Early practical experience and the social responsiveness of clinical education: systematic review

doi:10.1136/bmj.331.7513.387

BMJ 2005;331:387-391 (13 August), doi:10.1136/bmj.331.7513.387

Learning in practice

Early practical experience and the social responsiveness of clinical education: systematic review

Sonia Littlewood, medical student¹, Valmae Ypinazar, research fellow², Stephen A Margolis, head of region, Rural Clinical Division CQ Region², Albert Scherpbier, director of Institute of Medical Education³, John Spencer, chair of medical education in primary health care⁴, Tim Dornan, consultant physician¹

¹ Hope Hospital (University of Manchester School of Medicine), Manchester M6 8HD, ² University of Queensland School of Medicine, PO Box 4143, Rockhampton, Queensland 4700, Australia, ³ University of Maastricht, PO Box 616, 6200 MD, Maastricht, Netherlands, ⁴ University of Newcastle, Newcastle upon Tyne NE2 4HH, UK

Correspondence to: T Dornan tim.dornan{at}manchester.ac.uk

Abstract

Objectives To find how early experience in clinical and communitysettings ("early experience") affects medical education, andidentify strengths and limitations of the available evidence.

Design A systematic review rating, by consensus, the strengthand importance of outcomes reported in the decade 1992-2001.

Data sources Bibliographical databases and journals were searchedfor publications on the topic, reviewed under the auspices ofthe recently formed Best Evidence Medical Education (BEME) collaboration.

Selection of studies All empirical studies (verifiable, observationaldata) were included, whatever their design, method, or languageof publication.

Results Early experience was most commonly provided in communitysettings, aiming to recruit primary care practitioners for underservedpopulations. It increased the popularity of primary care residencies,albeit among self selected students. It fostered self awarenessand empathic attitudes towards ill people, boosted students'confidence, motivated them, gave them satisfaction, and helpedthem develop a professional identity. By helping develop interpersonalskills, it made entering clerkships a less stressful experience.Early experience helped students learn about professional rolesand responsibilities, healthcare systems, and health needs ofa population. It made biomedical, behavioural, and social sciencesmore relevant and easier to learn. It motivated and rewardedteachers and patients and enriched curriculums. In some countries,junior students provided preventive health care directly tounderserved populations.

Conclusion Early experience helps medical students learn, helpsthem develop appropriate attitudes towards their studies andfuture practice, and orientates medical curriculums towardssociety's needs. Experimental evidence of its benefit is unlikelyto be forthcoming and yet more medical schools are likely toprovide it. Effort could usefully be concentrated on evaluatingthe methods and outcomes of early experience provided withinnon-experimental research designs, and using that evaluationto improve the quality of curriculums.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Relevant Articles

More confused—but better informed: Jane Smith
BMJ 2005 331: 0. [Extract] [Full Text] [PDF]

The challenges of systematic reviews of educational research: Jill Morrison
BMJ 2005 331: 391. [Full Text]

What can experience add to early medical education? Consensus survey: Tim Dornan and Chris Bundy
BMJ 2004 329: 834. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

Masella, R. S. (2007). Renewing Professionalism in Dental Education: Overcoming the Market Environment. J Dent Educ 71: 205-216 [Abstract] [Full text]
Eagles, J. M., Wilson, S., Murdoch, J. M., Brown, T. (2007). What impact do undergraduate experiences have upon recruitment into psychiatry?. Psychiatr. Bull. 31: 70-72 [Full text]
Liaschenko, J, Oguz, N Y, Brunnquell, D (2006). Critique of the "tragic case" method in ethics education.. J. Med. Ethics 32: 672-677 [Abstract] [Full text]
Smith, S, Thirumamanivannan, G (2006). Instructional design and the emergency department.. Emerg. Med. J. 23: 794-795 [Abstract] [Full text]
Masella, R. S. (2006). The hidden curriculum: value added in dental education.. J Dent Educ 70: 279-283 [Full text]
Morrison, J. (2005). The challenges of systematic reviews of educational research. BMJ 331: 391-391 [Full text]