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

Abstract

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.

The do’s, don’ts and don’t knows of establishing a sustainable longitudinal integrated clerkship

“…LICs were first established in the USA in the mid-20th century as a way of enhancing recruitment to community-based roles in underserved, predominantly remote and rural areas [1,2]. Because of perceived educational benefits, they have spread to a variety of different settings including some where a student's clinical base is a tertiary teaching hospital in a large city [2,13,14]. Worley et al [2] describe a large increase in the number and variety of LICs since the turn of the 21st century and a doubling in the numbers between 2009 and 2016 to 54 programs over four continents.…”

Dundee’s Longitudinal Integrated Clerkship: drivers, implementation and early evaluation

“…We have encountered similar problems to those described by others who have set up LICs [20][21][22], however, the length of waiting times for out-patient clinic appointments and planned investigations, procedures and follow up in the UK National Health Service [23] has had an impact; students have sometimes lost touch with their patients or the immediacy of their associated learning needs. The students, with the support of their tutors, have been creative and imaginative in dealing with this problem by going to clinics at which patients like theirs are seen or identifying other patients from their practices with similar problems but who are further along their journeys and following them to clinic instead.…”

Urban-based Longitudinal Integrated Clerkship: A scoping review

“…There were 19 codes under the theme "shortage of educational resources of AMC." Subthemes derived from these codes were as follows: shortage of administrative staff to assist with LIC implementation [23,35,37]; inadequate preceptors to teach students in LICs [18,23,35]; students were unable to meet various types of patients because of their preceptors' subspecialties [23,35]; limited space in hospitals for LIC [22,23,29,38,40,41]; LICs required significant financial resources [23,27,37]; and students' schedules it were complicated to make [18,23,25,35]; and students had to move long distances on a tight schedule [18,23].…”

“…There were nine codes under the theme "lack of understanding about LIC." Subthemes derived from these codes were as follows: no one with in-depth knowledge about LICs [37]; students were unable to understand the purpose of LICs [20]; participants had difficulties comprehending the advantages of LICs [35]; and participants were doubtful about the cost effectiveness of LICs [35,37].…”

“…Shortage of educational Shortage of administrative staff to assist with LIC implementation 23,35,37 27 resources of AMC Inadequate preceptors to teach students in LICs 18,23,35 Students were unable to meet various types of patients because of their preceptors' subspecialties.…”