Flexibility in primary medical programs: A scoping review

Abstract

Introduction: Students and universities increasingly seek flexibility in learning options, however terms such as flexible are not consistently defined in the medical education literature. This review aimed to 1) propose a definition for flexibility in medical education and 2) create a typology of contemporary examples of how flexibility has been operationalised in medical education. Method: A systematic scoping review of papers published in English since 2009 was undertaken. The focus was on papers reporting initiatives to create flexibility in primary medical programs. Results: Based on review of 1,641 search returns and 140 full-text articles, two interconnected concepts were identified: flexibility and individualisation. Flexibility describes mechanisms that allow students choice in how they allocate time and resources to meet the requirements of their course, including time-variable progression, acceleration, deceleration, articulated degree entry and exit options, and pedagogical approaches that reduce time required in classrooms. Individualisation describes options that enable student-driven direction, extension or expansion of medical education into special interest areas, including dual degrees, breadth subjects, curriculum tracks, elective service-learning pathways, electives and selectives. Conclusions: Though not always clearly defined as such, international medical education literature describes a rich variety of flexibility and individualisation initiatives. While the constructs of flexibility and individualisation are interconnected, they can assist curriculum designers to differentiate between the mechanisms that enable flexibility in how students meet course requirements and the mechanisms that enable individual choice in what students study. Flexibility and individualisation initiatives target different needs, including both students’ needs and medical workforce needs; they also suggest different institutional and financial implications. Consensus on and consistent use of common terminology about flexibility and individualisation initiatives will improve the “searchability” and synthesis of research on such initiatives and their impacts and enablers, as well as encourage further research, publication and synthesis of outcomes of such initiatives.

Walking backwards into the future of health professional practice

“…Student selected components (SSCs) are standard features within UK curricula, providing students with a choice of topics to explore more deeply (Riley, 2009). SSCs are not common in Australasia (Barrett et al, 2022) but could become useful vehicles for faculty to gain confidence in teaching students about key professional challenges. These educational initiatives could then be organised methodically as core material.…”

You can't study medicine part-time, can you?

“…Informed by our scoping review of flexible medical education (Barrett et al, 2022), we surmise that no medical school appears to offer time-flexible study options for the whole course, notwithstanding that a number have options for interrupted, accelerated or decelerated study. Significant minorities of students, 14% in one cohort from the United States reported in an earlier study (Saalwachter et al, 2006), take leave during their course for various reasons, including personal, health or financial reasons, or to complete additional study.…”

“…We are educators at an Australian medical school engaged in curriculum redesign for a time-flexible curriculum and have recently conducted a scoping review on flexible medical education (Barrett et al, 2022). The scoping review found that there are limited examples of time-flexible entry-to-practice medical education.…”

Editorial, Vol 25.1: Digital technologies in health: Implications for health professional education

“…Graduate and postgraduate courses could promote admission of students from diverse undergraduate programs, ensuring that support is available as students enhance their basic clinical sciences. Programs can also enable the intercalation of honours, master's and PhD programs in diverse fields or promote other avenues for individualisation, such as electives and research projects (Barrett et al, 2022).…”