From leadership research to district action: How to establish a new medical school? A scoping review of the key considerations

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: review-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract Establishing new medical schools in medically under-served regions is suggested as part of the solution to the problem of doctor shortages and maldistributions. Establishing a new medical school is, however, a complex undertaking with high financial and political stakes. Critically, the evidence-base for this significant activity has not previously been elucidated. This paper presents the first scoping review on this vitally important, yet under-researched aspect of medical education and health workforce planning. To better understand the process of new medical school establishment, this review posed two research questions: (1) What is the nature of the available literature on establishing a new medical school?; (2) What are the key factors to be considered when establishing a new medical school? Five databases and grey literature were searched in 2015 and 2021 for English-language articles, using search terms related to new medical schools and their establishment. Inclusion and exclusion criteria were based on relevance and suitability in answering the research questions. Seventy-eight articles were analysed both structurally and thematically to understand the nature of the literature and the key considerations involved. Structurally, most articles were descriptive pieces outlining personal and institutional experiences and did not make use of research methodologies nor theory. Thematically, thirteen key considerations were identified including reasons for establishment; location choices; leadership and governance; costs and funding; partnerships; staffing; student numbers; student recruitment; curriculum design and implementation; clinical training sites; buildings and facilities; information and technology resources; and accreditation. Significant gaps in the literature included how to obtain the initial permission from governing authorities and the personal costs and burnout experienced by founding leaders and staff. Although, the literature on new medical school establishment is empirically and theoretically under-developed, it is still useful and reveals a number of important considerations that could assist founding leaders and teams to maximise the outcomes and impact of their establishment efforts. Critically, the evidence-base underpinning this complex undertaking needs to be better informed by theory and research. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s10459-024-10370-y. Keywords: New medical schools, Establishing, Establishment, Scoping review, Medical education

Study methods

We chose to conduct a scoping review since they are useful for identifying and synthesising the key aspects of a broad concept and have great utility in mapping the size, variety, and nature of the existing literature, particularly when a topic has not been reviewed before or when the information is likely to be broad, complex, and heterogenous (Arksey & O'Malley, 2005; Munn et al., 2018; Peters et al., 2015, 2020; Thomas et al., 2017; Tricco et al., 2018). We followed defined scoping review methodology: (1) identify the review research questions (presented above); (2) identify relevant studies/articles; (3) select the studies/articles; (4) chart the data; (5) collate, summarise, and report results (Arksey & O'Malley, 2005; Levac et al., 2010; Peters et al., 2020; Thomas et al., 2017).

Limitations

A scoping review was ideal for analysing this broad, complex, and heterogenous topic, especially given the dearth of prior research, published literature reviews, and applied theories. However, the iterative refinement of inclusion and exclusion criteria based on ‘best fit’ in scoping reviews can lend itself to interpretive subjectivity. The unlimited date ranges and publication types facilitated broad coverage of a poorly studied topic, but too large a scope could limit the analysis to a superficial treatment and/or a lengthy treatise. Although limiting the articles to English-language provided some level of bounding, it may have narrowed understanding and missed key multi-cultural perspectives.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Sneha Kirubakaran; Koshila Kumar; Paul Worley; Joanne Pimlott; Jennene Greenhill. How to establish a new medical school? A scoping review of the key considerations. Advances in Health Sciences Education (2024-09-04). https://doi.org/10.1007/s10459-024-10370-y

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.