The review examined evidence on the relationship between postgraduate entrance examination preparation, or PGEE, and clinical internship. The main PGEE review period in China overlaps with the clinical-internship phase of medical training, creating a potential conflict between examination preparation and participation in clinical activities. The review describes concerns in which examination preparation receives excessive emphasis, students are absent from internships, and opportunities to develop clinical skills become inadequate. Clinical internship is described as a central link between medical theory and practice, with a role in building clinical competence. Under traditional management models, the available evidence associated PGEE preparation with lower attendance and lower theoretical and practical clinical-skill scores.

Researchers followed PRISMA guidelines and searched the Cochrane Library, PubMed, EMbase, CNKI, Wanfang and VIP from their inception through 14 April 2026. Studies investigating the relationship between PGEE and clinical internship were eligible when they contained relevant quantitative data. Two researchers independently extracted data and assessed study quality. The Cochrane Risk of Bias 2 tool was used for randomized controlled trials, while the Newcastle-Ottawa Scale was applied to non-randomized studies. Meta-analysis was conducted in RevMan 5.4, and a random-effects model was used for all pooled estimates because heterogeneity was anticipated. The evidence therefore combines results reported across different study designs, and the authors’ conclusion should not be read as proof that integrated teaching will produce identical effects in every setting.

For the three outcomes with reported pooled estimates, integrated teaching produced more favorable results. Combining case-based learning, or CBL, with the PGEE syllabus was associated with a mean difference of 4.60 points in theoretical scores compared with the approaches evaluated in the included studies, with a 95% confidence interval of 3.37 to 5.83. The corresponding pooled association for clinical skills was a standardized mean difference of 1.24, with a 95% confidence interval of 0.73 to 1.75. For PGEE success rates, the pooled relative risk was 1.48, with a 95% confidence interval of 1.19 to 1.84. All three associations were statistically significant at P less than 0.05. These results support the review’s central interpretation that PGEE preparation and clinical internship are not inherently contradictory: aligning the teaching content may help students address examination requirements while continuing to develop clinical abilities.

Variation among the underlying studies limits the certainty of those estimates. Statistical heterogeneity was high for the theoretical-score result, with I² of 83.6%, and for clinical-skill performance, with I² of 91.2%. Heterogeneity was lower for PGEE success rates but remained present at I² of 51.4%. In addition, the pooled estimates were derived from studies of generally low-to-moderate methodological quality, creating a risk that the apparent benefits have been overestimated. The authors classify the findings as hypothesis-generating and as a reference for designing future high-quality investigations rather than as definitive practice recommendations. They state that validation will require future large-scale, multicenter randomized controlled trials; the present evidence does not establish that integrated teaching reliably produces each of these outcomes across institutions.

Subject of Research: Effects of postgraduate entrance examination preparation and integrated teaching on clinical internships among Chinese medical students

Article Title: The impact of postgraduate entrance examination on clinical internship of clinical medical students in China: a systematic review and meta-analysis

Article References: Ao, R., Wei, L., Jiawei, L., Yi, C., Xiangyu, Z., Qinpei, W., Jiaojiao, L., Yun, G., & Shiqiao, L. (2026). The impact of postgraduate entrance examination on clinical internship of clinical medical students in China: a systematic review and meta-analysis. BMC Medical Education. https://doi.org/10.1186/s12909-026-10368-7

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10368-7

Keywords: medical education, clinical internship, postgraduate entrance examination, China, systematic review, meta-analysis, integrated teaching, case-based learning, clinical skills, student attendance, impact, postgraduate

The study is grounded in a long intellectual tradition. Sociologists from Ibn Khaldun to Montesquieu speculated about the relationship between climate and social organization, and modern researchers have built an increasingly rigorous evidence base on the topic. Econometric studies have shown that extreme weather events reduce schooling and educational attainment in settings as varied as Madagascar, Ethiopia, and the global tropics. Research published in Nature Human Behaviour found that heat exposure inhibits learning both internationally and within the United States, with each additional hot school day measurably reducing achievement. Laboratory work in ergonomics has demonstrated that both hot and cold temperature exposure degrade human performance, while building science has documented how classroom air quality and thermal comfort affect students’ subjective perception, physiological responses, and learning outcomes. What has been missing, the Turkish authors contend, is a fine-grained sociological account of how these forces play out inside actual schools, in the words of the people who inhabit them every day.

To fill that gap, Gürbüz and Sever designed a qualitative study using a phenomenological approach, a method that seeks to capture the essence of lived experience rather than to measure variables statistically. They deliberately chose two contrasting provinces. Ağrı, in eastern Turkey, is defined by a cold, continental climate with long, harsh winters in which temperatures routinely plunge far below freezing. Siirt, in the country’s southeast, endures a hot climate in which late spring and summer bring punishing heat. The comparison allowed the researchers to ask whether the same underlying mechanism, the interaction between climate and educational practice, manifests differently under opposite thermal regimes.

