Diffusion of innovation and longitudinal integrated clerkships: Results of the clerkship directors in internal medicine annual survey

Abstract

Purpose: Longitudinal integrated clerkships (LICs) are innovative educational models that emphasize medical student continuity with patients, preceptors, peers, and health systems. We characterize LIC growth in the US and interpret the growth using Rogers’ Diffusion of Innovation Theory.

Methods: In 2015, we surveyed 123 US allopathic medical schools affiliated with Clerkship Directors in Internal Medicine (CDIM). The organization’s annual survey was supplemented with questions aimed to quantify the number of current and planned LICs and to determine the intended purpose of starting LICs.

Results: Of the 94 (out of 123 possible) schools which were responding, 35 (37%) have at least one LIC of six months or greater; of these 20 are year-long. Nineteen schools are engaged in planning a new LIC or increasing the number of students in an LIC. At least 45 (48%) responding schools will have LICs in future years. Respondents report implementing LICs to foster continuity of care, support patient-centeredness, advance inter-professional education, and address workforce shortages.

Conclusions: The number of LICs is increasing across the US. We considered the data through the lens of Diffusion of Innovation Theory, speculated that LIC growth has reached “critical mass,” and considered why the LIC innovation may be self-sustaining.

Acknowledgements

The authors wish to thank the Clerkship Directors in Internal Medicine organization for their support and assistance with this project, Monica McNulty from the University of Colorado for her assistance with data analysis, and Nora Osman, MD and Karen Hauer, MD for their feedback on the manuscript.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Longitudinal integrated clerkship (LIC): A clinical education structure in which medical students participate in comprehensive care of patients and populations in continuing learning relationships over time and across disciplines and venues.

Worley P, Couper I, Strasser R, Graves L, Cummings BA, Woodman R, Stagg P, Hirsh D and The CLIC Research Collaborative. 2016. A typology of longitudinal integrated clerkships. Med Educ. 50(9):922–932.

Additional information

Notes on contributors

Lindsay Mazotti

Lindsay A. Mazotti, MD, is Assistant Physician-in-Chief of Education and Development at Kaiser Permanente (KP) East Bay, Associate Professor of Clinical Medicine at the University of California San Francisco and Associate Professor at the Kaiser Permanente School of Medicine.

Jennifer Adams

Jennifer E. Adams, MD, is Director of the Denver Health Longitudinal Integrated Clerkship at the University of Colorado and an Associate Professor of Medicine at the University of Colorado School of Medicine.

Bruce Peyser

Bruce Peyser, MD, is Professor of Medicine at Duke University School of Medicine.

Katherine Chretien

Katherine C. Chretien, MD, is Assistant Dean for Student Affairs and Associate Professor of Medicine at the George Washington University School of Medicine and Health Sciences.

Briar Duffy

Briar Duffy, MD, is Internal Medicine Program Director, former Internal Medicine Clerkship Director and an Assistant Professor of Medicine at the University of Minnesota Medical School.

David A. Hirsh

David A. Hirsh, MD, is Director of the Harvard Medical School Cambridge Integrated Clerkship, Cambridge Health Alliance, Cambridge, MA, Director of the Harvard Medical School Academy Medical Education Fellowship, and Associate Professor of Medicine at Harvard Medical School, Boston, MA.