Longitudinal Integrated Clerkship Model Research Articles

Characterization of Distinctive Teaching Practices in Longitudinal Integrated Clerkships: Perspectives From Students and Faculty

Phenomenon : Longitudinal integrated clerkships (LICs) are novel curricula that place medical students in long-term learning and coaching relationships with faculty and require adaptation of teaching practices on the behalf of faculty to maximize learning outcomes. An understanding of how teaching in an LIC model differs from teaching trainees in more traditional models is critical to ensuring curricular innovation success through faculty development. Approach : A qualitative approach was used to describe the teaching practices of faculty and learning experiences of student participants in longitudinal integrated clerkships in different clinical and community settings. Forty-five faculty and 20 students participated in focus groups. Thematic analysis of focus group data was used to identify differences and similarities between groups, sites, and specialties. Findings : Two groupings of themes emerged in thematic analysis: (1) precepting strategies distinctive to the longitudinal integrated clerkship model and (2) precepting strategies enhanced when employed in the LIC model. Distinct to the LIC model, preceptors and students described the importance of understanding the curricular structure and supporting students in longitudinal care of patients. Enhanced in the LIC model are the strategies of relationship-based teaching, support of autonomy, feedback, and support of longitudinal growth in skills. Insights : Students and faculty across LIC sites were broadly aligned in their opinions of best practices for teaching in an LIC model. The longitudinal relationship between student and faculty in an LIC distinguishes this model from traditional block rotations and a distinctive approach to successful teaching is demonstrated. Preceptors use time afforded to build trusting relationships with students, which created opportunity for novel teaching approaches and enhanced otherwise effective teaching strategies. A focus on orientation to the curricular model and support of longitudinal relationships with patients may serve as an anchor for faculty development efforts in the development of an LIC.

A Third-Year Medical School Ophthalmology Curriculum for a Longitudinal Integrated Clerkship Model

Abstract Background Longitudinal Integrated Clerkships (LICs) are innovative educational models that allow medical student continuity with patients, preceptors, colleagues, and health care systems. Given their benefits, the number of LICs continues to increase. We share a pilot model for an ophthalmology LIC curriculum at the University of Colorado School of Medicine targeted for students to see patients through transitions of care. Methods A needs assessment was performed including literature search, interviews with expert faculty, and a precurricular student questionnaire. Based on our findings, we developed a pilot two-part curriculum consisting of an introductory lecture and a half-day clinical experience designed to integrate patient eye care into the LIC model. At the end of the year, students completed a questionnaire assessing attitude, confidence, and knowledge. Precourse data were collected from students in the academic year (AY) 2018/2019 to aid with the needs assessment. Postcourse data were collected after completion of the curriculum from students in AY 2019/2020. Data from questionnaire were intended to improve our curricular experience. Results Our curriculum was piloted between the 2019 and 2020 AY. The completion rate of our curriculum was 100%. The questionnaire response rate was 90% in pre- and postcurricular groups (n=15/17 and n=9/10, respectively). Hundred percent of students from both groups responded that it is “very important”/“important” for all physicians to be able to identify when ophthalmology referral is indicated. After the intervention, there were significant differences in the rate of students responding that they were “confident” diagnosing acute angle-closure glaucoma (36 vs. 78%, p=0.04), treating a chemical burn (20 vs 67%, p=0.02), and diagnosing viral conjunctivitis (27 vs. 67%); 90% of students reported increased confidence in longitudinal care of patients in the eye clinic. Conclusions Medical students believe in the importance of ophthalmic education regardless of their specialty of choice. We present a pilot model to introduce ophthalmology within an LIC model. Future studies with a larger sample are needed to determine the impact of this model in terms of knowledge acquisition and relationship between curriculum and ophthalmology interest among students. Our curriculum can be adapted to other underrepresented specialties in the medical school curriculum and is easily exportable to other LICs.

