Decentralised training for medical students: a scoping review

Area of Science:

• Medical Education
• Global Health
• Health Professions Education

Background:

• Medical students increasingly train at sites beyond tertiary academic health centers.
• Decentralised clinical training offers documented benefits for students, health services, and communities.
• A knowledge base is needed to develop effective models for undergraduate medical student training in lower and middle-income countries (LMICs).

Purpose of the Study:

• To identify approaches to decentralised medical training.
• To understand the implementation of these training approaches.
• To determine the outcomes of decentralised training models to inform future development, particularly in LMICs.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (EBSCO Host, ERIC, HRH Global Resources, Index Medicus, MEDLINE, WHO Repository) and additional sources.
• 3383 references were initially identified, with 288 key additional records sourced.
• Publications were screened using prespecified criteria, and data were charted and analyzed qualitatively and quantitatively using an online Smartsheet database.

Main Results:

• 105 articles were included in the review, with common terminology including 'rural', 'community based', and 'longitudinal rural' training.
• Most publications originated from Australia, the USA, Canada, and South Africa, with 55% describing rotations longer than six months.
• Thematic analysis revealed four key themes: student learning, the training environment, the role of the community, and leadership and governance.

Conclusions:

• Decentralised training approaches are characterized by multiple, interconnected factors.
• The student experience is influenced by the training context, leadership, governance, site, and community dynamics.
• Insights from this review are relevant for expanding decentralised clinical training, including in LMIC settings.