Characterization of Distinctive Teaching Practices in Longitudinal Integrated Clerkships: Perspectives From Students and Faculty

Abstract

Phenomenon: Longitudinal integrated clerkships (LICs) are novel curricula that place medical students in long-term learning and coaching relationships with faculty and require adaptation of teaching practices on the behalf of faculty to maximize learning outcomes. An understanding of how teaching in an LIC model differs from teaching trainees in more traditional models is critical to ensuring curricular innovation success through faculty development. Approach: A qualitative approach was used to describe the teaching practices of faculty and learning experiences of student participants in longitudinal integrated clerkships in different clinical and community settings. Forty-five faculty and 20 students participated in focus groups. Thematic analysis of focus group data was used to identify differences and similarities between groups, sites, and specialties. Findings: Two groupings of themes emerged in thematic analysis: (1) precepting strategies distinctive to the longitudinal integrated clerkship model and (2) precepting strategies enhanced when employed in the LIC model. Distinct to the LIC model, preceptors and students described the importance of understanding the curricular structure and supporting students in longitudinal care of patients. Enhanced in the LIC model are the strategies of relationship-based teaching, support of autonomy, feedback, and support of longitudinal growth in skills. Insights: Students and faculty across LIC sites were broadly aligned in their opinions of best practices for teaching in an LIC model. The longitudinal relationship between student and faculty in an LIC distinguishes this model from traditional block rotations and a distinctive approach to successful teaching is demonstrated. Preceptors use time afforded to build trusting relationships with students, which created opportunity for novel teaching approaches and enhanced otherwise effective teaching strategies. A focus on orientation to the curricular model and support of longitudinal relationships with patients may serve as an anchor for faculty development efforts in the development of an LIC.

Keywords:

• Longitudinal integrated clerkship
• LIC
• faculty development
• clerkship

Acknowledgments

The authors thank the study participants for their time and insights and Dr. Tai Lockspeiser for her careful and thoughtful review of the manuscript. We also thank Dr. Shanta Zimmer for her support of the LIC curriculum at the CUSOM. We appreciate the time and generous sharing of opinions and insights of all student and faculty participants in focus groups.

Ethical approval

This study was declared exempt by the Colorado Multiple Institution Review Board (COMIRB), no. 21-2639, February 26, 2021.

Previous presentations

This work was presented at the University of Colorado Academy of Medical Educators Education and Innovation Week, March 1, 2021, virtual conference; at the Society of General Internal Medicine Annual Meeting, April 23, 2021, virtual conference; and at the International Consortium of Longitudinal Clerkships, October 10, 2021, virtual conference.

Disclosure statement

There are no relevant financial or nonfinancial competing interests to report.

Additional information

Funding

This work was supported by the Kettering Family Foundation.