Centre for Medical Education Research, Durham University, Durham, UK.
Med Educ. 2013 Oct;47(10):969-78. doi: 10.1111/medu.12215.
The delivery of undergraduate clinical education in underserved areas is increasing in various contexts across the world in response to local workforce needs. A collective understanding of the impact of these placements is lacking. Previous reviews have often taken a positivist approach by only looking at outcome measures. This review addresses the question: What are the strengths and weaknesses for medical students and supervisors of community placements in underserved areas?
A systematic literature review was carried out by database searching, citation searching, pearl growing, reference list checking and use of own literature. The databases included MEDLINE, EMBASE, PsycINFO, Web of Science and ERIC. The search terms used were combinations and variations of four key concepts exploring general practitioner (GP) primary care, medical students, placements and location characteristics. The papers were analysed using a textual narrative synthesis.
The initial search identified 4923 results. After the removal of duplicates and the screening of titles and abstracts, 185 met the inclusion criteria. These full articles were obtained and assessed for their relevance to the research question; 54 were then included in the final review. Four main categories were identified: student performance, student perceptions, career pathways and supervisor experiences.
This review reflects the emergent qualitative data as well as the quantitative data used to assess initiatives. Underserved area placements have produced many beneficial implications for students, supervisors and the community. There is a growing amount of evidence regarding rural, underserved areas, but little in relation to inner city, deprived areas, and none in the UK.
为满足当地劳动力需求，全世界各种背景下的医疗服务不足地区都在增加本科生临床教育的投入。然而，对于这些实习的影响，目前还缺乏共识。之前的综述往往采取实证主义的方法，只关注结果衡量指标。本综述旨在探讨以下问题：对于医学生和社区服务不足地区的导师而言，社区实习的优势和劣势分别是什么？
通过数据库搜索、引文搜索、珍珠生长法、参考文献检查和使用自身文献，进行了系统的文献综述。数据库包括 MEDLINE、EMBASE、PsycINFO、Web of Science 和 ERIC。使用的检索词是四个关键概念的组合和变体，这四个概念分别是全科医生（GP）初级保健、医学生、实习和地点特征。使用文本叙述综合法对文献进行分析。
最初的搜索共确定了 4923 项结果。在去除重复项并筛选标题和摘要后，有 185 项符合纳入标准。获取这些全文文章并评估其与研究问题的相关性；然后有 54 项被纳入最终综述。确定了四个主要类别：学生表现、学生认知、职业道路和导师经验。
本综述反映了新兴的定性数据以及用于评估各项举措的定量数据。服务不足地区的实习对学生、导师和社区都产生了许多有益的影响。关于农村服务不足地区的证据越来越多，但关于城市内贫困地区的证据很少，英国则没有相关证据。
