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Mazotti LA, Adams JE, DeWitt DE. A value analysis of longitudinal integrated clerkships: consideration of costs and benefits. EDUCATION FOR PRIMARY CARE 2024:1-7. [PMID: 38565150 DOI: 10.1080/14739879.2024.2329887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
Longitudinal Integrated Clerkships (LICs) prioritise longitudinal relationships with faculty, patients, and place. Research shows that LICs benefit students and faculty, but most medical schools have limited LIC programmes. This is likely due to perceptions that LICs are more costly and complex than traditional block rotations (TBRs). The perceived cost versus evidence-based value related to clerkship education has not been examined in detail. Until recently, no 'All-LIC' medical school exemplars existed in the US, limiting the value of this model as well as the ability to examine relative cost and complexity. In this paper, we draw on our experience launching three 'All-LIC' medical schools in the United States - schools in which the entire clerkship class participates in a comprehensive clerkship-year LIC. We propose that the known benefits of LICs coupled with cost-mitigation strategies related to running an 'All LIC' model for core clinical clerkships, rather than block and LIC models simultaneously, results in a higher value for medical schools.
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Affiliation(s)
- Lindsay A Mazotti
- Clinical education, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Jennifer E Adams
- Medical education and clinical clerkships, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dawn E DeWitt
- Interprofessional health education, research, and scholarship, Washington State University College of Medicine, Spokane, WA, USA
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Bentley SA, Cartledge A, Guest DJ, Cappuccio S, Woods CA. Practitioner perspectives on extended clinical placement programs in optometry. Clin Exp Optom 2021; 99:248-57. [DOI: 10.1111/cxo.12337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/20/2015] [Accepted: 06/28/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sharon A Bentley
- Australian College of Optometry, National Vision Research Institute, Carlton, Australia,
- Deakin Optometry, School of Medicine, Deakin University, Waurn Ponds, Australia,
| | - Amy Cartledge
- School of Medicine, Deakin University, Waurn Ponds, Australia,
| | - Daryl J Guest
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Australia,
| | | | - Craig A Woods
- Deakin Optometry, School of Medicine, Deakin University, Waurn Ponds, Australia,
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Maloney S, Pather N, Foo J, Lazarus MD. Spending Wisely: The Role of Cost and Value Research in the Pursuit of Advancing Anatomical Sciences Education. ANATOMICAL SCIENCES EDUCATION 2021; 14:263-269. [PMID: 33068329 DOI: 10.1002/ase.2027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
Studies of "cost and value" in anatomical sciences education examine not only what works, but at what cost, thus evaluating the inputs and outputs of education. This research provides insights into how to use available resources (e.g., academic time, budgets, infrastructure) as a mechanism to obtaining the maximum outcomes available. The purpose of this viewpoint article is to expand on the application of cost and value concepts to anatomical sciences education, contextualizing these concepts through a deeper dive into the more costly educational approaches of human donor dissection. In doing so, both questions and opportunities are raised for the discipline of anatomical sciences going forward. Educational decisions, inclusive of cost and value appraisals, consider the range of outcomes for which the activity is designed to achieve, and the activity's integration with the philosophy of the educational program it is contributing to; these decisions, thus, evaluate more than just cost alone. Healthcare students' engagement with human donor dissection pedagogy offers an array of reported non-economic benefits, including non-traditional discipline-independent skill (NDIS) development (e.g., professionalism, teamwork skills). These skills are often harder to measure, but are no less important to the final pedagogical decision-making process. The goal of cost and value research is to create an evidence-base toward education that delivers maximum value for a given spend. Anatomy educators, researchers, and decision makers who embrace cost and value dialogue, and interpret and apply findings from studies of educational costs, are best positioned to improve the educational value for their learners and provide effective outputs for all stakeholders.
