INTRODUCTION
METHODS
Study title | Study design, evidence level, and overall quality | Intervention method, students’ stage, patient education subjects, and patient target group | Number of participants [n(p) = number of patients, n(s) = number of medical students] and effect sizes (P1–4 = Kirkpatrick level of patient outcome, S1–4 = Kirkpatrick level of student outcome) |
---|---|---|---|
Standardized instructions: do they improve communication of discharge information from the emergency department?22
| Study design: non-randomized controlled trial | Medical students providing verbal and written discharge instructions to parents of children with otitis media, after consultation with an attending physician | n(p) = 136 n(s) = not reported P1) Parent satisfaction: 96% |
Evidence level: 3 | |||
Study quality: moderate | |||
Health fairs as a unique teaching methodology23
| Study design: post-intervention survey | First- and second-year medical students organizing a community-based health fair, with information about blood pressure, diabetes, and explanation of lab results to patients with hypertension, carcinomas, nipple retraction, or chronic infection | n(p) = 152 n(s) = 213 P1) Patient satisfaction: 93% of patients rated good or higher |
Evidence level: 4 | |||
Study quality: weak | |||
An office-based Internet patient education system: a pilot study24
| Study design: post-intervention interview | Medical students assisting patients with use of the Internet/computer for patient education on the Web | n(p) = 50 n(s) = not reported P1) Patient satisfaction: 90% of patients more satisfied with visit to clinic than usual P3) Patient-reported change in behavior after patient education: 77% of patients |
Evidence level: 4 | |||
Study quality: weak | |||
The attitudes of cardiac arrest survivors and their family members towards CPR courses25
| Study design: non-randomized controlled trial | Medical students providing courses in basic and advanced life support for cardiac arrest survivors and their families in comparison with general public (subjects: diagnosing unconsciousness, respiratory and cardiac arrest, and CPR) | n(p) = 101 n(s) = 9 P1) Patient satisfaction: 96% of patients rated good or higher P2) Patient-reported knowledge of CPR: 96% of patients understand principle after training P2) Patient-reported confidence in performing CPR after training: 79% of patients |
Evidence level: 3 | |||
Study quality: moderate | |||
Applying practical preventive skills in a preclinical preceptorship26
| Study design: uncontrolled before-and-after study | Preclinical medical students providing foot-care education to diabetic patients during preclinical preceptorship | n(p) = 321 n(s) = 158 S2) Student-reported self-efficacy in patient education: 0% of students before vs. 90% of students after (significance not reported) |
Evidence level: 4 | |||
Study quality: moderate | |||
Evaluating a diabetes foot care program in a preceptorship for medical students27
| Study design: post-intervention survey | Preclinical medical students providing foot-care education for diabetic patients during 4-week ambulatory educational experience | n(p) = 310 n(s) = 156 P1) Patient satisfaction: 90.3% of patients rated valuable P2) Patient-reported improved knowledge: 84% of patients P2) Patient-reported improved health attitude: 88.8% of patients |
Evidence level: 4 | |||
Study quality: weak | |||
The summer assistantship in patient education: a preclinical preceptorship28
| Study design: post-intervention survey | Medical students between the first and second year educating and counseling people with arthritis, diabetes, depression, or hypertension in family practice full-time over 5–7 weeks in summer | n(p) = 6000 encounters n(s) = 40 S1) Student satisfaction: 98% of students very satisfied S2) Student-reported improved skills: 90% of students |
Evidence level: 4 | |||
Study quality: weak | |||
Enhancing the relationship and improving communication between adolescents and their health care providers: a school based intervention by medical students29
