended beyond knowledge acquisition to encompass affective, social, and professional development. Students perceived ECE as their first authentic engagement with patients and communities, fostering empathy, responsibility, confidence, and early professional identity formation. Through direct interaction with community members, students were able to contextualize preclinical knowledge and develop a more holistic understanding of health and medical practice. Despite initial anxiety, supportive learning environments, peer collaboration, and guided supervision enabled students to adapt and engage meaningfully with community-based activities. At the same time, students identified logistical and structural challenges, highlighting the importance of institutional support, careful scheduling, and accessibility considerations. Embedding structured reflection, mentorship, and student involvement in program organization may further enhance the educational value of ECE. In peripheral and resource-limited settings, early community-based learning represents a powerful strategy for aligning medical education with social accountability and local health needs. By foregrounding students’ voices, this study underscores the importance of early experiential learning in shaping competent, empathetic, and socially responsive future physicians. Further longitudinal and multi-institutional research is needed to examine the sustained impact of ECE on professional identity development and career trajectories. Declarations Ethics approval and consent to participate Ethical approval was obtained from the Research Ethics Committee of the Faculty of Health Sciences, Universitas Borneo Tarakan (Approval No. 15/KEPK-UBT/2025). This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants prior to participation. Participation was voluntary, and participants were informed that their decision to participate or to withdraw from the study at any time would not affect their academic standing. Confidentiality was ensured through the use of pseudonyms, and all data were securely stored on password-protected devices accessible only to the research team. Consent for publication Not Applicable Funding Not Applicable Author Contribution INN led the conception and design of the study, conducted data collection, and was primarily responsible for data analysis, interpretation, and manuscript drafting. YS and TSP contributed to the study design, oversaw the research process, critically reviewed the data analysis, and provided substantive revisions to the manuscript. All authors gave their approval for submission to BMC Medical Education and reviewed and approved the final version of the manuscript. Acknowledgement The authors would like to acknowledge the contributions of all individuals who supported this study. We are grateful to the student participants for sharing their experiences and perspectives. We also thank peer reviewers for their constructive feedback, as well as independent peer coders who contributed to ensuring the rigour and reliability of the data analysis. We acknowledge senior academic mentors for their valuable guidance throughout the research process, and a language editor for thorough proofreading that substantially improved the clarity of the manuscript. Technical assistance during data transcription is also acknowledged, including the use of an artificial intelligence–based transcription tool. Data Availability The qualitative datasets generated and/or analysed during the current study are not publicly available due to ethical and confidentiality considerations, as the data contain information that could compromise participant anonymity. De-identified excerpts of the data are available from the first author upon reasonable request, subject to approval by the relevant ethics committee. References Kristina TN, Majoor GD, Van der Vleuten CP. 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20:00:27","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":20830,"visible":true,"origin":"","legend":"","description":"","filename":"InterviewGuideEnglishVersion.docx","url":"https://assets-eu.researchsquare.com/files/rs-8386629/v1/6e2d600d8d9a59303f498feb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring early community exposure among first-year medical students in a peripheral Indonesian medical school: a qualitative case study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMedical education has undergone a global shift from a predominantly biomedical model toward approaches that emphasize social accountability, contextual learning, and humanistic values. Contemporary medical graduates are expected not only to demonstrate scientific competence but also to understand the social determinants of health, communicate effectively with diverse populations, and respond to community health needs with empathy and professionalism. Community-based education (CBE) has been widely adopted as a curricular strategy to bridge theoretical knowledge with real-world health contexts by situating learning within communities and primary care settings [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly Community Exposure (ECE) represents a structured form of CBE in which medical students, often during their first year, engage directly with patients, families, and community members under guided supervision. ECE aims to contextualize biomedical knowledge while fostering non-technical competencies such as communication, teamwork, reflection, and ethical sensitivity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. For novice learners transitioning into medical training, early exposure to authentic health care environments provides an opportunity to experience medicine as a social practice rather than a purely academic discipline.