title: Patient perceptions of innovative longitudinal integrated clerkships based in regional, rural and remote primary care: a qualitative study.
abstract: BACKGROUND
  Medical students at the University of Wollongong experience continuity of patient care and clinical supervision during an innovative year-long integrated (community and hospital) clinical clerkship. In this model of clinical education, students are based in a general practice 'teaching microsystem' and participate in patient care as part of this community of practice (CoP). This study evaluates patients' perceptions of the clerkship initiative, and their perspectives on this approach to training 'much-needed' doctors in their community.
  
  
  METHODS
  Semi-structured, face-to-face, interviews with patients provided data on the clerkship model in three contexts: regional, rural and remote health care settings in Australia. Two researchers independently thematically analysed transcribed data and organised emergent categories into themes.
  
  
  RESULTS
  The twelve categories that emerged from the analysis of transcribed data were clustered into four themes: learning as doing; learning as shared experience; learning as belonging to a community; and learning as 'becoming'. Patients viewed the clerkship learning environment as patient- and student-centred, emphasising that the patient-student-doctor relationship triad was important in facilitating active participation by patients as well as students. Patients believed that students became central, rather than peripheral, members of the CoP during an extended placement, value-adding and improving access to patient care.
  
  
  CONCLUSIONS
  Regional, rural and remote patients valued the long-term engagement of senior medical students in their health care team(s). A supportive CoP such as the general practice 'teaching microsystem' allowed student and patient to experience increasing participation and identity transformation over time. The extended student-patient-doctor relationship was seen as influential in this progression. Patients revealed unique insights into the longitudinal clerkship model, and believed they have an important contribution to make to medical education and new strategies addressing mal-distribution in the medical workforce.
authors: School of Rural Medicine, University of New England, Armidale, NSW 2351, Australia. nicky.hudson@une.edu.au
authors: Judith N
authors: JN
authors: Hudson
authors: Patricia J
authors: PJ
authors: Knight
authors: Kathryn M
authors: KM
authors: Weston
mesh_terms: D000368:Aged; D001315:Australia; D002982:Clinical Clerkship; D003153:Community Health Services / Q000458:organization & administration; D003266:Continuity of Patient Care; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation; D018802:Patient-Centered Care; D010361:Patients / Q000523:psychology* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D018794:Problem-Based Learning; D036301:Qualitative Research; D012041:Regional Medical Programs; D019035:Rural Health Services / Q000592:standards