Development and sustainment of professional relationships within longitudinal integrated clerkships in general practice (LICs): a narrative review.

Longitudinal integrated clerkships (LICs) are a relatively new model of clinical medical education, whereby students participate in patient care over time and develop relationships with those patients', their clinicians, and other health care staff involved in the care of those patients. It has been called 'relationship-based education' but, to date, no review has investigated the development and impact of these central relationships within this curricula model. The aim of this study is to review the literature pertaining to relationships in LICs, specifically to understand how they come about and how they affect learning. The search strategy systematically explored PubMed, ERIC (EBSCO) and Academic Search Complete, using key words and MESH terms. Original research published in peer-reviewed journals between January 2007 and August 2020 that were written in the English language were included in the review. After applying set inclusion and exclusion criteria, 43 studies were included in this review. A qualitative thematic analysis was undertaken, and results were synthesised narratively. Four distinct categories were identified: defining relationships in LICs, developing relationships in LICs, relationship maintenance and multi-stakeholder impact. The longitudinal integrated clerkship model of clinical education facilitates the development of meaningful triangular relationships between student, clinical teacher and patient, which are the central drivers of successful learning within the context of an LIC. These relationships are nested in a set of important supporting relationships involving other supervisors, the medical school and university, the practice clinical and administrative team and peers.

The future of health professions education: Emerging trends in the United States.

The future of health professions education: Emerging trends in the United States.

Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso.

Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso.

Professional identity formation within Longitudinal Integrated Clerkships: a scoping review protocol

BackgroundProfessional identity development is an area of contemporary interest within medical education. It can be defined as ‘the foundational process one experiences during the transformation from lay person to physician’. In order for this transformation to occur, medical values and principles are internalised. A robust professional identity is key to confident practice as a medical professional. As such, research regarding what works to encourage identity development is popular. New models of educational delivery, such as the increasingly popular Longitudinal Integrated Clerkship model (LICs), present an interesting opportunity to investigate impact on identity. As no previous literature reviews focus on identity development within LICs, it is unclear what is already known about their impact. Therefore, a scoping review synthesising current knowledge and mapping areas for future research is necessary.MethodsArksey and O’Malley’s scoping review steps will be used as a methodological framework. MEDLINE, EMBASE, PubMed, Web of Knowledge, ERIC, PsychINFO, Google Scholar, JSTOR, Scopus, and Web of science will be searched (from inception onwards). We will include single studies of any design (e.g. quantitative and qualitative) and reviews examining professional identity within Longitudinal Integrated Clerkships involving health profession students. Two reviewers will complete all screening and data abstraction independently. Deductive coding will be presented as a quantitative textual meta-analysis. Inductive coding will be presented in narrative format.DiscussionThis scoping review will explore professional identity formation within LICs, evaluating any known impact of the educational model and mapping the ways in which identity within LICs has been researched. Mapping of current knowledge should highlight whether LICs as an educational model can influence professional identity development and outline gaps in what is known about their impact to date. Theory used in LIC-based identity research will also be mapped, in order to summarise the main theoretical orientations of research to date. It is anticipated that through such evidence synthesis, directions for future research will become clear.Systematic review registrationOpen Science Framework: osf.io/hk83p

It Takes a Village: Utilizing a Community-based Longitudinal Integrated Clerkship Model at a Regional Medical Campus to Provide the Core Emergency Medicine Clerkship Experience.

