Continuity in Undergraduate Medical Education: Mission Not Accomplished

Abstract

Evidence is mounting that longitudinal medical student clerkships provide better educational experiences than traditional block clerkship "silos." Education studies across institutions demonstrate positive effects of continuity on medical students, including creating patientcentered learning environments, improving fidelity of evaluations and feedback, improving medical student patient-centeredness, enabling more autonomous functioning in the clinical workplace, and increased recruitment and retention of students into primary care careers. Outcome studies show potential for longitudinal students to add value to patient care. This perspective piece summarizes the current evidence basis for longitudinal clerkships broken down by Kirkpatrick level (reactions, perceptions/attitudes, knowledge, behaviors, and patient benefits). Despite this evidence, expansion of longitudinal clerkships has been slow-i.e., fewer than half of current US medical schools offer one. While more recent curricular innovations center around Entrustable Professional Activities (EPAs), there are clear opportunities for medical schools to use longitudinal clerkships as a lens through which EPAs can be effectively evaluated. This perspective highlights the synergy between longitudinal clerkships and EPAs, showing that successful implementation of the former should empower the latter. While large, complex educational interventions are daunting tasks, change is needed. Regulatory organizations should mandate continuity-focused experiences for US medical graduates.

Professional identity formation within longitudinal integrated clerkships: A scoping review

“…We included 27 articles. Geographically, first authors were from the United States (n = 11), 12,18,[41][42][43][44][45][46][47][48][49] Canada (n = 7), 19,[50][51][52][53][54][55] Australia (n = 6), [56][57][58][59][60][61] South Africa (n = 1), 62 Thailand (n = 1) 63 and the UK (n = 1). 1 There were 20 qualitative studies including six qualitative case studies, 43,47,49,57,58,61 eight prospective longitudinal qualitative studies, 12,19,46,51,56,59,60,62 one retrospective longitudinal qualitative study, 18 three phenomenological studies, 50,52,54 one phenomenographic study 42 and one grounded theory study.…”

“…1 There were 20 qualitative studies including six qualitative case studies, 43,47,49,57,58,61 eight prospective longitudinal qualitative studies, 12,19,46,51,56,59,60,62 one retrospective longitudinal qualitative study, 18 three phenomenological studies, 50,52,54 one phenomenographic study 42 and one grounded theory study. 55 In addition to qualitative empirical research, there were four commentaries, 41,44,45,53 two narrative literature reviews 1,63 and one mixed methods case study. 48 All empirical articles were conducted with participants from LICs that ran in either students' penultimate or final year of medical school-that is senior medical students.…”

Continuity of supervision: Does it mean what we think it means?

“…Both Homer's and Merriam‐Webster's definitions hold true when it comes to continuity of supervision (CoS) in competency‐based medicine education (CBME), an outcome‐based approach to medical education driven by the need to train physicians for safe, independent practice 3,4 . Many authors in the CBME literature posit that continuity of supervision is an important element of good CBME and that a lack of continuity of supervision not only interferes with learning and assessment, but can even result in harms to learners and patients 5‐8 . However, 'continuity of supervision', as the term is used in the literature, is a chimera.…”

“…In this article, we explore the potential dangers of basing assumptions of the importance of CoS in CBME on evidence from the UME level where CBME is yet to be widely implemented 8,19 . First, we discuss current understandings of what is meant by CoS and examine some of its evidence and where such evidence comes from.…”

Entrustment decisions and the clinical team: A case study of early clinical students

“…The differences between learning contexts for and characteristics of medical students in clinical rotations compared to graduate medical trainees must be carefully considered when implementing competency‐based curricula in UME 1,14,15 . Not only do medical students clearly have a different body of knowledge, skills, attitudes and experiences, but most medical students also have significantly less or even no experience navigating clinical workplaces 16 compared to residents.…”