Table 4.

Summary of systematic review

	University	Author (year)	Description of CBE	Type of evaluation	Evaluation findings	Evaluation method
1.	Aberdeen (University of)	Sinclair et al (2006)32	Years 1–3: GP-led patient-centred tutorials and clinical sessions Year 4: 5-week community-themed clinical rotation Year 5: optional 7-week general practice attachment	Impact assessment	Increase in students interested in pursuing a career in general practice as curriculum progressed Exposure to community settings had positive effect on students’ attitudes towards a career in general practice	Questionnaire—Student Survey
2.	Barts and The London School of Medicine and Dentistry	Nicholson et al (2001)31	Year 4: Community-based Module prior to obstetrics and gynaecology hospital placement	Implementation assessment Impact assessment	Adequate clinical exposure within the community Variation in opportunities to gain relevant experience in clinical exposure Students found small-group learning and GP attitudes to be beneficial to their learning Multidisciplinary interaction enhanced their clinical experience Successfully Incorporated specialty with community environment	Questionnaire—Student Feedback
3.	Birmingham (University of)	Parle et al (1999)7	Years 1–4: General practice practice visits	Implementation assessment Impact assessment	Students found GP tutors to be encouraging GP tutors reported: ▸ Enhanced development of both students and GPs ▸ Organisational drawbacks	Questionnaire—Student Feedback
4.	Cambridge (University of)	Alderson and Oswald (1999)33	15-month attachment to general practice practice	Implementation assessment	Adequate exposure of all clinical specialities was achieved Individual experiences may vary due to variation in opportunities	Student log Diary
5.	Cambridge (University of)	Oswald et al (2001)17	15-month attachment to general practice practice	Implementation assessment Impact assessment Cost assessment	Course was feasible in terms of organisation and student logistics Extended relationships with patients enriched students’ clinical experience No difference in academic performance on formative assessments between students undertaking community-based versus hospital-based teaching Reported costs were less than the average ‘SIFT into the Future’ student-year	Debriefing Sessions—Student Feedback
6.	Cardiff University	Grant and Robling (2006)24	Year 5: General practice attachment	Needs assessment Impact assessment	All parties found the attachment to be positive general practices felt more confident clinically through teaching students Primary care team felt team ethic was strengthened	Discussion Meetings—Primary Care Team Feedback Interviews—general practice Feedback
7.	Dundee (University of)	Muir (2007)25	Year 1–3: Patient Follow-up in the community	Impact assessment	Students were able to gain a better insight into patient-centred medicine as a result of the attachment Early exposure to patients evoked student enthusiasm	Focus Group—Student Interview
8.	Glasgow (University of)	Davison et al (1999)6	Year 1: Educational exercise of three teaching sessions	Needs assessment	Students found that learning objectives were met through community-themed educational exercises	Questionnaire—Student Evaluation
9.	Glasgow (University of)	Mullen et al (2010)26	Year 1: Patient interviews in the community	Impact assessment	Integration of community-based exercise positively influenced students’ attitudes in regards to: ▸ Understanding of psychosocial model of illness ▸ Development of empathy	Questionnaire—Student Evaluation
10.	Imperial College	Powell and Easton (2012)27	Year 3: 3-session surgical module conducted by general practice tutors	Implementation Assessment	Surgical teaching delivered by general practices was favourable based on the following benefits: ▸ Protected time for learning ▸ Regular access to suitable patients ▸ Learner-centred teaching However GP lacked specialist knowledge, and teaching was not directed by syllabus	Focus group—Student Interview
11.	King's College London	Seabrook et al (1999)8	Year 1: Healthcare Team Module Year 2: Special Study Module	Implementation assessment Impact assessment	Community-based courses are feasible and well-received by students Multidisciplinary teamwork is encouraged positively	Questionnaires—Student feedback Small-group discussions—Student feedback Focus groups—Tutor Feedback
12.	King's College London	Gavin et al (2002)19	Year 2—Community-based Special Study Module	Impact assessment	Student appreciation of: ▸ Psychosocial needs of patients ▸ Inter-professional teamwork	Questionnaire survey: students and teaching professionals
13.	Leeds (University of)	Thistlethwaite and Jordan (1999)10	Year 3: general practice-led days in community setting	Impact assessment	Early community exposure to patient-centred consultations allowed students to: ▸ Appreciate importance of patient-centred communication ▸ Gain more confidence in their abilities Direct observation and feedback from clinician was beneficial to student learning	Focus Groups—Student Interviews
14.	Leeds (University of)	Thistlethwaite (2000)13	Year 3: general practice-led days in community setting	Implementation assessment Impact assessment	Positive feedback from students: ▸ Community environment allowed ease of patient-centre approach ▸ Students now routinely ask about patient concerns Positive feedback from general practices: ▸ Teaching was motivating and gratifying	Questionnaire—Student Feedback
15.	Leeds (University of), Sheffield (University of) and Hull York Medical School	Macallan and Pearson (2013)42	Years 3–4: General practice attachment	Implementation assessment	general practice enthusiasm and engagement crucial to determining the quality of the placement Well-organised general practice were valued by students Students felt that general practices needed to be better informed of placement outcomes	Focus Groups—Student Interviews
