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

Abstract Background Clinical internship serves as the core link bridging medical theory and practice, playing a crucial role in fostering clinical competence among medical students. In China, the peak period for postgraduate entrance examination (PGEE) review largely overlaps with the critical phase of clinical internship, giving rise to prevalent issues such as overemphasis on examinations at the expense of internships, internship absenteeism, and inadequate skill training. These problems have become a analysis on effects of interventions on theoretical scores (A), skill performance scoresdilemma in medical education. Existing studies lack systematic quantitative integration of the relationship between PGEE and clinical internship. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Databases including the Cochrane Library, PubMed, EMbase, CNKI, Wanfang, and VIP were searched from their inception to April 14, 2026. Studies exploring the correlation between PGEE and clinical internship with available quantitative data were included. Two independent researchers performed data extraction and quality assessment. For RCTs, the Cochrane Risk of Bias tool (RoB 2) was used; for non-randomised studies, the Newcastle-Ottawa Scale (NOS) was applied. Meta-analysis was performed using RevMan 5.4 software and a random-effects model was applied for all pooled estimates due to anticipated heterogeneity. Results A total of 15 studies involving 4,182 participants were included. Under traditional management models, PGEE preparation was significantly associated with reduced internship attendance, as well as lower theoretical and practical skill scores. Notably, internship and PGEE are not inherently contradictory and can be mutually promoted through reasonable planning. Meta-analysis results showed that integrated teaching (combining CBL with the PGEE syllabus) significantly improved theoretical scores (MD = 4.60, 95%CI: 3.37–5.83, I²=83.6%), clinical skills (SMD = 1.24, 95%CI: 0.73–1.75, I²=91.2%), and PGEE success rates (RR = 1.48, 95%CI: 1.19–1.84, I²=51.4%), (all P < 0.05). However, these pooled results are derived from low-to-moderate quality studies with statistical heterogeneity, and must be interpreted with caution to avoid over-estimation of efficacy. Conclusion PGEE exerts dual effects on clinical internship. Integrating internship teaching with PGEE requirements may potentially help resolve time conflicts and mitigate negative impacts. However, given the overall low-to-moderate quality of the evidence base, these findings should be considered primarily as hypothesis-generating and as a reference for designing future high-quality investigations, rather than as definitive practice recommendations, requiring validation through future large-scale, multicenter randomized controlled trials.