A review of longitudinal clinical programs in US medical schools

Figures & data

Table 1. Characteristics of longitudinal clinical program structure among included programs at US medical schools.

Program characteristics	Number (%)
Total schools searched (n = 137)
Schools with one longitudinal clinical program identified	49 (35.8)
Schools with two or more longitudinal clinical programs identified	20 (14.6)
Schools with no longitudinal clinical programs identified	68 (49.6)
Total programs identified (n = 98)
Programs with stated goals	89 (90.8)
Programs with no stated goals	9 (9.2)
Date established (n = 98)
Prior to 2000	7 (7.1)
2000 to 2004	12 (12.2)
2005 to 2009	12 (12.2)
2010 to 2014	37 (37.8)
Unknown	30 (30.6)
Curricular vs. extracurricular (n = 98)
Curricular programs	95 (96.9)
Extracurricular programs	3 (3.1)
Mandatory vs. elective (n = 98)
Mandatory (all students participate)	46 (46.9)
Elective (not all students participate)	52 (53.1)
Phase of training (n = 98)
Programs exclusively in pre-clinical years	26 (26.5)
Programs exclusively in clinical years	51 (52.0)
Programs spanning pre-clinical and clinical years	21 (21.4)
Program length (n = 98)
6 months to <1 year	12 (12.2)
1 year	47 (48.0)
>1 year	39 (39.8)
Program type (n = 98)
Longitudinal integrated clerkship (LIC)	26 (26.5)
Patient attachment only	20 (20.4)
Clinic attachment only	49 (50.0)
Patient and clinic attachment	3 (3.1)

Table 2. Prevalence of the major, minor, and sub-categories of stated program goals among included Longitudinal Clinical Programs at US medical schools.

Program goals	Number/total programs (%)
Exposure^a	70/89 (78.7)
Specific patient demographics^b	33/89 (37.1)
Geriatric patients^c	5/89 (5.6)
Underserved patients	8/89 (9.0)
Urban patients	4/89 (4.5)
Rural patients	9/89 (10.1)
Patients with chronic disease	9/89 (10.1)
Other	5/89 (5.6)
Specialties	22/89 (24.7)
Primary care	21/89 (23.6)
Other	1/89 (1.1)
Outpatient/Community-based care	15/89 (16.9)
Social Medicine	36/89 (40.4)
Social determinants of health	16/89 (18.0)
Psychosocial aspects of health	12/89 (13.5)
Healthcare system	22/89 (24.7)
Recruitment	10/89 (11.2)
Specific geographic area	7/89 (7.9)
Specific specialty	5/89 (5.6)
Skill development	58/89 (65.2)
Clinical Skills	39/89 (43.8)
History and physical	12/89 (13.5)
Clinical reasoning and diagnosis	9/89 (10.1)
Plan and management	7/89 (7.9)
Communication with patients	9/89 (10.1)
Prevention/health maintenance	6/89 (6.7)
Shared decision making	2/89 (2.2)
Patient-centered care	8/89 (9.0)
Unspecified	17/89 (19.1)
Other	3/89 (3.4)
Professional Skills	39/89 (43.8)
Professionalism	10/89 (11.2)
Humanism	10/89 (11.2)
Ethics	6/89 (6.7)
Leadership	5/89 (5.6)
Cultural competency	13/89 (14.6)
Interprofessional team-based care	13/89 (14.6)
Advocacy	2/89 (2.2)
Lifelong learning	4/89 (4.5)
Quality improvement	4/89 (4.5)
Other	4/89 (4.5)
Understanding the patient experience	17/89 (19.1)
Foster longitudinal relationships	29/89 (32.6)
Between student and supervisor	7/89 (7.9)
Between student and patient	24/89 (27.0)
Between student and clinical team	1/89 (1.1)
Between student and other	3/89 (3.4)
Integrate pre-clinical and clinical curricula	10/89 (11.2)

^aSix major categories of stated programmatic goals were included in the framework and are indicated in bold above. An LCP could be assigned one or more of the codes under this category.

^bMinor categories were identified as sub-groups within certain major categories and are indicated in italics above. An LCP could be assigned one or more of the codes under this sub-group.

^cSub-categories were further subdivided within certain minor categories and are identified in plain text above. A program could be assigned one or more of the codes under this sub-group.

Figure 1. Longitudinal clinical program type (LIC, patient attachment, or clinic attachment) is associated with programmatic goals including ‘exposure to specific patient demographics,’ ‘exposure to primary care,’ and ‘understanding the patient experience’.

*Association between patient attachment and “exposure to specific patient demongraphics” (P=0.04) ˆAssociation between LIC and “exposure to primary care” (P=0.04) §Association between patient attachment and “understanding the patient experience” (P=0.03)

Figure 2. Longitudinal clinical program phase of training (Pre-clinical, clinical, or both) is associated with the programmatic goal of ‘developing clinical skills.’

*Association between pre-clinical phase of training and “developing clinical skills” (P=0.01)