BACKGROUND: Fifth-year medical students from the University of Pretoria participated in a four-week rotation in the primary care clinics of a large metropolitan centre. An academic service-learning (ASL) approach was introduced into this rotation to improve the integration of theoretical learning and clinical practice through relevant community service and structured reflection. METHODS: Students wrote semi-structured reflective journals as a means to gaining greater insight into their learning experiences. These reflections were analysed qualitatively with a view to improving the community-based curriculum. RESULTS: Four major themes were identified: expectations and the reality of primary care; service and learning; becoming a doctor; and making a difference. CONCLUSION: While students gained a deeper insight into their development as clinicians, using an ASL approach also assisted the faculty in making an informed educational diagnosis of the curriculum.