BackgroundTo identify the: extent to which medical students in China experience burnout; factors contributing to this; potential solutions to reduce and prevent burnout in this group; and the extent to which the experiences of Chinese students reflect the international literature.MethodsSystematic review and narrative synthesis. Key words, synonyms and subject headings were used to search five electronic databases in addition to manual searching of relevant journals. Titles and abstracts of publications between 1st January 1989-31st July 2016 were screened by two reviewers and checked by a third. Full text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted and synthesised.ResultsThirty-three studies were eligible and included in the review. Greater levels of burnout were generally identified in males, more senior medical students, and those who already experienced poorer psychological functioning. Few studies explored social or contextual factors influencing burnout, but those that did suggest that factors such as the degree of social support or the living environment surrounding a student may be a determinant of burnout.ConclusionsGreater understanding of the social and contextual determinants of burnout amongst medical students in China is essential towards identifying solutions to reduce and prevent burnout in this group.

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BackgroundCollaboration is of increasing importance in medical education and medical practice. Students’ and tutors’ perceptions about small group learning are valuable to inform the development of strategies to promote group dynamics and collaborative learning. This study investigated medical students’ and tutors’ views on competencies and behaviours which promote effective learning and interaction in small group settings.MethodsThis study was conducted at UNSW Australia. Five focus group discussions were conducted with first and second year medical students and eight small group tutors were interviewed. Data were transcribed verbatim and thematic analysis was conducted.ResultsStudents and tutors identified a range of behaviours that influenced collaborative learning. The main themes that emerged included: respectfulness; dominance, strong opinions and openness; constructiveness of feedback; active listening and contribution; goal orientation; acceptance of roles and responsibilities; engagement and enthusiasm; preparedness; self- awareness and positive personal attributes. An important finding was that some of these student behaviours were found to have a differential impact on group interaction compared with collaborative learning. This information could be used to promote higher quality learning in small groups.ConclusionThis study has identified medical students’ and tutors’ perceptions regarding interactional behaviours in small groups, as well as behaviours which lead to more effective learning in those settings. This information could be used to promote learning in small groups.

This paper presents the results of a study on the impact of a new integrated medical educational design on students' approaches to learning. Although the new program was based on curriculum features identified in the research literature as likely to promote deeper approaches to learning, the results revealed a more complex response from students. While a proportion of students reacted as expected and changed to deeper approaches, a significant subgroup moved in the opposite direction and adopted more surface approaches. Further analysis revealed that specific features of the new curriculum -integration of content, requirement for both independent and collaborative learning -were likely to polarise students. The findings suggest that shifting students towards deeper approaches to learning may be a more complex task than previously understood. The authors suggest some ways in which such major curriculum change may be moderated so that all learners are more likely to benefit.

CONTEXT This paper explores how structured feedback and other features of workplace-based assessment (WBA) impact on medical students' learning in the context of an evaluation of a workplace based performance assessment: the teamwork mini-clinical evaluation exercise (T-MEX). The T-MEX enables observation-based measurement of and feedback on the behaviours required to collaborate effectively as a junior doctor within the health care team. The instrument is based on the mini-clinical evaluation exercise (mini-CEX) format and focuses on clinical encounters such as consultations with medical and allied health professionals , discharge plan preparation, handovers and team meetings. METHODS The assessment was implemented during a 6-week period in 2010 with 25 medical students during their final clinical rotation. Content analysis was conducted on the written feedback provided by 23 assessors and the written reflections and action plans proposed by the 25 student participants (in 88 T-MEX forms). Semi-structured interviews with seven assessors and three focus groups with 14 student participants were conducted and the educational impact was explored through thematic analysis. RESULTS The study enabled the identification of features of WBA that promote the development of collaborative competencies. The focus of the assessment on clinical encounters and behaviours important for collaboration provided opportunities for students to engage with the health care team and highlighted the role of teamwork in these encounters. The focus on specific behaviours and a stage-appropriate response scale helped students identify learning goals and facilitated the provision of focused feedback. Incorporating these features within an established format helped students and supervisors to engage with the instrument. Extending the format to include structured reflection enabled students to self-evaluate and develop plans for improvement. CONCLUSIONS The findings illuminate the mechanisms by which WBA facilitates learning. The educational features highlighted include effectively structured feedback processes, support for situated learning, a positive backwash (facilita-tion of learning through preparation for the assessment), and facilitation of informed self-assessment.