Burden, Responsibility, and Reward: Preceptor Experiences With the Continuity of Teaching in a Longitudinal Integrated Clerkship

Teherani, Arianne; O’Brien, Bridget; Masters, Dylan E; Poncelet, Ann; Robertson, Patricia A.; Hauer, Karen E.

doi:10.1097/acm.0b013e3181b38b01

Cited by 78 publications

(145 citation statements)

References 8 publications

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“…However, while there was a higher time commitment at the beginning of longitudinal placements, this decreased as students became more skilled, in contrast to the time needed at the beginning of each traditional student block for orientation (Poncelet et al 2011). Some preceptors expanded their working hours to fit in time for teaching (Teherani et al 2009) and overall felt that LIC students took more time because of individualised mentoring and disruption to clinic hours (Tehereni et al 2009). Rural preceptors were motivated by the desire to increase rural recruitment (Walters et al 2011).…”

Section: Continuity Of Mentorshipmentioning

confidence: 99%

“…Some preceptors reduced the number of patients seen to accommodate students depending on feasibility (Teherani et al 2009), which could impact on patients' waiting times due to less availability of appointment times. They also reported feeling pressure because of the frequently competing needs of their patients and students (Walters et al 2011).…”

Section: Continuity Of Mentorshipmentioning

confidence: 99%

“…New tutors could be initially wary of the additional workload and concerned about students moving from being observers to participants in practice (DenzPenhey et al 2004). Preceptors reported a need to develop alternate teaching skills due to their greater responsibility for student developmental learning (Teherani et al 2009). However, while there was a higher time commitment at the beginning of longitudinal placements, this decreased as students became more skilled, in contrast to the time needed at the beginning of each traditional student block for orientation (Poncelet et al 2011).…”

Section: Continuity Of Mentorshipmentioning

confidence: 99%

“…In the HMS study, faculty satisfaction was high with the majority (82.6%) finding their professional lives more satisfying ). Teaching of longitudinal students was rated as positive and rewarding (Teherani et al 2009;Poncelet et al 2011), bringing kudos and recognition (Walters et al 2011). However, some community preceptors were concerned that students did not see a wide diversity of patients, as they were dependent on the opportunistic nature of primary care attendances (Teherani et al 2009).…”

Section: Continuity Of Mentorshipmentioning

confidence: 99%

“…Teaching of longitudinal students was rated as positive and rewarding (Teherani et al 2009;Poncelet et al 2011), bringing kudos and recognition (Walters et al 2011). However, some community preceptors were concerned that students did not see a wide diversity of patients, as they were dependent on the opportunistic nature of primary care attendances (Teherani et al 2009). Others felt they needed greater support from their specialist colleagues in the clinics (von Below et al 2008).…”

Section: Continuity Of Mentorshipmentioning

confidence: 99%

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A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26

et al. 2013

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Background: Traditionally, clinical learning for medical students consists of short-term and opportunistic encounters with primarily acute-care patients, supervised by an array of clinician preceptors. In response to educational concerns, some medical schools have developed longitudinal placements rather than short-term rotations. Many of these longitudinal placements are also integrated across the core clinical disciplines, are commonly termed longitudinal integrated clerkships (LICs) and often situated in rural locations. This review aimed to explore, analyse and synthesise evidence relating to the effectiveness of longitudinal placements, for medical students in particular to determine which aspects are most critical to successful outcomes. Method: Extensive search of the literature resulted in 1679 papers and abstracts being considered, with 53 papers ultimately being included for review. The review group coded these 53 papers according to standard BEME review guidelines. Specific information extracted included: data relating to effectiveness, the location of the study, number of students involved, format, length and description of placement, the learning outcomes, research design, the impact level for evaluation and the main evaluation methods and findings. We applied a realist approach to consider what works well for whom and under what circumstances. Findings: The early LICs were all community-based immersion programs, situated in general practice and predominantly in rural settings. More recent LIC innovations were situated in tertiary-level specialist ambulatory care in urban settings. Not all placements were integrated across medical disciplines but were longitudinal in relation to location, patient base and/or supervision. Twentyfour papers focussed on one of four programs from different viewpoints. Most evaluations were student opinion (survey, interview, focus group) and/or student assessment results. Placements varied from one half day per week for six months through to full time immersion for more than 12 months. The predominant mechanism relating to factors influencing effectiveness was continuity of one or more of: patient care, supervision and mentorship, peer group and location. The success of LICs and participation satisfaction depended on the preparation of both students and clinical supervisors, and the level of support each received from their academic institutions. Conclusion: Longitudinal placements, including longitudinal integrated placements, are gaining in popularity as an alternative to traditional block rotations. Although relatively few established LICs currently exist, medical schools may look for ways to incorporate some of the principles of LICs more generally in their clinical education programmes. Further research is required to ascertain the optimum length of time for placements depending on the defined learning outcomes and timing within the programme, which students are most likely to benefit and the effects of context such as location and type of integration.

