Turkeshi Eralda, Michels Nele R, Hendrickx Kristin, Remmen Roy
Faculty of Medicine, Department of Family Medicine, University of Medicine in Tirana, Tirana, Albania.
Faculty of Medicine and Health Sciences, Department of General Practice, University of Antwerp, Antwerp, Belgium.
BMJ Open. 2015 Aug 4;5(8):e008265. doi: 10.1136/bmjopen-2015-008265.
Synthesise evidence about the impact of family medicine/general practice (FM) clerkships on undergraduate medical students, teaching general/family practitioners (FPs) and/or their patients.
Medline, ERIC, PsycINFO, EMBASE and Web of Knowledge searched from 21 November to 17 December 2013. Primary, empirical, quantitative or qualitative studies, since 1990, with abstracts included. No country restrictions. Full text languages: English, French, Spanish, German, Dutch or Italian.
Independent selection and data extraction by two authors using predefined data extraction fields, including Kirkpatrick's levels for educational intervention outcomes, study quality indicators and Best Evidence Medical Education (BEME) strength of findings' grades. Descriptive narrative synthesis applied.
Sixty-four included articles: impact on students (48), teaching FPs (12) and patients (8). Sample sizes: 16-1095 students, 3-146 FPs and 94-2550 patients. Twenty-six studies evaluated at Kirkpatrick level 1, 26 at level 2 and 6 at level 3. Only one study achieved BEME's grade 5. The majority was assessed as grade 4 (27) and 3 (33). Students reported satisfaction with content and process of teaching as well as learning in FM clerkships. They enhanced previous learning, and provided unique learning on dealing with common acute and chronic conditions, health maintenance, disease prevention, communication and problem-solving skills. Students' attitudes towards FM were improved, but new or enhanced interest in FM careers did not persist without change after graduation. Teaching FPs reported increased job satisfaction and stimulation for professional development, but also increased workload and less productivity, depending on the setting. Overall, student's presence and participation did not have a negative impact on patients.
Research quality on the impact of FM clerkships is still limited, yet across different settings and countries, positive impact is reported on students, FPs and patients. Future studies should involve different stakeholders, medical schools and countries, and use standardised and validated evaluation tools.
综合关于家庭医学/全科医学（FM）实习对本科医学生、培训全科医生/家庭医生（FPs）和/或其患者影响的证据。
2013年11月21日至12月17日检索了Medline、教育资源信息中心（ERIC）、心理学文摘数据库（PsycINFO）、荷兰医学文摘数据库（EMBASE）和科学网。纳入自1990年以来的原始、实证、定量或定性研究，并包含摘要。无国家限制。全文语言：英语、法语、西班牙语、德语、荷兰语或意大利语。
由两名作者使用预定义的数据提取字段进行独立选择和数据提取，包括柯克帕特里克教育干预结果层次、研究质量指标以及最佳证据医学教育（BEME）研究结果等级强度。采用描述性叙述性综合分析。
纳入64篇文章：对学生的影响（48篇）、对家庭医生教学的影响（12篇）和对患者的影响（8篇）。样本量：16 - 1095名学生、3 - 146名家庭医生和94 - 2550名患者。26项研究在柯克帕特里克一级水平进行评估，26项在二级水平，6项在三级水平。只有一项研究达到BEME的5级。大多数被评估为4级（27项）和3级（33项）。学生对家庭医学实习的教学内容、过程以及学习表示满意。他们强化了之前的学习，并在处理常见急性和慢性疾病、健康维护、疾病预防、沟通和解决问题的技能方面提供了独特的学习。学生对家庭医学的态度得到改善，但毕业后对家庭医学职业的新兴趣或增强的兴趣并未持续不变。培训家庭医生报告工作满意度增加以及对专业发展有激励作用，但根据环境不同，工作量也增加且工作效率降低。总体而言，学生的参与对患者没有负面影响。
关于家庭医学实习影响的研究质量仍然有限，但在不同环境和国家，均报告了对学生、家庭医生和患者的积极影响。未来的研究应纳入不同利益相关者、医学院校和国家，并使用标准化和经过验证的评估工具。
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