Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Neurology, University of California, San Francisco, CA, USA.
J Gen Intern Med. 2019 Oct;34(10):2254-2259. doi: 10.1007/s11606-019-04949-0.
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.
越来越多的证据表明，纵向医学生实习比传统的块状实习“孤岛”提供更好的教育体验。跨机构的教育研究表明连续性对医学生有积极的影响，包括创造以患者为中心的学习环境、提高评估和反馈的保真度、提高医学生以患者为中心的能力、使临床工作场所的自主功能更加强大，以及增加学生对初级保健职业的招募和留用。结果研究表明，纵向学生有可能为患者护理增加价值。这篇观点文章总结了目前按柯克帕特里克级别（反应、认知/态度、知识、行为和患者获益）划分的纵向实习的证据基础。尽管有这些证据，但纵向实习的扩展一直很缓慢——即目前只有不到一半的美国医学院提供这种实习。虽然最近的课程创新围绕可信赖专业活动（EPAs）展开，但医学院显然有机会将纵向实习作为一个视角，通过该视角可以有效地评估 EPAs。这一观点突出了纵向实习和 EPAs 之间的协同作用，表明前者的成功实施应该能够推动后者的发展。虽然大型、复杂的教育干预措施是艰巨的任务，但需要进行变革。监管机构应要求美国医学毕业生有以连续性为重点的体验。
