Longitudinal integrated clerkships: transforming medical education worldwide?

Abstract

In the 60 years following the Flexner Report of 1910, little changed in undergraduate clinical education until the model of a longitudinal integrated clerkship (LIC) evolved as an alternative to specialty-based block rotations. The first LIC, the Rural Physician Associate Program (RPAP) was introduced by the University of Minnesota in 1971 as a rural workforce initiative. Despite the success of the RPAP, it took 20 years for other institutions to develop the next generation of LICs in the 1990s. These initiatives have been shown to be successful in terms of recruitment into primary care and rural practice. The reliance of LICs on educational continuity appears to provide many advantages. Research over the last decade has shown the potential educational advantages of LICs undertaken in both rural and urban clinical settings. Compared with students who undertake teaching hospital clerkship blocks, students who complete some LICs have improved academic results, enhanced patient-centredness, greater exposure to common conditions and more meaningful learning relationships with patients and academic mentors. In this edition of Medical Education, two papers report other potential benefits for student feedback and for general practitioners as educators.