title: Social learning in a longitudinal integrated clinical placement.
abstract: Recent research has demonstrated that longitudinal integrated placements (LICs) are an alternative mode of clinical education to traditional placements. Extended student engagement in community settings provide the advantages of educational continuity as well as increased service provision in underserved areas. Developing and maintaining LICs require a differing approach to student learning than that for traditional placements. There has been little theoretically informed empirical research that has offered explanations of which are the important factors that promote student learning in LICs and the relationships between those factors. We explored the relationship between student learning, student perceptions of preparedness for practice and student engagement, in the context of a rural LIC. We used a sequential qualitative design employing thematic, comparative and relational analysis of data from student interviews (n = 18) to understand possible processes and mechanisms of student learning in the LIC. Through the theoretical lens of social learning systems, we identified two major themes; connectivity and preparedness for practice. Connectivity described engagement and relationship building by students, across formal and informal learning experiences, interprofessional interactions, social interactions with colleagues, interaction with patients outside of the clinical setting, and the extent of integration in the wider community. Preparedness for practice, reflected students' perceptions of having sufficient depth in clinical skills, personal and professional development, cultural awareness and understanding of the health system, to work in that system. A comparative analysis compared the nature and variation of learning across students. In a relational analysis, there was a positive association between connectivity and preparedness for practice. Connectivity is a powerful enabler of students' agentic engagement, collaboration, and learning within an LIC. It is related to student perceptions of preparedness for practice. These findings provide insight for institutions wishing to develop similar programmes, by encouraging health professional educators to consider all of the potential elements of the placements, which most promote connectivity.
authors.affiliation: Sydney Medical School - Northern, University of Sydney, Sydney, Australia. christopher.roberts@sydney.edu.au.
authors.forename: Chris
authors.initials: C
authors.lastname: Roberts
authors.affiliation: Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, Australia.
authors.forename: Michele
authors.initials: M
authors.lastname: Daly
authors.affiliation: Charles Perkins Centre and School of Mathematics and Statistics, University of Sydney, Sydney, Australia.
authors.forename: Fabian
authors.initials: F
authors.lastname: Held
authors.affiliation: Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Lyle
mesh_terms: D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence; D054521:Cultural Competency; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D006801:Humans; D007398:Interpersonal Relations; D007400:Interprofessional Relations; D008137:Longitudinal Studies; D012111:Residence Characteristics; D019035:Rural Health Services / Q000458:organization & administration*; D000067570:Social Learning; D017132:Workplace
keywords: Clinical education; Connectivity; Longitudinal integrated clerkships; Preparedness for practice; Professional development; Rural and remote health education; Social learning system; Work place learning