\u003c/p\u003e \u003cp\u003eExisting evidence suggests that ECE contributes positively to students\u0026rsquo; cognitive, affective, and professional development. Studies from high-income settings report that early patient and community contact enhances patient-centred communication, promotes interest in primary care, and supports long-term professional motivation [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In low- and middle-income countries, ECE has been shown to increase students\u0026rsquo; awareness of health inequities, strengthen social accountability, and foster commitment to underserved populations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Through engagement with community realities, students begin to recognize health as a multifactorial phenomenon shaped by socioeconomic, cultural, and environmental factors rather than solely by biological mechanisms.\u003c/p\u003e \u003cp\u003eBeyond knowledge acquisition, ECE has been associated with early professional identity formation (PIF). Early immersion in clinical and community contexts enables students to observe professional role models, reflect on their own values, and internalize norms such as empathy, responsibility, and collaboration [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Experiential learning theory suggests that such authentic encounters promote deeper learning through reflection and meaning-making, while social cognitive theory highlights the role of observation, feedback, and environmental support in building self-efficacy and motivation [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These theoretical perspectives underscore the formative potential of ECE during the earliest stages of medical education.\u003c/p\u003e \u003cp\u003eIn Indonesia, the relevance of ECE is heightened by persistent disparities in health care access and workforce distribution across its geographically dispersed regions. Rural, border, and island areas continue to experience shortages of physicians and limited access to comprehensive health services [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In response, Indonesian medical schools have increasingly incorporated ECE to strengthen students\u0026rsquo; understanding of primary care, cultural diversity, and community health needs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Previous studies in Indonesian contexts have reported improvements in students\u0026rsquo; communication skills, empathy, and awareness of social determinants of health, although challenges related to logistics, supervision, and curricular integration remain [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecent national efforts to expand medical education into peripheral regions have led to the establishment of new medical schools intended to address regional workforce gaps. Universitas Borneo Tarakan (UBT), located in North Kalimantan, launched its medical program in the 2024/2025 academic year with a strong emphasis on social accountability and community-oriented learning. As part of its foundational curriculum, ECE was introduced as a mandatory first-year activity to immerse students early in community and primary care settings. However, despite growing literature on ECE from established institutions, little is known about how first-year medical students in newly established, peripheral medical schools experience their initial community exposure.\u003c/p\u003e \u003cp\u003eThe first year of medical school represents a critical period of transition marked by identity exploration, emotional adjustment, and the formation of early professional values. Understanding how students interpret and make meaning of ECE during this phase is essential for optimizing curriculum design and support mechanisms. This study therefore aimed to explore the experiences and perceptions of first-year medical students participating in the inaugural ECE program at Universitas Borneo Tarakan. By examining students\u0026rsquo; narratives, this study seeks to contribute empirical insights into the role of early community exposure in shaping learning, motivation, and professional identity within peripheral medical education contexts.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis study employed a qualitative exploratory case study design to examine first-year medical students\u0026rsquo; experiences of Early Community Exposure (ECE) within a newly established medical school. A qualitative approach was considered appropriate for capturing the complexity of students\u0026rsquo; perceptions, emotions, and meaning-making processes associated with early community-based learning. The case study design enabled in-depth exploration of a bounded educational phenomenon situated within a specific institutional and sociocultural context.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearch setting\u003c/h3\u003e\n\u003cp\u003eThe study was conducted at Universitas Borneo Tarakan (UBT), a public university located in Tarakan, North Kalimantan, Indonesia. The medical program at UBT was established in the 2024/2025 academic year as part of a national strategy to expand medical education into peripheral and border regions. The curriculum was developed in collaboration with Universitas Gadjah Mada to ensure alignment with national accreditation standards.\u003c/p\u003e \u003cp\u003eTarakan is an island city characterized by geographic isolation, cultural diversity, and uneven health service distribution. These contextual features present unique challenges for healthcare delivery and provide a relevant setting for community-based medical education. At UBT, ECE was implemented as a compulsory first-year curricular component emphasizing experiential learning, social accountability, and early professional development. ECE activities included household visits, community health surveys, patient interviews, and group-based health promotion activities conducted in collaboration with local primary health centers and community health volunteers.