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Longitudinal integrated clerkships are the wave of the future
Clinical participation of medical students in three contemporary training models.
Shahi R et al. Medical Education 2015; 49: 1219-28.


Reviewed by Michael S. Ryan

What was the study question?

How do learning outcomes differ between three contemporary models of clinical education: 1) Hospital-based, “block” rotations; 2) Community-based, longitudinally-integrated clerkships (LIC); 3) A hybrid model?

How was the study done?

This was a mixed methods study of third year students from a single institution in Australia.   Participants self-selected into one of the three clinical education models.  At scheduled intervals throughout the third year, quantitative and qualitative analyses were performed to compare and contrast the experiences.  Quantitative analysis included a review of logbooks.  Qualitative analysis involved direct observations through fieldwork and semi-structured interviews.

What were the results?

Thirty five students (20 from the hospital-block, 7 from the LIC, and 8 from the hybrid model) participated in the study.  Students in the LIC model saw significantly (p<0.001) more patients per week (28.8) than students in the hospital “block” (15.7) and hybrid (18.4) models, respectively.  They also performed 2.5 times more histories and 1.7 times more examinations.  The qualitative analysis revealed 4 major concepts: active participation, relationships, teamwork, and systems of supervision which were generally improved in community-based settings and the LIC model in particular. 

What are the implications of these findings? 

There is growing literature supporting the value of community-based longitudinal models of clinical education.  This study is one of the first to specifically compare the LIC model to more traditional models using rigorous educational outcome measures.  While the sample size was small and the setting was outside of North America, the findings add to growing support for the value of community-based LIC models in providing more experiential learning opportunities for third year medical students. 

Editor’s note: This is heartening information especially for those institutions (like mine, Brown) rolling out an LIC for the first time (RR).

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