Social learning in a longitudinal integrated clinical placement

Abstract

Recent research has demonstrated that longitudinal integrated placements (LICs) are an alternative mode of clinical education to traditional placements. Extended student engagement in community settings provide the advantages of educational continuity as well as increased service provision in underserved areas. Developing and maintaining LICs require a differing approach to student learning than that for traditional placements. There has been little theoretically informed empirical research that has offered explanations of which are the important factors that promote student learning in LICs and the relationships between those factors. We explored the relationship between student learning, student perceptions of preparedness for practice and student engagement, in the context of a rural LIC. We used a sequential qualitative design employing thematic, comparative and relational analysis of data from student interviews (n = 18) to understand possible processes and mechanisms of student learning in the LIC. Through the theoretical lens of social learning systems, we identified two major themes; connectivity and preparedness for practice. Connectivity described engagement and relationship building by students, across formal and informal learning experiences, interprofessional interactions, social interactions with colleagues, interaction with patients outside of the clinical setting, and the extent of -016-9740-3 integration in the wider community. Preparedness for practice, reflected students' perceptions of having sufficient depth in clinical skills, personal and professional development, cultural awareness and understanding of the health system, to work in that system. A comparative analysis compared the nature and variation of learning across students. In a relational analysis, there was a positive association between connectivity and preparedness for practice. Connectivity is a powerful enabler of students' agentic engagement, collaboration, and learning within an LIC. It is related to student perceptions of preparedness for practice. These findings provide insight for institutions wishing to develop similar programmes, by encouraging health professional educators to consider all of the potential elements of the placements, which most promote connectivity.Adv in Health Sci Educ (2017) 22:1011-1029 DOI 10.1007/s10459

The do’s, don’ts and don’t knows of establishing a sustainable longitudinal integrated clerkship

“…They argue that deriving a strategy from such a framework will help to achieve sustainability. An emphasis of the framework they used (Roberto and Levesque's Change Management Framework [35]) is on relationship building, which is appropriate in the context given that the LIC model has relationships at its core [1,4,5,[36][37][38][39][40][41][42][43][44]. Hudson et al [34] emphasized the importance of maintaining communication with all partners and stakeholders (supervisors, students, patients and healthcare providers) throughout and beyond the implementation and evaluation phases.…”

Emotional challenges of medical students generate feelings of uncertainty

“…Students were uncertain of what was expected of them, and the short clinical placements made it difficult to become a part of the team. Students also described it as energy draining, and this may influence their education negatively because it has been shown that being included in the medical team, being allowed to participate and feeling that they belong are important for students’ learning in clinical environments . One reason why students do not feel confident in sharing experiences of emotional difficulties and feelings of uncertainty with their supervisors might be the short placements.…”

Medical student wellbeing – a consensus statement from Australia and New Zealand

“…In the clinical years, longer rotations, or longitudinal integrated clerkships [31] provide mechanisms for peer networks and continuity of clinical supervision to support learning and personal development. Such approaches can increase the sense of connectivity that underpins wellbeing [32]. Offer progressive levels of challenge to prepare for troubling encounters:Challenges within a supportive and collegial environment should be deliberately built into the curriculum in a graduated fashion, and can be supported by simulation activities such as learning how to break bad news [33].…”

“…In the clinical years, longer rotations, or longitudinal integrated clerkships [31] provide mechanisms for peer networks and continuity of clinical supervision to support learning and personal development. Such approaches can increase the sense of connectivity that underpins wellbeing [32].…”