Students' experiences of role, relationships and learning in two clerkship models.

CONTEXT: An increasing number of medical schools around the world are implementing longitudinal integrated clerkships (LICs). The University of Alberta's third-year LIC admits a small group of each class. Those not in the LIC undertake a rotation-based clerkship (RBC). All students have a fourth-year RBC. Meaningful participation in patient care and guidance have been identified as affordances for work-based learning.

METHODS: This qualitative study is part of an ongoing research programme conducted in a hermeneutic phenomenological frame. The overarching research question is: What is the lived experience of integrated community clerkship (ICC) students in their clerkships? This paper focuses on an emic question, that is, one arising from the analysis, which was: What was the experience of ICC students in their transitioning to the fourth year? One-to-one reflective conversations with LIC students when they were at the end of their fourth year were the source of the material analysed. Transcripts were first analysed by each researcher and then co-analysed with an emphasis on overall meaning. Results are from conversations with 33 students from the first five LIC cohorts. Socio-cultural learning theory was used as an interpretive framework.

RESULTS: This study identifies that the length and nature of placements led to continuity relationships for students with patients and teachers and meaningful participation in patient care. These are an interwoven set of affordances that facilitate learning in the ICC. Participants described the loss of these affordances in the RBC, resulting in diminished confidence, disruption of the learning trajectory and a re-forming of identity.

CONCLUSION: It is important for all medical schools with LICs followed by RBCs to consider the differences between these two clerkships as experienced by students in order to determine how best to support students as they navigate through both. Medical educators need to examine all of their clerkships to identify the affordances that support learning.