Transnational medical education programmes and preparation for different country medical practice: A systematic review

BACKGROUND: Medical education is becoming more internationalised. Increasing numbers of students engage in Transnational Medical Education Programmes, pursuing their Primary Medical Qualification outside of their home country; with plans to transition back to their home country - or a third country - after graduation. Medical education is however, inextricably embedded within medical contexts, and a potential mismatch exists between graduates' place of training and place of practice in terms of the knowledge, skills and values required to practice safely in a different context.

AIM: What types of Transnational Medical Education programmes can be identified from the international literature? What are the strengths and weaknesses of these programmes and do they prepare students for international practice?

METHODS: This review was based on the PRISMA-Guidelines for systematic reviews. We searched five electronic databases: MEDLINE, EMBASE, CINAHL, WEB of Science and ERIC. No date or language restrictions were placed on the inclusion criteria. Data extraction was completed by two independent reviewers. Quality appraisal was carried out using the Mixed Methods Appraisal Tool (MMAT), and a narrative synthesis of the included papers was conducted.

RESULTS: Our literature search identified 12 studies. From the included studies we were able to identify three types of Transnational Medical Education Programme, and a number of strengths and weaknesses of these programmes. Strengths were: increasing medical workforce capacity, enhancing the quality of education locally, promoting intercultural competence and increasing exposure to new ways of working (enhanced communication skills, shared decision-making, experience of multidisciplinary teamwork and patient-centeredness). Weaknesses were: potential curriculum misalignment within the context of clinical practice, language barriers and encountering differences in hierarchical systems, shared decision making and patient-centredness all of which impact preparation for practice.

CONCLUSION: Transnational medical education programmes address shortages within the medical workforce by creating additional training opportunities. They can also drive up the quality of medical education locally. There is, however, a potential mismatch between the curriculum and the place of practice which can impact upon graduates' preparation for professional practice.