Health Professions Education Unit, Hull York Medical School, University of York, York, UK.
Academy for Primary Care, Hull York Medical School, University of Hull, Hull, UK.
Med Educ. 2021 Aug;55(8):912-924. doi: 10.1111/medu.14461. Epub 2021 Feb 24.
Although the uptake of Longitudinal Integrated Clerkships (LICs) is increasing worldwide, and there are documented benefits to participation, there is a lack of conceptual evidence regarding how LICs exert many of their benefits, including their influence on the recruitment and retention of practitioners to underserved areas or specialties. Whilst career choice and professional identity development have been previously connected within medicine, what is known about the ways in which LICs influence identity remains unclear. A scoping review was conducted to explore current knowledge and map directions for future research.
In 2020, the authors searched nine bibliographic databases for articles discussing identity within the context of LICs using a systematic search strategy. Two reviewers independently screened all articles against eligibility criteria and charted the data. Eligible articles were analysed by quantitative and qualitative thematic analysis.
849 articles were identified following an extensive search. 131 articles were selected for full-text review, with 27 eligible for inclusion. Over half of all articles originated from the United States or Canada, and research most frequently explored identity development from sociocultural orientations. Qualitatively, four themes were identified: (a) The importance of contextual continuities; (b) Symbiotic relationship of responsibility and identity development; (c) Becoming a competent carer; and (d) Influence of LICs on career identity.
This scoping review adds weight to the supposition that participation in LICs facilitates identity development, namely through contextual continuities and the responsibility students assume as they become co-providers of patient care. There are suggestions that LICs encourage the development of an 'ethic of caring'. As little research compares comprehensive LICs with other clerkship models, it remains difficult to say to what degree identity formation is facilitated above and beyond other models. Future comparative research, and research exploring identity formation from diverse theoretical perspectives would add depth.
尽管纵向综合临床实习(LICs)在全球范围内的采用率正在上升,并且有参与的记录证明其有好处,但对于 LICs 如何发挥其许多好处,包括对招募和留住从业者到服务不足的地区或专业领域的影响,缺乏概念性证据。虽然职业选择和专业身份发展在医学领域之前已经联系在一起,但对于 LICs 影响身份的方式知之甚少。进行了范围审查,以探索当前的知识并为未来的研究指明方向。
在 2020 年,作者使用系统的搜索策略,在九个书目数据库中搜索了讨论 LICs 背景下身份的文章。两名审查员独立筛选所有符合入选标准的文章并记录数据。对合格的文章进行定量和定性主题分析。
经过广泛的搜索,共确定了 849 篇文章。对 131 篇文章进行了全文审查,其中 27 篇符合入选标准。所有文章中超过一半的文章来自美国或加拿大,研究最常从社会文化取向探索身份发展。定性分析确定了四个主题:(a)上下文连续性的重要性;(b)责任和身份发展的共生关系;(c)成为一名有能力的护理人员;(d)LICs 对职业身份的影响。
这项范围审查为以下假设提供了更多依据,即参与 LICs 有助于身份发展,主要是通过上下文连续性和学生承担的责任,因为他们成为患者护理的共同提供者。有迹象表明,LICs 鼓励培养“关爱伦理”。由于很少有研究将综合 LICs 与其他实习模式进行比较,因此仍然难以确定身份形成在何种程度上得到促进,超过了其他模式。未来的比较研究和从不同理论视角探索身份形成的研究将增加深度。