| Study design: post-intervention survey | Second- and fourth-year medical students giving a workshop at high schools about communicating with professionals and legal/ethical aspects of care. Learners in the high school were children who visit the primary care physician | n(p) = 1651 n(s) = 181 P1) Patient satisfaction: 94% of patients scored workshop as “just right” P3) Patient-reported behavior on follow-up: 57% of patients experienced difference in encounter with physician (n(p) = 17) |
Evidence level: 4 | |||
Study quality: weak | |||
A wellness class for inpatients with psychotic disorders30
| Study design: uncontrolled before-and-after study | Medical students giving 30-min didactic presentations about diet and exercise to inpatients with chronic psychotic disorders | n(p) = 50 n(s) = not reported P2) Knowledge of patients on exam: 4.3% improved score on exam before intervention and after intervention (p < 0.02) |
Evidence level: 4 | |||
Study quality: weak | |||
A preclinical training model for chronic care education31
| Study design: post-intervention survey | Preclinical medical students counseling diabetic patients in ambulatory care about diabetes foot care | n(p) = 424 n(s) = 124 P1) Patient satisfaction: 95% of patients rated useful |
Evidence level: 4 | |||
Study quality: weak | |||
Making health literacy real: adult literacy and medical students teach each other32
| Study design: post-intervention survey | Medical students giving presentations about health literacy (e.g., living with diabetes or controlling blood pressure) to adult learners who are following a literacy course and have hypertension, diabetes, cancer, depression, or mental illness | n(p) = 30 n(s) = 45 P2) Patient-reported improved knowledge: 44% of patients P2) Student-reported improved communication skills: 88% of students |
Evidence level: 4 | |||
Study quality: weak | |||
Caring for underserved patients through neighborhood health screening: outcomes of a longitudinal, interprofessional, student-run home visit program in Singapore33
| Study design: uncontrolled before-and-after study | Different grades of medical students providing in-home medical services (e.g., information on disease management, medication/treatment compliance, managing complications) to patients with hypertension, diabetes, dyslipidemia, colorectal cancer, or cervical cancer in a low-income neighborhood | n(p) = 209 + 355 = 564 (two cohorts) n(s) = 240 P1) Patient satisfaction: 82% of patients satisfied (n = 291, cohort 2) P3) Blood pressure control: 42% hypertensive patients pre vs. 79% hypertensive patients post (n = 82, p < 0.001, cohort 1) S1) Student satisfaction: 70% of students S2) Student-reported development of communication skills: 98.6% of students S2) Student-reported improvement of relationship: 92.8% of students S2) Student-reported improved self-efficacy in patient counseling: 92.3% of students |
Evidence level: 4 | |||
Study quality: moderate | |||
Effects of interprofessional education on patient perceived quality of care34
| Study design: non-randomized controlled trial | Fourth-year medical students participating in inter-professional student teams at clinical education ward and providing information on treatment, daily living with disease, and self-care | n(p) = 102 treatment vs. 85 control group n(s) = not reported In comparison with regular care P) Patient-reported involvement in decisions: 62% higher number of patients in clinical education ward P2) Patient-reported knowledge of daily living with disease: 50% higher number of patients in clinical education ward (p < 0.006) P2) Patient-reported understanding of treatment information: 69% higher number of patients in clinical education ward (p < 0.02) |
Evidence level: 3 | |||
Study quality: moderate | |||
The clinical skills experience of rural immersion medical students and traditional hospital placement students: a student perspective35
| Study design: non-randomized controlled trial | Sixth-year medical students participating in rotations in rural practice and providing patient education to rural community | n(p) = not reported n(s) = 6 treatment vs. 17 control S2) Student-reported improved patient education self-efficacy compared to traditional rotations: 31.6% higher number of students confident in providing patient education (significance not reported) |
