Flinders University Rural Clinical School, Faculty of Health Sciences, Flinders University, Mount Gambier, South Australia, Australia.
Med Educ. 2012 Nov;46(11):1028-41. doi: 10.1111/j.1365-2923.2012.04331.x.
Longitudinal integrated clerkships (LICs) have been widely implemented in both rural and urban contexts, as is now evident in the wealth of studies published internationally. This narrative literature review aims to summarise current evidence regarding the outcomes of LICs for student, clinician and community stakeholders.
Recent literature was examined for original research articles pertaining to outcomes of LICs.
Students in LICs achieve academic results equivalent to and in some cases better than those of their counterparts who receive clinical education in block rotations. Students in LICs are reported to have well-developed patient-centred communication skills, demonstrate understanding of the psychosocial contributions to medicine, and report more preparedness in higher-order clinical and cognitive skills in comparison with students in traditional block rotations (TBRs). Students in LICs take on increased responsibility with patients and describe having more confidence in dealing with ethical dilemmas. Continuity of supervision reportedly facilitates incremental knowledge acquisition, and supervisors provide incrementally progressive feedback. Despite early disorientation regarding the organising of their learning, students feel well supported by the continuity of student-preceptor relationships and value the contributions made by these. Students in LICs living and working in rural areas are positively influenced towards primary care and rural career choices.
A sound body of knowledge in the field of LIC research suggests it is time to move beyond descriptive or exploratory research that is designed to justify this new educational approach by comparing academic results. As the attributes of LIC alumni are better understood, it is important to conduct explanatory research to develop a more complete understanding of these findings and a foundation for new theoretical frameworks that underpin educational change.
Longitudinal integrated clerkships are now recognised as representing credible and effective pedagogical alternatives to TBRs in medical education.
纵向综合实习（LIC）已在城乡地区广泛实施，这从国际上发表的大量研究中可见一斑。本叙事文献综述旨在总结 LIC 对学生、临床医生和社区利益相关者的结果的现有证据。
为了确定与 LIC 结果相关的原始研究文章，查阅了最近的文献。
LIC 中的学生在学术成果方面与接受块状轮换临床教育的学生相当，在某些情况下甚至更好。报告称，LIC 中的学生具有良好的以患者为中心的沟通技巧，对医学的社会心理贡献有更深入的理解，与传统块状轮换（TBR）中的学生相比，他们在高级临床和认知技能方面表现出更高的准备程度。LIC 中的学生对患者承担更多的责任，并表示在处理伦理困境方面更有信心。据报道，连续监督有助于逐步增加知识的获取，并且监督者提供渐进式的反馈。尽管在组织学习方面早期感到困惑，但学生们表示，他们受益于学生导师关系的连续性，并重视这些关系的贡献。在农村地区生活和工作的 LIC 学生受到积极影响，倾向于选择基层医疗和农村职业。
在 LIC 研究领域，有大量的知识表明，现在是时候超越描述性或探索性研究了，这些研究旨在通过比较学术成果来证明这种新的教育方法是合理的。随着对 LIC 校友属性的更好理解，进行解释性研究以更全面地理解这些发现并为新的理论框架奠定基础非常重要，这些理论框架是教育变革的基础。
纵向综合实习现在被认为是医学教育中 TBR 的可信且有效的替代教学方法。