16.	Leicester (University of)	Lennox and Petersen (1998)30	Year 3: Patient Study	Needs assessment Implementation assessment Impact assessment	Precourse needs assessment of CBE programme based on students’ opinions of: ▸ Structure of course ▸ Method of implementation ▸ Assessment format End-course impact assessment revealed that: Course effectively achieves GMC recommendations for ‘Tomorrow's Doctors’ ▸ End-Course Implementation assessment revealed that: Continuation of the course was supported by all participants (students, patients and agencies)	Questionnaire—Student, Patient and Agency Feedback
17.	Leicester (University of)	Hastings et al (2000)11	Year 3 or 4: General practice practice-based teaching	Implementation assessment	Comparison of practice-based & hospital-based teaching with respect to the ‘teaching content’ and the ‘teaching processes revealed students favouring practice-teaching in both respects	Questionnaire—Student Feedback
18.	Leicester (University of)	Anderson et al (2003)21	Year 3: Community placement and Patient study	Implementation assessment Impact assessment	Implementation assessment: ▸ Continuation of course was well-supported by students, patients and staff ▸ Impact assessment: ▸ Course effectively achieved students’ learning objectives in community education. ▸ Positive patient and staff experience in their involvement in medical education	Questionnaires—Student and Patient Feedback Focus Groups—Staff Interviews
19.	Liverpool (University of)	Watmough (2012)28	Years 1–4: Community-based teaching Year 5: Community placement	Implementation assessment Impact assessment	Implementation assessment: ▸ Increased curriculum time on community-based teaching was appreciated in terms of clinical skills practice, and understanding the role of primary care Impact assessment: ▸ Reformed course achieved significantly better understanding on the relationship between primary, social care and hospital care	Questionnaires and Interviews—Student Feedback
20.	Liverpool (University of)	Watmough et al (2012)43	Years 1–4: Community-based teaching Year 5: Community placement	Impact assessment	Impact assessment: ▸ Graduates from reformed curriculum had more confidence in clinical skills & communication skills, but felt less well prepared with their medical knowledge	Questionnaires—Student Feedback
21.	Manchester (University of)	Jones et al (2002)20	Years 3–4: General practice teaching in core modules Year 5: Community placement	Impact assessment	Overall positive impact on students’ perception of preparedness in competencies and skills for entering professional practice. This includes a significantly improved understanding of the role of primary care. Students also had no disadvantage to graduates of traditional programme in terms of basic science and clinical knowledge	Questionnaires—Student and Supervisor Feedback
22.	Newcastle University Medical School	Stacy and Spencer (1999)9	Year 2: Patient study projects	Impact assessment	Patients have a positive perception of their role in community-based teaching. They also feel that they benefited from participation	Interviews
23.	Royal Free and University College Medical Schools	Walters et al (2003)22	Year 4: Community education integrated in the psychiatry attachment	Impact assessment	Impact of participation in teaching on patients: ▸ Mainly positive experience (more balanced doctor–patient relationship, and some had therapeutic benefit) ▸ However a few patients found the teaching encounter distressing	Questionnaire—Patient Survey Interviews—Patients, Students and general practice tutor Feedback
24.	Royal Free and University College Medical Schools	Jones et al (2005)23	Intercalated BSc in Primary Health Care	Impact assessment	Students saw benefit in: ▸ Development of critical approach and skills relevant to medicine ▸ Adding depth to views on general practice and primary care	Interviews—Student Feedback
25.	Sheffield (University of)	Howe and Ives (2001)15	Year 4:General practice placement	Impact assessment	Increased exposure to primary and community care alters career intention, and enhances the view of the role of primary care	Questionnaires—Student Feedback
26.	Sheffield (University of)	Howe (2001)14	Year 4: General practice placement	Needs assessment	Students value community-based learning which have the qualities of: ▸ Person-centred clinical methods and learning contexts ▸ Positive attitude and committed general practice tutors and primary care teams	Questionnaire—Student feedback
27.	University College London	Coleman and Murray (2002)18	general practice placement	Impact assessment	Patients mainly felt positive about participating in community-based teaching. However there were also negative aspects that may concern patients There may also be shifts in the doctor–patient relationship	Interviews—Students and general practice tutor Feedback
28.	University College London	Murray et al (2001)16	general practice placement as part of the internal medicine clerkship	Implementation assessment	▸ Time spent on teaching and learning activities were similar in both settings ▸ Supervised interaction with patients (which was experienced mainly with the general practice) is perceived by students as the most educationally valuable and enjoyable activity ▸ Patient-based learning was highly valued	Student Log Diary
29.	University College London	O'Sullivan et al (2000)12	Year 3: Community Medicine placement	Implementation assessment Impact assessment	Implementation assessment ▸ Basic clinical skills could be learnt in both settings, but general practice was better for learning of communication skills & psychosocial issues ▸ General practice teaching was advantageous in terms of: quality of teaching, tutors’ teaching attitude, teaching methods, course organisation. Impact assessment revealed that: ▸ General practice enabled students to increase their confidence and competence	Interviews—Student Feedback Focus Groups—Student Feedback