Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study

Abstract

Purpose Longitudinal integrated clerkships (LICs) have been implemented worldwide to increase authentic student participation in patient care over time. Studies have shown benefits of the model include the ability of LICs to attract future practitioners to underserved areas, student engagement in advocacy, and development of an “ethic of caring.” Less is known, however, about how LICs impart their benefits, although LICs may strengthen professional identity. As such, this study aimed to explore medical student professional identity construction through time within LICs internationally. Method This was a longitudinal qualitative study from 2019 to 2020, involving 33 students across 4 medical schools in the United Kingdom, Ireland, and the United States. The authors explored participating students’ identity construction during LICs. Data collection involved 3 stages: individual, semistructured interviews at entry (n = 33) and exit of the LIC (n = 29), and audio diaries throughout. Data were analyzed inductively using a reflexive thematic approach. Results Three themes were identified. Longitudinal relationships with patients and preceptors encouraged patient care ownership and responsibility; LIC students identified as patient advocates; and longitudinal relationships shaped students’ social consciences. Themes were underpinned by continuity of relationships between students and patients, and students and tutors. Conclusions Though continuity is lauded as the cornerstone of LICs, these findings suggest that this is too broad a way of understanding the benefits of LICs. Instead, continuity should be seen as facilitating the development of important relationships within diverse communities of practice, which leads medical students to construct professional identities as responsible, compassionate advocates for underserved populations. This was the case across the institutions, nations, and LIC types in this study. By highlighting the ways in which LICs influence identity, these findings offer important insight relating to the future development and delivery of LICs.

Preliminary Workforce Outcomes of an Urban Longitudinal Integrated Clerkship

“…Both urban and rural communities are challenged by disparities in health outcomes and inadequate access to care, driving medical schools to develop curricular interventions to address these societal challenges. The literature suggests that formative undergraduate medical education experiences in underserved communities can support interest and commitment 6,24,25,31,32 . There remains a need to understand outcomes that extend beyond graduation from medical school.…”

Understanding integrated care through patient journeys

“…In education, IPJM tools could be used with healthcare students to encourage reflection on the complexities of patients' journeys through healthcare systems. There might be an obvious role for IPJM, such as in longitudinal models of clinical education, where students are expected to follow patients' journeys over time, 17 but we also propose that IPJM may be of use (perhaps even greater use) where there is not a formal requirement within curricula to journey with patients through time. IPJM and structured reflection on patients' narratives using this approach could encourage a more longitudinal view of patient care following a one‐off encounter with a patient where they describe their experiences through time.…”

Qualitative Findings of a Nominal Group Process to Identify Critical Factors in New LIC Implementation

“…Preliminary results were presented virtually and discussed at the CLICs 2021 Conference in Stellenbosch, South Africa. 64 Subsequent efforts led to a collaboration of several participating medical schools on a Personally Arranged Learning Session (PeArL) on recruiting, retaining, and supporting preceptors in the early stages of LICs at the CLIC 2022 Conference in Limerick, Ireland, 65 as well as a roundtable discussion on community preceptor recruitment for LICs at the Society of Teachers of Family Medicine (STFM) 2023 Conference on Medical Student Education in New Orleans. 66 After the initial focus groups were held, we realized there was an opportunity for a continuing workgroup to problem solve and support one another in their early stage LIC implementation.…”