A typology of longitudinal integrated clerkships

Abstract

Context Longitudinal integrated clerkships (LICs) represent a model of the structural redesign of clinical education that is growing in the USA, Canada, Australia and South Africa. By contrast with time‐limited traditional block rotations, medical students in LICs provide comprehensive care of patients and populations in continuing learning relationships over time and across disciplines and venues. The evidence base for LICs reveals transformational professional and workforce outcomes derived from a number of small institution‐specific studies. Objectives This study is the first from an international collaborative formed to study the processes and outcomes of LICs across multiple institutions in different countries. It aims to establish a baseline reference typology to inform further research in this field. Methods Data on all LIC and LIC‐like programmes known to the members of the international Consortium of Longitudinal Integrated Clerkships were collected using a survey tool developed through a Delphi process and subsequently analysed. Data were collected from 54 programmes, 44 medical schools, seven countries and over 15 000 student‐years of LIC‐like curricula. Results Wide variation in programme length, student numbers, health care settings and principal supervision was found. Three distinct typological programme clusters were identified and named according to programme length and discipline coverage: Comprehensive LICs; Blended LICs, and LIC‐like Amalgamative Clerkships. Two major approaches emerged in terms of the sizes of communities and types of clinical supervision. These referred to programmes based in smaller communities with mainly family physicians or general practitioners as clinical supervisors, and those in more urban settings in which subspecialists were more prevalent. Conclusions Three distinct LIC clusters are classified. These provide a foundational reference point for future studies on the processes and outcomes of LICs. The study also exemplifies a collaborative approach to medical education research that focuses on typology rather than on individual programme or context.

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries

“…Yet, while much has been written about the benefit to students of training in community settings, the value to health facilities is less clear. 11,12 Students learn about community medicine and social determinants of health, yet little is known about students’ contribution to patient care, particularly in low-resource settings, 3,4,10,13 and few studies describe medical students’ impact on staff or patient satisfaction. 14,15 …”

“…From previous literature and site visits to the MEPI-participating schools, and from TWG members’ experiences in each country, we developed a common framework that linked academic activity to potential impact on health facilities (Figure 1). 3,4,13–22 Developing this framework allowed our study team, with members from 10 different countries, to identify common elements of education activities and common areas of intersection between medical students and health facilities such as staff interactions, quality of care, patient experiences, and facility outreach. In this study we used this common framework to extend the understanding of how undergraduate medical students can make contributions to the health facilities where they train.…”

Legeutdanning i og for distriktene

“…Interessen for Longitudinal Integrated Clerkships (LICs) har vaert raskt økende, noe som blant annet har resultert i etablering av et verdensomspennende forskningsnettverk. Her samler og analyserer man data fra universiteter som benytter kontinuitet i «student-lege/ laerer-pasient-relasjonen» som et prinsipp i sine undervisningsprogrammer (Worley et al, 2016). I dette nettverket bidrar også Tromsø med data basert på utplasseringsperioden hos allmennleger.…”

Identifying the learning objectives of clinical clerkship in community health in Japan: Focus group

“…LIC is featured in its continuity . More than half of the LIC is longer than 6 months . Because LIC is expected to resolve the shortage of physicians, it is sometimes conducted in a rural area .…”