\u003c/p\u003e\n\u003ch3\u003eParticipants and sampling\u003c/h3\u003e\n\u003cp\u003eParticipants were first-year medical students who had completed the ECE program. Purposive sampling was used to recruit students who were able to provide rich and reflective accounts of their experiences. Inclusion criteria were: (1) enrollment as a first-year medical student at UBT, (2) full participation in ECE activities, and (3) willingness to participate in an interview. Students who were unable to complete substantial portions of the ECE program due to illness or personal reasons were excluded.\u003c/p\u003e \u003cp\u003e To enhance variation in perspectives, snowball sampling was subsequently used to recruit participants from different ECE groups and community placements. Sampling continued until thematic saturation was achieved, defined as the point at which no new concepts or insights emerged from additional interviews. A total of 15 students participated in the study.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected through individual, semi-structured, in-depth interviews conducted between January and March 2025. Interviews were facilitated by the first author, a physician and medical educator with formal training in qualitative research methods. Prior to data collection, the interviewer engaged in reflexive practices to identify potential assumptions and biases related to early community-based education.\u003c/p\u003e \u003cp\u003eA semi-structured interview guide was specifically developed for this study, informed by principles of community-based education, experiential learning, and social cognitive theory. The guide was designed to elicit rich accounts of students\u0026rsquo; experiences and was refined through internal discussion among the research team. Topics explored included students\u0026rsquo; perceptions of early community exposure activities, emotional responses, learning experiences, communication with community members, professional values, and perceived challenges. Open-ended questions and probing prompts were used to encourage depth and reflection.\u003c/p\u003e \u003cp\u003eInterviews were conducted in Bahasa Indonesia, lasted between 45 and 70 minutes, and were audio-recorded with participants\u0026rsquo; consent. All interviews were transcribed verbatim, and transcripts were reviewed for accuracy by a trained research assistant. To preserve contextual meaning, data analysis was conducted using the original Bahasa Indonesia transcripts. Selected quotations were later translated into English and back-translated to ensure semantic fidelity. An English-language version of the interview guide was prepared and provided as supplementary material.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were analyzed thematically following the six-phase approach described by Braun and Clarke. Analysis began with repeated reading of transcripts to achieve familiarization, followed by initial coding. A hybrid inductive\u0026ndash;deductive approach was applied, allowing codes to emerge from the data while also being informed by theoretical constructs from community-based education, experiential learning, and social cognitive theory.\u003c/p\u003e \u003cp\u003eCoding was conducted manually and supported by NVivo 12 qualitative data analysis software. Codes were iteratively compared and grouped into categories, which were subsequently refined into overarching themes representing shared patterns of meaning across participants. Themes were reviewed and refined through team discussions to ensure coherence, internal consistency, and alignment with the research aim.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTrustworthiness\u003c/h2\u003e \u003cp\u003eSeveral strategies were employed to enhance the rigor and trustworthiness of the study. Credibility was supported through prolonged engagement with the data, triangulation of interview transcripts and reflexive field notes, and member checking, in which participants reviewed summaries of key findings. Dependability was strengthened by maintaining an audit trail documenting analytic decisions and code development. Confirmability was addressed through reflexive journaling and peer debriefing with researchers not directly involved in data collection. Transferability was facilitated through detailed descriptions of the research context, participants, and educational setting.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the Research Ethics Committee of the Faculty of Health Sciences, Universitas Borneo Tarakan (Approval No. 15/KEPK-UBT/2025). All participants provided written informed consent prior to participation. Participation was voluntary, and students were assured that their academic standing would not be affected by their decision to participate or withdraw. Confidentiality was maintained through the use of pseudonyms, and all data were stored securely on password-protected devices accessible only to the research team.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFifteen first-year medical students participated in the interviews. Analysis of their narratives revealed seven interrelated themes (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) that illustrate how students experienced, interpreted, and internalized Early Community Exposure (ECE). Collectively, these themes portray ECE as a formative learning experience that shaped students\u0026rsquo; cognitive understanding, emotional engagement, and emerging professional identity.