Realist approach to evaluating an interprofessional education program for medical students in clinical practice at a community hospital.

We examined the interrelationships between context, mechanism, and outcome using a realist approach following the introduction of interprofessional education (IPE) to clinical practice for medical students in the community. Through participant observation and interviews, a working hypothesis was developed. To evaluate IPE in clinical practice, medical students' reports were thematically analyzed, and configuration on contexts, mechanisms, and outcomes were identified using a realist approach. Influential contexts were medical students' experience of clinical practice and learning characteristics, the capacity of other professionals, interprofessional relationships, and characteristics of the community hospital. One key mechanism was observational learning. Others were self-regulated learning, legitimate peripheral participation, experiential learning, contact hypotheses, awareness of social structure, and cognitive empathy. As faculties supported these key mechanisms, medical students became aware of the legitimacy of community-oriented primary care, noting the roles of physicians who support patients' and/or their family's life in collaboration with other professionals, and reflecting the necessity of shifting from physician-centered perspectives. As a result, medical students deepened their empathic understanding for other professionals. Faculties should develop IPE programs in clinical practice based on the 'mechanism', 'context', 'outcome' pattern and 'context-mechanism-outcome' configuration in primary care settings.