A systematic review of the approaches to multi-level learning in the general practice context, using a realist synthesis approach: BEME Guide No. 55

<b>Background:</b> Recent global increases in medical student numbers and shifts in medical education from teaching hospitals to community settings call for effective strategies to meet the demand for general practice teaching placements. It has been proposed that “multi-level learning” (MLL), in which learning and teaching are shared across different levels of learners, may provide teaching efficiencies and valuable experiences for learners and teachers. <b>Aims:</b> To identify, evaluate and synthesize the evidence related to the types, benefits, challenges, and facilitators of MLL in community-based general practice, and the underlying mechanisms and associated contexts to explain the reported outcomes. <b>Method:</b> A realist synthesis approach guided the systematic review. <b>Results</b>: Fifteen papers were identified, providing primary evaluation data predominantly from interviews with or surveys of key stakeholders. Generally, all levels of learners reported overall satisfaction with their MLL experiences. Medical students appreciated learning from prevocational doctors and registrars due to social and cognitive congruence. Mechanisms and contexts that supported our hypotheses regarding successful MLL outcomes were identified, with “a strong teaching culture” being a major mechanism. <b>Conclusions:</b> The findings can help inform practices considering the implementation or enhancement of MLL initiatives in general practice. Further research should include measuring defined learning outcomes.

【研究背景】近年来全球医学生规模持续扩大，医学教育也正从教学医院向社区场景转型，亟需出台有效策略以满足全科实践教学岗位的需求。有研究提出，“多层级学习（multi-level learning, MLL）”模式可让不同层级的学习者共享教学与学习过程，既能提升教学效率，也能为学习者与授课者带来宝贵的实践体验。【研究目的】针对社区全科实践场景下多层级学习的模式类型、优势、挑战及推动因素相关证据开展识别、评估与综合分析，并探究可解释相关研究结果的内在作用机制与关联场景。【研究方法】本系统综述采用现实主义综合法作为研究框架。【研究结果】本次综述共纳入15篇文献，其原始评估数据主要来自对关键利益相关者的访谈与问卷调查。总体而言，各层级学习者均对自身的多层级学习体验表示满意。医学生之所以青睐向执业前医师与专科培训医师学习，源于双方在社会角色与认知层面的契合度。本研究还识别出了可支撑“多层级学习可取得良好效果”这一假设的作用机制与场景，其中“浓厚的教学文化”是核心作用机制。【研究结论】本研究结果可为全科实践领域考虑开展或优化多层级学习项目的实践工作提供参考依据。未来研究应纳入标准化学习成果的量化评估环节。