The research group comprised 82 participants: 27 students, 27 teachers, and 28 school administrators drawn from schools across both provinces. Participants were selected through maximum diversity sampling, an intentional strategy designed to capture as wide a range of perspectives and circumstances as possible rather than to produce a statistically representative sample. Data collection and analysis followed established interpretative phenomenological procedures, and the study received ethics approval from Ağrı İbrahim Çeçen University in accordance with the Declaration of Helsinki. The findings were then organized around three intersecting contexts that the authors identified as the main channels through which climate reaches the classroom: the sociocultural, the economic, and the educational.

The sociocultural channel proved to be among the most striking. In Ağrı, the long winter season reshapes the rhythm of social and family life, and with it the rhythm of schooling. Snow, ice, and extreme cold affect student attendance, complicate journeys to and from school, and restrict outdoor activity during breaks, a problem that connects to broader research showing that season and weather strongly influence physical activity levels. In Siirt, the equivalent disruption arrives with the heat. As air temperatures climb in late spring and summer, the study found that negative effects on educational practices intensified, echoing earlier work in Şanlıurfa, another hot Turkish province, which documented how climate characteristics affect the learning and teaching performance of secondary school students and teachers. In both cases, the climate does not merely make people uncomfortable; it restructures the social conditions under which education takes place.

The economic channel operates through family livelihoods and school resources. Seasonal agricultural labor, a well-documented feature of rural Turkey, pulls children out of school during certain periods of the year, and the timing of that labor is itself dictated by climate. Weather-dependent work patterns shape when families can afford to prioritize schooling and when economic necessity wins. At the institutional level, schools in both provinces were found to be vulnerable to climate impacts and, in the authors’ assessment, weak in terms of climate interaction, meaning that school buildings and routines had not been designed with regional climatic conditions in mind. This vulnerability was most severe in schools constructed without consideration of local climate, where problems multiplied.

The educational channel is the most direct. The study found that hot and cold weather conditions had a more negative impact on educational practices than cloudy, windy, or rainy conditions did. Extreme temperatures interfere with concentration, lesson pacing, the scheduling of the school year, and the physical usability of classrooms and schoolyards. In Ağrı, educational practices were more negatively affected overall, because the extended winter season prolongs exposure to disruptive cold. In Siirt, the damage was concentrated in the hottest months, when overheated classrooms undermine the very conditions learning requires. These findings align closely with the international quantitative literature: a meta-analytic review of temperature and performance found that both heat and cold degrade task performance, and studies of school buildings in cold climates, from Russia to China, have emphasized the importance of thermal design for educational quality.

What makes the study distinctive is its insistence that climate is not simply a background variable but an active participant in the social institution of education. The authors frame their work within ecological models of human development, in which children’s growth is understood as nested within overlapping environmental systems, from the family to the school to the broader culture and physical environment. Seen through this lens, a snowed-in road or an unventilated classroom is not an inconvenience at the margins of education; it is part of the ecological structure that determines what schooling can actually deliver. The research also resonates with historical evidence: an analysis of school logbooks from the Outer Hebrides of Scotland in the late nineteenth and early twentieth centuries showed that extreme weather repeatedly disrupted schooling and exposed social vulnerabilities that persist in different forms today.

The policy implications are straightforward but consequential. The authors recommend that regional climatic conditions be taken into account when establishing educational programs and institutions, in order to safeguard the quality of education. In practice, that means school calendars that reflect local seasonal realities, building codes and architectural standards suited to cold or hot climates, investment in heating, insulation, and ventilation where they are most needed, and curricula and scheduling decisions that anticipate the disruptions that weather reliably brings. As climate change intensifies heat extremes and weather volatility across the globe, the study suggests that educational planners can no longer treat climate as a fixed given. The classrooms of the future, the research implies, will succeed or fail in part on how well societies learn to design education around the atmosphere that surrounds them.

Subject of Research: The interaction between regional climate conditions and educational practices in schools

Article Title: A sociological research regarding the interaction between educational practices and climate

Article References: Gürbüz, M., & Sever, M. (2026). A sociological research regarding the interaction between educational practices and climate. SN Social Sciences, 6(10), Article 449. https://doi.org/10.1007/s43545-026-01745-6

Image Credits: AI Generated

DOI: 10.1007/s43545-026-01745-6

Keywords: climate, education, sociology of education, qualitative research, phenomenology, school buildings, heat exposure, cold climate, Turkey, student attendance, educational attainment, school policy