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Affiliation(s)
- Stephen Maloney
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Nalini Pather
- Department of Anatomy, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan Foo
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Foo J, Maloney S. On "Effects of Student Physical Therapists on Clinical Instructor Productivity Across Settings in an Academic Medical Center." Apke TL, Whalen M, Buford J. Phys Ther. 2020;100:209-216. Phys Ther 2020; 100:1231-1232. [PMID: 32302405 DOI: 10.1093/ptj/pzaa066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/07/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Jonathan Foo
- Department of Physiotherapy, Monash University, Frankston, VIC, Australia
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Bartlett M, Couper I, Poncelet A, Worley P. The do's, don'ts and don't knows of establishing a sustainable longitudinal integrated clerkship. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:5-19. [PMID: 31953655 PMCID: PMC7012799 DOI: 10.1007/s40037-019-00558-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION The longitudinal integrated clerkship is a model of clinical medical education that is increasingly employed by medical schools around the world. These guidelines are a result of a narrative review of the literature which considered the question of how to maximize the sustainability of a new longitudinal integrated clerkship program. METHOD All four authors have practical experience of establishing longitudinal integrated clerkship programs. Each author individually constructed their Do's, Don'ts and Don't Knows and the literature that underpinned them. The lists were compiled and revised in discussion and a final set of guidelines was agreed. A statement of the strength of the evidence is included for each guideline. RESULTS The final set of 18 Do's, Don'ts and Don't Knows is presented with an appraisal of the evidence for each one. CONCLUSION Implementing a longitudinal integrated clerkship is a complex process requiring the involvement of a wide group of stakeholders in both hospitals and communities. The complexity of the change management processes requires careful and sustained attention, with a particular focus on the outcomes of the programs for students and the communities in which they learn. Effective and consistent leadership and adequate resourcing are important. There is a need to select teaching sites carefully, involve students and faculty in allocation of students to sites and support students and faculty though the implementation phase and beyond. Work is needed to address the Don't Knows, in particular the question of how cost-effectiveness is best measured.
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Affiliation(s)
- Maggie Bartlett
- Education in General Practice, Dundee University School of Medicine, Dundee, UK.
| | - Ian Couper
- Faculty of Medicine and Health Sciences, Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ann Poncelet
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Paul Worley
- Department of Health, GPO Box 9848, 2601, Canberra, Australian Capital Territory, Australia
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Graziano SC, McKenzie ML, Abbott JF, Buery-Joyner SD, Craig LB, Dalrymple JL, Forstein DA, Hampton BS, Page-Ramsey SM, Pradhan A, Wolf A, Hopkins L. Barriers and Strategies to Engaging Our Community-Based Preceptors. TEACHING AND LEARNING IN MEDICINE 2018; 30:444-450. [PMID: 29578818 DOI: 10.1080/10401334.2018.1444994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
ISSUE This article, from the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is a review of commonly cited barriers to recruiting and retaining community-based preceptors in undergraduate medical education and potential strategies to overcome them. EVIDENCE Community-based preceptors have traditionally served as volunteer, nonsalaried faculty, with academic institutions relying on intrinsic teaching rewards to sustain this model. However, increasing numbers of learners, the burdens of incorporating the electronic medical record in practice, and increasing demands for clinical productivity are making recruitment and retention of community-based preceptors more challenging. IMPLICATIONS General challenges to engaging preceptors, as well as those unique to women's health, are discussed. Potential solutions are reviewed, including alternative recruitment strategies, faculty development to emphasize efficient teaching practices in the ambulatory setting, offers of online educational resources, and opportunities to incorporate students in value-added roles. Through examples cited in this review, clerkship directors and medical school administrators should have a solid foundation to actively engage their community-based preceptors.