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMeaningful and engaging learning experiences\u003c/h2\u003e \u003cp\u003eStudents consistently described ECE as a meaningful and enjoyable experience characterized by a supportive and welcoming atmosphere. Interactions with supervising physicians, community members, and peers fostered a strong sense of belonging and psychological safety. Students reported feeling accepted by healthcare providers and trusted by patients, which enhanced their confidence and willingness to engage actively in learning.\u003c/p\u003e \u003cp\u003ePatient involvement was particularly salient. Students emphasized the importance of listening attentively and building rapport, describing these encounters as emotionally impactful and personally validating. The informal and non-pressured learning environment was perceived as distinct from classroom-based instruction, allowing students to engage more authentically and comfortably with real health contexts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEarly learning transformation through authentic experience\u003c/h2\u003e \u003cp\u003eECE was widely perceived as students\u0026rsquo; first authentic encounter with medical practice. Hands-on activities, such as interviewing patients and conducting basic health assessments, were described as transformative learning moments that made abstract concepts tangible. Students reported that experiential learning enhanced retention and understanding, with practical experiences described as more memorable than theoretical instruction alone.\u003c/p\u003e \u003cp\u003eSeveral students reflected that ECE prompted early exploration of professional interests, including preventive medicine and health education roles. These reflections suggest that early exposure not only supports skill acquisition but also encourages self-discovery and career-related reflection at an early stage of training.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBridging theory and practice\u003c/h2\u003e \u003cp\u003eStudents highlighted ECE as an effective bridge between preclinical theory and real-world application. Applying recently learned concepts\u0026mdash;such as blood pressure measurement and cardiovascular physiology\u0026mdash;within community settings reinforced their understanding and revealed the complexity of clinical realities. Students noted that real patient encounters rarely followed textbook patterns, prompting them to adapt, think critically, and appreciate contextual variability.\u003c/p\u003e \u003cp\u003eThis integration of theory and practice strengthened students\u0026rsquo; perception of curricular relevance and helped them recognize the value of foundational sciences when applied in authentic settings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEarly professional identity formation\u003c/h2\u003e \u003cp\u003eParticipation in ECE contributed to the early development of students\u0026rsquo; professional identity. Students described gaining new perspectives on the role of physicians, moving beyond task-oriented views toward a more relational and community-engaged understanding of medical practice. Observing role models and interacting directly with patients prompted reflection on personal strengths, limitations, and professional aspirations.\u003c/p\u003e \u003cp\u003eMotivation to pursue a medical career was reinforced through these experiences. Students articulated emerging ideals of what it means to be a good doctor, emphasizing empathy, communication skills, responsibility, and ethical conduct.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eInternalization of professional values\u003c/h2\u003e \u003cp\u003eECE facilitated the internalization of core professional values. Students frequently described empathic responses to patients\u0026rsquo; life circumstances, often engaging in perspective-taking and emotional reflection. A sense of responsibility toward patients and communities emerged as students felt accountable for contributing meaningfully during activities.\u003c/p\u003e \u003cp\u003eTeamwork and collaboration were also emphasized, with students highlighting shared responsibilities and peer support as central to positive learning experiences. Exposure to diverse community members fostered cultural openness and adaptability, reinforcing the importance of respectful and inclusive practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAdaptation, confidence, and motivation\u003c/h2\u003e \u003cp\u003eMany students reported initial anxiety prior to community engagement, particularly related to communication skills and fear of making mistakes. However, these concerns diminished as students adapted to the environment and received support from peers, facilitators, and community members. Gradual increases in confidence were attributed to repeated exposure, positive feedback, and normalization of early discomfort.\u003c/p\u003e \u003cp\u003eMotivation was sustained through a combination of intrinsic factors\u0026mdash;such as personal growth and patient interaction\u0026mdash;and extrinsic elements, including group activities and social engagement. These experiences contributed to increased enthusiasm and resilience during the program.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSuggestions for program optimization\u003c/h2\u003e \u003cp\u003eDespite overall positive experiences, students identified areas for improvement. Time constraints and scheduling inconsistencies were perceived as limiting the depth of engagement. Students suggested extending the duration of ECE activities and improving advance communication and briefing processes.