Medical students, in many ways, are apprenticed doctors. Much of their time, especially in the 3rd and 4th years, is spent on direct patient care in the hospital and clinics. Mandatory rotations in surgery, medicine,pediatrics, neurology, obstetrics/gynecology and family medicine are completed typically in the 3rd year. With a change in rotation discipline comes a change in supervising physicians and mentors lending itself to a fragmented clinical experience.
It is no surprise that a recent paper in Medical Education comparing preceptors’ and students’ perceptions of student evaluation in block clerkships and longitudinal integrated clerkships favored longitudinal integrated clerkships. Longitudinal integrated clerkships are core clinical experiences that include longitudinal ambulatory preceptorships to facilitate continuity in students’ relationships with preceptors and patients over periods of 6 months to 1 year. This is in contrast to the traditional 4-12 week rotation. Both preceptors and students favored evaluation in the longitudinal clerkships on three factors: validity of evaluation process, quality of clinical skill evaluation, and willingness to provide constructive feedback.
There is no evidence, however, that a longitudinal clerkship experience will produce a more learned, better skilled and more empathic physician come graduation time.
The finding is nevertheless important and highlights an important challenge. A student cannot complete a longitudinal experience across all specialties as this is simply not feasible given time and faculty constraints. The challenge lies in how to best choose a longitudinal clerkship such that the educational and future specialty choice of the student is best met without compromising meaningful learning experiences across the other required rotations.