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Affiliation(s)
- Scott C Graziano
- a Department of Obstetrics and Gynecology , Loyola University Stritch School of Medicine , Maywood , Illinois , USA
| | - Margaret L McKenzie
- b Department of Obstetrics and Gynecology , Cleveland Clinic Lerner College of Medicine , Cleveland , Ohio , USA
| | - Jodi F Abbott
- c Department of Obstetrics and Gynecology , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Samantha D Buery-Joyner
- d Department of Obstetrics and Gynecology , Virginia Commonwealth University School of Medicine, Inova Campus , Church Falls , Virginia , USA
| | - LaTasha B Craig
- e Department of Obstetrics and Gynecology , University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - John L Dalrymple
- f Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center , Harvard Medical School Boston , Massachusetts , USA
| | - David A Forstein
- g Touro College of Osteopathic Medicine, Harlem Campus , Touro College and University System , New York , New York , USA
| | - Brittany S Hampton
- h Obstetrics and Gynecology, Women and Infants' Hospital , Providence , Rhode Island , USA
| | - Sarah M Page-Ramsey
- i Obstetrics and Gynecology, University of Texas Health Sciences Center , San Antonio , Texas , USA
| | - Archana Pradhan
- j Department of Obstetrics , Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School , New Brunswick , New Jersey , USA
| | - Abigail Wolf
- k Obstetrics and Gynecology, Jefferson Medical College at Thomas Jefferson University , Philadelphia , Pennsylvania , USA
| | - Laura Hopkins
- l Department of Obstetrics , Gynecology, and Newborn Care, University of Ottawa , Ottawa , Ontario , Canada
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Somporn P, Ash J, Walters L. Stakeholder views of rural community-based medical education: a narrative review of the international literature. MEDICAL EDUCATION 2018; 52:791-802. [PMID: 29603320 DOI: 10.1111/medu.13580] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/02/2018] [Accepted: 02/07/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Rural community-based medical education (RCBME), in which medical student learning activities take place within a rural community, requires students, clinical teachers, patients, community members and representatives of health and government sectors to actively contribute to the educational process. Therefore, academics seeking to develop RCBME need to understand the rural context, and the views and needs of local stakeholders. OBJECTIVES The aim of this review is to examine stakeholder experiences of RCBME programmes internationally. METHODS This narrative literature review of original research articles published after 1970 utilises Worley's symbiosis model of medical education as an analysis framework. This model proposes that students experience RCBME through their intersection with multiple clinical, social and institutional relationships. This model seeks to provide a framework for considering the intersecting relationships in which RCBME programmes are situated. RESULTS Thirty RCBME programmes are described in 52 articles, representing a wide range of rural clinical placements. One-year longitudinal integrated clerkships for penultimate-year students in Anglosphere countries were most common. Such RCBME enables students to engage in work-integrated learning in a feasible manner that is acceptable to many rural clinicians and patients. Academic results are not compromised, and a few papers demonstrate quality improvement for rural health services engaged in RCBME. These programmes have delivered some rural medical workforce outcomes to communities and governments. Medical students also provide social capital to rural communities. However, these programmes have significant financial cost and risk student social and educational isolation. CONCLUSIONS Rural community-based medical education programmes are seen as academically acceptable and can facilitate symbiotic relationships among students, rural clinicians, patients and community stakeholders. These relationships can influence students' clinical competency and professional identity, increase graduates' interest in rural careers, and potentially improve rural health service stability. Formal prospective stakeholder consultations should be published in the literature.
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Affiliation(s)
- Praphun Somporn
- Hatyai Medical Education Centre, Hatyai Hospital, Hat Yai, Songkhla, Thailand
| | - Julie Ash
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia
| | - Lucie Walters
- Flinders Rural Health South Australia, Flinders University, Mount Gambier, South Australia, Australia
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Hudson JN, Poncelet AN, Weston KM, Bushnell JA, A Farmer E. Longitudinal integrated clerkships . MEDICAL TEACHER 2017; 39:7-13. [PMID: 27832713 DOI: 10.1080/0142159x.2017.1245855] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
There is increased interest in longitudinal integrated clerkships (LICs) due to mounting evidence of positive outcomes for students, patients and supervising clinicians. Emphasizing continuity as the organizing principle of an LIC, this article reviews evidence and presents perspectives of LIC participants concerning continuity of care, supervision and curriculum, and continuity with peers and systems of care. It also offers advice on implementing or evaluating existing LIC programs.