\u003c/p\u003e \u003cp\u003eParticipants also proposed greater student involvement in program organization through student-led committees, which they believed could enhance ownership and efficiency. Accessibility concerns, particularly for elderly community members, were highlighted as an important consideration for future program planning.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes, subthemes, and representative quotations from first-year medical students\u0026rsquo; experiences of Early Community Exposure\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubthemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRepresentative quotations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeaningful experiences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSense of belonging; patient involvement; positive atmosphere; enjoyable activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;I felt welcomed by the doctor\u0026hellip; it was as if they truly accepted us.\u0026rdquo; (S11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly learning transformation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePractical skills; first-hand experience; reflective learning; career exploration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;This became our first learning experience for what lies ahead.\u0026rdquo; (S14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBridging theory and practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurriculum relevance; application of knowledge; clinical complexity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;It became clearer when linked with real hypertension cases.\u0026rdquo; (S8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional identity formation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMotivation; role perception; self-awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;This strengthened my resolve to pursue medicine.\u0026rdquo; (S2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmpathy; responsibility; teamwork; cultural openness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;My empathy just emerged naturally.\u0026rdquo; (S14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdaptation and motivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnxiety; confidence building; peer support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;At first I was nervous\u0026hellip; but it turned out I didn\u0026rsquo;t need to be afraid.\u0026rdquo; (S11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProgram optimization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime management; organization; accessibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;If the duration were longer, it would be even better.\u0026rdquo; (S6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored first-year medical students\u0026rsquo; experiences of Early Community Exposure (ECE) in a newly established medical school located in a peripheral region of Indonesia. The findings demonstrate that ECE functioned as a formative learning experience that integrated cognitive learning, emotional engagement, and early professional identity formation. Students perceived ECE not merely as an introductory curricular activity, but as a transformative encounter that shaped how they understood medicine, patients, and their future professional roles.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePrincipal findings\u003c/h2\u003e \u003cp\u003eECE was experienced as meaningful, engaging, and humanistic, fostering a sense of belonging and psychological safety. Students described early patient interactions as emotionally impactful and confidence-building, reinforcing the value of authentic learning environments. These findings align with previous studies demonstrating that early exposure to real clinical and community contexts promotes deep learning and empathy development among novice medical students [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eECE also served as an effective bridge between preclinical theory and real-world practice. Students reported that applying recently learned concepts in community settings enhanced understanding and retention while revealing the complexity and unpredictability of health problems. This supports evidence that early experiential learning strengthens contextualization of knowledge and counters the fragmentation often observed in preclinical curricula [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Intentional alignment between foundational sciences and ECE activities therefore appears essential to maximize educational benefit.\u003c/p\u003e \u003cp\u003eA key contribution of this study is its insight into early professional identity formation (PIF). Students articulated evolving perceptions of what it means to be a physician, emphasizing empathy, responsibility, teamwork, and ethical awareness. Early patient and community contact allowed students to observe professional role models and reflect on their own values, consistent with existing literature on PIF in medical education [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. These findings suggest that ECE can serve as an early catalyst for identity development, particularly when supported by reflective opportunities and mentorship.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTheoretical interpretation\u003c/h2\u003e \u003cp\u003eThe findings can be interpreted through the lenses of experiential learning theory and social cognitive theory. From an experiential learning perspective, ECE provided concrete experiences that encouraged reflection, conceptualization, and application\u0026mdash;key processes for meaningful learning [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Students\u0026rsquo; descriptions of memorable, hands-on encounters support the notion that learning is enhanced when knowledge is constructed through experience rather than passive reception.