A contextual definition of longitudinal integrated clerkships within the UK and Ireland: A bi-national modified Delphi study.

Disagreement exists within the UK and Ireland regarding how Longitudinal Integrated Clerkships should be defined, and the relevance of international definitions. In this modified, online Delphi study, we presented the UK and Ireland experts in Longitudinal Integrated Clerkships with statements drawn from international definitions, published LIC literature, and the research team's experience in this area and asked them to rate their level of agreement with these statements for inclusion in a bi-national consensus definition. We undertook three rounds of the study to try and elicit consensus, making adaptations to statement wording following rounds 1 and 2 to capture participants' qualitative free text-comments, following the third and final round, nine statements were accepted by our panel, and constitute our proposed definition of Longitudinal Integrated Clerkships within the UK and Ireland. This definitional statement corresponds with some international literature but offers important distinctions, which account for the unique context of healthcare (particularly primary care) within the UK and Ireland (for example, the lack of time-based criteria within the definition). This definition should allow UK and Irish researchers to communicate more clearly with one another regarding the benefits of LICs and longitudinal learning and offers cross-national collaborative opportunities in LIC design, delivery and evaluation.

The impact of longitudinal integrated clerkships on patient care: a qualitative systematic review.

BACKGROUND: Longitudinal Integrated Clerkships (LIC) are a relatively novel type of clinical placement model within medical education, particularly within the UK. The research on LICs primarily focuses on the impact of the model on students, tutors, communities, and organisations. The impact of LICs on patients has not yet been adequately synthesised. This systematic review aims to fill this gap by examining empirical evidence regarding the impact of LICs on patient care using quality-of-care measures, namely, health process measures and outcome measures. METHODS: A systematic search was conducted in MEDLINE, PsycINFO, Academic Search Premier, Education Research Complete, CINAHL Complete, ERIC, Web of Science, and Scopus. Two reviewers independently conducted the screening process for study selection. Results across studies were analysed and summarised by thematic analysis. RESULTS: The reviewers screened 1632 records. Seven studies met the inclusion criteria following a full-text review, from which four themes were created. Three themes describe health process measures, including: 1) Advocacy within healthcare system, 2) Provision of supplementary and personalised care, and 3) Providing companionship with care. One theme described a health outcome measure: Therapeutic Alliance. CONCLUSION: Current evidence demonstrates an overall beneficial impact of LICs on patient health processes and outcome measures. However, the available evidence is weak and limited. Further research is required to illuminate the true impact of LICs on patient health.

Identity in lockdown: supporting primary care professional identity development in the COVID-19 generation.

The current COVID-19 pandemic has dramatically impacted undergraduate medical studies. Whilst challenges for knowledge and clinical skills are being actively addressed, wider considerations such as the impact on professional identity development have been mostly neglected thus far. A robust professional identity is linked to professional behaviour and has been shown to reduce burnout and be an important factor for general practice career choice amongst medical students. The Communities of Practice Model is a sociocultural approach that conceptualises the formation of professional identity through student engagement within a community. We argue the current suspension of clinical placements holds the potential to negatively influence such identity acquisition. In this commentary we explore how the Communities of Practice Model may inform professional identity development of medical students within the COVID-19 environment, considering digital communities and volunteering roles within primary care. We further encourage educators and institutions to consider professional identity in future planning to address the challenges posed by the current situation, both in terms of placement loss but also changes in the way primary care is delivered. Such considerations will be essential if we are to avoid problems relating to poor medical student professional identity development in future.

Empathy in Medical Education: Its Nature and Nurture - a Qualitative Study of the Views of Students and Tutors.

Context: Medical education is committed to teaching patient centred communication and empathy. However, quantitative research suggests empathy scores tend to decline as students progress through medical school. In qualitative terms, there is a need to better understand how students and tutors view the practice and teaching of clinical empathy and the phenomenon of empathic erosion. Methods: Working within a constructivist paradigm, researchers thematically analysed the individual interview data from a purposive sample of 13 senior students and 9 tutors. Results: The four major themes were as follows: (1) 'the nature of empathy', including the concept of the innate empathy that students already possess at the beginning of medical school; (2) 'beyond the formal curriculum' and the central importance of role modelling; (3) 'the formal curriculum and the tick-box influence of assessments'; and (4) the 'durability of empathy', including ethical erosion and resilience. A garden model of empathy development is proposed - beginning with the innate seeds of empathy that students bring to medical school, the flowering of empathy is a fragile process, subject to both enablers and barriers in the formal, informal, and hidden curricula. Conclusion: This study provides insights into empathic erosion in medical school, including the problems of negative role modelling and the limitations of an assessment system that rewards 'tick-box' representations of empathy, rather than true acts of compassion. It also identifies factors that should enable the flowering of empathy, such as new pedagogical approaches to resilience and a role for the arts and humanities.

Professional identity formation within Longitudinal Integrated Clerkships: a scoping review protocol.

BACKGROUND: Professional identity development is an area of contemporary interest within medical education. It can be defined as 'the foundational process one experiences during the transformation from lay person to physician'. In order for this transformation to occur, medical values and principles are internalised. A robust professional identity is key to confident practice as a medical professional. As such, research regarding what works to encourage identity development is popular. New models of educational delivery, such as the increasingly popular Longitudinal Integrated Clerkship model (LICs), present an interesting opportunity to investigate impact on identity. As no previous literature reviews focus on identity development within LICs, it is unclear what is already known about their impact. Therefore, a scoping review synthesising current knowledge and mapping areas for future research is necessary. METHODS: Arksey and O'Malley's scoping review steps will be used as a methodological framework. MEDLINE, EMBASE, PubMed, Web of Knowledge, ERIC, PsychINFO, Google Scholar, JSTOR, Scopus, and Web of science will be searched (from inception onwards). We will include single studies of any design (e.g. quantitative and qualitative) and reviews examining professional identity within Longitudinal Integrated Clerkships involving health profession students. Two reviewers will complete all screening and data abstraction independently. Deductive coding will be presented as a quantitative textual meta-analysis. Inductive coding will be presented in narrative format. DISCUSSION: This scoping review will explore professional identity formation within LICs, evaluating any known impact of the educational model and mapping the ways in which identity within LICs has been researched. Mapping of current knowledge should highlight whether LICs as an educational model can influence professional identity development and outline gaps in what is known about their impact to date. Theory used in LIC-based identity research will also be mapped, in order to summarise the main theoretical orientations of research to date. It is anticipated that through such evidence synthesis, directions for future research will become clear. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework: osf.io/hk83p.

A Narrative Literature Review Considering the Development and Implementation of Longitudinal Integrated Clerkships, Including a Practical Guide for Application.

Hailed by supporters as the answer to many challenges facing medical schools and the wider health care system, longitudinal integrated clerkships (LICs) offer a practical and sustainable alternative to more traditional block rotational models. Given this, their popularity as a curricular measure is increasing, although such clerkships remain relatively novel within the United Kingdom. This narrative literature review of international work provides a comprehensive introduction to developing and implementing LICs within medical education. This review generates a practical guide for medical educators with a focus on the development and implementation of LICs within the United Kingdom, on which there is little work. Using illustrated examples and with reference to contemporary literature, it outlines the rationale for considering an LIC within a curriculum, the different types of LIC, barriers and enabling factors to LIC implementation and considers the contemporary application of LIC models within the United Kingdom. The practical guide details key questions educators must consider when developing and implementing an LIC, particularly within the landscape of UK medical education.