The objective was to evaluate the efficacy of a required emergency medicine (EM) experience embedded in a new community-based longitudinal integrated clerkship (LIC) for participating students and faculty. We developed and implemented a community-based LIC EM experience. The experience included 10 clinical shifts, one emergency medical services prehospital care shift, four didactic sessions, one reflection, and an emergency medicine simulation session. Students' outcomes were assessed using end-of-year surveys, focus groups, an emergency medicine subject examination, simulation performance, and clinical evaluations of the students by faculty. Faculty were recruited, underwent faculty development, and were evaluated by students. Faculty perceptions were gathered from a focus group and faculty retention rates were collected. Three cohorts of LIC students (total N=61) have completed their core emergency medicine experience in our community-based LIC. Among students, 76% to 95% rated the overall quality of teaching as very good or excellent and 66% to 100% rated the quality of learning in their community-based setting as very good or excellent. All students who passed the EM subject examination achieved the clinical competencies of the experience based on clinical evaluations. Among faculty, we have retained greater than 95% each year and they have reflected positively on their precepting experience. Implementing a required EM experience within a community-based LIC model can be an effective learning experience for students and perceived positively by community-based faculty. This model may offer an opportunity to expand clinical learning experiences in EM.

Co-editors' notes

This issue covers numerous and diverse topics related to health professions education and policy development. Contributions are truly global as we are publishing papers of authors from Africa, Argentina, Canada, China, India, Saudi Arabia, Sweden, and the United States. Of interest in this issue is that the scope goes beyond medicine alone, and in the spirit of health professions as a whole brings in disciplines such as dentistry and physiotherapy, as well as focus on the community. In the article, “Is Emotional Intelligence Related to Objective Parameters of Academic Performance in Medical, Dental and Nursing Students: A Systematic Review,” Singh et al. present the results of a systematic review aimed to address the question of the influence of emotional intelligence (EI) on objective parameters of academic performance in undergraduates in three disciplines. Databases were systematically searched for empirical studies which measured the EI of medical, nursing, or dental undergraduate students and compared it with academic performance. Findings of the review showed that EI has a greater role in the academic success of clinical year medical and dental students. In the paper, “Assessing Perceptions of Professionalism in Medical Learners by the Level of Training and Sex,” Spiwak et al. looked at male and female perceptions of 16 vignettes related to such items as lapse in excellence, inappropriate dress, lack of altruism, disrespect, shirking duty, and abuse of power. They found significant differences on many items, with females more likely to rate items as more severe. The authors conclude that more work is needed in the area of professionalism and sex. This is especially important in light of changing conceptions of gender. Rashid et al. – “Doctor, Teacher, Translator: International Medical Students' Experiences of Clinical Teaching on an English-language Undergraduate Medical Course in China”– offer a description of student experiences related to participation in and completion of an English language program. Nonnative English-speaking students indicate that while English proficiency was variable in their clinical teachers, they were able to navigate the challenges of studying clinical medicine from teachers with limited English skills. The students felt that other attributes such as enthusiasm, interactivity, and a desire to teach superseded English proficiency of the clinical teacher. The authors call for future study of clinical teacher perceptions of working with non native English-speaking students and graduate outcomes of students participating in the course. In “Rural Stream: An Effective Alternative to the Longitudinal Integrated Clerkship Model for Small Rural Communities,” Carson et al. provide insight into a regionalized medical program where students spend the first two and one-half years of their undergraduate degree in district hospitals. The authors emphasize the importance of immersion and community engagement. While a challenge, Carson et al. show that effective medical education can occur locally, in small rural communities. There are four Letters to the Editor in this issue. Abu-Zaid (“Where do Medical Students Submit Their Work?”) replies to an Education for Health paper contending that main stream journals should encourage publication of student research work. Kuntz et al. (“Video Review with Sports Performance Software Improves Trainee Endotracheal Intubation Time, Performance, and Confidence”) where the researchers take success from one sector and apply it to another. Gali et al. (“Introducing a Communication Skills Course in an Indian Dental Institution: An Academic Experience”) where the educators share their experience in introducing a communication skills module to preclinical undergraduates. Finally, Paraskevopoulos and Papandreou (“Physiotherapy Clinical Placement during the COVID-19 Pandemic”) propose an alternative method of clinical education delivery through an online platform. Please feel free to submit a Letter to the Editor to Education for Health in response to any topics in this issue that spark your interest or attention.