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Affiliation(s)
- Judith Nicky Hudson
- a School of Medicine and Public Health, University of Newcastle , Newcastle , NSW , Australia
- b Graduate School of Medicine , University of Wollongong , Wollongong , Australia
| | | | - Kath M Weston
- b Graduate School of Medicine , University of Wollongong , Wollongong , Australia
| | - John A Bushnell
- b Graduate School of Medicine , University of Wollongong , Wollongong , Australia
| | - Elizabeth A Farmer
- b Graduate School of Medicine , University of Wollongong , Wollongong , Australia
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Crampton P, Hetherington J, McLachlan J, Illing J. Learning in underserved UK areas: a novel approach. CLINICAL TEACHER 2015; 13:102-6. [PMID: 26111933 DOI: 10.1111/tct.12385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is an insufficient number of medical students intending to pursue general practitioner (GP) careers. The undergraduate curriculum has traditionally prioritised teaching in large hospital settings despite most National Health Service patient contact occurring in primary care. Primary care is faced with providing health care for an ageing population with high levels of co-morbidities. Patients who live in deprived areas suffer many disadvantages affecting their health and additionally tend to be underserved. Globally, there has been an initiative to provide medical students with extended clinical placements in rural and remote areas. These placements have identified many beneficial outcomes; however, little is known about placements in other underserved, deprived areas. This paper describes an innovative pilot programme to address these issues. CONTEXT The North East of England has a large proportion of the most deprived communities and worst health care outcomes in England. In Teesside, Phase 1 Medicine at Durham University provides the pre-clinical curriculum. Durham students then join Newcastle University for Phase 2 Medicine, the clinical years. INNOVATION The Difficult and Deprived Areas Programme (DDAP) places fourth-year students in general practice and community settings in post-industrial, deprived areas for 14 weeks, thus adopting and applying principles from rural initiatives (continuity and immersion) to other deprived settings. The DDAP allows students to learn about psychosocial determinants of health and to pursue community interests whilst gaining an excellent clinical grounding. There is an insufficient number of medical students intending to pursue general practitioner careers IMPLICATIONS The DDAP provides a model for educators seeking to implement initiatives in similar underserved, deprived settings, which may potentially alleviate GP workforce shortages.
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Affiliation(s)
- Paul Crampton
- Centre for Medical Education Research, Durham University, Durham, UK
| | | | - John McLachlan
- Centre for Medical Education Research, Durham University, Durham, UK
| | - Jan Illing
- Centre for Medical Education Research, Durham University, Durham, UK
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Hudson JN, Farmer EA, Weston KM, Bushnell JA. Using a framework to implement large-scale innovation in medical education with the intent of achieving sustainability. BMC MEDICAL EDUCATION 2015; 15:2. [PMID: 25592295 PMCID: PMC4310178 DOI: 10.1186/s12909-014-0282-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/30/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND Particularly when undertaken on a large scale, implementing innovation in higher education poses many challenges. Sustaining the innovation requires early adoption of a coherent implementation strategy. Using an example from clinical education, this article describes a process used to implement a large-scale innovation with the intent of achieving sustainability. Desire to improve the effectiveness of undergraduate medical education has led to growing support for a longitudinal integrated clerkship (LIC) model. This involves a move away from the traditional clerkship of 'block rotations' with frequent changes in disciplines, to a focus upon clerkships with longer duration and opportunity for students to build sustained relationships with supervisors, mentors, colleagues and patients. A growing number of medical schools have adopted the LIC model for a small percentage of their students. At a time when increasing medical school numbers and class sizes are leading to competition for clinical supervisors it is however a daunting challenge to provide a longitudinal clerkship for an entire medical school class. This challenge is presented to illustrate the strategy used to implement sustainable large scale innovation. WHAT WAS DONE A strategy to implement and build a sustainable longitudinal integrated community-based clerkship experience for all students was derived from a framework arising from Roberto and Levesque's research in business. The framework's four core processes: chartering, learning, mobilising and realigning, provided guidance in preparing and rolling out the 'whole of class' innovation. DISCUSSION Roberto and Levesque's framework proved useful for identifying the foundations of the implementation strategy, with special emphasis on the relationship building required to implement such an ambitious initiative. Although this was innovation in a new School it required change within the school, wider university and health community. Challenges encountered included some resistance to moving away from traditional hospital-centred education, initial student concern, resource limitations, workforce shortage and potential burnout of the innovators. Large-scale innovations in medical education may productively draw upon research from other disciplines for guidance on how to lay the foundations for successfully achieving sustainability.
