Accepted Type
Oral
Code
OC2-3-2
Acceptance Declaration
Accept
Additional Information
I declare I have no actual or potential conflict of interest in relation to this program.
Was this work accepted for CCME 2020?
yes
Category
General Call (Workshop, Oral Presentation, Poster Presentation)
Type
Oral
Sub Type
Education Research
Will the presenter be a:
Other
Presenter Other
Faculty
Affiliation
Considered for Poster
yes
Title
Autopsy of a Longitudinal Integrated Clerkship: An Organizational Process Analysis of a Clerkship Program's Demise
Length of Presentation
Background/Purpose
In 2014 the University of Toronto launched a multi-site, urban longitudinal integrated clerkship (LInC), encompassing all medical and surgical disciplines. After expanding to 10% of the class in seven sites, this pilot program was terminated in 2018. This descriptive study outlines the reasons for the program's discontinuation using an organizational processes framework.
Methods
As co-creators of the program, we identified several factors that led to the program's collapse. Based on our observations and qualitative analysis of focus group transcripts, we have described our findings related to the structural, human resource, symbolic and political challenges.
Results
Structurally, the co-existence of LInC and block clerkship within the same hospitals created confusion and competition for scarce clinical resources. From a human resource perspective, the program carried a significant administrative burden to allow for the creation of personalized daily schedules for each LInC student. Symbolically LInC represented the promotion of heightened humanism in medicine. Paradoxically this holistic emphasis was perceived as both less rigorous compared to traditional block clerkship, and as an invalidation of block student interpersonal skills. Politically, LInC created issues of equity among the medical school class, due to the significant resources allocated to a small minority of the class perceived as being treated preferentially.
Conclusion
LInC challenged the culture of our large, traditional medical school. Despite the program being highly successful clinically, asking students to choose between two parallel clerkship curricula co-existing in the same institution proved unsustainable. We are planning on bringing the most impactful elements of the program to the entire medical school class.
Keyword 1
Longitudinal integrated clerkship
Keyword 2
Organizational process analysis
Keyword 3
Curriculum development
Level of Training
Undergraduate
Abstract Themes
Curriculum
Curriculum
Integrated
Additional Theme (First choice)
Undergraduate
Additional Theme (Second Choice)
Additional Theme (Third Choice)
Authors
Presenter
Clare Hutchinson
Term 1
Yes
Term 2
Yes
Term 3
Yes
Term 4
Yes
Term 5
Yes