Umeå University's proposed "Rural Stream" - An effective alternative to the longitudinal integrated clerkship model for small rural communities?

Umeå University Faculty of Medicine (UUFM), Sweden, has a regionalized medical program in which students spend the final 2½ years of their undergraduate degree in district hospitals. In late 2018, UUFM started a "rural stream" pilot exposing students to smaller rural locations. The objectives are to deliver the benefits for medical education and rural workforce development that have been observed in longitudinal integrated clerkships (LICs) while maintaining consistency between learning experiences in the main campus, regional campuses, and rural locations. This article compares the UUFM rural stream with those typical of the LICs described in the medical education literature. Comparisons are made in terms of the four key criteria for LIC success, and additional characteristics including peer and interprofessional learning, "'continuity," and curriculum development. The rural stream has elements of length, immersion, position in the degree program, and community engagement that are both similar to, and different from, LICs. Key challenges are to ensure that participating students create close relationships with host medical facilities and communities. The rural stream also has some potential advantages, particularly in relation to team learning. Alternatives to the LIC rural stream model as typically described in the literature may be required to allow for immersive medical education to occur in smaller rural communities and to be suitable for medical schools with more traditional approaches to education.

UK longitudinal integrated clerkships: where are we now?

ABSTRACTIn this article, we discuss whether it is possible for UK institutions to influence the international longitudinal integrated clerkship (LIC) narrative, in the context of supplying future clinicians to a fragmented health service that is battling a General Practice recruitment crisis. Perhaps more importantly, we will discuss whether the ‘LIC model’ fits the UK undergraduate framework. We intend to present some emerging evidence of LICs in the UK, informed by a UK-wide survey and observations from a 2019 UK LIC think tank and then discuss whether the global CLIC definition applies to the UK context with possible ways forward.

A National Survey of Undergraduate Clinical Education in Internal Medicine.

In the present milieu of rapid innovation in undergraduate medical education at US medical schools, the current structure and composition of clinical education in Internal Medicine (IM) is not clear. To describe the current composition of undergraduate clinical education structure in IM. National annual Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey. One hundred twenty-nine clerkship directors at all Liaison Committee on Medical Education accredited US medical schools with CDIM membership as of September 1, 2017. IM core clerkship and post-core clerkship structure descriptions, including duration, educational models, inpatient experiences, ambulatory experiences, and requirements. The survey response rate was 83% (107/129). The majority of schools utilized one core IM clerkship model (67%) and continued to use a traditional block model for a majority of their students (84%). Overall 26% employed a Longitudinal Integrated Clerkship model and 14% employed a shared block model for some students. The mean inpatient duration was 7.0 ± 1.7weeks (range 3-11weeks) and 94% of clerkships stipulated that students spend some inpatient time on general medicine. IM-specific ambulatory experiences were not required for students in 65% of IM core clerkship models. Overall 75% of schools did not require an advanced IM clinical experience after the core clerkship; however, 66% of schools reported a high percentage of students (> 40%) electing to take an IM sub-internship. About half of schools (48%) did not require overnight call or night float during the clinical IM sub-internship. Although there are diverse core IM clerkship models, the majority of IM core clerkships are still traditional block models. The mean inpatient duration is 7weeks and 65% of IM core clerkship models did not require IM-specific ambulatory education.

Teaching Medical Students in a New Rural Longitudinal Clerkship: Opportunities and Constraints.

