Continuity in a longitudinal out-patient attachment for Year 3 medical students

Wamsley, Maria; Dubowitz, Nadine; Kohli, Puja; Cooke, Molly; O’Brien, Bridget

doi:10.1111/j.1365-2923.2009.03424.x

Cited by 39 publications

(73 citation statements)

References 18 publications

(28 reference statements)

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“…Of note is that except for the placements described in Carney et al (2005), Deterding et al (1999), Hamilton et al (1998), Henley et al (2000), Lubetkin et al (1999), Peters et al (2001), von Below et al (2008 and Walmsley et al (2009), students undertaking these longitudinal placements are volunteers, though most have to go through a selection process if the programme is oversubscribed. Poncelet et al (2011) use a lottery to select from volunteers.…”

Section: Classifications Of Papersmentioning

confidence: 99%

“…After much discussion, the TRG defined longitudinal for the purposes of the inclusion criteria for this review as lasting over 13 weeks with students interacting with the same patient population and/or the same faculty member/preceptor/clinician over this time period. Bell et al 2008;Berger & Schaffer, 1986;Couper & Worley, 2010;Denz-Penhey et al 2004;DenzPenhey & Murdoch, 2008;Frattarelli & Kamemoto 2004;Geyman et al 1984;Hadac et al 1979;Hamilton et al 1998;Hauer et al 2012;Hirsh et al 2012;Lewin et al 1999;McLaughlin et al 2011;Mihalynuk et al 2008;O'Brien et al 2012;Ogur et al 2007;Ogur & Hirsh, 2009;Poncelet et al 2011;Poole et al 2010;Power et al 2006;Ringdahl et al 2009;Schauer & Schieve, 2006;Stagg et al 2009;Walmsley et al 2009;Walters et al 2011;Wilson & Cleland, 2008;Worley & Lines, 1999;Worley et al , 2004Worley et al , 2006Zink et al 2010b 51-100 8 Couper et al 2011;Denz-Penhey & Murdoch, 2009;Denz-Penhey et al 2004;Florence et al 2007;Henley et al 2000;Herold et al 1993;von Below et al 2008;Zink et al 2008101-200 4 Carney et a...…”

Section: Findings Answering the Research Questionsmentioning

confidence: 99%

“…Wilson & Cleland 2008) understanding that the learning outcomes were the same as those of students undertaking traditional block rotations if such activities were running in parallel. Some outcomes were very broad and more related to program objectives rather than assessable outcomes, for example: integration of basic and clinical science (Bell 2008), humanism in patient care (Bell et al 2008;Couper & Worley 2010), concepts relating to the doctor-patient relationship (Lewin et al 1999;Carney et al 2005), primary care needs of rural, underserved communities (Florence et al 2007;Halaas et al 2008), development of insights into community-based Bell et al 2008;Berger & Schaffer, 1986;Denz-Penhey et al 2004;Hadac et al 1979;Hamilton et al 1998;Henley et al 2000;Hirsh et al 2012;Lemon et al 1995;Lewin et al 1999;Lubetkin et al 1999;Ogur et al 2007;Peters et al 2001;Poncelet et al 2011;Poole et al 2010;Prislin et al 1998;Ringdahl et al 2009;Schauer & Schieve, 2006;Stagg et al 2009;Verby 1988;von Below et al 2008;Wee et al 2011;Wilson & Cleland, 2008 Student 1:1 interviews 14 Couper et al 2011;Denz-Penhey et al 2004Denz-Penhey & Murdoch 2008;Hamilton et al 1998;Hauer et al 2012;Walmsley et al 2009;W...…”

Section: What Learning Outcomes/objectives Are Defined?mentioning

confidence: 99%

“…Longer rotations enabled the development of personal relationships and rapport with patients (Geyman et al 1984;Walmsley et al 2009) and the ability to follow patients over time; this allowed students to see how illnesses develop, change and either resolve or worsen with time Couper & Worley 2010). Students were involved with, and learned about, the 'whole life cycle of health and disease' (Couper et al 2011, online p. 4).…”

Section: Continuity Of Patient Carementioning

confidence: 99%

“…Students were involved with, and learned about, the 'whole life cycle of health and disease' (Couper et al 2011, online p. 4). They gained an enhanced understanding of the psychosocial impact of chronic disease and its management (Walmsley et al 2009). They also began to develop a physician identity grounded in caring , with the realisation that continuity of care generates a trusting relationship between patient and doctor that may help to prevent exacerbations of chronic illness (Berger & Schaffer 1986).…”

Section: Continuity Of Patient Carementioning

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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