Evidence level: 3 | |||
Study quality: weak | |||
The crimson care collaborative: a student-faculty initiative to increase medical students’ early exposure to primary care36
| Study design: case series | Student-designed and student-run clinic providing primary care services (such as patient education about medication or designing patient education materials) with preclinical and clinical medical students | n(p) = 17 n(s) = not reported P3) Blood pressure control in 76% of 17 patients who visited the clinic vs. 48.4% in average population (significance not reported) |
Evidence level: 4 | |||
Study quality: weak | |||
Approach to antihypertensive adherence: a feasibility study on the use of student health coaches for uninsured hypertensive adults37
| Study design: uncontrolled before-and-after study | Clinical-year medical students’ health coaching for uninsured hypertensive patients of a free clinic, e.g., making phone calls to patients once every 2 weeks and explaining medication use, home blood pressure monitoring, and encouraging lifestyle goals | n(p) = 25 n(s) = 5 P1) Patient satisfaction: 92.8% of patients rated just right P2) Patient-reported improved knowledge: 71.4% of patients rated very much P3) Patient-reported improved behavior to hypertension: 92.9% of patients rated very much P3) Medication adherence on Brief Medication Questionnaire (BMQ) adherence scale: pre 2.33 vs. post 1.25, lower is better (p < 0.1) P3) Blood-pressure control: 147/92 average (SD = 18.7/17.4) pre-test vs. 136/85 average (SD = 18.3/6.5) post-test (systolic blood pressure shows significant difference with p < 0.03) |
Evidence level: 4 | |||
Study quality: weak | |||
Teaching patient-centered communication skills: a telephone follow-up curriculum for medical students38
| Study design: non-randomized controlled trial | Third-year medical students in clinical rotation telephoning neurology, psychiatric, or surgical patients at home about medication adherence, comprehension of treatment plan, and understanding of illness, 1 week after clinical encounter | n(p) = not reported n(s) = 101 S1) Student-reported value/satisfaction: 84.2% of students S2) Student-reported deepening relationship with patients: 18.4% of students S2) Student-reported improved skills in patient education: 71% of students S3) Student-reported change in patient education behavior: 41% of students |
Evidence level: 3 | |||
Study quality: moderate | |||
Involving medical students in informed consent: a pilot study39
| Study design: post-intervention interview | Sixth-year medical students providing additional conversation about surgery (surgical complications or risks) with surgical patients shortly before surgery | n(p) = 55 n(s) = 9 P2) Patient-reported improved understanding of treatment: 96.4% of patients S2) Student-reported improved self-efficacy in patient education: 100% of students |
Evidence level: 4 | |||
Study quality: weak |
RESULTS
Search Results
Interventions and Outcomes
Study Quality Assessment
Study title | Selection bias | Study design | Confounders | Blinding | Data collection | Withdrawals | Overall study quality |
---|---|---|---|---|---|---|---|
Standardized instructions: do they improve communication of discharge information from the emergency department?22
| 2 | 1 | 1 | 2 | 3 | 1 | Moderate |
Health fairs as a unique teaching methodology23
| 3 | 3 | 3 | 2 | 3 | 2 | Weak |
An office-based Internet patient education system: a pilot study24
| 2 | 3 | 3 | 2 | 3 | 2 | Weak |
The attitudes of cardiac arrest survivors and their family members towards CPR courses25
| 3 | 1 | 1 | 2 | 3 | 3 | Moderate |
Applying practical preventive skills in a preclinical preceptorship26
| 2 | 2 | 3 | 2 | 3 | 1 | Moderate |
Evaluating a diabetes foot care program in a preceptorship for medical students27
| 2 | 3 | 3 | 2 | 3 | 2 | Weak |
The summer assistantship in patient education: a preclinical preceptorship28
| 3 | 3 | 3 | 2 | 3 | 2 | Weak |
