Educational outcomes and learning mechanisms of home and community visits in undergraduate medical education: a mixed-methods systematic review

BACKGROUND: Home and community visits are widely used in undergraduate primary care education, yet reported educational effects may combine objective performance with students' self-reported confidence, skills, or attitudes. AIM: To synthesise educational outcomes and learning mechanisms, and examine how measurement, supervision, and reflection shape interpretation. METHODS: A PRISMA-informed mixed-methods systematic review included 36 full-text studies. Quantitative measures were classified as objective or observer-assessed, validated or standardised self-report, or locally developed or unvalidated self-report; qualitative and mixed-methods data were analysed thematically. Visit delivery and reflective approaches were also extracted. RESULTS: One controlled study showed large improvements in objective functional-status knowledge (SMD 1.73, 95% CI 1.06-2.40) and observer-assessed OSCE performance (SMD 2.72, 95% CI 1.93-3.51). Most favourable findings for attitudes, teamwork, confidence, and perceived skills relied on self-report. Fifteen studies described clinician- or professional-accompanied visits, 13 student-led visits without a clinician physically present, and eight mixed or unclear arrangements; none directly compared these models. Empathy and patient-centredness were prominent in qualitative accounts but inconsistent on standardised scales. Detailed learning accounts most often came from structured written reflection followed by facilitated discussion or debriefing, although no reflective approach was compared directly. CONCLUSION: Home and community visits can support contextual and functional learning, but confidence in effects depends on how outcomes are measured. Supervision, narrative space, reflection, and assessment should be matched to the intended educational purpose.