Designing for generalism, courage, and systems: a curriculum scholarship account of an integrated family medicine and primary care block.

Background: Pre-clerkship Family Medicine teaching often covers content well but does too little with experiential immersion, structured reflection, and the open engagement with clinical uncertainty that defines generalist work in practice. We describe the partnership-based redesign of the COM353 Family Medicine and Primary Care block at Alfaisal University, Riyadh, with student-reported outcomes from the first delivered cohort. The paper is offered as a worked account of how academic-academic and academic-service partnerships can themselves become curriculum. Pedagogical framework: The redesign rests on three commitments developed in dialog with the Department of Family and Community Medicine at the University of Toronto: generalism as a clinical method that has to be taught deliberately, clinical courage as a disposition that can be cultivated, and community-based practice as a primary site of clinical learning. Teaching is built around an iterative concept-experience-reflection cycle, with didactic sessions, structured Primary Health Care Center placements, simulation, problem-based learning, and reflective writing. Learning environment and pedagogical format: COM353 is a four-week mandatory block for third-year medical students delivered through formal partnerships with Primary Health Care Centers in Riyadh and aligned with Saudi Arabia's Vision 2030 health workforce priorities. Learning objectives target seven domains spanning generalist competencies, experiential learning, uncertainty tolerance, reflection, and systems thinking. Preliminary results from the first delivered cohort: A post-block survey of the January 2026 cohort produced 96 completed responses (response rate 76.2%). Domain means ranged from 3.90 to 4.27 on a five-point Likert scale, with Cohen's d 0.92 to 1.58. Multiple linear regression identified Systems Thinking ( Discussion and implications: A pre-clerkship block built on explicit pedagogy and run through partnership was associated with coherent, favorable student-reported outcomes across the competencies it set out to develop. That systems thinking emerged as the dominant predictor matters for design: when students grasp healthcare as a system, the rest of the curriculum lands harder. The model has practical relevance for medical schools in Gulf and other LMIC settings working toward PHC-centered health system reform.