\u003c/p\u003e \u003cp\u003eFrom a social cognitive perspective, students\u0026rsquo; gradual transition from anxiety to confidence reflects the role of environmental support, peer collaboration, and positive feedback in developing self-efficacy [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Observing clinicians, interacting with patients, and receiving affirmation from peers and facilitators contributed to increased motivation and engagement. These findings highlight the importance of supportive learning environments, particularly for novice learners navigating unfamiliar professional contexts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eImplications for medical education\u003c/h2\u003e \u003cp\u003eThe findings have several implications for curriculum design and implementation. First, integrating ECE early in the curriculum can support holistic development by simultaneously addressing cognitive, affective, and professional domains. Second, structured reflection should be embedded within ECE to help students process emotional experiences and consolidate professional identity development. Third, mentorship and peer-support mechanisms are essential for mitigating early anxiety and fostering confidence and resilience.\u003c/p\u003e \u003cp\u003eInstitutionally, adequate logistical planning and collaboration with community health centers are critical to ensuring sustainable and equitable ECE implementation. Students\u0026rsquo; suggestions for extended program duration, clearer scheduling, and greater student involvement in organization reflect growing learner agency and align with calls for student\u0026ndash;faculty partnerships in curriculum development [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In peripheral and resource-limited settings, such partnerships may enhance program relevance and responsiveness to local health needs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThis study provides in-depth, contextually grounded insights into early community exposure in a newly established medical school located in a peripheral Indonesian region\u0026mdash;an underrepresented context in the medical education literature. The qualitative case study design enabled rich exploration of students\u0026rsquo; lived experiences, while methodological rigor was supported through reflexivity, triangulation, and member checking.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. The study was conducted at a single institution with a relatively small cohort, which may limit transferability. Participants\u0026rsquo; accounts may have been influenced by social desirability bias, given their early stage of training. Additionally, the study captured short-term perceptions following ECE; longitudinal research is needed to examine the sustained impact of early community exposure on professional identity, career choices, and clinical competence.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eEarly Community Exposure (ECE) provided first-year medical students at Universitas Borneo Tarakan with a pivotal and multifaceted learning experience that extended beyond knowledge acquisition to encompass affective, social, and professional development. Students perceived ECE as their first authentic engagement with patients and communities, fostering empathy, responsibility, confidence, and early professional identity formation. Through direct interaction with community members, students were able to contextualize preclinical knowledge and develop a more holistic understanding of health and medical practice.\u003c/p\u003e \u003cp\u003eDespite initial anxiety, supportive learning environments, peer collaboration, and guided supervision enabled students to adapt and engage meaningfully with community-based activities. At the same time, students identified logistical and structural challenges, highlighting the importance of institutional support, careful scheduling, and accessibility considerations. Embedding structured reflection, mentorship, and student involvement in program organization may further enhance the educational value of ECE.\u003c/p\u003e \u003cp\u003eIn peripheral and resource-limited settings, early community-based learning represents a powerful strategy for aligning medical education with social accountability and local health needs. By foregrounding students\u0026rsquo; voices, this study underscores the importance of early experiential learning in shaping competent, empathetic, and socially responsive future physicians. Further longitudinal and multi-institutional research is needed to examine the sustained impact of ECE on professional identity development and career trajectories.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e Ethical approval was obtained from the Research Ethics Committee of the Faculty of Health Sciences, Universitas Borneo Tarakan (Approval No. 15/KEPK-UBT/2025). This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants prior to participation. Participation was voluntary, and participants were informed that their decision to participate or to withdraw from the study at any time would not affect their academic standing. Confidentiality was ensured through the use of pseudonyms, and all data were securely stored on password-protected devices accessible only to the research team.