Table 3 Representative data extracted from CMOs based on the medical students' final reports

1

Reflections on the familiar local own community elicited by integrating discovery learning and comparison

Student A: "Recently, the manager of a new grocery store in my neighborhood was always chatting with a local family as if they were friends, and I was very interested in the fact that the area that had not been bustling before became lively every day after that grocery store opened, regardless of the social class of people, so I turned my attention to the community during this training. It was a very meaningful experience for me personally because I was able to understand academically how the manager's actions impacted and contributed to the community."

Student B: "I have rarely thought about the health issues in the town where I grew up, and it made me realize that the reason these issues exist may be because I, as a member of the local youth, was not interested in them."

Student C: "In preparing for my presentation, I was able to sense that the characteristics of X city that I investigated (far from Tokyo) were different from those of the cities of the other presenters, and that these characteristics could be successfully reconciled by consideration based on regional background."

2

Intrinsic intellectual curiosity generated by discerning familiar community issues through community diagnosis

Student D: "Interestingly, I noticed that I have almost no network with the elderly in my neighborhood. Two houses away and you don't even know who lives there anymore, which I think is an indication that community-based communities are more sparse than they used to be."

Student E: "I felt that the problem in urban areas can be summarized as how to encourage patients who do not belong to the community to improve their health checkup rates and lifestyle-related diseases in a highly viable and sustainable manner. In particular, I felt that this is a problem unique to urban areas, where the hurdles to joining a community alone are high due to the high number of people moving in and out of the community. I could recognize it as an urban problem where we live"

3

Value-associated interests triggered by identifying relationships between health problems and community data on learning responsibility

Student F: "In my previous training, I have dealt with each patient's disease by asking about his/her medical history and life history, but in this community diagnosis, in order to examine the health issues of the people in the region, in addition to the direct health checkup rate and prevalence rate, I also examined the geographical characteristics, industry, and health of the region, which seemingly have no direct relation to health. It was very interesting to see how indirectly local issues came to the surface by examining factors such as population, connections, infrastructure, etc., and I learned the importance of viewing things from a variety of perspectives."

Student G "My friend mentioned neighborhood associations as a way to deal with "isolation," and in my thinking stage, I thought about preventing "isolation" by successfully matching the parent–child generation, which is common in Y town, with the elderly, but I thought that the neighborhood association connection was not quite in line with the times and abandoned further thinking. However, when you mentioned the importance of making the best use of the original Japanese neighborhood association and redefining the definition of that connection, I was glad to hear that you had thought of that."

4

Reflection on oneself directed by stimulating cognitive flexibility to identify complex relationships

Student H. "I learned that it is easy to link one factor to an outcome when considering the regional nature of a disease, for example, but it is not easy to consider whether there are other factors and which one has the greater influence, so I learned that we should take as broad a view as possible when considering the regional nature of a disease."

Student I: "When I thought about a concrete action plan, I realized that I would need the cooperation of quite a few people when I thought about where and with whom I would need to cooperate. I don't know if I will ever be involved in social prescribing as a physician in the future, but if I do, I will need to cooperate with various people in the community, so I hope I can build good relationships with them on a regular basis."