Outcomes of longitudinal integrated clinical placements for students, clinicians and society

Abstract

Longitudinal integrated clerkships are now recognised as representing credible and effective pedagogical alternatives to TBRs in medical education.

A review of longitudinal clinical programs in US medical schools

“…Hereby, we found that both the non-LIC clinic attachments (50.0% of LCPs in our study) and LICs (26.5% of LCPs) name primary care exposure and recruitment as explicit goals significantly more often than non-LIC longitudinal patient attachment programs ( P  = .05 and P  = .02 respectively). These findings connect to outcomes in the literature demonstrating that LICs effectively support the primary care workforce [11,19,40,41]. We also consider these findings in the context of earlier studies demonstrating that 95% of students seeking primary care careers ‘desire for longitudinal patient care opportunities’ [42, p. 324].…”

“…In our study, 73.5% of programs offered longitudinal structures with LIC-like elements but did not meet the criterion of the international research definition of an LIC that states LICs must ‘meet the majority of the academic year’s core clinical competencies across multiple disciplines simultaneously’ [15,16,18,19]. By using a broader definition of LCPs, our study characterizes longitudinal programs which would have been excluded under stricter criteria.…”

“…We limited programs to those at least six months in length based on the determination of ‘longitudinal’ in a narrative review [19]. Rather than relying solely on program length, we required a stated emphasis on longitudinality as a proxy for schools’ deliberate intentions to create curricular connectivity [6].…”

“…Based on domains examined in an earlier review of longitudinal community and hospital placements [13], we extracted the following six structural characteristics for each LCP: date established, curricular vs. extracurricular, mandatory vs. elective, phase of training, program length, and program type (LIC, patient attachment, clinic attachment, or both patient and clinic attachment). We classified programs as LICs based on self-identification or by applying the 2007 consensus definition [15,16,18,19]. We defined ‘patient attachments’ as programs where students selected or were assigned patients to follow over time, either within a single venue or across multiple clinical sites.…”

“…When programs met criteria for patient attachment and clinic attachment but not the full LIC definition (specifically, not offering ‘the majority of the academic year’s core clinical competencies across multiple disciplines simultaneously’) [15,16,19], we characterized these as ‘both patient and clinic attachments’ (see Supplementary Material 1, which depicts and characterizes types of LCP programs—patient attachment, clinic attachment, or both patient and clinic attachment). Because patient and clinic attachments may not be mutually exclusive (i.e., students assigned to one clinic would likely see the same patients over time), we made definitions based on the programs’ described structures and not on the students’ experiences of these structures.…”