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Background: 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. Aims: 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. Method: A realist synthesis approach guided the systematic review. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

Background: Medical school is a challenging environment that requires students to deal effectively with stress borne out of the medical education environment, as well as their personal lives. Previous research has not systemically distinguished between academic and personal sources of stress, and in particular has not explored the independent contribution that academic stressors make to medical student depression.Purposes: This study aimed to investigate whether academic stressors make a unique contribution to the level of depressive symptoms in medical students, over and above the contribution made by personal stressors alone.Methods: Sixty-seven medical students completed an online questionnaire designed to measure the total number of recent life events (personal and academic), and their perceived impact, using a modified version of the Psychiatric Epidemiology Research Interview Life Events Scale. Depressive symptoms were measured using the Centre for Epidemiological Studies Depression Scale.Results: Both the total number of personal stressors,r(67) = .363,p= .003, and their perceived impact,r(67) = .412,p= .001, were found to be positively related to depressive symptoms. A positive relationship was also observed between depressive symptoms and the total number of academic stressors,r(67) = .321,p= .008, and their perceived impact,r(67) = .489,p< .001. In addition, it was found that the perceived impact of academic stressors was able to explain higher levels of depressive symptoms in medical students over and above the effect afforded by personal stressors alone.Conclusion: The findings of this study suggest that stress borne out of the medical school environment contributes to depressive symptoms in medical students over and above the contribution made by personal stressors alone. This indicates that although it is important to help students cope with stress borne out of their personal lives, interventions by medical schools aimed at reducing the impact of academic stressors on medical student depression may also be of great importance. [ABSTRACT FROM PUBLISHER]