Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study.

Abstract

Longitudinal integrated clerkships (LICs) have been implemented worldwide to increase authentic student participation in patient care over time. Studies have shown benefits of the model include the ability of LICs to attract future practitioners to underserved areas, student engagement in advocacy, and development of an "ethic of caring." Less is known, however, about how LICs impart their benefits, although LICs may strengthen professional identity. As such, this study aimed to explore medical student professional identity construction through time within LICs internationally. This was a longitudinal qualitative study from 2019 to 2020, involving 33 students across 4 medical schools in the United Kingdom, Ireland, and the United States. The authors explored participating students' identity construction during LICs. Data collection involved 3 stages: individual, semistructured interviews at entry (n = 33) and exit of the LIC (n = 29), and audio diaries throughout. Data were analyzed inductively using a reflexive thematic approach. Three themes were identified. Longitudinal relationships with patients and preceptors encouraged patient care ownership and responsibility; LIC students identified as patient advocates; and longitudinal relationships shaped students' social consciences. Themes were underpinned by continuity of relationships between students and patients, and students and tutors. Though continuity is lauded as the cornerstone of LICs, these findings suggest that this is too broad a way of understanding the benefits of LICs. Instead, continuity should be seen as facilitating the development of important relationships within diverse communities of practice, which leads medical students to construct professional identities as responsible, compassionate advocates for underserved populations. This was the case across the institutions, nations, and LIC types in this study. By highlighting the ways in which LICs influence identity, these findings offer important insight relating to the future development and delivery of LICs.