Responding to change in a medical student rural community service: Insights from activity theory.

IDS implementation can upset the balance of rural health care supply and demand, resulting in accumulating tensions within and between activity systems. Those contradictions exposed medical students to an expansive learning cycle, resulting in transformational change and learning. Under the context of IDS programmes, health care service-learning can create a 'win-win' situation. Not merely medical students but also community residents gain benefits. This result may be extrapolated to health care service-learning programmes with similar context.