Enhancing the relationship and improving communication between adolescents and their health care providers: a school based intervention by medical students29
| 2 | 3 | 3 | 2 | 3 | 2 | Weak |
A wellness class for inpatients with psychotic disorders30
| 3 | 2 | 3 | 2 | 3 | 2 | Weak |
A preclinical training model for chronic care education31
| 2 | 3 | 3 | 2 | 3 | 2 | Weak |
Making health literacy real: adult literacy and medical students teach each other32
| 3 | 3 | 3 | 2 | 3 | 2 | Weak |
Caring for underserved patients through neighborhood health screening: outcomes of a longitudinal, interprofessional, student-run home visit program in Singapore33
| 1 | 2 | 3 | 2 | 3 | 1 | Moderate |
Effects of interprofessional education on patient perceived quality of care34
| 2 | 1 | 1 | 2 | 1 | 2 | Moderate |
The clinical skills experience of rural immersion medical students and traditional hospital placement students: a student perspective35
| 3 | 1 | 3 | 2 | 3 | 3 | Weak |
The crimson care collaborative: a student-faculty initiative to increase medical students’ early exposure to primary care36
| 3 | 3 | 3 | 2 | 3 | 1 | Weak |
Approach to antihypertensive adherence: a feasibility study on the use of student health coaches for uninsured hypertensive adults37
| 3 | 2 | 3 | 2 | 2 | 3 | Weak |
Teaching patient-centered communication skills: a telephone follow-up curriculum for medical students38
| 2 | 1 | 3 | 2 | 3 | 3 | Moderate |
Involving medical students in informed consent: a pilot study39
| 2 | 3 | 3 | 2 | 3 | 2 | Weak |
Expert Ratings
Study title | Learning yield [education professionals n = 5, mean (SD)] | Impact on quality of care [patients n = 2, care professionals n = 2, researchers n = 2, mean (SD)] | Practical feasibility [all stakeholders n = 11, mean (SD)] | Overall score [all stakeholders n = 11, mean (SD)] |
---|---|---|---|---|
Higher-than-average scores on all aspects | ||||
The attitudes of cardiac arrest survivors and their family members towards CPR courses25
| 7.6 (0.9) †
| 7.3 (1.4) †
| 7.8 (1.2) †
| 7.8 (0.6) †
|
Higher-than-average learning yield, impact on quality of care, and overall score | ||||
Effects of interprofessional education on patient perceived quality of care34
| 8.4 (0.5) †
| 7.3 (0.8) †
| 6.7 (1.0) | 7.8 (0.3) †
|
The crimson care collaborative: a student–faculty initiative to increase medical students’ early exposure to primary care36
| 8.0 (1.0) †
| 7.7 (1.4) †
| 6.9 (1.6) | 7.7 (1.0) †
|
The summer assistantship in patient education: a preclinical preceptorship28
| 8.2 (0.4) †
| 7.7 (1.0) †
| 6.8 (1.8) | 7.6 (1.1) †
|
Caring for underserved patients through neighborhood health screening: outcomes of a longitudinal, interprofessional, student-run home visit program in Singapore33
| 8.4 (0.5) †
| 8.2 (1.2) †
| 6.1 (2.0) | 7.4 (1.7) †
|
Approach to antihypertensive adherence: a feasibility study on the use of student health coaches for uninsured hypertensive adults37
| 7.4 (0.5) †
| 7.7 (0.5) †
| 6.8 (1.2) | 7.1 (0.7) †
|
Higher-than-average impact on quality of care | ||||
Standardized instructions: do they improve communication of discharge information from the emergency department?22
| 6.0 (1.0) | 7.0 (1.7) †
| 8.3 (1.0) †
| 7.0 (1.0) |
Evaluating a diabetes foot care program in a preceptorship for medical students27
| 6.6 (1.1) | 7.0 (1.1) †
| 7.0 (0.6) | 7.0 (0.8) |
Making health literacy real: adult literacy and medical students teach each other32
| 6.6 (1.1) | 7.5 (1.6) †
| 6.8 (1.2) | 6.9 (1.3) |
Enhancing the relationship and improving communication between adolescents and their health care providers: a school based intervention by medical students29
| 5.6 (1.3) | 6.8 (0.8) †
| 6.8 (0.6) | 6.5 (1.0) |
Higher-than-average learning yield | ||||
Health fairs as a unique teaching methodology23
| 7.4 (1.1) †
| 5.2 (2.3) | 7.1 (1.2) | 6.4 (1.7) |
Higher-than-average practical feasibility | ||||
An office-based Internet patient education system: a pilot study24
| 6.6 (1.1) | 6.5 (2.0) | 7.3 (1.0) †
| 7.1 (0.8) †
|
Involving medical students in informed consent: a pilot study39
| 6.8 (0.4) | 5.7 (2.2) | 7.4 (1.4) †
| 6.8 (1.1) |
Applying practical preventive skills in a preclinical preceptorship26
| 7.0 (0.7) | 6.2 (1.2) | 7.2 (0.8) †
