title: Dimensions of integration, continuity and longitudinality in clinical clerkships.
abstract: BACKGROUND
  Over the past few decades, longitudinal integrated clerkships (LICs) have been proposed to address many perceived short-coming of traditional block clerkships. This growing interest in LICs has raised broader questions regarding the role of integration, continuity and longitudinality in medical education. A study with complementary theoretical and empirical dimensions was conducted to derive a more precise way of defining these three underlying concepts within the design of medical education curricula.
  
  
  METHODS
  The theoretical dimension involved a thematic review of the literature on integration, continuity and longitudinality in medical education. The empirical dimension surveyed all 17 Canadian medical schools on how they have operationalised integration, continuity and longitudinality in their undergraduate programmes. The two dimensions were iteratively synthesised to explore the meaning and expression of integration, continuity and longitudinality in medical education curriculum design.
  
  
  RESULTS
  Integration, continuity and longitudinality were expressed in many ways and forms, including: integration of clinical disciplines, combined horizontal integration and vertical integration, and programme-level integration. Types of continuity included: continuity of patients, continuity of teaching, continuity of location and peer continuity. Longitudinality focused on connected or repeating episodes of training or on connecting activities, such as encounter logging across educational episodes. Twelve of the 17 schools were running an LIC of some kind, although only one school had a mandatory LIC experience. An ordinal scale of uses of integration, continuity and longitudinality during clerkships was developed, and new definitions of these concepts in the clerkship context were generated.
  
  
  CONCLUSIONS
  Different clerkship designs embodied different forms and levels of integration, continuity and longitudinality. A dichotomous view of LICs and rotation-based clerkships was found not to represent current practices in Canada, which instead tended to fall along a continuum of integration, continuity and longitudinality.
authors: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors: Rachel H
authors: RH
authors: Ellaway
authors: Department of Community and Family Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA.
authors: Lisa
authors: L
authors: Graves
authors: Department of Medicine and Centre for Medical Education, McGill University, Montréal, Quebec, Canada.
authors: Beth-Ann
authors: BA
authors: Cummings
mesh_terms: D002170:Canada; D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence; D003266:Continuity of Patient Care; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D006801:Humans; D007858:Learning; D008611:Mentors; D017145:Models, Educational; D013337:Students, Medical; D011795:Surveys and Questionnaires