A review of longitudinal clinical programs in US medical schools

Galina Gheihman,Tomi Jun,Grace J Young,Daniel Liebman,Krishan Sharma,Eileen Brandes,Barbara Ogur,David A Hirsh

doi:10.1080/10872981.2018.1444900

Galina Gheihman, Tomi Jun + Show 6 more

Open Access

https://doi.org/10.1080/10872981.2018.1444900

Copy DOI

Abstract

ABSTRACTBackground: Longitudinal clinical experiences are a common component of undergraduate medical curricula, yet these programs have not been systematically characterized in US medical schools.Objective: Our study sought to identify and characterize longitudinal clinical programs (LCPs) in US medical schools and measure associations between programs’ structures and goals.Design: Using a mixed-methods approach, we conducted a secondary analysis of data from publicly available websites. We conducted a systematic keyword search of the websites of 137 LCME-accredited US medical schools to identify LCPs. We included programs with student–patient interactions of at least six months. We categorized programs using qualitative thematic analysis and compared associations between program structures and goals.Results: We identified 98 LCPs in 69 schools. Half (52.0%) of LCPs occurred during the core clinical year. Program structures included ‘clinic attachments’ (50.0%), ‘longitudinal integrated clerkships’ (26.5%), and ‘patient attachments’ (20.4%). We identified goals in 89 programs, including ‘exposing students to specific topics, patient demographics, or practice settings’ (78.7%); ‘clinical or professional skill development’ (65.2%); and ‘understanding the patient experience’ (19.1%). Patient attachments were associated with ‘exposure to specific patient demographics’ (P = .04) and ‘understanding the patient experience’ (P = .03). Pre-clinical programs were associated with clinical skills development (P = .01).Conclusions: Our study identifies the scope and nature of LCPs in US medical schools. Understanding connections between educational structures and goals may guide program design and research investigations of educational processes and outcomes.

Highlights

Academic leaders in medicine have called for the transformation of health professions education [1,2,3,4]
Medical schools are implementing curricular structures grounded in educational continuity [5,6,7,8,9], including longitudinal clinical programs (LCPs) [10,11,12,13] and a subset of LCPs, longitudinal integrated clerkships (LICs) [14,15,16]
When we compared program types directly, we found patient attachment programs were more likely to have goals related to exposing students to specific patient demographics than either LICs (P = .02) or clinic attachments (P = .01)

Summary

Introduction

Academic leaders in medicine have called for the transformation of health professions education [1,2,3,4]. The Lancet Commission Report [1] urges educational leaders to develop curricula that will serve patient and population needs, foster better understanding of the clinical context, emphasize continuous care over episodic encounters, and broaden training venues beyond inpatient care To address these goals, medical schools are implementing curricular structures grounded in educational continuity [5,6,7,8,9], including longitudinal clinical programs (LCPs) [10,11,12,13] and a subset of LCPs, longitudinal integrated clerkships (LICs) [14,15,16]. This study highlights associations between program type and educational factors such as setting and faculty specialty Another recent typology [22] characterizes LCPs in Canada, placing programs along a continuum of integration, continuity, and longitudinality. Longitudinal clinical experiences are a common component of undergraduate medical curricula, yet these programs have not been systematically characterized in US medical schools

Methods

Results

Conclusion