title: Continuity in a longitudinal out-patient attachment for Year 3 medical students.
abstract: BACKGROUND
  Concerns about the quality of medical student learning experiences during traditional clerkships have prompted calls to restructure clinical education around continuity. Many US medical schools have added longitudinal out-patient attachments to enhance student continuity with patients and supervising doctors. However, continuity with patients can be difficult to achieve and little is known about the independent effect of continuity with a supervising doctor and setting. This study describes students' perceptions of the types of continuity experienced in longitudinal attachments and the learning associated with continuity.
  
  
  METHODS
  This is a qualitative study using a grounded theory approach. Interviews were conducted with 12 Year 3 medical students about their continuity experiences with patients, supervisors and settings during their attachment. The resulting data were subjected to thematic analysis.
  
  
  RESULTS
  Continuity with supervising doctors provided students with career mentorship and personal support. Student autonomy varied and was most dependent on the supervisor and setting. Students with patient continuity were more likely to report learning about chronic illness and communication skills. Students described the longitudinal attachment as helping them to develop their clinical skills and gain self-confidence within their role as future doctors, and as influencing their career choice.
  
  
  CONCLUSIONS
  There is much variation in student experiences of patient continuity during a longitudinal attachment. Continuity with patients, supervisors and settings affects student learning in different ways. Additional dimensions of the experience, such as the nature of the patient-doctor relationship, the pace of work and the patient population, impact learning outcomes and should be considered when continuity experiences are being designed.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California 94143-0320, USA. maria.wamsley@ucsf.edu
authors.forename: Maria A
authors.initials: MA
authors.lastname: Wamsley
authors.forename: Nadine
authors.initials: N
authors.lastname: Dubowitz
authors.forename: Puja
authors.initials: P
authors.lastname: Kohli
authors.forename: Molly
authors.initials: M
authors.lastname: Cooke
authors.forename: Bridget C
authors.initials: BC
authors.lastname: O'Brien
mesh_terms: D001291:Attitude of Health Personnel; D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence; D003266:Continuity of Patient Care; D006801:Humans; D008505:Medical Staff, Hospital / Q000193:education*; D008611:Mentors; D010044:Outpatient Clinics, Hospital; D010817:Physician-Patient Relations; D017009:Professional Autonomy; D012495:San Francisco; D013337:Students, Medical / Q000523:psychology