Adoption and Variability of Longitudinal Clinical Experiences, Including Longitudinal Integrated Clerkships, in U.S. Allopathic Medical Schools: A Comprehensive Review
Abigail Ellstrom, Amirmohammad Shafiee, Carl Berghult, Joseph Mellberg, Winston Scambler, David ShauBackground
Longitudinal clinical experiences (LCEs) represent a broad curricular approach in medical education that emphasizes continuity of care and relationship-building with patients and healthcare teams. In contrast to traditional block-based rotations, LCEs allow students to participate in patient care across time and may include outpatient clinics, patient-following models, and longitudinal integrated clerkships (LICs). LICs represent one well-established model within the broader LCE framework, typically involving simultaneous participation across multiple specialties over months. Given the growing use and variability of longitudinal models in undergraduate medical education, this study aimed to assess the current landscape of LCE implementation, including LICs, across United States medical schools.
Methods
We conducted a comprehensive survey of all accredited allopathic medical schools in the U.S., examining their curricula with a focus on LCEs including LIC implementation. Data was collected on the prevalence of longitudinal clinical programs, types of models used, and average length of programs.
Results
Approximately 64% of medical schools offer some form of LCE. The majority of these programs were mandatory for students (80%), while the rest were offered as an elective option. The programs ranged from being incorporated in exclusively preclinical years, exclusively clinical years, or both. The average length of a longitudinal program was identified to be 24 months. One-third of programs implemented a traditional LIC system, while the rest incorporated longitudinal clinical experiences through a clinic attachment, a patient attachment, or some combination of the two.
Conclusion
There is a trend towards increased adoption and diversification of longitudinal clinical education with LIC models and other LCEs in U.S. medical schools. When compared to a previous analysis, schools are integrating LCEs earlier. This shift reflects growing recognition of the benefits of longitudinal experiences in medical education. Future research should focus on long-term outcomes of longitudinal programs, strategies for overcoming implementation challenges, and standardization.