The hidden curriculum and its marginalisation of Longitudinal Integrated Clerkships

Abstract

Longitudinal Integrated Clerkships (LICs) have a growing presence as a model of educational delivery on the stage of UK medical education, where they are most frequently based within primary care. Yet, despite both local and internationally reported benefits, significant challenges to programme implementation and student engagement remain. Although perhaps initially challenges could be explained by the novelty of LICs, UK LICs have aged, yet challenges remain, leading to the marginalisation of LICs within UK medical schools. This leading article suggests institutional hidden curricula may be an important vehicle for this marginalisation and explores how the dominant fact-based paradigm of UK medical education could act to dissuade student engagement with LICs. So long as the hidden curricula messages we transmit to early-stage medical students revolve around the disproportionate importance of cognitive knowledge acquisition, UKbased LICs are unlikely to realise their full impact or benefit, in comparison to successfully running LICs internationally. Alternatively, refocusing early medical education on patient interaction, encouraging students to take an active role in their care, would send a different hidden curricula message more aligned with the ethos of LICs, and so would likely increase uptake to later stage comprehensive programmes.

Professional identity formation within longitudinal integrated clerkships: A scoping review

“…As such, LICs also facilitate student identity formation as competent, knowledgeable physicians. Brown et al put forth the opinion that, when LICs are advertised to students primarily on the basis of fostering caring attributes, uptake programmes may be low 81 . Further balancing the promotion of LIC’s academic and caring identity benefits when discussing the model with students and faculty may improve enthusiasm, which some have suggested, anecdotally, may be waning 44 …”

“…51,55 This sense of competency is often fostered through external validation from one's preceptors, peers or patients. 80 Within an LIC, this validation is often more readily provided through longitudinal patient and preceptor relationships, where explicit feedback is more highly valued, and implicit feedback is offered through the level of trust and autonomy afforded to students. 55 As such, LICs also facilitate student identity formation as competent, knowledgeable physicians.…”

Exploring the Impact of Pre-course High-Fidelity Simulation on Professional Socialization of Medical Students in Emergency Medicine Internship Rotation—A Qualitative Approach

“…From the medical professional socialization perspective, interactions between newcomers and other members of the community of practice facilitates proper supervision and scaffolding (17,(37)(38)(39). Such supervision ensures that students are involved in activities and practices that enable constructive friction between what they know and what they do not know (10,38,41). Consequently, students get an opportunity to translate their theoretical knowledge into practice while gradually gaining new knowledge and skills.…”

Not all who wander are lost: evaluation of the Hull York medical school longitudinal integrated clerkship

“…The pilot was generally well received by students and faculty, but there were several areas in which delivery could be improved. The challenges encountered parallel those reported by other programme evaluations [7,10,[24][25][26][27]32]. Similarly, this evaluation recognises the need for LIC champions [7,27,32], re-structuring assessment formats [7,10,25,27], and the importance of integrating LICs into broader medical school curriculum [7].…”

“…Within the UK, despite publishing one of the early initiatives [23], the prevalence of LICs has lagged behind other countries including Australia, United States, South Africa and Canada [2,7,24,25]. Recent literature has postulated at various reasons as to why the UK healthcare landscape may make the LIC model more complex to implement given the relationships between primary and secondary healthcare settings [5] and institutional hidden curricula [26]. Yet, there are small-scale LICs at medical schools such as Dundee, Imperial and Cardiff [27,28] that have proven successful, placing students at the forefront of healthcare delivery.…”