The impact of clerkship model and clinical setting on medical student’s participation in the clinical workplace: A comparison of rural LIC and rural block rotation experience

Abstract

Purpose

To compare the participation of rural Longitudinal Integrated Clerkship (LIC) and rural Block Rotation (BR) students in surgical clinical activities.

Methods

Third-year medical students from Deakin University’s Rural Clinical Schools were invited to record their participation during clinical encounters with ten common surgical conditions, using a descriptive five-point progressive entrustment scale. Participation levels of LIC and BR students were compared for differences, according to clinical task and context.

Results

LIC students recorded greater active participation across all clinical tasks.

Highest levels of active participation occurred in General Practice, a setting only LIC students were exposed to at this course stage. BR students recorded the majority of their surgical encounters in the hospital inpatient setting, where their involvement was predominantly observational. Both groups recorded high levels of participation in the Emergency Department.

Conclusions

Active participation in clinical encounters with surgical patients was enhanced by participation in a LIC program and cannot be attributed to the rural context alone. Student participation is influenced by clinical context, presenting the opportunity to reconsider the design of clerkships to include models that facilitate active student participation. Further research is required to investigate the learner, supervisor and contextual factors influencing entrustment decisions within clerkships.

Keywords:

• Surgery
• clinical skills
• medical education research
• medicine
• work-based

Disclosure statement

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

Additional information

Notes on contributors

Lara Fuller

Associate Professor Lara Fuller, MBBS (Hons), FRACGP, GCME, AMusA, is Director of the Rural Community Clinical School, the Longitudinal Integrated Clerkship Program within Deakin’s Doctor of Medicine. As an academic General Practitioner her interests are in curriculum design for rural medical education, learning in Longitudinal Integrated Clerkships, rural clinical training pathways and rural workforce outcomes. She is a member of the Federation of Rural Australian Medical Educators (AusFRAME) and the International Consortium of Longitudinal Integrated Clerkships (CLIC).

Mary Lawson

Mary Lawson, BSc(Hons), is the Assessment Lead for Deakin University’s Doctor of Medicine. She is a medical education generalist with experience across the undergraduate and postgraduate spectrum in curriculum design and evaluation, teacher training and many areas of assessment but particularly online and in the workplace.

Jessica Beattie

Jessica Beattie, MHHSM, B.App Sci, is a lecturer in Rural General Practice (Program Development and Support) within the Rural Community Clinical School. She is a rural health researcher with experience across rural medical education and rural medical workforce.