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot Applicable\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNot Applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eINN led the conception and design of the study, conducted data collection, and was primarily responsible for data analysis, interpretation, and manuscript drafting. YS and TSP contributed to the study design, oversaw the research process, critically reviewed the data analysis, and provided substantive revisions to the manuscript. All authors gave their approval for submission to BMC Medical Education and reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e \u003cp\u003eThe authors would like to acknowledge the contributions of all individuals who supported this study. We are grateful to the student participants for sharing their experiences and perspectives. We also thank peer reviewers for their constructive feedback, as well as independent peer coders who contributed to ensuring the rigour and reliability of the data analysis. We acknowledge senior academic mentors for their valuable guidance throughout the research process, and a language editor for thorough proofreading that substantially improved the clarity of the manuscript. Technical assistance during data transcription is also acknowledged, including the use of an artificial intelligence\u0026ndash;based transcription tool.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe qualitative datasets generated and/or analysed during the current study are not publicly available due to ethical and confidentiality considerations, as the data contain information that could compromise participant anonymity. De-identified excerpts of the data are available from the first author upon reasonable request, subject to approval by the relevant ethics committee.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKristina TN, Majoor GD, Van der Vleuten CP. Does community-based education come close to what it should be? A case study from the developing world: students\u0026rsquo; opinions. Educ Health (Abingdon). 2006;19(2):179\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLestari E, Yuliyanti S. Community-based interprofessional learning promotes equality of participation among health professions students. Online J Health Allied Sci. 2018;17(2):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRandita ABT, Widyandana W, Claramita M. IPE-COM: a pilot study on interprofessional learning design for medical and midwifery students. J Multidiscip Healthc. 2019;12:767\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTyastuti D, Hutapea R, Susani Y, et al. Early clinical exposure: Indonesian students\u0026rsquo; experiences. Korean J Med Educ. 2013;25(4):289\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClaramita M, Setiawati EP, Kristina TN, Emilia O, Van der Vleuten C. Community-based educational design for undergraduate medical education: a grounded theory study. BMC Med Educ. 2019;19:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClaramita M, Susilo AP. Improving communication skills in the Southeast Asian health care context. Perspect Med Educ. 2014;3(6):474\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLestari E, Scherpbier A, Stalmeijer R. Stimulating students\u0026rsquo; interprofessional teamwork skills through community-based education: a mixed methods evaluation. J Multidiscip Healthc. 2020;13:1143\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorley P, Silagy C, Prideaux D, Newble D, Jones A. The Parallel Rural Community Curriculum: an integrated clinical curriculum based in rural general practice. Med Educ. 2000;34(7):558\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLittlewood S, Ypinazar V, Margolis SA, Scherpbier A, Spencer J, Dornan T. Early practical experience and the social responsiveness of clinical education: systematic review. BMJ. 2005;331(7513):387\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldstein AO, Calleson D, Bearman R, Steiner BD, Frasier PY, Slatt L. Teaching advanced leadership skills in community service to medical students. Acad Med. 2009;84(6):754\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOhta R, Ryu Y, Sano C. The contribution of community-based medical education to medical education and healthcare in Japan: a literature review. Hum Resour Health. 2021;19:113.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhattacharyya A, Blane D, Mercer SW. Evolution of students\u0026rsquo; perceptions of early patient contact in a longitudinal integrated clerkship in general practice: a qualitative study. BMJ Open. 2018;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing medical education to support professional identity formation. Acad Med. 2014;89(11):1446\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonrouxe LV. Identity, identification and medical education: why should we care? Med Educ. 2010;44(1):40\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKolb DA. Experiential learning: experience as the source of learning and development. 2nd ed. Upper Saddle River: Pearson; 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice Hall; 1986.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClaramita M, Utarini A, Soebono H, van Dalen J, Van der Vleuten C. Doctor\u0026ndash;patient communication in a Southeast Asian setting: the conflict between ideal and reality. Adv Health Sci Educ Theory Pract. 