title: A critical hybrid realist-outcomes systematic review of relationships between medical education programmes and communities: BEME Guide No. 35.
abstract: BACKGROUND
  The relationships between medical schools and communities have long inspired and troubled medical education programmes. Successive models of community-oriented, community-based and community-engaged medical education have promised much and delivered to varying degrees. A two-armed realist systematic review was undertaken to explore and synthesize the evidence on medical school-community relationships.
  
  
  METHODS
  One arm used standard outcomes criteria (Kirkpatrick levels), the other a realist approach seeking out the underlying contexts, mechanisms and outcomes. 38 reviewers completed 489 realist reviews and 271 outcomes reviews; 334 articles were reviewed in the realist arm and 181 in the outcomes arm. Analyses were based on: descriptive statistics on both articles and reviews; the outcomes involved; the quality of the evidence presented; realist contexts, mechanisms, and outcomes; and an analysis of underlying discursive themes.
  
  
  RESULTS
  The literature on medical school-community relationships is heterogeneous and largely idiographic, with no common standards for what a community is, who represents communities, what a relationship is based on, or whose needs are or should be being addressed or considered.
  
  
  CONCLUSIONS
  Community relationships can benefit medical education, even if it is not always clear why or how. There is much opportunity to improve the quality and precision of scholarship in this area.
authors.affiliation: a Northern Ontario School of Medicine , Canada .|b University of Calgary , Canada .
authors.forename: R H
authors.initials: RH
authors.lastname: Ellaway
authors.affiliation: a Northern Ontario School of Medicine , Canada .|c Laurentian University , Canada .
authors.forename: L
authors.initials: L
authors.lastname: O'Gorman
authors.affiliation: a Northern Ontario School of Medicine , Canada .
authors.forename: R
authors.initials: R
authors.lastname: Strasser
authors.affiliation: a Northern Ontario School of Medicine , Canada .
authors.forename: D C
authors.initials: DC
authors.lastname: Marsh
authors.affiliation: a Northern Ontario School of Medicine , Canada .|d University of Toronto , Canada.
authors.forename: L
authors.initials: L
authors.lastname: Graves
authors.affiliation: a Northern Ontario School of Medicine , Canada .
authors.forename: P
authors.initials: P
authors.lastname: Fink
authors.affiliation: a Northern Ontario School of Medicine , Canada .
authors.forename: C
authors.initials: C
authors.lastname: Cervin
mesh_terms: D001290:Attitude; D003159:Community-Institutional Relations; D054521:Cultural Competency; D004501:Education, Medical / Q000458:organization & administration*; D006801:Humans; D007858:Learning; D012111:Residence Characteristics; D012577:Schools, Medical / Q000458:organization & administration*