“Continuity” as an Organizing Principle for Clinical Education Reform

Hirsh, David; Ogur, Barbara; Thibault, George E.; Cox, Malcolm

doi:10.1056/nejmsb061660

Cited by 440 publications

(441 citation statements)

References 44 publications

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“…Thistlethwaite et al (2013) systematically reviewed longitudinal placements and highlight program outcomes that connected to program goals featured in our data, notably ‘the development of a patient-centred approach to clinical care, presentations of illness in primary care settings and the development of insights into community-based medicine’ [13, p. e1352]. The authors describe the importance of educational continuity [6,15,16], a framework based in creating longitudinal relationships, and a goal found among 29/89 (32.6%) of US medical schools in our study. Although the authors’ outcomes data appear to support the goals we discerned among US LCPs, it is noteworthy that their systematic review included programs 13 weeks or more in length whereas our review—consistent with two earlier works [19,43]––only included longitudinal programs six months in length or longer.…”

Section: Discussionmentioning

confidence: 99%

“…This typology highlights a way to assess longitudinal clinical education in programs without relying on a strictly length-based definition [13,23]. Through this lens, we see the diversity of programs that use continuity as an organizing principle to foster longitudinal relationships among students, patients, and providers [6,19,36,43]. …”

Section: Discussionmentioning

confidence: 99%

“…We limited programs to those at least six months in length based on the determination of ‘longitudinal’ in a narrative review [19]. Rather than relying solely on program length, we required a stated emphasis on longitudinality as a proxy for schools’ deliberate intentions to create curricular connectivity [6]. We defined ‘continuity with patients’ as the opportunity for a student to meet with a given patient more than once during the program.…”

Section: Methodsmentioning

confidence: 99%

“…In the LIC model, students care for a diverse panel of patients whom they follow across multiple clinical settings over extended periods of time, in lieu of traditional block rotations within discrete specialties [6,14,17]. The literature describes LIC goals, structures, and outcomes [15–21]; less is known about the broader array of LCPs that do not meet LIC criteria [10,13,22].…”

Section: Introductionmentioning

confidence: 99%

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A review of longitudinal clinical programs in US medical schools

Gheihman

Jun

Young

et al. 2018

Medical Education Online

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Background: Longitudinal clinical experiences are a common component of undergraduate medical curricula, yet these programs have not been systematically characterized in US medical schools.Objective: Our study sought to identify and characterize longitudinal clinical programs (LCPs) in US medical schools and measure associations between programs’ structures and goals.Design: Using a mixed-methods approach, we conducted a secondary analysis of data from publicly available websites. We conducted a systematic keyword search of the websites of 137 LCME-accredited US medical schools to identify LCPs. We included programs with student–patient interactions of at least six months. We categorized programs using qualitative thematic analysis and compared associations between program structures and goals.Results: We identified 98 LCPs in 69 schools. Half (52.0%) of LCPs occurred during the core clinical year. Program structures included ‘clinic attachments’ (50.0%), ‘longitudinal integrated clerkships’ (26.5%), and ‘patient attachments’ (20.4%). We identified goals in 89 programs, including ‘exposing students to specific topics, patient demographics, or practice settings’ (78.7%); ‘clinical or professional skill development’ (65.2%); and ‘understanding the patient experience’ (19.1%). Patient attachments were associated with ‘exposure to specific patient demographics’ (P = .04) and ‘understanding the patient experience’ (P = .03). Pre-clinical programs were associated with clinical skills development (P = .01).Conclusions: Our study identifies the scope and nature of LCPs in US medical schools. Understanding connections between educational structures and goals may guide program design and research investigations of educational processes and outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A review of longitudinal clinical programs in US medical schools

Gheihman

Jun

Young

et al. 2018

Medical Education Online

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“…LIC students follow a panel of patients during the clinical year, creating opportunities to foster meaningful relationships with patients and preceptors [30,31]. …”

Section: Innovate!mentioning

confidence: 99%

Roadmap for creating an accelerated three-year medical education program

Leong

Cangiarella

Fancher

et al. 2017

Medical Education Online

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Medical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development – meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring – and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public. Abbreviations: CAMPP: Consortium of accelerated medical pathway programs; GME: Graduate medical education; LCME: Liaison committee on medical education; NRMP: National residency matching program; UME: Undergraduate medical education

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Context (Place) Matters

Hafferty

2008

Arch Pediatr Adolesc Med

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was uncommon, vitamin D-deficient rickets was virtually eliminated. 9 Cognizant of the problem of labeling asymptomatic children as having vitamin D deficiency based on a laboratory measurement without other confirmatory evidence, Gordon et al obtained radiographs on study children with low levels. While signs of rickets were uncommon, one-third of these patients had radiographic evidence of demineralization. 7 To the authors, this relatively high frequency of signs of demineralization underscored the deleterious effects of vitamin D deficiency, as they have defined it. However, for 67% of the children classified as having deficiency there was no evidence of any bone abnormality.Perhaps more importantly, the clinical significance of mild to moderate bone demineralization on radiograph in a healthy infant or toddler is not well described. This is the other major issue to consider when interpreting the results of the study by Gordon et al. It is possible that some of the children with vitamin D levels of 20 ng/mL or lower and bone demineralization on radiograph will go on to develop rickets in the near future or have bone disease later in life. It is equally, or more, likely that for most of these asymptomatic children the changes seen on radiograph are transient and will go away when sunlight exposure and vitamin D intake increases.The results of this study suggest that a vitamin D level is not a good screening test for rickets in asymptomatic children; 92.5% of those with hypovitaminosis D, as defined by Gordon et al, had no evidence of rickets on radiograph. 7 Future research is needed to determine whether infants and toddlers with vitamin D levels of 20 ng/mL or lower are at significant short-or long-term risk for other bone disease or different conditions. Pending this research, the recommendations by Gordon et al that all young children should receive vitamin D supplementation and that children with risk factors should have periodic vitamin D levels obtained 7 may be premature. ). Financial Disclosure: None reported. REFERENCES 1. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-281. 2. Gartner LM, Greer FR. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics. 2003;111(4, pt 1):908-910. 3. Ryan AS. The resurgence of breastfeeding in the United States.

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“Continuity” as an Organizing Principle for Clinical Education Reform

Cited by 440 publications

References 44 publications

A review of longitudinal clinical programs in US medical schools

A review of longitudinal clinical programs in US medical schools

Roadmap for creating an accelerated three-year medical education program

Context (Place) Matters

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