The Key Literature in Medical Education podcast turns its attention to undergraduate medical education (i.e. medical school) this week. Think about your own clerkship. Did you rotate every 4 weeks to a new service – medicine, pediatrics, psychiatry – spending the first half of the rotation simply trying to figure out the culture and how not to embarrass yourself? Maybe there’s a better way? In fact, this debate around discrete rotations versus longitudinal rotations is the topic of a debate I will be moderating at the International Conference on Residency Education, Saturday Oct 1. Check back here the week of September 26 for details on how you can stream the debate live or find details at #ICRE2016.
Back to the podcast… the idea of a longitudinal clerkship has appeal. A medical student follows a cohort of patients through all of the ins-and-outs of the healthcare system, gaining an integrated appreciation for how all the parts work. However, there are likely some operational / design features that such an idealist design fails to appreciate. The podcast this week looks at the typology (i.e., cardinal features) of a longitudinal clerkship.
KeyLIME Session 116 – Article under review:
View/download the abstract here.
Worley P, Couper I, Strasser R, Graves L, Cummings B-A, Woodman R, Stagg S, Hirsh D and the Consortium of Longitudinal Integrated Clerkships (CLIC). A typology of longitudinal integrated clerkships. Medical Education. 2016. [epub ahead of print]
Reviewer: Linda Snell (@LindaSMedEd)
Longitudinal integrated clerkships (LICs) are a relatively new approach to clinical education for senior medical students: shaped by continuity, extended education experiences, and long relationships between students, patients and physicians (teachers). Thought to be more ‘authentic’ with extended immersion and students’ meaningful contribution to care and thus perhaps encourage students to choose careers in underserved contexts.
These programs are burgeoning: 17 in 2009 to 48 in 2013 in US, Canada, Australia, and South Africa.
However the definition and characteristics of an LIC are variable and contentious. A consortium of LIC schools (CLIC) proposed a consensus description using the elements of longer time than usual block rotation, ongoing relationships (clinical and learning), and incorporating experiences in multiple disciplines to meet most of the academic core competencies. In most of these the student follows the patient through multiple contexts of care.
‘to establish a baseline reference typology to inform further research’
Type of Paper
Research: Delphi, survey
Key Points on Methods
CLIC formed research subgroup (methodology design group – MDG)
- Delphi process of all CLIC members to develop survey items
- Survey – via online, phone or Skype interview or FtF
(demographic: # & gender of students and % of total class, # & size community, rural, length of LIC, proportion of academic year and where situated in medical curriculum, who teaches/supervises, # disciplines)
Analysis: standard stats, univariate and ANOVA, cluster analysis and a ‘qualitative review of results focused on length, proportion of academic year and # disciplines taught’
Showed results on a world map to provide a visual representation.
Iterative discussion of results with CLIC.
54 programs from 44 schools (6 schools had >1 models) with 15,000 student-years represented.
All met criteria of ‘comprehensive care over time’ and ‘continuing learning relationships’. BUT length of LIC varied from 6-54 weeks, with 2/3 being full year.
Typology based on:
-3 distinct types of LICs identified – according to length & discipline coverage:
- amalgamated: shorter clerkships that combine learning in a # of disciplines, but not the ‘majority’ of curricular content or time [the authors propose that these not be called LICs]
- blended: incorporate majority of disciplines but use complementary discipline-specific rotations to complete academic year
- comprehensive: all disciplines incorporated delivered as an integrated program (very few discipline-specific)
-2 contexts programs based in:
- general practice/family medicine, usually in ambulatory settings in smaller communities with FPs/GPs as supervisors
- urban settings, hospitals and clinics where subspecialists more likely to supervise
The type varies according to geography – more likely to be integrated in N America, and with longer standing programs
A minority of schools have >1 type – up to 4
The authors think they have demonstrated ’the common elements and diversity’ of LICs. They propose a series of excellent research questions. As many programs share core characteristics, it allows study across schools to increase power and generalizability.
Spare Keys – other take home points for clinician educator
Note the ability of consortia to generate research ideas then have the human and other resources as well as the power to obtain meaningful results, and further to use the results to generate research questions
Authors note varying language to describe same phenomenon in different countries, so interviews useful for clarification (see Cantillon et al ‘Lost in Translation’, Med Ed 2009)
Strasser, Graves, Cummings.
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