Table 2 Illustrative outcomes from the pre-service education experimental and descriptive literature

Qualified student body

Grumbach & Chen, 2006 [6]

USA

Medical students

661

265

396

4

2B

Applicants from minority and disadvantaged groups who participated in post-baccalaureate pre-medical programmes were significantly (P = 0.001) more like to gain admission. Participants demonstrated higher MCAT scores (odds ratio 8.06, CI, 4.08 – 9.71)

Rolfe et al., 2004 [7]

Australia

Medical students

498

344

154

4

1B

Graduates from prior 16 years were surveyed. Students admitted directly from high school were equally successful to those admitted following university education. No significant differences were demonstrated in terms of academic performance (P = 0.83) or postgraduate practice sites in urban or rural settings (P = 0.46)

Student support and retention

Santee & Garavalia, 2006 [8]

N/A

Nursing students

20

1

2B

This systematic review concluded that peer tutoring had positive impact on academic performance, compared to no tutoring. Peer tutoring performed slightly better than faculty tutoring. However, few higher quality studies could be identified for inclusion in the review

Pariyo et al., 2009 [9]

N/A

Students of various health professions

2

1

1B

This Cochrane review concluded that a student support package that included social and academic support and mentorship, and career guidance, resulted in an increase in the number of minority students who enrolled and graduated from health training institutions

Competency-based curriculum

Tamblyn et al., 2005 [35]

Canada

Medical students

751

151

600

2

4B

Three comparison cohorts of medical graduates who had studied within a traditional curriculum were compared to one cohort of graduates of a problem-based-learning (PBL) focused curriculum. Assessment of their performance in practice on measures of preventive care, continuity of care, diagnosis and management were significantly higher for the PBL cohort (for example, a four-fold increase in disease specific prescribing compared to prescribing for symptom relief)

Curriculum aligned with national health priorities

Kaye et al., 2010 [11]

Uganda

Medical students

60

30

30

3

1B

Students who completed a PBL curriculum, including experiential training in rural health settings, were compared to a cohort who graduated from a traditional curriculum. The PBL experience significantly influenced the choice to work in a rural/underserved area

Laven & Wilkinson, 2003 [12]

N/A

Medical students

12

1

1B

This systematic review addressed the effect of rural background on willingness to enter rural practice identified a strong association. Odds ratios exceeded 2.0. Rural undergraduate training had a similar positive influence

Longombe, 2009 [13]

Democratic Republic of the Congo

Medical school graduates

163

43

120

4

1B

Graduates of a medical school located in a rural area were compared to graduates of an urban-located school. Almost all (97.7%) of the graduates from the rural-located school were employed in the province in which they were educated; the majority (81.4%) in rural areas. Urban graduates were dispersed throughout the country, but only 23.7% were practicing in rural areas

Teachers/tutors competent in technical areas

Steinert el al., 2006 [14]

N/A

Faculty of various health professions

53

1

1A

This systematic review concluded that faculty development activities (seminars, workshops, short-courses) are highly valued and lead to learning and behaviour change, as well as better teaching performance

1B

2A

2B

3

4B

Competent preceptors

Udlis 2008 [15]

N/A

Nursing students

16

1

2A

This integrative review indicated that participation in a one-to-one preceptorship programme increased role conception and performance. However, no evidence was found that the preceptorship experience promoted critical thinking, clinical competence or improvement in licensing examination pass rates

2B

Enhanced learning activities

Cook et al., 2008 [16]

N/A

Students of various health professions

201

1

1B

This systematic review compared Internet-based education to no intervention on outcomes addressing knowledge, skills, learner behaviours and patient effects. Data synthesis shows that Internet-based learning - when compared with no intervention - is associated with large positive effects (P <0.001 for each) but the effectiveness of Internet-based learning appears to be similar to that of traditional methods

2B

3

Cook et al., 2011 [17]

N/A

Students of various health professions

609

1

1B

A total of 137 randomized studies, 67 two-group comparisons, and 405 pre-test/post-test studies concluded that in comparison with no intervention, technology-enhanced simulation training in health professions education is consistently associated with large effects for outcomes of knowledge, skills and behaviours (all effect sizes >1), and moderate effects for patient-related outcomes (effect size 0.50)

2B

3

4B

Multidisciplinary learning experiences

Reeves et al., 2010 [18]

N/A

Students of various health professions

6

1

1A

A Cochrane review identified six studies (randomized controlled trials (RCT) or experimental studies on inter-professional education (IPE)); however, because component activities and measured outcomes were not consistent among the studies, comparison was limited. All six studies were favourable for the effect of IPE on student learning and clinical behaviours

1B

1C

1D

Varied clinical practice sites

Dornan et al., 2006 [19]

N/A

Students of various health professions

73

1

1A

This systematic review concluded that having practical experience in clinical sites early in the curriculum of studies was motivating for students, helped them be more confident with patients; less stressed, more self-reflective, and enhanced their professional identity

1B

2A

2B

3

Littlewood et al., 2005 [20]

N/A

Medical students

73

1

2A

This systematic review indicated that early immersion into clinical practice fostered more positive attitudes toward studies, greater understanding of subject matter, enhancement of clinical skills, and had benefits on organizations, populations and patients

3

4B