Decentralised training for medical students: a scoping review

Abstract

BackgroundIncreasingly, medical students are trained at sites away from the tertiary academic health centre. A growing body of literature identifies the benefits of decentralised clinical training for students, the health services and the community. A scoping review was done to identify approaches to decentralised training, how these have been implemented and what the outcomes of these approaches have been in an effort to provide a knowledge base towards developing a model for decentralised training for undergraduate medical students in lower and middle-income countries (LMICs).MethodsUsing a comprehensive search strategy, the following databases were searched, namely EBSCO Host, ERIC, HRH Global Resources, Index Medicus, MEDLINE and WHO Repository, generating 3383 references. The review team identified 288 key additional records from other sources. Using prespecified eligibility criteria, the publications were screened through several rounds. Variables for the data-charting process were developed, and the data were entered into a custom-made online Smartsheet database. The data were analysed qualitatively and quantitatively.ResultsOne hundred and five articles were included. Terminology most commonly used to describe decentralised training included ‘rural’, ‘community based’ and ‘longitudinal rural’. The publications largely originated from Australia, the United States of America (USA), Canada and South Africa. Fifty-five percent described decentralised training rotations for periods of more than six months. Thematic analysis of the literature on practice in decentralised medical training identified four themes, each with a number of subthemes. These themes were student learning, the training environment, the role of the community, and leadership and governance.ConclusionsEvident from our findings are the multiplicity and interconnectedness of factors that characterise approaches to decentralised training. The student experience is nested within a particular context that is framed by the leadership and governance that direct it, and the site and the community in which the training is happening. Each decentralised site is seen to have its own dynamic that may foreground certain elements, responding differently to enabling student learning and influencing the student experience. The insights that have been established through this review have relevance in informing the further expansion of decentralised clinical training, including in LMIC contexts.

Transformative learning as pedagogy for the health professions: a scoping review

“…First, context is critical. As the training of health professionals continues to move towards settings where they are active participants in care, often in unfamiliar surroundings (whether learning for the first time in a hospital or on an elective in a foreign country), increased opportunities for exposure to learning experiences that are potentially transformative will become available. Moving outside of the conventional classroom offers both students and educators the freedom to explore issues beyond the formal curriculum, such as social justice, that are implicit in the work of the original theorists in the field.…”

“…First, context is critical. As the training of health professionals continues to move towards settings where they are active participants in care, 109 often in unfamiliar surroundings (whether learning for the first time in a hospital or on an elective in a foreign country), increased opportunities for exposure to learning experiences that are potentially transformative will become available.…”

Mapping evidence on community-based clinical education models for undergraduate physiotherapy students: a scoping review protocol

“…However, a global shift towards community-based clinical practice conducted away from the university, and large academic hospitals necessitate a change towards rural and peri-urban clinical placements (5). This type of training is also known as decentralized clinical training (6,7).…”

“…Therefore, diversified clinical training of physiotherapy students is essential for a curriculum that aims to provide clinical competence and social accountability (3, [12][13][14][15]. While this is also true for medical students (6,16), global debates regarding practical placements and their effectiveness in producing graduates who are prepared for the changing health needs in the developing world (5,(17)(18)(19)(20). The primary purpose of a school of physiotherapy is to develop graduates that have both the clinical reasoning and practical skills required to function as competent practitioners in all levels of care (21).…”

Thinking about context: consciously and critically

“…Context as a concern for teaching and learning in the health professions is increasingly attracting attention in the health professions education (HPE) literature. This focus is unsurprising given, for example, the current trend in a growing number of countries around the world towards moving the clinical training of our students to sites outside of the traditional academic hospital . One of the challenges when thinking about context, however, resides in the way in which it defies definitional clarity and is seen to have ‘many meanings’ that straddle issues of time and space .…”