The current provision of community-based teaching in UK medical schools: an online survey and systematic review

Abstract

ObjectiveTo evaluate the current provision and outcome of community-based education (CBE) in UK medical schools.Design and data sourcesAn online survey of UK medical school websites and course prospectuses and a systematic review of articles from PubMed and Web of Science were conducted. Articles in the systematic review were assessed using Rossi, Lipsey and Freeman's approach to programme evaluation.Study selectionPublications from November 1998 to 2013 containing information related to community teaching in undergraduate medical courses were included.ResultsOut of the 32 undergraduate UK medical schools, one was excluded due to the lack of course specifications available online. Analysis of the remaining 31 medical schools showed that a variety of CBE models are utilised in medical schools across the UK. Twenty-eight medical schools (90.3%) provide CBE in some form by the end of the first year of undergraduate training, and 29 medical schools (93.5%) by the end of the second year. From the 1378 references identified, 29 papers met the inclusion criteria for assessment. It was found that CBE mostly provided advantages to students as well as other participants, including GP tutors and patients. However, there were a few concerns regarding the lack of GP tutors’ knowledge in specialty areas, the negative impact that CBE may have on the delivery of health service in education settings and the cost of CBE.ConclusionsDespite the wide variations in implementation, community teaching was found to be mostly beneficial. To ensure the relevance of CBE for ‘Tomorrow's Doctors’, a national framework should be established, and solutions sought to reduce the impact of the challenges within CBE.Strengths and limitations of this studyThis is the first study to review how community-based education is currently provided throughout Medical Schools in the UK. The use of Rossi, Lipsey and Freeman's method of programme evaluation means that the literature was analysed in a consistent and comprehensive way. However, a weakness is that data from the online survey was obtained from online medical school prospectuses. This means the data may be incomplete or out of date. Data in the literature review may also be skewed by publication bias.

Current efforts in medical education to incorporate national health priorities

“…Early exposure of students to general practice and other community settings provides students with increased insight into patient‐centred medicine, improves continuity of care and enhances communication skills . This approach has been shown to increase students' interest in general practice as a career choice – an important outcome given the UK's changing demographics and an accompanying shift in emphasis from management to prevention . Further studies from Thailand, Jordan, Australia, Canada and the USA have shown that community‐oriented training in undergraduate medical education through specific programmes or standalone rural schools provides students with better understanding of community needs, hands‐on experience and exposure to health issues that are locally relevant, and can generate a sense among students of being valued by the community.…”

“…14 British medical schools include community-based education as a component of medical education, with a variety of teaching methods employed to promote better understanding of health concerns at the community level. 15 Early exposure of students to general practice and other community settings provides students with increased insight into patient-centred medicine, improves continuity of care and enhances communication skills. 15 This approach has been shown to increase students' interest in general practice as a career choicean important outcome given the UK's changing demographics and an accompanying shift in emphasis from management to prevention.…”

Medical students’ feedback regarding their clinical learning environment in primary healthcare: a qualitative study

“…The trend today is that an increasing share of medical students’ learning takes place in primary healthcare (PHC) [1]. This is the natural result of the changes in many of our healthcare systems, where most patients are taken care of in healthcare units outside the hospitals, which makes common conditions rare at our hospitals.…”

Evaluation of Out-Patient Care Educational Environment of National Defence University, Malaysia utilizing the ACLEEM Inventory

“…Sociological perspectives need to be incorporated into the traditional biomedical curriculum to produce competency-based and community-oriented physicians. Many schools have entirely restructured their curricula with a community-oriented approach, and other medical institutions have also made significant changes by introducing a communitybased element into their curriculum (18,19). A study conducted in the UK found that out of the 32 undergraduate UK medical schools, 31 provided a variety of community-based education (CBE) training (20).…”