Coproducing clinical curricula in undergraduate medical education: Student and faculty experiences in longitudinal integrated clerkships

Abstract

Purpose

Educational coproduction, in which learners partner with educators to create and improve their educational experiences, can facilitate student-centered medical education. Empirical descriptions of best practices for involving students in clinical curricular coproduction are needed. We aimed to understand faculty and student perspectives on methods, perceived benefits, and common barriers and solutions to clinical curricular coproduction.

Methods

We conducted an international mixed-methods study of clinical curricular coproduction in undergraduate medical education and longitudinal integrated clerkships specifically. Faculty and students identified through an international listserv received an electronic survey to identify methods, benefits, and challenges of clinical curricular coproduction. We conducted semi-structured interviews with a subset of survey participants. We present descriptive statistics for survey data and themes derived from inductive qualitative analysis.

Results

Two hundred forty-seven individuals (104 faculty; 143 students) representing 52 medical schools in eight countries completed the survey. Methods for clinical curricular coproduction ranged from informal, low-intensity learner involvement (e.g. verbal feedback) to formal, high-intensity learner involvement (e.g. committee membership). Perceived benefits included improvements in student-faculty relationships, program culture and design, and student development. Structural issues (e.g. scheduling) were the most common perceived barriers.

Conclusions

Clinical curricular coproduction among faculty and students is perceived to enhance collaboration, enable curriculum change, and support students’ professional development. Our study offers empirical guidance for involving students as partners in clinical curricular coproduction.

Keywords:

• Curricular coproduction
• curriculum development
• student involvement
• student engagement
• longitudinal integrated clerkships
• undergraduate medical education
• mixed-methods research

Acknowledgements

The authors would like to thank our survey and interview participants for sharing their perspectives and experiences. We thank Ms. Bernadette Duperron of CLIC and SLICC for administrative support.

Disclosure statement

David A. Hirsh discloses he is co-founder and director of Harvard Medical School’s Cambridge Integrated Clerkship. The authors report no other financial or other conflicts of interest.

Authors’ contributions

Galina Gheihman contributed to the initial design and conception of the study, data collection and analysis, and initial drafting and revision of the manuscript, completing the intellectual and other work typical of the first author.

Dana G. Callahan contributed to the initial design and conception of the study, data collection and analysis, and initial drafting and revision of the manuscript, completing the intellectual and other work typical of the first author.

Joshua Onyango contributed to the initial design and conception of the study, data collection and analysis, and initial drafting and revision of the manuscript.

Holly C. Gooding contributed to the initial design and conception of the study, data analysis, and revision of the manuscript, completing the intellectual and other work typical of the senior author.

David A. Hirsh contributed to the initial design and conception of the study, data analysis, and revision of the manuscript, completing the intellectual and other work typical of the senior author.

Glossary

Curricular coproduction: A process in which learners partner with educators to create their educational experiences, curricula, and learning environment. Learners may contribute to the design, implementation, and evaluation of both non-clinical and clinical curricula. The learner-educator partnership may range from low-intensity, low-reciprocity short term interactions, such as surveys or informal verbal feedback from learners to faculty, to high-intensity, high-reciprocity longitudinal interactions, such as students serving on a curriculum committee. Coproduction has emerged as a valuable strategy to support tenets of adult learning theory, learner-centered medical education, and continuous curricular quality improvement.

Englander R, Holmboe E, Bataldan P, Rosemary MC, Durham, CF, Foster T, Ogrinc G, Ercan-Fang N, Batalden M. Coproducing health professions education: a prerequisite to coproducing health care service? Acad Med. 2020;95:1006–1013.

Longitudinal integrated clerkship (LIC): A model to provide the central element of clinical education whereby medical students: (1) participate in the comprehensive care of patients over time, (2) participate in continuing learning relationships with these patients’ clinicians, and (3) meet the majority of the year’s core clinical competencies, across multiple disciplines simultaneously through these experiences.

Poncelet AN, Hirsh DA, editors. The longitudinal integrated clerkship: principles, outcomes, practical tools and future directions. North Syracuse (NY): Gegensatz Press; 2016.

Additional information

Funding

This work was supported in part by the Cambridge Integrated Clerkship, which provided funding for an electronic gift card raffle entered by eligible study participants. This study was conducted with administrative support (i.e. sending out the surveys) from the Consortium for Longitudinal Integrated Clerkships (CLIC, https://clicmeded.com/), an international organization of LIC program directors, faculty members, and students, and the international Students for Longitudinal Integrated Clerkships and Curriculum (SLICC, https://sliccedu.org/) network, the student arm of CLIC.

Notes on contributors

Galina Gheihman

Galina Gheihman, MD, Resident physician in the Departments of Neurology at Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, Massachusetts, United States.

Dana G. Callahan

Dana G. Callahan, MD, Resident physician in the Department of Internal Medicine at Brigham and Women’s Hospital, Boston, Massachusetts, United States.

Joshua Onyango

Joshua Onyango, MD, EdM, Resident physician in the Department of Internal Medicine at Yale-New Haven Hospital, New Haven, Connecticut, United States.

Holly C. Gooding

Holly C. Gooding, MD, MSc, Associate Professor of Pediatrics at Emory University School of Medicine, Atlanta, Georgia, United States.

David A. Hirsh

David A. Hirsh, MD, FACP, George E. Thibault Academy Associate Professor and Director, Harvard Medical School Academy and Director and Cofounder, Harvard Medical School–Cambridge Integrated Clerkship, Harvard Medical School, Boston, Massachusetts and Cambridge Health Alliance, Cambridge, Massachusetts, United States.