Do Rural Longitudinal Integrated Clerkships Impact Choice of Residency Type and/or Permanent Community Practice in Surgery?

Purpose: Rural general surgery experiences during medical school appear to have influenced the decision of prospective general surgery applicants to pursue residency programs that provide rural surgery opportunities. This is an analysis of a single cohort, rural-focused, longitudinal integrated clerkship to determine if there is an association between type of residency program and completion of a rural-focused longitudinal integrated clerkship. Methods: An institutional database of de-identified, self-reported data was reviewed to identify rural-focused longitudinal integrated clerkship alumni who matched into a surgical residency program. Findings: Of the seventy-five alumni who chose a surgical residency program, 40 (53.3%) matched into a university-affiliated residency program, and 32 (42.6%) matched into an independent-academic program. There was no association between type of residency program and completion of a rural-focused longitudinal integrated clerkship. Conclusions: A rural-focused longitudinal integrated clerkship can help increase the rural physician workforce within both the state and region of the sponsoring institution. To facilitate heightened interest in rural general surgery, these types of programs should continue to be promoted.

Reflecting on the Advantages of Longitudinal Integrated Clerkships and COVID-19

The emergence of Coronavirus Disease 2019 (COVID-19) has dramatically changed the landscape of medical education. The global pandemic highlighted advantages of specific curricular frameworks. Longitudinal, integrated approaches may avoid some of the educational consequences seen in traditional models. This viewpoint highlights the advantages of a longitudinal integrated clerkship during the COVID-19 outbreak. These advantages include a relatively even exposure to multiple specialties, discipline specific assessment information despite an early truncation of clinical activity, and a seamless transition to ongoing integrated online learning, as a single integrated virtual clerkship model for an entire class. Notably, the longitudinal integrated clerkship avoided consequences seen in traditional clerkships such as missing entire rotations positioned in March-June 2020 and therefore, clerkship grades. The longitudinal clerkship allowed for students to receive discipline specific grades in all core specialties based on assessment of individual skills (direct observation and assessment of skills such as physical exam and history) versus discipline specific knowledge (subject exams). In addition, there are advantages of pre-existing relationships with preceptors and patients that could facilitate engagement in ongoing contact during virtual clerkships and opportunistic clinical experiences when it is safe for students to re-engage in clinical activities.