Towards medical pedagogical pragmatism: transforming medical students’ Understanding of community health needs through the integrated longitudinal community clerkship in rural South Africa

BACKGROUND: Community-oriented medical education seeks to align medical training with priority community health needs and their lived realities. While longitudinal community-based clerkships are increasingly adopted to promote socially accountable graduates, there is limited qualitative insights into how these experiences can transform students’ understanding of community health needs, particularly in resource-constrained settings. OBJECTIVE: This study explored how participation in a 20-week Integrated Longitudinal Community Clerkship at a South African medical school transformed medical students’ understanding of community health needs. METHODS: Using a qualitative interpretivist design, data were generated from reflective journals, focus group discussions, observations, and field notes involving fifth-year medical students (n = 113) placed at district and regional hospitals in the Eastern Cape Province. Data were analysed using Braun and Clarke’s reflexive thematic analysis, informed by Scott’s transformative learning framework. RESULTS: Two analytically developed themes captured medical students’ transformative learning: (1) they demonstrated a paradigm shift by reframing illness and care from a predominantly biomedical orientation to a broader appreciation of social, cultural, and structural determinants of health, and (2) they articulated a shift from abstract, classroom-based knowledge to a contextualised and pragmatic understanding of community health needs, facilitated by prolonged immersion in under-resourced environments and supported mentorship. CONCLUSION: The findings show that longitudinal community immersion can catalyse transformative learning that reshapes how medical students conceptualise community health needs. Such experiences can enhance context-responsive clinical reasoning and practical judgment, contributing to a form of medical pedagogical pragmatism that can strengthen social accountability in medical education, particularly in underserved settings.