Table 1. Main barriers to outpatient medical education
Main barriers Evidences from literature
Barriers related to educational environments and institutions Failure to recognize the need for excellence in teaching.10,14,27,39
A lack of institutional support.10,14,27,39
Conflicts between medical education and healthcare.10,14,27,28,39
No contact/lengthy distances between the outpatient clinic and university.7,10,14,29,31
Outpatientand university curricula not being integrated.7,10,14,29,31
Academic costs/insufficient funding for academic outpatient clinics.8,14,27,28,29,32,37
Inadequate financial incentives for academic staff.10,14,27,28,30,32,37 
Difficulties in the hiring of qualified academic staff.10,14,27,28,29,30,32,37,38 Inadequate criteria for the hiring of academic staff.10
Absence of a professional dedicated to teaching at the institution.32
Poor distribution of doctors.7,8,11,17,28,29
Inappropriate or small care rooms.2,5,6,10,11,14,17,18,21,23,24,27,28,31,32,34,40
Insufficient technological and audiovisual resources suitable for teaching.32,35,36
Academic staff-related Intense and inadequate care schedule for teaching/insufficient time for teaching.2,5,6,10,11,15,18,19,20,23,25,27,28,29,31,32,34,37,38,39,42
A lack of professional training and retraining.31
Fear of losing private patients.10,14,29,30
Fear of losing professional autonomy.10,30
Inadequate supervision model/teaching method.5,11,14,16,17,23,22,29,34,40
Inadequate service model for students.11,20
Inappropriate or absence of feedback.5,11,15,17,20,21,22,23,24,25,29,34
Patient-related The lack of suitable patients for teaching.5,19,31,32
Failure to obtain patient consent for academic activities.7,17
No follow-up/continuity of cases attended.7,17
Student-related A lack of commitment to and interest in learning.32
Increasing numbers of students in the internship group.32,35,36
Int J Med Educ. 2019; 10:180-190; doi: 10.5116/ijme.5d76.32c5