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Affiliation(s)
- Judith N Hudson
- Department of Rural Health, University of Newcastle, Tamworth Education Centre, 114-148 Johnston St, Tamworth, NSW, 2340, Australia.
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia.
| | - Elizabeth A Farmer
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia.
| | - Kathryn M Weston
- Public Health, Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia.
| | - John A Bushnell
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia.
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Ellaway R, Graves L, Berry S, Myhre D, Cummings BA, Konkin J. Twelve tips for designing and running longitudinal integrated clerkships. MEDICAL TEACHER 2013; 35:989-95. [PMID: 23883396 PMCID: PMC3836395 DOI: 10.3109/0142159x.2013.818110] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Longitudinal integrated clerkships (LICs) involve learners spending an extended time in a clinical setting (or a variety of interlinked clinical settings) where their clinical learning opportunities are interwoven through continuities of patient contact and care, continuities of assessment and supervision, and continuities of clinical and cultural learning. Our twelve tips are grounded in the lived experiences of designing, implementing, maintaining, and evaluating LICs, and in the extant literature on LICs. We consider: general issues (anticipated benefits and challenges associated with starting and running an LIC); logistical issues (how long each longitudinal experience should last, where it will take place, the number of learners who can be accommodated); and integration issues (how the LIC interfaces with the rest of the program, and the need for evaluation that aligns with the dynamics of the LIC model). Although this paper is primarily aimed at those who are considering setting up an LIC in their own institutions or who are already running an LIC we also offer our recommendations as a reflection on the broader dynamics of medical education and on the priorities and issues we all face in designing and running educational programs.
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Affiliation(s)
| | | | - Sue Berry
- Northern Ontario School of Medicine, Canada
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Crampton PES, McLachlan JC, Illing JC. A systematic literature review of undergraduate clinical placements in underserved areas. MEDICAL EDUCATION 2013; 47:969-78. [PMID: 24016167 DOI: 10.1111/medu.12215] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/04/2013] [Accepted: 02/25/2013] [Indexed: 05/16/2023]
Abstract
CONTEXT The delivery of undergraduate clinical education in underserved areas is increasing in various contexts across the world in response to local workforce needs. A collective understanding of the impact of these placements is lacking. Previous reviews have often taken a positivist approach by only looking at outcome measures. This review addresses the question: What are the strengths and weaknesses for medical students and supervisors of community placements in underserved areas? METHODS A systematic literature review was carried out by database searching, citation searching, pearl growing, reference list checking and use of own literature. The databases included MEDLINE, EMBASE, PsycINFO, Web of Science and ERIC. The search terms used were combinations and variations of four key concepts exploring general practitioner (GP) primary care, medical students, placements and location characteristics. The papers were analysed using a textual narrative synthesis. FINDINGS The initial search identified 4923 results. After the removal of duplicates and the screening of titles and abstracts, 185 met the inclusion criteria. These full articles were obtained and assessed for their relevance to the research question; 54 were then included in the final review. Four main categories were identified: student performance, student perceptions, career pathways and supervisor experiences. CONCLUSIONS This review reflects the emergent qualitative data as well as the quantitative data used to assess initiatives. Underserved area placements have produced many beneficial implications for students, supervisors and the community. There is a growing amount of evidence regarding rural, underserved areas, but little in relation to inner city, deprived areas, and none in the UK.
