Building Longitudinal Relationships Into a Traditional Block Clerkship Model: A Mixed-Methods Study.

Abstract

The authors describe the implementation of the novel Longitudinal Clinical Experiences with Patients (LCEP) curriculum, designed to integrate continuity and longitudinal patient relationships into a traditional block clerkship (BC), and present a mixed-methods analysis evaluating program effectiveness to assess its feasibility, value, and impact. This was a mixed-methods study of 54 Harvard Medical School students who participated in the LCEP during their core clerkship (third) year during the 2013-2014 academic year. Fifty-two students responded to an electronic survey about the patients they followed during the LCEP. Forty-two students completed confidential live interviews. Unique groups of 13-15 students were interviewed at 3 times during the year to assess students' perceptions of the LCEP over time. The data were analyzed using a content analysis framework. On average, students followed 3.3 LCEP patients over the clerkship year. Ninety-four percent (n = 49/52) of students were able to follow 2 or more patients longitudinally. Most students met their longitudinal patient in the inpatient setting (71%, n = 37/52). Subsequent encounters were most often in the ambulatory setting. Students described scheduling logistics as key to the success or failure of the program. Many students described the challenges of competing priorities between their BC responsibilities and longitudinal opportunities. Students found the LCEP deepened their understanding of the patient experience, the health care system, and disease progression. Over the course of an academic year, an increased proportion of students (60%) highlighted understanding the patient experience as a core value obtained through the LCEP. The LCEP was feasible and proved successful in promoting longitudinal patient relationships within a traditional BC model. Prioritizing the depth of experience with a smaller number of patients may reduce the barriers described by students. The results suggest that such a hybrid program promotes patient-centeredness.