Background:Medical schools in Africa are responding to the call to increase numbers of medical graduates by up-scaling decentralized clinical training. One approach to decentralized clinical training is the longitudinal integrated clerkship (LIC), where students benefit from continuity of setting and supervision. The ability of family physician supervisors to take responsibility for the clinical training of medical students over a longer period than the usual, in addition to managing their extensive role on the district health platform, is central to the success of such training.Objective:This study investigated the teaching experiences of family physicians as clinical supervisors in a newly introduced LIC model in a rural sub-district in the Western Cape, South Africa.Method:Nine semi-structured interviews were conducted with six family physicians as part of the Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) five-year longitudinal study. Code lists were developed inductively using Atlas.ti v7, they were compared, integrated, and categories were identified. Emerging common themes were developed.Findings:Three overarching themes emerged from the data, each containing subthemes. The rural platform was seen to be an enabling learning space for the LIC students. The family physicians’ experienced their new teaching role in the LIC as empowering, but also challenging. Lack of time for teaching and the unstructured nature of the work emerged as constraints. Despite being uncertain about the new LIC model, the family physicians felt that it was easier to manage than anticipated.Conclusion:The centrality of the rural context framed the teaching experiences of the family physicians in the new LIC, forming the pivot around which constraints and opportunities for teaching arose. The African family physician is well positioned to make an important contribution to the upscaling of decentralized medical training, but would need to be supported by academic institutions and health service managers in their teaching role.

Towards tailored teaching: using participatory action research to enhance the learning experience of Longitudinal Integrated Clerkship students in a South African rural district hospital.

BackgroundThe introduction of Stellenbosch University’s Longitudinal Integrated Clerkship (LIC) model as part of the undergraduate medical curriculum offers a unique and exciting training model to develop generalist doctors for the changing South African health landscape. At one of these LIC sites, the need for an improvement of the local learning experience became evident. This paper explores how to identify and implement a tailored teaching and learning intervention to improve workplace-based learning for LIC students.MethodsA participatory action research approach was used in a co-operative inquiry group (ten participants), consisting of the students, clinician educators and researchers, who met over a period of 5 months. Through a cyclical process of action and reflection this group identified a teaching intervention.ResultsThe results demonstrate the gaps and challenges identified when implementing a LIC model of medical education. A structured learning programme for the final 6 weeks of the students’ placement at the district hospital was designed by the co-operative inquiry group as an agreed intervention. The post-intervention group reflection highlighted a need to create a structured programme in the spirit of local collaboration and learning across disciplines. The results also enhance our understanding of both students and clinician educators’ perceptions of this new model of workplace-based training.ConclusionsThis paper provides practical strategies to enhance teaching and learning in a new educational context. These strategies illuminate three paradigm shifts: (1) from the traditional medical education approach towards a transformative learning approach advocated for the 21st century health professional; (2) from the teaching hospital context to the district hospital context; and (3) from block-based teaching towards a longitudinal integrated learning model. A programme based on balancing structured and tailored learning activities is recommended in order to address the local learning needs of students in the LIC model. We recommend that action learning sets should be developed at these LIC sites, where the relevant aspects of work-place based learning are negotiated.

Using a framework to implement large-scale innovation in medical education with the intent of achieving sustainability.

BackgroundParticularly when undertaken on a large scale, implementing innovation in higher education poses many challenges. Sustaining the innovation requires early adoption of a coherent implementation strategy. Using an example from clinical education, this article describes a process used to implement a large-scale innovation with the intent of achieving sustainability.Desire to improve the effectiveness of undergraduate medical education has led to growing support for a longitudinal integrated clerkship (LIC) model. This involves a move away from the traditional clerkship of ‘block rotations’ with frequent changes in disciplines, to a focus upon clerkships with longer duration and opportunity for students to build sustained relationships with supervisors, mentors, colleagues and patients. A growing number of medical schools have adopted the LIC model for a small percentage of their students. At a time when increasing medical school numbers and class sizes are leading to competition for clinical supervisors it is however a daunting challenge to provide a longitudinal clerkship for an entire medical school class. This challenge is presented to illustrate the strategy used to implement sustainable large scale innovation.What was doneA strategy to implement and build a sustainable longitudinal integrated community-based clerkship experience for all students was derived from a framework arising from Roberto and Levesque’s research in business. The framework’s four core processes: chartering, learning, mobilising and realigning, provided guidance in preparing and rolling out the ‘whole of class’ innovation.DiscussionRoberto and Levesque’s framework proved useful for identifying the foundations of the implementation strategy, with special emphasis on the relationship building required to implement such an ambitious initiative. Although this was innovation in a new School it required change within the school, wider university and health community. Challenges encountered included some resistance to moving away from traditional hospital-centred education, initial student concern, resource limitations, workforce shortage and potential burnout of the innovators.SummaryLarge-scale innovations in medical education may productively draw upon research from other disciplines for guidance on how to lay the foundations for successfully achieving sustainability.

