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.

Provision of registrar or undergraduate supervision in rural general practice by early‐career general practitioners

“…Further development of a regional and rural medical education and supervision workforce is vital for sustainable models of training in rural areas. Rural learning practices with a strong teaching culture can provide opportunities for multilevel learning and for registrars to develop teaching and leadership skills 1,4 . Further studies are needed to understand how the opportunity to develop skills and confidence in supervision during fellowship training can contribute to increased rural training capacity.…”

“…3 Learning practices that take on medical students also enable registrars to take on a teaching role. 4 The participation of newly fellowed GPs in supervision and in-practice teaching remains relatively unexplored. This time of adaption to independent practice is expected to influence subsequent practice.…”

“…A study of early‐career GPs (up to 5 years post‐fellowship) found those GPs providing supervision in their practice were more likely to be AMGs, working in a regional or remote area, and doing nursing home or home visits and/or providing after‐hours care 3 . Learning practices that take on medical students also enable registrars to take on a teaching role 4 . The participation of newly fellowed GPs in supervision and in‐practice teaching remains relatively unexplored.…”