Abstract
Health systems worldwide are increasingly unable to meet individual and population health needs. The shortage of healthcare workers in rural and other underserved communities is compounded by inadequate primary care infrastructure and maldistribution of services. At the same time, the medical education system has not changed to address the growing mismatch between population health needs and care delivery capacity. Internationally, leaders are calling for change to address these challenges. Substantive changes are needed in medical education’s stance, structure, and curricula. Educational continuity and symbiosis are two guiding principles at the center of current clinical educational redesign discourse. These principles rely on empirically-derived science to guide educational structure and improve outcomes. Educational continuity and symbiosis may improve student learning and support population health through workforce transformation. Longitudinal integrated clerkships (LICs), growing out of workforce imperatives in the 1970s, have demonstrated sustainable educational and workforce outcomes. Alongside the success of LICs, more innovation and more reaching innovation are needed. We propose restructuring clinical medical education specifically to address workforce needs and develop science-minded (rigorous, inquisitive, and innovative) and service-minded (humanistic, community-engaged, and socially accountable) graduates.
Highlights
Longitudinal integrated clerkships (LICs) serve as an example of an educational model grounded in educational continuity and symbiosis
Over substantial time, the University of Minnesota (UMN) and Flinders LIC programs have continued to demonstrate that graduates are more likely to practice primary care, to practice in rural communities, or both when compared to students in traditional programs [15,29,30,31,34,49,55,56]
We offer one example with longstanding and robust outcomes—workforce-oriented LIC models [28,29,31,34]
Summary
Students have limited work with health promotion, disease prevention, and in improving quality and safety These educational structural issues are compounded by other factors including the rise of private medical schools that disproportionately favor affluent students from urban centers [11] and the difference in pay between specialists and generalists [13,14]. The LIC structure does not rely on traditional specialty-specific inpatient block rotations for students’ core clinical learning; LICs are a restructuring of the core clinical year such that medical students “(1) participate in the comprehensive care of patients over time, (2) participate in continuing learning relationships with these patients’ clinicians, and (3) meet the majority of the year’s core clinical competencies, across multiple disciplines simultaneously through these experiences” [23,28]. This review seeks to provide an educational framework, successful examples, and evidence in the literature to guide international education leaders in addressing the imperatives for change
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