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Decentralised training for medical students: a scoping review

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      Abstract

      Background

      Increasingly, 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).

      Methods

      Using 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.

      Results

      One 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.

      Conclusions

      Evident 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.

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      Most cited references 123

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      Scoping studies: advancing the methodology

      Background Scoping studies are an increasingly popular approach to reviewing health research evidence. In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping studies. While this framework provides an excellent foundation for scoping study methodology, further clarifying and enhancing this framework will help support the consistency with which authors undertake and report scoping studies and may encourage researchers and clinicians to engage in this process. Discussion We build upon our experiences conducting three scoping studies using the Arksey and O'Malley methodology to propose recommendations that clarify and enhance each stage of the framework. Recommendations include: clarifying and linking the purpose and research question (stage one); balancing feasibility with breadth and comprehensiveness of the scoping process (stage two); using an iterative team approach to selecting studies (stage three) and extracting data (stage four); incorporating a numerical summary and qualitative thematic analysis, reporting results, and considering the implications of study findings to policy, practice, or research (stage five); and incorporating consultation with stakeholders as a required knowledge translation component of scoping study methodology (stage six). Lastly, we propose additional considerations for scoping study methodology in order to support the advancement, application and relevance of scoping studies in health research. Summary Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework. Continued debate and development about scoping study methodology will help to maximize the usefulness and rigor of scoping study findings within healthcare research and practice.
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        Health professionals for a new century: transforming education to strengthen health systems in an interdependent world.

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          Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study.

          Qualitative content analysis and thematic analysis are two commonly used approaches in data analysis of nursing research, but boundaries between the two have not been clearly specified. In other words, they are being used interchangeably and it seems difficult for the researcher to choose between them. In this respect, this paper describes and discusses the boundaries between qualitative content analysis and thematic analysis and presents implications to improve the consistency between the purpose of related studies and the method of data analyses. This is a discussion paper, comprising an analytical overview and discussion of the definitions, aims, philosophical background, data gathering, and analysis of content analysis and thematic analysis, and addressing their methodological subtleties. It is concluded that in spite of many similarities between the approaches, including cutting across data and searching for patterns and themes, their main difference lies in the opportunity for quantification of data. It means that measuring the frequency of different categories and themes is possible in content analysis with caution as a proxy for significance. © 2013 Wiley Publishing Asia Pty Ltd.
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            Author and article information

            Affiliations
            [1 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, , Stellenbosch University, ; Stellenbosch, South Africa
            [2 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Centre for Health Professions Education, Faculty of Medicine and Health Sciences, , Stellenbosch University, ; Stellenbosch, South Africa
            [3 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, , Stellenbosch University, ; Stellenbosch, South Africa
            [4 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, , Stellenbosch University, ; Stellenbosch, South Africa
            [5 ]ISNI 0000 0004 1936 9510, GRID grid.253615.6, Departments of Medicine and Health Policy, , George Washington University, ; Washington DC, USA
            Contributors
            mrdv@sun.ac.za
            scvs@sun.ac.za
            juliablitz@sun.ac.za
            icouper@sun.ac.za
            moodleyk@sun.ac.za
            ztalib@email.gwu.edu
            tyoung@sun.ac.za
            Journal
            BMC Med Educ
            BMC Med Educ
            BMC Medical Education
            BioMed Central (London )
            1472-6920
            9 November 2017
            9 November 2017
            2017
            : 17
            29121923 5680751 1050 10.1186/s12909-017-1050-9
            © The Author(s). 2017

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: FundRef http://dx.doi.org/10.13039/100000030, Centers for Disease Control and Prevention;
            Award ID: 1U2GGH001536-01
            Categories
            Research Article
            Custom metadata
            © The Author(s) 2017

            Education

            decentralised training, distributed, rural, medical student, undergraduate

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