A systematic review of the relationship between patient mix and learning in work-based clinical settings. A BEME systematic review: BEME Guide No. 24

Abstract

Background: Clinical workplace-based learning has been the means to becoming a medical professional for many years. The importance of an adequate patient mix, as defined by the number of patients and the types of medical problems, for an optimal learning process is based on educational theory and recognised by national and international accreditation standards. The relationship between patient mix and learning in work-based curricula as yet remains unclear. Aim: To review research addressing the relationship between patient mix and learning in work-based clinical settings. Method: The search was conducted across Medline, Embase, Web of Science, ERIC and the Cochrane Library from the start date of the database to July 2011. Original quantitative studies on the relationship between patient mix and learning for learners at any level of the formal medical training/career were included. Methodological quality was assessed and two reviewers using prespecified forms extracted results. Results: A total of 10,420 studies were screened on title and abstract. Of these, 298 articles were included for full-text analysis, which resulted in the inclusion of 22 papers. The quality of the included studies, scored with the Medical Education Research Study Quality Instrument (MERSQI), ranged from 8.0 to 14.5 (of 18 points). A positive relationship was found between patient mix and self-reported outcomes evaluating the progress in competence as experienced by the trainee, such as self-confidence and comfort level. Patient mix was also found to correlate positively with self-reported outcomes evaluating the quality of the learning period, such as self-reported learning benefit, experienced effectiveness of the rotation, or the instructional quality. Variables, such as supervision and learning style, might mediate this relationship. A relationship between patient mix and formal assessment has never been demonstrated. Conclusion: Patient mix is positively related to self-reported learning outcome, most evidently the experienced quality of the learning programme.

The Effect of Restricting Residents' Duty Hours on Patient Safety, Resident Well-Being, and Resident Education: An Updated Systematic Review

“…However, the studies included are the most applicable, current evidence on this topic, and the number of studies in our review is consistent with other reviews of issues in medical education. [51][52][53][54] Future directions for this field should include attempts to standardize outcome measures across studies so that there will be more generalizability and studies will be able to be compared more accurately. Additionally, duty hours are only 1 factor in the safety of patients cared for by residents; handover-related communication errors and supervision of residents have also been identified as contributing factors.…”

Exploring the process of professional socialisation and development during pharmacy pre-registration training in England

“…It is known from medical training that patient mix can impact upon learning in medical students and junior doctors . There were notable differences between the range of services, patient mix and medicines that trainees encountered.…”

“…It has been suggested that the pharmacy setting, and individuals within it, can have a dramatic impact on an impressionable learner's socialisation into the pharmacy profession as well as propagate the development of a range of professional skills. In other professions, such as medicine, issues relating to individual training sites, such as supervision and patient mix, have been implicated in affecting learning experiences of trainees . These factors shape how learners are supported and exposed to different learning opportunities and disease states and treatments.…”

Similarities and differences of a selection of key accreditation standards between chiropractic councils on education: a systematic review

“…Although none addressed the issue of students having to recruit their own patients, CCE-Canada and CCE-Australasia limited the proportion of family and/or friends allowed. Case mix has been shown to be positively related to learning outcomes, practitioner reported self-confidence, comfort level and learning benefit in medical education [39]. This suggests that chiropractic students being exposed to a broader case mix, such as hospital settings, could enhance their learning and as such should be considered.…”