2011;16(1):69\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWerdhani RA, Kusuma Dewi D, Findyartini A, Ramlan AA, Sugiharto A. How community-oriented medicine is implemented in medical education. J Community Med Public Health Res. 2024;5(1):90\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSari D, Prabandari YS, Claramita M. Students\u0026rsquo; empathy in medical education: a qualitative study at an Indonesian medical school. J Educ Eval Health Prof. 2016;13:17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEkawati FM, Claramita M, Hort K, Furler J, Licqurish S, Gunn J. Patients\u0026rsquo; experience of using primary care services in the context of Indonesian universal health coverage reforms. Asia Pac Fam Med. 2017;16:4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTyastuti D, Lindayani L, Mulyono B, et al. Reflection in early clinical exposure: students\u0026rsquo; perspectives from Indonesian medical schools. BMC Med Educ. 2019;19:27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWerdhani RA, Yulianti DR, Lestari E, et al. Community-based education in Indonesian medical schools: challenges and opportunities. BMC Med Educ. 2024;24:54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDornan T, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach. 2006;28(1):3\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHunt JB, Bonham C, Jones L. Understanding the goals of service learning and community-based medical education: a systematic review. Acad Med. 2011;86(2):246\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBovill C, Cook-Sather A, Felten P. Students as co-creators of teaching approaches, course design, and curricula. Int J Acad Dev. 2011;16(2):133\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Early community exposure, Community-based medical education, Professional identity formation, Qualitative research, Indonesia","lastPublishedDoi":"10.21203/rs.3.rs-8386629/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8386629/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMedical education has increasingly emphasized social accountability and community-oriented learning to prepare graduates for complex health system challenges. Early Community Exposure (ECE) introduces medical students to real-world community and primary care contexts early in training, with the potential to foster empathy, professionalism, and contextual understanding of health. While ECE has been widely implemented, evidence remains limited regarding its impact on first-year medical students in newly established medical schools located in peripheral regions of Indonesia. This study explored how novice medical students experienced and interpreted their first exposure to community-based learning.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study employed a qualitative exploratory case study design. Participants were first-year medical students who completed the inaugural ECE program at Universitas Borneo Tarakan, a newly established medical school in North Kalimantan, Indonesia. Using purposive and snowball sampling, 15 students participated in in-depth semi-structured interviews conducted between January and March 2025. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using a hybrid inductive\u0026ndash;deductive approach informed by community-based education, experiential learning, and social cognitive theory. Strategies to enhance trustworthiness included member checking, reflexive journaling, and peer debriefing.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSeven interrelated themes were identified: (1) meaningful experiences, (2) early learning transformation, (3) bridging theory and practice, (4) professional identity formation, (5) internalization of professional values, (6) adaptation and motivation, and (7) program optimization. Students described ECE as a transformative and humanistic learning experience that enhanced empathy, responsibility, teamwork, and confidence. ECE enabled students to contextualize preclinical knowledge within real community settings while fostering early professional identity formation. Challenges included limited time allocation, scheduling constraints, and accessibility issues for some community participants.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eEarly Community Exposure provided first-year medical students with a pivotal learning experience that integrated cognitive, affective, and professional development from the outset of training. Embedding structured reflection, mentorship, and institutional support may further strengthen the educational impact of ECE, particularly in peripheral and resource-limited settings. These findings highlight the value of early community-based learning in preparing socially accountable physicians.\u003c/p\u003e","manuscriptTitle":"Exploring early community exposure among first-year medical students in a peripheral Indonesian medical school: a qualitative case study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 20:00:20","doi":"10.21203/rs.3.rs-8386629/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-12T17:16:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-06T01:40:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-27T09:35:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"223936646294339248920475496030785572300","date":"2026-01-23T09:35:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"258248415610773644352010612542749514295","date":"2026-01-23T05:38:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-22T08:04:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297771257271695323987007400870325121227","date":"2026-01-22T08:01:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-20T11:04:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-19T08:55:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-29T09:41:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T07:35:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-12-29T07:26:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"09c70494-bbc3-4f58-bc2f-faa901e51ada","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T10:24:35+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 20:00:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8386629","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8386629","identity":"rs-8386629","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}