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Background. Many healthcare education programmes embody methods of ‘active learning’ in authentic contexts. What students learn from authentic early experiences when exposed to healthcare in local communities is less clear.  Objectives. We explored medical students’ learning in South African communities by analysing their reflection on and meaning given to interactions with patients.  Methods. A directed content analysis was done on a sample of 58 students’ reflection reports with regard to the meaning of disease. Four different perspectives were coded, and labelled as positivist, compassionate, moralist and spiritualist.  Results. Students documented their greater understanding of their patients’ circumstances and their compassion and respect for patients and their diseases. Overall, the positivist biomedical perspective was observed, followed by the compassionate perspective. In their reflections, students expressed combined perspectives, i.e. the positivist perspective together with one or more of the others. Moralist and spiritualist perspectives were also observed in the data. The students indicated the benefits they had experienced, i.e. by visiting a patient in his/her home environment, they were able to construct and contextualise the patients’ lives more holistically.  Conclusions. Raising medical students’ awareness of the realities of seeing patients in primary health clinics, district hospitals and at home, may contribute to their understanding of the meaning of disease and illness and their ability to better serve communities in need.

Medical students’ reflections on the meaning of disease and illness in South African communities