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Affiliation(s)
- Paul E S Crampton
- Centre for Medical Education Research, Durham University, Durham, UK
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Walters L, Greenhill J, Richards J, Ward H, Campbell N, Ash J, Schuwirth LWT. Outcomes of longitudinal integrated clinical placements for students, clinicians and society. MEDICAL EDUCATION 2012; 46:1028-41. [PMID: 23078680 DOI: 10.1111/j.1365-2923.2012.04331.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
CONTEXT Longitudinal integrated clerkships (LICs) have been widely implemented in both rural and urban contexts, as is now evident in the wealth of studies published internationally. This narrative literature review aims to summarise current evidence regarding the outcomes of LICs for student, clinician and community stakeholders. METHODS Recent literature was examined for original research articles pertaining to outcomes of LICs. RESULTS Students in LICs achieve academic results equivalent to and in some cases better than those of their counterparts who receive clinical education in block rotations. Students in LICs are reported to have well-developed patient-centred communication skills, demonstrate understanding of the psychosocial contributions to medicine, and report more preparedness in higher-order clinical and cognitive skills in comparison with students in traditional block rotations (TBRs). Students in LICs take on increased responsibility with patients and describe having more confidence in dealing with ethical dilemmas. Continuity of supervision reportedly facilitates incremental knowledge acquisition, and supervisors provide incrementally progressive feedback. Despite early disorientation regarding the organising of their learning, students feel well supported by the continuity of student-preceptor relationships and value the contributions made by these. Students in LICs living and working in rural areas are positively influenced towards primary care and rural career choices. DISCUSSION A sound body of knowledge in the field of LIC research suggests it is time to move beyond descriptive or exploratory research that is designed to justify this new educational approach by comparing academic results. As the attributes of LIC alumni are better understood, it is important to conduct explanatory research to develop a more complete understanding of these findings and a foundation for new theoretical frameworks that underpin educational change. CONCLUSIONS Longitudinal integrated clerkships are now recognised as representing credible and effective pedagogical alternatives to TBRs in medical education.
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Affiliation(s)
- Lucie Walters
- Flinders University Rural Clinical School, Faculty of Health Sciences, Flinders University, Mount Gambier, South Australia, Australia.
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Hudson JN, Knight PJ, Weston KM. Patient perceptions of innovative longitudinal integrated clerkships based in regional, rural and remote primary care: a qualitative study. BMC FAMILY PRACTICE 2012; 13:72. [PMID: 22839433 PMCID: PMC3503733 DOI: 10.1186/1471-2296-13-72] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 07/11/2012] [Indexed: 11/23/2022]
Abstract
Background Medical students at the University of Wollongong experience continuity of patient care and clinical supervision during an innovative year-long integrated (community and hospital) clinical clerkship. In this model of clinical education, students are based in a general practice ‘teaching microsystem’ and participate in patient care as part of this community of practice (CoP). This study evaluates patients’ perceptions of the clerkship initiative, and their perspectives on this approach to training ‘much-needed’ doctors in their community. Methods Semi-structured, face-to-face, interviews with patients provided data on the clerkship model in three contexts: regional, rural and remote health care settings in Australia. Two researchers independently thematically analysed transcribed data and organised emergent categories into themes. Results The twelve categories that emerged from the analysis of transcribed data were clustered into four themes: learning as doing; learning as shared experience; learning as belonging to a community; and learning as ‘becoming’. Patients viewed the clerkship learning environment as patient- and student-centred, emphasising that the patient-student-doctor relationship triad was important in facilitating active participation by patients as well as students. Patients believed that students became central, rather than peripheral, members of the CoP during an extended placement, value-adding and improving access to patient care. Conclusions Regional, rural and remote patients valued the long-term engagement of senior medical students in their health care team(s). A supportive CoP such as the general practice ‘teaching microsystem’ allowed student and patient to experience increasing participation and identity transformation over time. The extended student-patient-doctor relationship was seen as influential in this progression. Patients revealed unique insights into the longitudinal clerkship model, and believed they have an important contribution to make to medical education and new strategies addressing mal-distribution in the medical workforce.
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Affiliation(s)
- Judith N Hudson
- School of Rural Medicine, University of New England, Armidale, NSW 2351, Australia.
