Development of a longitudinal integrated clerkship at an academic medical center

Abstract

In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

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

“…Papers with comparison data 24 Bell et al 2008;Denz-Penhey & Murdoch, 2010;Florence et al 2007;Frattarelli & Kamemoto, 2004;Hauer et al 2012;Herold et al 1993;Hirsh et al 2012;Lewin et al 1999;McLaughlin et al 2011;Mihalynuk et al 2008;Ogur et al 2007;Poncelet et al 2011;Poole et al 2010;Power et al 2006;Ringdahl et al 2009;Schauer & Schieve, 2006;Verby, 1988;Wilson & Cleland, 2008;Worley & Lines, 1999;Zink et al 2010a Data collected pre and post placements 3 Bell et al 2008;Hirsh et al 2012;Wilson & Cleland, 2008 Data collected during/mid and post placements 13 Denz-Penhey et al 2004Denz-Penhey & Murdoch, 2009;Hauer et al 2012;Lubetkin et al 1999;Mihalynuk et al 2008;O'Brien et al 2012;Ogur et al 2007;Poncelet et al 2011;Walters et al 2011;Worley et al , 2006 Data collected post placements only 37 Berger & Schaffer, 1986;Carney et al 2005;Couper et al 2011;Couper & Worley, 2010;DenzPenhey & Murdoch, 2008Deterding, et al 1999;Florence et al 2007;…”

“…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). 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).…”

“…Evaluation data showed that students valued the opportunity to work and learn with a defined group of patients over time (Poncelet et al 2011). 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).…”

“…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...…”

“…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...…”