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J Gen Intern Med. 2019 Oct;34(10):2254-2259. doi: 10.1007/s11606-019-04949-0.

Continuity in Undergraduate Medical Education: Mission Not Accomplished.

Author information

1
Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. daevans@nm.org.
2
Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
3
Department of Neurology, University of California, San Francisco, CA, USA.
4
Department of Medical Education, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
5
Cambridge Health Alliance and Center for Primary Care, Harvard Medical School, Boston, MA, USA.

Abstract

Evidence is mounting that longitudinal medical student clerkships provide better educational experiences than traditional block clerkship "silos." Education studies across institutions demonstrate positive effects of continuity on medical students, including creating patient-centered learning environments, improving fidelity of evaluations and feedback, improving medical student patient-centeredness, enabling more autonomous functioning in the clinical workplace, and increased recruitment and retention of students into primary care careers. Outcome studies show potential for longitudinal students to add value to patient care. This perspective piece summarizes the current evidence basis for longitudinal clerkships broken down by Kirkpatrick level (reactions, perceptions/attitudes, knowledge, behaviors, and patient benefits). Despite this evidence, expansion of longitudinal clerkships has been slow-i.e., fewer than half of current US medical schools offer one. While more recent curricular innovations center around Entrustable Professional Activities (EPAs), there are clear opportunities for medical schools to use longitudinal clerkships as a lens through which EPAs can be effectively evaluated. This perspective highlights the synergy between longitudinal clerkships and EPAs, showing that successful implementation of the former should empower the latter. While large, complex educational interventions are daunting tasks, change is needed. Regulatory organizations should mandate continuity-focused experiences for US medical graduates.

KEYWORDS:

Entrustable Professional Activities; Longitudinal Integrated Clerkship; continuity in medical education; undergraduate medical education; value-added medical education

PMID:
31346908
PMCID:
PMC6816620
[Available on 2020-10-01]
DOI:
10.1007/s11606-019-04949-0

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