Same but Different: Exploring Mechanisms of Learning in a Longitudinal Integrated Clerkship

Acad Med. 2020 Mar;95(3):411-416. doi: 10.1097/ACM.0000000000002960.


Purpose: Longitudinal integrated clerkships (LICs) are a widely used method of delivering clerkship curricula. Although there is evidence that LICs work and core components of LIC training have been identified, there is insufficient understanding of which components are integral to why they work. To address this question, this research explored how students experienced the first year of an LIC program. The aim was to use participants' understanding of their learning experiences to identify potential mechanisms of the LIC curriculum model.

Method: Thirty-two interviews were conducted with 13 University of Toronto students, 7 LIC and 6 block rotation students from the same site, from October 2014 to September 2015. A thematic analysis was performed iteratively to explore participants' understanding of their key learning experiences and outcomes.

Results: Participants in both cohorts described their key learning outcome as integration and application of knowledge during patient care. Experiences supporting this outcome were articulated as longitudinal variable practice and continuity of relationships with preceptors and patients. Critically, these experiences manifested differently for the 2 cohorts. For block students, these learning experiences appeared to reflect the informal curriculum, whereas for LIC students, learning experiences were better supported by the LIC formal curriculum.

Conclusions: The results illustrate the importance of learning experiences that support longitudinality and continuity. By also emphasizing variability and knowledge integration, they align with literature on expert development. Notably, many of the learning experiences identified resulted from informal learning and thus support going beyond the formal curriculum when evaluating the effectiveness of curricula.

MeSH terms

  • Adult
  • Clinical Clerkship / methods*
  • Curriculum*
  • Education, Medical, Undergraduate / organization & administration*
  • Female
  • Humans
  • Male
  • Ontario
  • Problem-Based Learning / methods*
  • Students, Medical / psychology*
  • Students, Medical / statistics & numerical data*
  • Young Adult