A systematic review of the approaches to multi-level learning in the general practice context, using a realist synthesis approach: BEME Guide No. 55

Abstract

Background: Recent global increases in medical student numbers and shifts in medical education from teaching hospitals to community settings call for effective strategies to meet the demand for general practice teaching placements. It has been proposed that “multi-level learning” (MLL), in which learning and teaching are shared across different levels of learners, may provide teaching efficiencies and valuable experiences for learners and teachers.

Aims: To identify, evaluate and synthesize the evidence related to the types, benefits, challenges, and facilitators of MLL in community-based general practice, and the underlying mechanisms and associated contexts to explain the reported outcomes.

Method: A realist synthesis approach guided the systematic review.

Results: Fifteen papers were identified, providing primary evaluation data predominantly from interviews with or surveys of key stakeholders. Generally, all levels of learners reported overall satisfaction with their MLL experiences. Medical students appreciated learning from prevocational doctors and registrars due to social and cognitive congruence. Mechanisms and contexts that supported our hypotheses regarding successful MLL outcomes were identified, with “a strong teaching culture” being a major mechanism.

Conclusions: The findings can help inform practices considering the implementation or enhancement of MLL initiatives in general practice. Further research should include measuring defined learning outcomes.

Acknowledgments

We would like to acknowledge Lars Erikson, The University of Queensland, UQ Library, Herston Qld 4006, Australia, for his contributions and assistance with the literature searching. Many thanks also to Dr. G. Dodd Denton, Ochsner Clinical School, The University of Queensland, LA, USA, for his contributions to the review in its early stages of development.

Disclosure statement

YW received a University of Queensland Summer Research Scholarship as a medical student to work on the preliminary stages of this review.

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Marie-Louise Dick

Marie-Louise Dick, MBBS, FRACGP, MPH, is an Honorary Associate Professor in General Practice at The University of Queensland.

Margaret Henderson

Margaret Henderson, MBBS, FRACGP, GradDip Clin Ed, is a Lecturer in General Practice at The University of Queensland.

Yi Wei

Yi Wei, BHSc/MBBS, commenced work on this project as a medical student on a University of Queensland Summer Research Scholarship. She is currently working in Emergency at The Queen Elizabeth II Jubilee Hospital, Brisbane, Australia and will start General Practice vocational training in 2019.

David King

David King, MBBS, FRACGP, MPH, is a Senior Lecturer in General Practice at the University of Queensland.

Katrina Anderson

Katrina Anderson, BMed M Th, FRACGP, is an Associate Professor, General Practice at the Australian National University Medical School.

Jill Thistlethwaite

Jill Thistlethwaite, BSc, MBBS, PhD, MMEd, FRCGP, FRACGP, is an Adjunct Professor at University Technology Sydney, Honorary Professor in the School of Education at the University of Queensland, and a medical advisor for NPS Medicine Wise in Australia.