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Hudson JN, Weston KM, Farmer EA. Engaging rural preceptors in new longitudinal community clerkships during workforce shortage: a qualitative study. BMC FAMILY PRACTICE 2011; 12:103. [PMID: 21951836 PMCID: PMC3191469 DOI: 10.1186/1471-2296-12-103] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 09/27/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND In keeping with its mission to produce doctors for rural and regional Australia, the University of Wollongong, Graduate School of Medicine has established an innovative model of clinical education. This includes a 12-month integrated community-based clerkship in a regional or rural setting, offering senior students longitudinal participation in a 'community of practice' with access to continuity of patient care experiences, continuity of supervision and curriculum, and individualised personal and professional development. This required developing new teaching sites, based on attracting preceptors and providing them with educational and physical infrastructure. A major challenge was severe health workforce shortages. METHODS Before the new clerkship started, we interviewed 28 general practitioners to determine why they engaged as clerkship preceptors. Independent researchers conducted semi-structured interviews. Responses were transcribed for inductive qualitative content analysis. RESULTS The new model motivated preceptors to engage because it enhanced their opportunities to contribute to authentic learning when compared with the perceived limitations of short-term attachments. Preceptors appreciated the significant recognition of the value of general practice teaching and the honour of major involvement in the university. They predicted that the initiative would have positive effects on general practitioner morale and improve the quality of their practice. Other themes included the doctors' commitment to their profession, 'handing on' to the next generation and helping their community to attract doctors in the future. CONCLUSIONS Supervisors perceive that new models of clinical education offer alternative solutions to health care education, delivery and workforce. The longitudinal relationship between preceptor, student and community was seen as offering reciprocal benefits. General practitioners are committed to refining practice and ensuring generation of new members in their profession. They are motivated to engage in novel regional and rural longitudinal clinical clerkships as they perceive that they offer students an authentic learning experience and are a potential strategy to help address workforce shortages and maldistribution.
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Affiliation(s)
- Judith N Hudson
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia.
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McDonnel Smedts A, Lowe MP. Efficiency of clinical training at the Northern Territory Clinical School: placement length and rate of return for internship. Med J Aust 2008; 189:166-8. [PMID: 18673106 DOI: 10.5694/j.1326-5377.2008.tb01953.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 04/08/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effect of duration of clinical training placements in the Northern Territory on rate of return of medical students for an internship in the NT. DESIGN, SETTING AND PARTICIPANTS Retrospective analysis of medical school and hospital data on all medical students who completed a placement with the Northern Territory Clinical School (NTCS) between 1998 and 2007. MAIN OUTCOME MEASURES Logistic regression analysis of weeks spent training in the NT against the binary category of return or non-return for an internship in the NT; number of weeks of placement in the NT required for one returning intern for training models with different placement duration and timing. RESULTS 683 students completed an NTCS placement: short-term Year 4 placements only, 538 (duration, 1-19 weeks, 534; and > or = 20 weeks, 4); Year 3 40-week placements only, 16; and both Year 3 and Year 4 placements,129 (Year 4 duration, 1-19 weeks, 82; and > or = 20 weeks, 47). For each student who returned for an NT internship, 122 weeks of placement were required. Placement length was a significant predictor of an NT internship (P < 0.05; odds ratio, 1.08; 95% CI, 1.07-1.09). The most efficient training models (fewest weeks per returning intern) were longer placements (> or = 20 weeks) in Year 4, both for students who also undertook a 40-week Year 3 placement and those who did not (90 and 47 weeks of training per intern, respectively). Students who spent only brief periods in the NT in Year 4 were less likely to return for an internship (P < 0.05). CONCLUSIONS The rate of return increased with the total length of time spent training in the NT. Short-term Year 4 placements offered the least return for the total number of weeks of placement provided.
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Page S, Birden H. Twelve tips on rural medical placements: what has worked to make them successful. MEDICAL TEACHER 2008; 30:592-6. [PMID: 18608947 DOI: 10.1080/01421590801965129] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Providing undergraduate and post-graduate rural training opportunities aids rural medical recruitment. Medical schools that provide rural educational placements, and the communities that host those placements, must give serious consideration to the structure and supports required to ensure both quality and enjoyment of rural placements. This paper presents tips for success gleaned from the results of experience in providing rural placement opportunities to medical students throughout their medical school experience.
