Not all who wander are lost: evaluation of the Hull York medical school longitudinal integrated clerkship

Abstract

Longitudinal integrated clerkships (LICs) are increasingly available within the United Kingdom, but gaps in knowledge remain regarding their efficacy and the influence of local context. In 2019-20, the Hull York Medical School ran a pilot LIC for 6 fourth-year medical students. This work describes the longitudinal qualitative programme evaluation. LIC students participated in two focus groups, one after four months, and another at the end of the programme. In total, 16 faculty were also interviewed regarding their experiences in developing, implementing and running the LIC. Students' GP supervisors were difficult to engage in detailed evaluation due to the COVID-19 pandemic, and so were briefly surveyed at the end of the LIC. All data were pooled and analysed together using reflexive thematic analysis. Two major themes were identified: 'Trajectory of the LIC', describing the learning curve students and faculty encounter, and 'Institutional decision making', describing the need for clarity regarding the programme's purpose. The programme was largely positively received, but areas for improvement locally, and transferrable recommendations, were identified. Aligning assessment to programme aims is an important area for future development, alongside balancing structured with unstructured time, and supporting students as they navigate a J-shaped learning curve.

Professional identity formation within longitudinal integrated clerkships: A scoping review

“…As this review suggests that the contextual continuities inherent to LICs foster a greater degree of responsibility than within block models, it is likely that LIC students undergo a period of identity ‘disorientation’ as Wyatt et al suggest, as they adjust to the responsibility of their new role. It has been suggested by Hirsh that LIC students journey a J‐shaped learning curve within LICs, 72,73 where ‘things tend to get worse before they get better’ 74 —identity disorientation in response to increased responsibility may offer one explanation for this initial period of difficulty and also add to understandings of how students come to subsequently flourish, as their identity is reformed in a way that resonates with their future status as a qualified physician. This supports the stages of ‘reconceptualisation’ and ‘reprioritisation’ within Wyatt et al’s cognitive model of adjusting to patient ownership.…”

Reflecting on 12 years of training medical students in rural longitudinal integrated clerkships

“… 8 , 10 Although there are numerous learning opportunities and supportive relationships available in the LIM, for the first 5 years of their course, students have been trained in a tertiary hospital environment that is vastly different from primary health care environments, so there is often a significant adjustment period for students, during which they experience high levels of discomfort. 11 , 12 , 13 Because of this challenge, the selection process in earlier years allowed only students with strong academic records to participate in this model of training. However, over time, we have learnt that the LIM also allows for students with challenging academic records to flourish and surpass expectations regarding their capabilities and professional development.…”

Recruiting students to rural Longitudinal Integrated Clerkships: A qualitative study of medical educationists’ experiences across continents

“…I posted a picture in the chat that's from a 2021 article [24], and it actually graphically describes a J curve of learning, which David Hirsh [co-founder of Harvard Medical School Cambridge Integrated Clerkship [25]] often talks about. And I find that very useful to explain the learning within a LIC.…”