A critical hybrid realist-outcomes systematic review of relationships between medical education programmes and communities: BEME Guide No. 35

Abstract

Background: The relationships between medical schools and communities have long inspired and troubled medical education programmes. Successive models of community-oriented, community-based and community-engaged medical education have promised much and delivered to varying degrees. A two-armed realist systematic review was undertaken to explore and synthesize the evidence on medical school–community relationships.

Method: One arm used standard outcomes criteria (Kirkpatrick levels), the other a realist approach seeking out the underlying contexts, mechanisms and outcomes. 38 reviewers completed 489 realist reviews and 271 outcomes reviews; 334 articles were reviewed in the realist arm and 181 in the outcomes arm. Analyses were based on: descriptive statistics on both articles and reviews; the outcomes involved; the quality of the evidence presented; realist contexts, mechanisms, and outcomes; and an analysis of underlying discursive themes.

Findings: The literature on medical school–community relationships is heterogeneous and largely idiographic, with no common standards for what a community is, who represents communities, what a relationship is based on, or whose needs are or should be being addressed or considered.

Conclusions: Community relationships can benefit medical education, even if it is not always clear why or how. There is much opportunity to improve the quality and precision of scholarship in this area.

Acknowledgements

We would like to thank our reviewers for their essential contributions: Suzanne Allen, Richard Arnold, Lesley Bainbridge, Shital Bhandary, Charles Boelen, Robert Bowman, Kathleen D. Brooks, Peggy Alexiadis Brown, Ian Cameron, Suzanne Cashman, Ian Couper, Beth-Ann Cummings, Tim Dubé, Barbara Gottlieb, Jane Greacen, Jennene Greenhill, Jill Konkin, Joel Lanphear, Christos Lionis, Randall Longenecker, Marie Matte, Dodi Meyer, Karien Mostert, Doug Myhre, Robyn Preston, Roger Schauer, Leonardo Vieira Targa, Lee Toner, Maureen Topps, Shambhu Upadhyay, Susan van Schalkwyk and Staci Young. We would also like to thank Paul Worley and his colleagues for the conversation that sparked the creation of this review, and we would like to acknowledge Teresa Marsh’s contributions to the pilot stage of the review. Finally we would like to acknowledge the support of the CIHLC Project and the Centre for Rural and Northern Health Research (CRaNHR) in the execution of this review.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. This study was provided with financial support by the Canadian Interprofessional Health Leadership Consortium (CIHLC) and the Northern Ontario School of Medicine. The study was also provided with logistical support from the Centre for Rural and Northern Health Research (CRaNHR). None of these agencies had direct input into the design or execution of the study.

Supplementary material available online at http://dx.doi.org/10.3109/0142159X.2015.1112894