Acad Med. 2023 Dec 1;98(12):1420-1427. doi: 10.1097/ACM.0000000000005447. Epub 2023 Aug 30.
The authors examined whether students participating in an urban longitudinal integrated clerkship (LIC) with a curriculum focused on care for underserved populations have a sustained commitment to urban underserved care through residency training and into practice.
This mixed-methods study collected data from medical student application essays to the Denver Health LIC (DH-LIC), end-of-course surveys, residency match outcomes, and postgraduation surveys annually for academic years 2014 to 2022. The authors analyzed students' responses to the surveys on interest in working with underserved patients, understanding the rewards and challenges of working in safety net institutions, working in the community to improve health, and working at DH. The authors qualitatively coded the 70 application essays of all selected students using summative content analysis.
Seventy DH-LIC students were compared with 1,450 medical students between 2014 and 2022. Qualitative analysis of LIC application essays revealed 3 themes: interest in working with underserved populations, work experience with underserved populations, and personal experience with medical vulnerability. Fifty-seven DH-LIC participants (81.4%) expressed high levels of career interest in working with underserved populations, 45 (64.3%) had high levels of work experience with underserved populations, and 18 (25.7%) expressed high levels of personal experience. Graduates of the DH-LIC program demonstrated a high degree of continuing interest in practicing in urban underserved settings throughout medical school and postgraduate training. Ten graduates (71.4%) in practice work in urban underserved settings. Participants reported a high or very high level of interest and commitment to working with underserved populations (96.7%-100%), understanding the safety net health care system (91.7%-98.6%), and working in communities (95.0%-100%) at all time points studied.
Early data indicate high rates of graduates working in urban underserved settings. These preliminary outcomes suggest the LIC may support the development of a committed workforce for urban underserved communities.
作者研究了参加以关注服务不足人群为重点的城市纵向综合实习（LIC）的学生，是否通过住院医师培训和进入实践，对城市服务不足人群的护理保持持续的承诺。
这项混合方法研究从 2014 年至 2022 年，通过对丹佛健康 LIC（DH-LIC）的医学生申请论文、课程结束后的调查、住院医师匹配结果以及毕业后每年的调查，收集数据。作者分析了学生对以下方面的调查回复：对服务不足患者的工作兴趣、了解在安全网机构工作的回报和挑战、在社区工作以改善健康以及在 DH 工作。作者对所有选定学生的 70 篇 LIC 申请论文进行了总结性内容分析的定性编码。
在 2014 年至 2022 年期间，将 70 名 DH-LIC 学生与 1450 名医学生进行了比较。对 LIC 申请论文的定性分析揭示了 3 个主题：对服务不足人群的工作兴趣、服务不足人群的工作经验以及个人医疗脆弱性的经历。57 名 DH-LIC 参与者（81.4%）对服务不足人群的工作表达了浓厚的职业兴趣，45 名（64.3%）有丰富的服务不足人群工作经验，18 名（25.7%）表达了丰富的个人经验。DH-LIC 项目的毕业生在整个医学院和研究生培训期间都表现出对在城市服务不足环境中执业的高度持续兴趣。10 名（71.4%）在实践中工作的毕业生在城市服务不足地区工作。参与者报告说，他们对服务不足人群（96.7%-100%）、对安全网医疗保健系统（91.7%-98.6%）和社区工作（95.0%-100%）的兴趣和承诺程度很高或非常高。
早期数据显示，服务不足的城市毕业生就业率较高。这些初步结果表明，LIC 可能支持为城市服务不足社区培养一支有承诺的劳动力队伍。