Unfreezing the Flexnerian Model: introducing longitudinal integrated clerkships in rural communities

Physician shortages in rural areas remain severe but may be ameliorated by recent expansions in medical school class sizes. Expanding student exposure to rural medicine by increasing the amount of prolonged clinical experiences in rural areas may increase the likelihood of students pursuing a career in rural medicine. This research sought to investigate the perspective of rural physicians on the introduction of a rurally based nine-month Longitudinal Integrated Clerkship (LIC). In this mixed-methods study, nine physician leaders were interviewed from five Maine, USA, rural hospitals participating in an LIC. Semi-structured interviews were audiotaped and transcribed. Qualitative analysis techniques were used to code the transcripts and develop themes. Forty-seven participating rural LIC preceptors were also surveyed through an online survey. Four major themes related to implementing the LIC model emerged: (1) melting old ways, (2) overcoming fears, (3) synergy of energy, and (4) benefits all-around. The faculty were very positive about the LIC, with increased job satisfaction, practice morale, and ongoing learning, but concerned about the financial impact on productivity. The importance of these themes and perceptions are discussed within the three-stage model of change by Lewin. These results describe how the innovative LIC model can conceptually unfreeze the traditional Flexnerian construct for rural physicians. Highlighting the many stakeholder benefits and addressing the anxieties and fears of rural faculty may facilitate the implementation of a rural LIC. Given the net favorable perception of rural faculty of the LIC, this educational model has the potential to play a major role in increasing the rural workforce.

Clinical scholarship among preceptors supervising longitudinal integrated medical clerkships in regional and rural communities of practice.

All senior medical students at the University of Wollongong undertake a longitudinal integrated community-based clerkship, supervised by experienced general practitioners in a regional or rural community. This study investigates the influence of the longitudinal integrated clerkship model of medical education on scholarship among preceptors in these practice communities. General practitioner preceptors were interviewed after the first student cohort had completed their 38-week placements. Analysis of transcripts identified themes supporting clinical scholarship among preceptors. The entire transcript for each preceptor was analysed, permitting a quantitative determination of each theme. Quotations supporting the themes were selected. The setting was the primary health care practices supervising the longitudinal integrated clerkship medical students. Twenty-six preceptors who supervised longitudinal integrated clerkship medical students in rural and regional New South Wales participated. None had previously been involved in this model of medical education. The study looked for evidence of clinical scholarship among preceptors supervising students in the longitudinal medical student clerkship. Thematic analysis of interview transcripts revealed evidence of clinical scholarship in regional/rural clinical medicine. The 'practice' was validated as a place where scholarship occurs, an 'academy of learning' and part of the university. About half of the preceptors believed the longitudinal integrated clerkship gave students a deeper link with the community. Two thirds of participants perceived an improved quality of care in their practice. Longitudinal integrated clerkships in teaching communities of practice provide the opportunity for emergence of clinical scholarship among preceptors supporting the learning needs of medical students.

Challenges in transformation of the "traditional block rotation" medical student clinical education into a longitudinal integrated clerkship model.

