Flexibility in primary medical programs: A scoping review

Abstract

Introduction: Students and universities increasingly seek flexibility in learning options, however terms such as flexible are not consistently defined in the medical education literature. This review aimed to 1) propose a definition for flexibility in medical education and 2) create a typology of contemporary examples of how flexibility has been operationalised in medical education. Method: A systematic scoping review of papers published in English since 2009 was undertaken. The focus was on papers reporting initiatives to create flexibility in primary medical programs. Results: Based on review of 1,641 search returns and 140 full-text articles, two interconnected concepts were identified: flexibility and individualisation. Flexibility describes mechanisms that allow students choice in how they allocate time and resources to meet the requirements of their course, including time-variable progression, acceleration, deceleration, articulated degree entry and exit options, and pedagogical approaches that reduce time required in classrooms. Individualisation describes options that enable student-driven direction, extension or expansion of medical education into special interest areas, including dual degrees, breadth subjects, curriculum tracks, elective service-learning pathways, electives and selectives. Conclusions: Though not always clearly defined as such, international medical education literature describes a rich variety of flexibility and individualisation initiatives. While the constructs of flexibility and individualisation are interconnected, they can assist curriculum designers to differentiate between the mechanisms that enable flexibility in how students meet course requirements and the mechanisms that enable individual choice in what students study. Flexibility and individualisation initiatives target different needs, including both students’ needs and medical workforce needs; they also suggest different institutional and financial implications. Consensus on and consistent use of common terminology about flexibility and individualisation initiatives will improve the “searchability” and synthesis of research on such initiatives and their impacts and enablers, as well as encourage further research, publication and synthesis of outcomes of such initiatives.