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Affiliation(s)
- Sue Page
- North Coast Medical Education Collaborative and Northern Rivers University, Department of Rural Health, Lismore, Australia
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Wray N, McCall L. Money matters: students' perceptions of the costs associated with placements. MEDICAL EDUCATION 2007; 41:975-81. [PMID: 17908115 DOI: 10.1111/j.1365-2923.2007.02840.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
CONTEXT Placements are an integral component of the medical, nursing and allied health curricula. However, apart from the relocation costs associated with placements, little research on students' understandings and experiences of the financial implications of placements has been carried out. OBJECTIVES We report on students' financial concerns associated with placements, which emerged as a main theme in a broader study we conducted on the impact of undergraduate student placement experiences on graduate practice. METHODS We conducted a qualitative study which included focus group discussions (n = 17), individual interviews (n = 48) and written responses (n = 2) with undergraduate students (n = 103) and graduates (n = 27) from a tertiary institution in Victoria, Australia. RESULTS Students identified that income generation and the costs associated with transport and placement location contributed to the financial burden of placements. Students also spoke of the implications of high financial strain impacting on their accumulation of debt as well as on their health and wellbeing. DISCUSSION Our study advances our understanding of the implications of financial hardship experienced by medical, nursing and allied health students. In our study, students, regardless of their placement location, experienced increased demands and associated stress as a result of managing placements, paid employment and limited financial resources. We recommend that further quantitative research be conducted to measure the variables identified as emerging themes in this study.
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Affiliation(s)
- Natalie Wray
- Department of General Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, East Bentleigh, Victoria, Australia.
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Pearce R, Laurence CO, Black LE, Stocks N. The challenges of teaching in a general practice setting. Med J Aust 2007; 187:129-32. [PMID: 17635101 DOI: 10.5694/j.1326-5377.2007.tb01161.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 06/06/2007] [Indexed: 11/17/2022]
Abstract
An attractive strategy to meet the increasing need for medical education is teaching in community general practice. General practice will be in a position to meet and sustain this need only if various conditions are met, including: Teaching is undertaken in general practice at all levels of medical education (medical student, postgraduate years 1-3 and GP vocational training); Standards and quality of teaching are maintained while the number of sites involved increases; Further Australian research is conducted into innovative models of general practice teaching and their cost-effectiveness; and Appropriate remuneration and infrastructure is available to support practices and general practitioners involved in teaching.
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Affiliation(s)
- Rod Pearce
- Adelaide to Outback GP Training Program, Adelaide, SA, Australia.
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Abstract
OBJECTIVE This study was undertaken to assess the evidence of whether new forms of medical training, where substantial training takes place in general practice, will be acceptable to GPs. In particular, we asked the questions: Are GPs willing to act as trainers and supervisors in their practices? Do GPs have the appropriate skills to be trainers? Do practices have the infrastructure and resources to support placements? And, are patients happy to be seen by medical students and General Practice Registrars? DESIGN Key Australian and international databases, key Australian journals and key Australian websites were searched for literature on general practice-based training of medical students and General Practice Registrars. RESULTS In the international and Australian literature, we found that many GPs consider training medical students and General Practice Registrars to be intrinsically satisfying. They vary in their skills, and most medical schools have made significant investments in training and support activities. Many practices do not have the necessary infrastructure, and investments need to be made if extended placements are to be successful. Many patients are happy to be seen by students and Registrars, but careful thought needs to be given to implementing appropriate models so that students have good learning opportunities, patients are not disadvantaged and general practices can operate efficiently. CONCLUSION The success of this new model of clinical placements is dependent on medical schools having a detailed understanding of the needs and expectations of GPs.
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Affiliation(s)
- Karen Larsen
- Centre for Equity and Primary Health Research in the Illawarra and Shoalhaven (CEPHRIS), Faculty of Medicine, University of New South Wales, Wollongong DC, NSW 2500, Australia.
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