Supplemental Digital Appendix 1
Description of LICs at All 4 sites; Classification Using Worley and Colleagues’
Typology
36; and Analysis of Levels of Integration, Continuity, and Longitudinality, From a Multi-Institution Study of Student Identity Construction in Longitudinal Integrated Clerkships, 2019–2020
HYMS Comprehensive LIC
UoD Comprehensive LIC
ULSoM Amalgamative Clerkship
CUSOM
Comprehensive LIC Description of
programme
- 6 students - Voluntary
recruitment - Primary care
base with secondary care follow- up - Year-long,
penultimate clinical year - Rural setting
- 6 students - Voluntary
recruitment - Primary
care base with secondary care follow- up - Year-long,
penultimate clinical year - Both rural
and urban settings
- 73 students - Mandatory
placement - Primary
care - 18-weeks
long, penultimate clinical year - Both rural
and urban settings
- 10 students - Voluntary
application, competitive selection process - Academic
safety net hospital - Year-long,
penultimate clinical year - Urban
setting
Classification as per Worley et al’s typology
Comprehensive LIC (LIC-C)
Comprehensive LIC (LIC-C)
Amalgamative Clerkship (LIC-A)
Comprehensive LIC (LIC-C)
Integration of clinical disciplines
Complete integration of clinical disciplines across the duration of the LIC.
Complete integration of clinical disciplines across the duration of the LIC.
Some, as disciplines walk in through the door within primary care.
Outcomes primary care focused, although there is no set exposure to secondary care, outcomes are not unique to primary care setting e.g., how to diagnose medical, surgical, and psychiatric conditions that span primary and secondary care settings.
Complete integration of clinical disciplines across the duration of the LIC.
Programme-level integration
Relatively lacking- no central organisation of programme-level integration, no explicit external LIC thematic framework, as outcomes and assessment remain aligned with the
There are programme- long themes that span the duration of the LIC.
There are programme-long themes that span the duration of the LIC.
There are programme-long themes that span the duration of the LIC.
patient panel. patient panel. presenting to student primary care clinics or students scheduling follow up
appointments for patients. Patients may also be assigned to students under GP supervision and encouraged to attend student clinics for their ongoing healthcare needs.
patient panel.
Continuity of teaching
Primary care preceptors remained the same throughout the LIC.
Continuity of programme faculty.
Primary care preceptors remained the same throughout the LIC.
Continuity of programme faculty.
Primary care preceptors remained the same throughout the LIC.
Continuity of programme faculty.
Preceptor continuity throughout the LIC - one preceptor for each core specialty parallel stream.
Continuity of programme faculty.
Continuity of location
Placed in same general practice for duration of the one-year
programme.
Access to same secondary care settings for the duration of the one-year programme.
Placed in same general practice for duration of the one- year programme.
Access to same secondary care settings for the duration of the one- year programme.
Placed in same general practice for duration of the 18- week programme.
Placed in same hospital and
outpatient system for the duration of the one-year programme.
Peer continuities Small peer cohort of 6 students, taught together to foster cohesion.
Small peer cohort of 6 students, taught together to foster cohesion.
Larger peer cohort, taught together to foster cohesion.
Small peer cohort of 10 students, taught together to foster cohesion.
Longitudinality There are brief in- patient immersions that disrupt the longitudinality of the clinical experience, and teaching, although this is longitudinal in nature.
There are brief in- patient immersions that disrupt the longitudinality of the clinical experience, and teaching, although this is longitudinal in nature.
Only interruptions to experience for weekly seminars, but these were also longitudinal in nature.
There are brief in- patient immersions that disrupt the longitudinality of the clinical experience, and teaching, although this is longitudinal in nature.
Program mission, as per online information
Mission involves increasing the recruitment and retention of general practitioners to rural North Yorkshire. Also aims to facilitate interprofessional attitudes to practice.
Mission involves both creating academically excellent doctors, but also to help address recruitment issues in general practice and rural areas.
Mission involves increasing the recruitment and retention of general practitioners to rural Ireland.
Mission involves supporting students’
personal and professional development, community engagement and developing a pipeline of physician leaders committed to care for underserved
populations.
Supplemental Digital Appendix 2
Semi-Structured Interview Question Stems, From a Multi-Institution Study of Student Identity Construction in Longitudinal Integrated Clerkships, 2019–2020
FIRST SEMI STRUCTURED INTERVIEW
Demographic information - Age
-Gender
-Race and ethnicity -Sexual orientation -Prior degree?
-Prior healthcare experience?
(Demographic info is voluntary, please inform students they can decline to answer if they wish).
Understanding general professional identity - Can you tell me more about your experience in becoming a medical student this far?
-When was the first time you felt like a medical student?
-If I were to ask you the question ‘Who are you?’ how would you respond?
- Have there been any moments throughout your training when you felt you particularly belonged?
-Have there been any times you felt you didn’t belong or have felt excluded?
-Have you ever had a crisis in your professional identity?
-Have you ever felt any conflict between who you are at home and who you are professionally? Examples?
-What do you like about who you are within a clinical environment? What don’t you like? Why?
Influences upon professional identity - What do you think has shaped you into the medical student you are today?
-What has been helpful in shaping you as a medical student? (Examples?)
-What hasn’t been as helpful in shaping you as a medical student? (Examples?)
- Can you tell me about any role models that you’ve had throughout the course? How did they help you?
-Do you think being resilient is part of being a medical student? Why? Is ‘resilient’ the best word to use? Have you had any experiences where you have had to be particularly ‘resilient’?
Questions concerning the longitudinal integrated clerkship
- What are your thoughts in general on longitudinal integrated clerkships?
-How is your longitudinal integrated clerkship going at the moment?
-Some people say there’s quite a transition to learning within an LIC- how have you found this change?
-What do you think the benefits of an LIC are for a medical student might be? What are you looking forward to?
-Do you think an LIC could cause any issues for medical students? What aren’t you looking forward to?
-How do you think an LIC may change you as a medical student?
-Has the LIC changed how you view yourself? If so, how?
-Has the LIC changed how you behave at all? If so, how?
-What has been your favorite part of the LIC so far?
-What has been your least favorite part of the LIC so far?
SECOND SEMI STRUCTURED INTERVIEW
Questions concerning the longitudinal integrated clerkship experience and identity formation
- Have your thoughts on LICs changed throughout your experience? If so, how?
-How is your longitudinal integrated clerkship going?
-What do you think the benefits of an LIC are for a medical student? Have you experienced any of these benefits? If not, what benefits have you experienced (if any)?
-Do you think an LIC could cause any issues for medical students? Have you experienced any of these issues? If not, what issues have you experienced (if any)?
-Can you tell me about any role models you’ve had throughout the LIC?
- Have there been any moments throughout your LIC when you felt you particularly belonged?
-Have there been any times you felt you didn’t belong or have felt excluded?
-Have you had any crises in your professional identity as a medical student throughout the LIC?
-I asked you this question last time, but if I asked you
‘who are you’, how would you respond?
- How do you think the LIC has changed you as a medical student (if at all)?
-Has the LIC changed how you view yourself? If so, how?
-Do you think the LIC has changed how you think other people view you? If so, how?
-Has the LIC changed how you behave? If so, how?
-How do you think the LIC has impacted upon you?
- Do you feel like more of a doctor after taking part in an LIC? Why/ why not? Any examples?
-What has been your favorite part of the LIC?
-What has been your least favorite part of the LIC?
[Space for follow-up questions building on previous collected data].
