Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct;34(10):2254-2259.
doi: 10.1007/s11606-019-04949-0.

Continuity in Undergraduate Medical Education: Mission Not Accomplished

Daniel B Evans  1 , Bruce L Henschen  2 , Ann N Poncelet  3 , LuAnn Wilkerson  4 , Barbara Ogur  5
Affiliations

Continuity in Undergraduate Medical Education: Mission Not Accomplished

Daniel B Evans et al. J Gen Intern Med. 2019 Oct.

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.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Articles in PubMed from 2007 to 2017 focused on medical student longitudinal clerkships or longitudinal experiences compared with articles focused on Entrustable Professional Activities for medical students.
See this image and copyright information in PMC

References

    1. Commonwealth Fund. Envisioning the Future of Academic Health Centers. 2003. Available at: http://www.commonwealthfund.org/publications/fund-reports/2003/feb/envis.... Accessed October 23, 2018.
    1. Whitcomb ME. Redesigning clinical education: a major challenge for academic health centers. Acad Med. 2005;80(7):615–616. - PubMed
    1. Abelson J. The Disappearing Doctor: How Mega-mergers are changing the business of medical care. Available at: https://www.nytimes.com/2018/04/07/health/health-care-mergers-doctors.html. Accessed October 23, 2018.
    1. Gawande A. The Heroism of Incremental Care. 2017. Available at: https://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental... . Accessed October 23, 2018.
    1. Hirsh DA, Ogur B, Thibault GE, Cox M. “Continuity” as an organizing principle for clinical education reform. N Engl J Med. 2007;356(8):858–866. - PubMed