Table 1 Level's of Bronfenbrenner's ecological systems theory [30,31,32,33]
Learner; individual level | The individual learner occupies a central position within the framework. The learner may be influenced by factors existing at and between each of the other levels |
Micro-system | This level sits directly around the learner and contains the environment and the factors that the learner directly experiences. Factors here may include direct experiences with peers, faculty, patients and in the learning environment and experiences of the curriculum |
Meso-system | This level acknowledges that factors within the micro-system are not isolated from each other. Dynamic relationships and interdependencies exist between the microsystem factors [31]. The mesosystem refers to the connections and relationships between two or more microsystems Bronfenbrenner identified four types of interactions that occur between microsystems factors and within the mesosystem that may impact on learners [31] |
Multi-Setting Participation The multi-setting participation link arises when the student engages in a more than one setting. This is relevant to medical student learning experiences due to their participation in a range of learning environments and settings including the medical school and a variety of placement, clinical and community settings | |
Indirect Linkage In indirect linkage, the learner is impacted indirectly by connections between microsystems factors | |
Intersetting Communications This includes communications and messages transmitted from one setting to another in order to provide “specific information to persons in the other setting” [31, 41] Communications here may be unidirectional or bidirectional and may occur in person, verbally, electronically etc | |
Inter-Setting Knowledge This refers to the information or experience that exists in one setting about the other setting [41] | |
Exo-system | This level includes factors that are not directly within the learner’s immediate environment, however, still have influence on their experience. Factors may be those in the wider local context and may include policy and processes in medical school environment, including the programme leadership, strategy and policy, wider university leadership and policy, and culture and values |
Macro-system | This level includes factors existing outside the medical learning environment (beyond the medical school, university, or clinical learning environment), but that influence the inner “sublevels” of the framework and the learner This may include the wider context in which the school exists, including social, political, historical, and global, as well as other factors, such as professional regulatory or curricular requirements |
Chrono-system | This level considers impacts and changes associated with the passage of time and how this may influence the learner and their development over time |