Barriers to outpatient education for medical students: a narrative review

Abstract

ObjectivesThis study surveys medical education literature published over the last 25 years (1993–2018) to identify the factors scholars consider deleterious to outpatient teaching for medical students. MethodsThis study conducts a review of medical education literature published between 1993 and 2018 using Medline, Lilacs, Ibecs, Cochrane Library, and Scielo databases. The following search terms were utilized: “Education, Medical, Undergraduate” AND “Ambulatory Care” AND “Teaching/methods” OR “Clinical Clerkship” OR “Preceptorship.” This study focuses on papers describing deleterious factors for outpatient teaching with medical students and analyzes their results, discussions, and conclusions sections. ResultsOf the 363 articles obtained, this study selected 33 for analysis. These papers identify numerous factors as barriers to outpatient education. For didactic purposes, these factors are categorized into four barrier groups: environment-institution, academic staff, students, and patients. Academic staff-related teaching barrier was the most frequently mentioned obstacle. Intense care schedule with little teaching time was considered the most common and relevant barrier to outpatient medical education, followed by inappropriate teaching environment and inadequate supervision model. ConclusionsThere is a lack of recent literature on studies focusing on barriers to effective outpatient medical education. Factors identified as harmful to outpatient education have been pointed out by course directors, academic staff, and students in the literature. However, many of these factors remain overlooked by educators, who can use these factors to modify their academic activities for more effective results.

Emociones del profesorado de educación física: revisión narrativa (2010-2020) (Physical education teacher emotions: narrative review (2010-2020))

“…Con la intención de profundizar en la calidad emocional, se ha optado por una aproximación de carácter cualitativo al fenómeno emocional del profesorado de EF y, a su vez, a un estudio de revisión narrativa (Franco, Machado, Grinbaum & Porfirio, 2019;Mujica et al, 2017). Este tipo de revisión favorece el análisis de los significados emocionales.…”

Creating a win-win for the health system and health Profession’s education: a direct observation clinical experience with feedback iN real-time (DOCENT) for low acuity patients in the emergency department

“…Faculty and trainees often cite patient volume, lack of dedicated time and inefficient care by trainees as precluding good educational experiences [ 6 – 12 ]. Conflicts often arise, particularly in private practices, regarding who to prioritize - patients or students - which can lead to loss of income [ 8 , 11 , 13 ]. Failure of professional programs to provide clear expectations, define educational experiences and offer standardized assessments contributes to poor faculty preparation [ 8 , 9 , 11 , 13 , 14 ].…”

“…Conflicts often arise, particularly in private practices, regarding who to prioritize - patients or students - which can lead to loss of income [ 8 , 11 , 13 ]. Failure of professional programs to provide clear expectations, define educational experiences and offer standardized assessments contributes to poor faculty preparation [ 8 , 9 , 11 , 13 , 14 ]. Students describe experiences that benefit the patient and not the student (i.e.…”

“…Students describe experiences that benefit the patient and not the student (i.e. “work without education”) or that result in “shadowing” only [ 8 , 9 , 11 , 13 , 14 ]. An absence of physical space and patient discomfort as well as poor faculty development and insufficient financial and professional recognition further hampers faculty participation in education [ 8 – 11 , 13 , 15 ].…”

Stress, Anxiety, and Depression and Their Related Factors Among Dental Students: A Cross-Sectional Study from Southeast of Iran

“…This challenge dates back to 1988 when International Meeting on Medical Education recommended the establishment of community-oriented medical education and the extension of clinical education from hospitals to the community (8). In 2001, the Accreditation Council of Graduate Medical Education (ACGME) stated that one-third of clinical training should be provided in outpatient settings (9).…”