Longitudinal integrated clerkships (LIC) in the first major clinical year in medical student training have been demonstrated to be at least equivalent to and in some areas superior to the "traditional block rotation" (TBR). Flinders University School of Medicine is starting a pilot changing the traditional teaching at the major Academic Medical Centre from TBR to LIC (50% of students in other locations in the medical school already have a partial or full LIC programme). This paper summarises the expected challenges presented at the "Rendez-Vous" Conference in October 2012: (a) creating urgency, (b) training to be a clinician rather than imparting knowledge, (c) resistance to change. We discuss the unexpected challenges that have evolved since then: (a) difficulty finalising the precise schedule, (b) underestimating time requirements, (c) managing the change process inclusively. Transformation of a "block rotation" to "LIC" medical student education in a tertiary academic teaching hospital has many challenges, many of which can be anticipated, but some are unexpected.

Surgical Skills Acquisition: Performance of Students Trained in a Rural Longitudinal Integrated Clerkship and Those From a Traditional Block Clerkship on a Standardized Examination Using Simulated Patients

ObjectivesRural longitudinal integrated clerkship (LIC) programs for third-year medical students provide strong educational curricula and can nurture interest in rural surgical practice. Students learn technical skills in an apprenticeship model. Variability in instruction and patient experiences across sites, coupled with a lack of simulation facilities, raise some concerns about technical skill development. To explore the adequacy of skills acquisition for students in the University of Minnesota Rural Physician Associate Program (RPAP), this study compared RPAP students’ performance on a scenario-based Objective Structured Assessment of Technical Skills (OSATS) with that of traditional surgery block clerkship students (Course 7500). Design, Setting, and ParticipantsThis is a nonexperimental post-only study. All enrolled students (n = 254) completed the OSATS examination. Students in the Course 7500 (n = 222) completed 15 hours of simulation skills training and supervised practice during their 6-week clerkship. RPAP students (n = 32) completed 3 hours of skills training before their 9-month rural assignment. Both groups had access to comprehensive online materials. Mean OSATS checklist, global rating, and total scores were compared at the end of training using t tests (p < 0.05). Self-reported OR and clinical experiences were explored. ResultsBoth groups did well on the OSATS. There were no statistical differences in completion time, checklist scores, mean global ratings, or total scores. RPAP students reported significantly more days in the OR, surgery cases, and first assists. Experience with OSATS tasks reported by RPAP students during clinical rotations correlated with their OSATS performance. ConclusionThis study supports the viability of the LIC model for fundamental skills acquisition when augmented with introductory simulation skills training and online resources. It also suggests that simulation fills a training gap for students in a traditional surgery block clerkship program. It opens a dialog about the potential partnership of surgery departments with rural LICs to address rural general surgery shortages. Further research in this aspect is needed.

A Comparison of Performance Evaluations of Students on Longitudinal Integrated Clerkships and Rotation-Based Clerkships

Longitudinal integrated clerkship (LIC) students typically perform as well as, if not better than, rotation-based clerkship (RBC) students on objective evaluations, yet few studies have compared performance in the clinical setting. This study compared in-training evaluation report (ITER) ratings of LIC and RBC students, including their correlation with more objective evaluations. On the basis of prior academic performance, LIC students (n = 27) at Universities of Alberta, British Columbia, and Calgary were matched with four RBC students from their center. The authors compared reliability of ITER ratings, ITER ratings of clinical skills and professional attributes, and the correlation between ITER ratings and objective evaluations of clinical skills and professional attributes on the Medical Council of Canada Qualifying Examination (MCCQE) Part I. ITER ratings of LIC students were more reliable and significantly higher than those of RBC students for both clinical skills and professional attributes. However, LIC students had lower objective structured clinical examination scores and weaker correlations between subjective and objective evaluations of clinical skills. By comparison, LIC students scored higher on a particular component of the MCCQE and had stronger correlations between subjective and objective evaluations of professionalism. The discrepancy between ratings of LIC students' clinical skills on ITER and other evaluation formats may be due to differences between the content of training and objective evaluations, or systematic rater biases. Further studies are needed to confirm and explain these findings. Promisingly, our data suggest that the LIC model may allow for a more predictive evaluation of professional competencies.