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Section: Continuity Of Mentorshipmentioning

confidence: 99%

Section: Continuity Of Mentorshipmentioning

confidence: 99%

Section: Continuity Of Mentorshipmentioning

confidence: 99%

Section: Continuity Of Mentorshipmentioning

confidence: 99%

Section: Continuity Of Mentorshipmentioning

confidence: 99%

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A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26

et al. 2013

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Surgical training rotation design: effects of hospital type, rotation theme and duration

et al. 2020

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Background: Entrants into UK surgical specialty training undertake a 2-year programme of core surgical training, rotating through specialties for varying lengths of time, at different hospitals, to gain breadth of experience. This study aimed to assess whether these variables influenced core surgical trainee (CST) work productivity. Methods: Intercollegiate Surgical Curriculum Programme portfolios of consecutive CSTs between 2016 and 2019 were examined. Primary outcome measures were workplace-based assessment (WBA) completion, operative experience and academic outputs (presentations to learned societies, publications and audits). Results: A total of 344 rotations by 111 CSTs were included. Incremental increases in attainment were observed related to the duration of core surgical training rotation. The median number of consultant-validated WBAs completed during core surgical training were 48 (range 0-189), 54 (10-120) and 75 (6-94) during rotations consisting of 4-, 6-and 12-month posts respectively (P < 0⋅001). Corresponding median operative caseloads (as primary surgeon) were 84 (range 3-357), 110 (44-394) and 134 (56-366) (P < 0⋅001) and presentations to learned societies 0 (0-12), 0 (0-14) and 1 (0-5) (P = 0⋅012) respectively. Hospital type and specialty training theme were unrelated to workplace productivity. Multivariable analysis identified length of hospital rotation as the only factor independently associated with total WBA count (P = 0⋅001), completion of audit (P = 0⋅015) and delivery of presentation (P = 0⋅001) targets. Conclusion: Longer rotations with a single educational supervisor, in one training centre, are associated with better workplace productivity. Consideration should be given to this when reconfiguring training programmes within the arena of workforce planning.

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Association between inpatient team continuity and clerkship student academic performance

Sawicki,

Sriram,

Hansen

et al. 2024

Journal of Hospital Medicine

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ObjectiveTo determine the association between inpatient team continuity, defined as the maximum number of days the same student, resident, and attending worked together on the inpatient wards, and the academic performance of students in a pediatric block clerkship.MethodsWe retrospectively identified students who rotated in the pediatric clerkship at a single institution from 2020 to 2022. We used multiple linear regression models to adjust for multiple confounders and used a one‐way analysis of variance to compare adjusted outcomes across quartiles of inpatient team continuity.ResultsA total of 227 students were included in the analysis. Students' preceptor ratings increased by 0.04 on a scale of 0–4 (95% confidence interval [CI] 0.01–0.06; p = .001), and their final pediatric grade increased by 0.02 on a scale of 0–4 (95% CI 0.01–0.02; p < .001) with each 1‐day increase in inpatient team continuity. There was no statistically significant association between team continuity and shelf exam scores or observed structured clinical examination scores. Preceptor ratings and final clerkship grades increased across quartiles of team continuity, with the greatest increase being between the second, 6–7 days of continuity, and third, 8–10 days of continuity, quartiles.ConclusionsIncreased inpatient team continuity is associated with students receiving higher preceptor ratings and achieving a higher final pediatric clerkship grade. While the mechanisms driving these associations remain unknown, the results add to the literature base supporting the importance of preceptor continuity in undergraduate medical education.

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Burden, Responsibility, and Reward: Preceptor Experiences With the Continuity of Teaching in a Longitudinal Integrated Clerkship

Abstract: To support and sustain the reward of LIC teaching for faculty, LIC developers should focus on targeted faculty development and resource allocation to clinical teaching.

Cited by 78 publications

References 8 publications

A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26

A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26

Surgical training rotation design: effects of hospital type, rotation theme and duration

Association between inpatient team continuity and clerkship student academic performance

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