A Narrative Literature Review Considering the Development and Implementation of Longitudinal Integrated Clerkships, Including a Practical Guide for Application

Abstract

Hailed by supporters as the answer to many challenges facing medical schools and the wider health care system, longitudinal integrated clerkships (LICs) offer a practical and sustainable alternative to more traditional block rotational models. Given this, their popularity as a curricular measure is increasing, although such clerkships remain relatively novel within the United Kingdom. This narrative literature review of international work provides a comprehensive introduction to developing and implementing LICs within medical education. This review generates a practical guide for medical educators with a focus on the development and implementation of LICs within the United Kingdom, on which there is little work. Using illustrated examples and with reference to contemporary literature, it outlines the rationale for considering an LIC within a curriculum, the different types of LIC, barriers and enabling factors to LIC implementation and considers the contemporary application of LIC models within the United Kingdom. The practical guide details key questions educators must consider when developing and implementing an LIC, particularly within the landscape of UK medical education.

The hidden curriculum and its marginalisation of Longitudinal Integrated Clerkships

“…Although relatively well established internationally [3,5], the UK has lagged behind in adopting this model of educational delivery [6]. The most recent global survey on LIC prevalence was conducted in 2014 and documented the existence of approximately 54 LIC programmes worldwide, noting the number of known LICs has doubled within the last 9 years [3].…”

Not all who wander are lost: evaluation of the Hull York medical school longitudinal integrated clerkship

“…Students and secondary care faculty both seemed most comfortable with scheduled opportunities, in opposition to primary care and non-clinical faculty, although students also commented on a lack of flexibility due to scheduling. Unfortunately, it seems the pilot programme has at times fallen prey to 'coveritis', a concept proposed by Bartlett et al to describe faculty's belief that 'they must personally teach all key topics to students' [27,28]. Counteracting 'coveritis' is key to 'enabl [ing] LICs to function in a way that is true to their original design' [28].…”

“…Unfortunately, it seems the pilot programme has at times fallen prey to 'coveritis', a concept proposed by Bartlett et al to describe faculty's belief that 'they must personally teach all key topics to students' [27,28]. Counteracting 'coveritis' is key to 'enabl [ing] LICs to function in a way that is true to their original design' [28]. Interestingly, although several LIC evaluations have shown challenges concerned with too little scheduling [24,25], this pilot seems oppositely afflicted, with too much scheduling, although disagreement existed regarding the perfect balance.…”

“…Recent literature has postulated at various reasons as to why the UK healthcare landscape may make the LIC model more complex to implement given the relationships between primary and secondary healthcare settings [5] and institutional hidden curricula [26]. Yet, there are small-scale LICs at medical schools such as Dundee, Imperial and Cardiff [27,28] that have proven successful, placing students at the forefront of healthcare delivery. There is a continued need to understand the effectiveness of UK-based LICs so that medical schools nationally can ascertain efficacy and consider future implementation.…”

Professional identity formation within Longitudinal Integrated Clerkships: a scoping review protocol

“…regarding education in underserved areas, they do not synthesise research pertinent only the use and impact of LICs. To the author’s best knowledge, only three formal LIC-specific literature reviews have been published—Walters et al’s narrative review synthesising the outcomes, including academic performance, of LICs for students [ 13 ], Brown et al’s narrative review on the development and implementation of LICs [ 14 ] and Bartlett et al’s narrative review regarding development of a sustainable LIC [ 15 ].…”