Intended for healthcare professionals


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

BMJ 2005; 331 doi: (Published 11 August 2005) Cite this as: BMJ 2005;331:387
  1. Sonia Littlewood, medical student1,
  2. Valmae Ypinazar, research fellow2,
  3. Stephen A Margolis, head of region, Rural Clinical Division CQ Region2,
  4. Albert Scherpbier, director of Institute of Medical Education3,
  5. John Spencer, chair of medical education in primary health care4,
  6. Tim Dornan, consultant physician (tim.dornan{at}
  1. 1 Hope Hospital (University of Manchester School of Medicine), Manchester M6 8HD
  2. 2 University of Queensland School of Medicine, PO Box 4143, Rockhampton, Queensland 4700, Australia
  3. 3 University of Maastricht, PO Box 616, 6200 MD, Maastricht, Netherlands
  4. 4 University of Newcastle, Newcastle upon Tyne NE2 4HH, UK
  1. Correspondence to: T Dornan
  • Accepted 27 May 2005


Objectives To find how early experience in clinical and community settings (“early experience”) affects medical education, and identify strengths and limitations of the available evidence.

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

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

Selection of studies All empirical studies (verifiable, observational data) were included, whatever their design, method, or language of publication.

Results Early experience was most commonly provided in community settings, aiming to recruit primary care practitioners for underserved populations. It increased the popularity of primary care residencies, albeit among self selected students. It fostered self awareness and empathic attitudes towards ill people, boosted students' confidence, motivated them, gave them satisfaction, and helped them develop a professional identity. By helping develop interpersonal skills, it made entering clerkships a less stressful experience. Early experience helped students learn about professional roles and responsibilities, healthcare systems, and health needs of a population. It made biomedical, behavioural, and social sciences more relevant and easier to learn. It motivated and rewarded teachers and patients and enriched curriculums. In some countries, junior students provided preventive health care directly to underserved populations.

Conclusion Early experience helps medical students learn, helps them develop appropriate attitudes towards their studies and future practice, and orientates medical curriculums towards society's needs. Experimental evidence of its benefit is unlikely to be forthcoming and yet more medical schools are likely to provide it. Effort could usefully be concentrated on evaluating the methods and outcomes of early experience provided within non-experimental research designs, and using that evaluation to improve the quality of curriculums.


  • The full report is available on

  • Contributors SL did the literature search, validated the methods, selected the articles, piloted the analysis and second-coded half the articles in the final analysis. TD conceived of the study, supervised SL's medical student project, convened the topic review group, validated the methods, second-coded half the articles, analysed the results, wrote the paper, and revised it after peer review. VY, SAM, AS, and JS helped validate the article selection, first coded papers, and participated actively throughout the conduct, analysis and writing of the study. TD is its guarantor.

  • Funding None, except that minor expenses were met from TD's endowment funds.

  • Competing interests None declared.

  • Ethical approval Because it did not involve human subjects, the study was not submitted to ethical scrutiny.

  • Accepted 27 May 2005
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