title: When a LIC came to town: the impact of longitudinal integrated clerkships on a rural community of healthcare practice.
abstract: BACKGROUND
  Two small rural towns in Australia, where medical practitioners provide primary care to the population, including emergency, anaesthetic and obstetric services, were early adopters of an innovative year-long integrated clerkship (clinical placement) designed to foster medical student skill attainment and a commitment to underserved rural communities. Primary care vocational trainees had previously trained in the region. Engaging with the university to participate in the clerkship initiative for undergraduate medical education offered the local healthcare service an opportunity to really integrate education with service. This study sought perspectives from a multidisciplinary group of stakeholders on the impact of the longitudinal integrated clerkship (LIC) on the healthcare community.
  
  
  METHODS
  Three analysts independently analysed the transcripts arising from semi-structured interviews with a range of health care clinicians and managers (N=23). Themes were identified using inductive content analysis methodology.
  
  
  RESULTS
  Four major themes emerged from the perspectives of a multi-professional group of participants from both towns: transforming a community of practice, realising the potential of the health service, investment in rural return, and sustainability.
  
  
  CONCLUSIONS
  There was significant clinical exposure, skill and teaching capacity in these previously unrecognised rural placements but realising the potential of the health service needs careful management to sustain this resource. Early engagement and initial enthusiasm have produced many positive outcomes for the healthcare community, but this alone is not sufficient to sustain an increasing role for rural primary care in medical education. The study identified issues that need addressing for sustainability, namely validation, time and costs. Strategies to address these are key to continuation of LICs in small rural communities.
authors.affiliation: University of Newcastle, Tamworth Education Centre, Tamworth, New South Wales, Australia. nicky.hudson@newcastle.edu.au.
authors.forename: Judith N
authors.initials: JN
authors.lastname: Hudson
authors.affiliation: Milton Medical Centre, Milton, New South Wales, Australia. brett@miltonmedical.com.au.
authors.forename: Brett
authors.initials: B
authors.lastname: Thomson
authors.affiliation: Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia. kathw@uow.edu.au.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Weston
authors.affiliation: Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia. patk@uow.edu.au.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Knight-Billington
mesh_terms: D000288:Administrative Personnel / Q000523:psychology / Q000706:statistics & numerical data; D001315:Australia; D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D003153:Community Health Services / Q000458:organization & administration*; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated; D004059:Diffusion of Innovation; D004501:Education, Medical / Q000379:methods / Q000592:standards; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008505:Medical Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D009517:New South Wales; D015279:Organizational Culture; D018802:Patient-Centered Care; D010558:Personnel Loyalty; D010560:Personnel Selection; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration* / Q000592:standards
keywords: Australia/Pacific; Community Participation; Education; General/Family Practice; Medical; Nursing; Other; Qualitative Research; Undergraduate; Workforce