Longitudinal Integrated Training in Residency: A Paradigm Shift Towards Structural Solutions for Achieving Key Educational Competencies

Abstract

Graduate medical education typically organizes clinical training into discrete rotations. Longitudinal integrated clerkships, recently adopted by undergraduate medical educators, have been shown to achieve important educational outcomes for students including greater patient-centeredness, advocacy, and integration with teams. Despite the introduction of longitudinal, integrated clerkships into undergraduate medical education, this training structure has rarely been used in graduate medical education. This study explored residents’ experiences and reflections on a longitudinal integrated block implemented in a large pediatric residency program.

Residents were purposively sampled to participate in an interview or focus group discussion after completing the longitudinal integrated block. Using a phenomenologic framework, a qualitative thematic analysis was performed to elucidate residents’ attitudes about the block structure, how the block affected relationships, feedback, and learning, and whether the block influenced their professional identity or practice.

Fourteen residents participated in total, ten in interviews and four in the focus group. Six major themes emerged from the analysis: 1) the longitudinal structure enhanced relationships and entrustment; 2) the longitudinal, integrated design impacted engagement and learning; 3) flexibility promoted self-directed learning and work-life balance; 4) the block offered a unique time for professional identity development; 5) the block was an opportunity to reclaim patient-centeredness as a core value; and 6) there were both benefits and drawbacks to the schedule.

Longitudinal integrated blocks may offer an improved structure for achieving important yet challenging educational outcomes in residency, such as enhanced interpersonal relationships, meaningful feedback, entrustment, patient-centeredness, and systems-based practice.