The role of role: learning in longitudinal integrated and traditional block clerkships

Hauer, Karen E.; Hirsh, David; Ma, Iris; Hansen, Lori; Ogur, Barbara; Poncelet, Ann; Alexander, Erik K.; O’Brien, Bridget

doi:10.1111/j.1365-2923.2012.04285.x

Cited by 117 publications

(173 citation statements)

References 34 publications

(73 reference statements)

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“…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;…”

Section: Methodsmentioning

confidence: 99%

“…Students began to assume a more doctor-like role with their preceptors framing this role as that of a legitimate team member ; this role was meaningful to students . Hauer et al (2012) compared students on longitudinal placements with those on block rotations across three institutions (University of California, HMS, University of South Dakota) and while both sets of students did assume this doctor-like role to some extent, Longitudinal placements the block students were only able to do this in ambulatory settings and even then reported this as rare. In comparison, the role was more commonly adopted by longitudinal students.…”

Section: How Do Longitudinal Placements Promote Learning?mentioning

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%

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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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Section: Methodsmentioning

confidence: 99%

Section: How Do Longitudinal Placements Promote Learning?mentioning

confidence: 99%

Section: Findings Answering the Research Questionsmentioning

confidence: 99%

Section: What Learning Outcomes/objectives Are Defined?mentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2013

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“…16 To address the issue of continuity, the 'longitudinal integrated clerkship' (LIC) is beginning to find favour within medical programs in Australia, Canada and the United States. 11,14,[21][22][23][24][25][26] However it is yet to appear in the literature related to other health professions, it is unknown whether this model translates to other health professions, 20 or what the long-term benefits or issues may be with the LIC approach. 27 In an LIC, students work with the same clinical educator and patients for an extended period of time (i.e.…”

Section: Clinical Education Theory and Practice Longitudinal Clinicalmentioning

confidence: 99%

Clinical education in the osteopathy program at Victoria University

Vaughan

Macfarlane

Florentine

2014

International Journal of Osteopathic Medicine

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Health professionals typically undertake some form of clinical training prior to graduation from a pre-professional education program. This can take place in a variety of settings including hospitals, out-patient clinics and in private healthcare facilities. Whilst there is a substantial body of literature that describes clinical education in areas such as medicine and nursing, there is very little in osteopathy. The purpose of this paper is to present an overview of clinical education in the osteopathy program at Victoria University. It is anticipated this will provide a basis for further discussion and research into an area that has limited coverage in the literature.

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Learning pediatric emergency medicine over time: A realist evaluation of a longitudinal pediatric emergency medicine clinical experience

Ngo

Chorley

et al. 2022

AEM Education and Training

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Introduction: Emergency medicine (EM) practitioners must be proficient at caring for patients of all ages, including pediatric patients. Traditionally, EM trainees learn pediatric emergency medicine (PEM) through block rotations. This is problematic due to the seasonal nature of pediatric diseases and infrequent critical events. Spaced repetition learning theory suggests PEM would be better learned through longitudinal rotations. The transition to competency-based medical education (CBME) in Canada is accelerating the need to find novel ways to attain competencies in postgraduate training. At McMaster University, senior EM trainees can choose either traditional PEM blocks or longitudinal rotations. Our objective was to understand how learners experience these different rotations given the transition to CBME in Canada. Methods: Using a realist framework of program evaluation, we conducted semistructured interviews with key stakeholders (trainees, program directors, attending physicians) in EM. The realist framework was used to understand how context interacts with theoretical mechanisms to produce outcomes of interest. Data were analyzed using inductive, conventional content analysis. All investigators coded a subset of transcripts independently and in duplicate to achieve intercoder agreement.Results: A total of 13 interviews were completed with trainees (n = 11) and staff physicians (n = 2). The learning experience exists within an educational and clinical context, which are logistically distinct but inseparable. The longitudinal learning experience appears to improve learning through spaced repetition, which prevents atrophy of skills and knowledge while also benefitting from the offsetting of seasonal variability associated with many pediatric diseases. Improved feedback and entrustment are facilitated through the building of coaching relationships over time. Barriers to the learning experience are related mainly to logistical difficulties associated with resolving longitudinal and blocked learning experiences. Improved relationships with the interprofessional team may provide distinct learning opportunities and improved team functioning. Block rotations were identified as more valuable to junior trainees learning fundamental concepts.

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The role of role: learning in longitudinal integrated and traditional block clerkships

Cited by 117 publications

References 34 publications

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

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

Clinical education in the osteopathy program at Victoria University

Learning pediatric emergency medicine over time: A realist evaluation of a longitudinal pediatric emergency medicine clinical experience

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