| 6.8 (0.9) |
Teaching patient-centered communication skills: a telephone follow-up curriculum for medical students38
| 6.8 (1.6) | 6.2 (2.1) | 7.3 (0.8) †
| 6.6 (1.4) |
Lower-than-average scores on all aspects | ||||
A preclinical training model for chronic care education31
| 6.2 (1.1) | 6.7 (0.8) | 6.9 (0.9) | 6.9 (0.7) |
The clinical skills experience of rural immersion medical students and traditional hospital placement students: a student perspective35
| 6.4 (0.5) | 6.3 (1.5) | 6.5 (1.4) | 6.2 (1.0) |
A wellness class for inpatients with psychotic disorders30
| 5.8 (1.5) | 5.7 (1.0) | 6.9 (0.8) | 5.8 (1.1) |
Average of all scores* | 7.0 | 6.7 | 7.1 | 7.0 |
Intra-class correlation coefficient‡
| 0.79§
| 0.54§
| 0.51 | 0.71§
|
Facilitators and Barriers
Category | Facilitators | Barriers |
---|---|---|
Trainee characteristics | ||
Learner readiness | None reported | |
Performance self-efficacy | - Students recognizing their independence in helping patients26
- Students recognizing their skills in patient education after feedback from patients33
| - Students having the feeling during the training that they were not capable of contributing to patient education38
|
Motivation scales | ||
Motivation to learn | - Preselected students based on exam results are more motivated28
| - Nature of student participation too voluntary, giving them the feeling that participation was not important26
- Strategy not applicable to all students because of voluntary application of only highly motivated students33
|
Transfer effort-Performance expectations | - Students not recognizing their training effort as useful for enhancing their professional role38
| |
Performance-Outcomes expectations | - Students recognizing that their contribution leads to better patient care33
| - Students not seeing the importance of their contribution to patient care38
|
Environment scales | ||
Feedback/Performance coaching | - Feedback on performance by supervisor(s) in written or oral form (in presentation meetings or individually)26
,
28
,
31
,
33
,
34
,
36
,
38
,
39
- Feedback from fellow students34
- Feedback from patients on postcards or oral27
| None reported |
Supervisor support | - Lack of time for support from or supervision by preceptors26
| |
Supervisor sanctions | None reported | - Supervisor(s) not acknowledging the importance of learning patient education26
- Students not enabled to perform patient education because their knowledge and skills are not recognized26
|
Peer support | - Senior medical students supervising or mentoring junior medical students23
- Interprofessional teams of students working together in providing patient education34
| None reported |
Resistance/Openness to change | - Differences between male and female students in openness to changing their behavior33
| |
Positive personal outcomes | - Students having clearer vision of ambitions as a result of experiences33
- Students being appreciated by other students33
| None reported |
Ability scales | ||
Opportunity to learn | - Making students members of the team28
- Technical resources such as access to health records or laptops for ambulatory care33
- Additional funding to create initiatives36
| None reported |
Personal capacity for learning | - Enough time to perform patient education29
- Students adequately prepared to perform patient education26
| - Time limitations due to other curricular activities37
- Workload too high or schedule too busy during preceptorships to perform patient education38
|
Perceived content validity | - Students appreciating and recognizing their role as physicians in performing patient education33
| - Students not appreciated as team members, but as assistants26
|
Transfer design | - Making students part of the team to enhance learning28
- Focusing on students’ professional role in designing educational set-up, e.g., with regard to patient interaction, communication skills, responsibility23
,
26
,
27
,
29
,
32
,
34
,
37
,
39
- Providing students with patient care experiences to enable them to shape their future careers26
,
33
,
36
,
37
- Enabling students to work together with other professions in healthcare34
| None reported |