Early Online: Issue 4
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Early Online: Issue 4: Exploring how longitudinal integrated clerkships at Stellenbosch University influence the career journeys of medical graduates. (2023). African Journal of Health Professions Education, 15(3). https://doi.org/10.7196/AJHPE.2023.v15i4.570

Abstract

Background. Longitudinal integrated clerkships (LICs) are increasingly being implemented across the globe for their educational benefits and the recruitment of rural medical practitioners. As new LICs are established, it is important to explore the extent to which these benefits manifest, and the influence of LICs on the career journeys of graduates. Stellenbosch University’s LIC has been running for 11 years, and to date the career outcomes of graduates have not been described.
Objectives. To explore factors that influence the career journeys of graduates from Stellenbosch University’s LIC.
Methods. An interpretivist, qualitative study was performed. Semi-structured interviews that were recorded and transcribed were conducted (8 graduates, ≥5 years after graduation). Inductive thematic analysis was done. Participants were asked to depict their career journeys. These pictures and an interview guide were used as prompts during the interviews.
Results. Three themes were generated from the data: (i) feeling prepared for the career journey; (ii) acquiring a new motivation and career goals; and (iii) unexpected influences on career journeys. The availability of posts and transformative influences are important factors in the career journeys of LIC graduates. These graduates were enabled by their undergraduate training to explore non-traditional career options and preferred working in rural environments. Although individual priorities caused many participants to work in urban settings, they indicated a desire to return to rural environments.
Conclusions. The LIC training at Stellenbosch University acts as a significant influence on the early career journeys of such graduates, which are possibly achieved in two ways. Firstly, LIC supports the development of professional identities among its graduates. Secondly, LIC supports transformative learning within a safe learning environment that leads to changes in perspectives regarding the graduates’ responsibility towards patients and communities.

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References

Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet 2010;376(9756):1923-1958. https://doi.org/10.1016/S0140- 6736(10)61854-5

Holst J. Increasing rural recruitment and retention through rural exposure during undergraduate training: An integrative review. Int J Environ Res Public Health 2020;17(17):1-19. https://doi.org/10.3390/ijerph17176423

Worley P, Couper I, Strasser R, et al. A typology of longitudinal integrated clerkships. Med Educ 2016;50(9):922-

https://doi.org/10.1111/medu.13084

Reid SJ, Couper ID, Volmink J. Educational factors that influence the urban-rural distribution of health professionals

in South Africa: A case-control study. S Afr Med J 2011;101(1):29-33. https://doi.org/10.7196/SAMJ.4342

Spooner S, Pearson E, Gibson J, Checkland K. How do workplaces, working practices and colleagues affect UK doctors’ career decisions? A qualitative study of junior doctors’ career decision making in the UK. BMJ Open

;7(10):1-9. https://doi.org/10.1136/bmjopen-2017-018462

Cosgrave C, Malatzky C, Gillespie J. Social determinants of rural health workforce retention: A scoping review.

Int J Environ Res Public Health 2019;16(3):314. https://doi.org/10.3390/ijerph16030314

Yang Y, Li J, Wu X, et al. Factors influencing subspecialty choice among medical students: A systematic review and

meta-analysis. BMJ Open 2019;9(3):e022097. https://doi.org/10.1136/bmjopen-2018-022097

Gupta S, Howden S. Medical students’ experiences of a longitudinal integrated clerkship: A threshold concepts

analysis. Educ Prim Care 2021;32(6):336-343. https://doi.org/10.1080/14739879.2021.1939796

Poncelet A, Hirsh D, eds. Longitudinal Integrated Clerkships: Principles, Outcomes, Practical Tools, and Future

Directions. New York: Gegensatz Press, 2016.

Hudson JN, Poncelet AN, Weston KM, Bushnell JA, Farmer E. Longitudinal integrated clerkships. Med Teach

;39(1):7-13. https://doi.org/10.1080/0142159X.2017.1245855

Consortium of Longitudinal Integrated Clerkships. LIC programs. 2021. https://clicmeded.com/lic-programs/

(accessed 27 August 2022).

Brown MEL, Anderson K, Finn GM. A narrative literature review considering the development and

implementation of longitudinal integrated clerkships, including a practical guide for application. J Med Educ

Curric Dev 2019;6:1-12. https://doi.org/10.1177/2382120519849409

Mezirow J. Transformative Dimensions of Adult Learning. San Francisco: Jossey-Bass, 1991.

Van Schalkwyk SC, Hafler J, Brewer TF, et al. Transformative learning as pedagogy for the health professions:

A scoping review. Med Educ 2019;53(6):547-558. https://doi.org/10.1111/medu.13804

Brown MEL, Whybrow P, Kirwan G, Finn GM. Professional identity formation within longitudinal integrated

clerkships: A scoping review. Med Educ 2021;55(8):912-924. https://doi.org/10.1111/medu.14461

Kerins J, Smith SE, Phillips EC, Clarke B, Hamilton AL, Tallentire VR. Exploring transformative learning when

developing medical students’ non‐technical skills. Med Educ 2020;54(3):264-274. https://doi.org/10.1111/

medu.14062

Walker JH, DeWitt DE, Pallant JF, Cunningham CE. Rural origin plus a rural clinical school placement is a

significant predictor of medical students’ intentions to practice rurally: A multi-university study. Rural Remote

Health 2012;12(1):1-9. https://doi.org/10.22605/RRH1908

Stagg P, Greenhill J, Worley PS. A new model to understand the career choice and practice location decisions of

medical graduates. Rural Remote Health 2009;9(4):1-10. https://doi.org/10.22605/RRH1245

Burch VC, McKinley D, van Wyk J, et al. Career intentions of medical students trained in six sub-Saharan African

countries. Educ Health: Change Learn Pract 2011;24(3):1-16. https://doi.org/10.4103/1357-6283.101416

Myhre DL, Bajaj S. Practice locations of longitudinal integrated clerkship graduates: A matched-cohort study.

Can J Rural Med 2016;21(1):13.

Playford DE, Ng WQ, Burkitt T. Creation of a mobile rural workforce following undergraduate longitudinal rural

immersion. Med Teach 2016;38(5):498-503. https://doi.org/10.3109/0142159X.2015.1060304

Denzin NK, Lincoln YS. The discipline and practice of qualitative research. In: Denzin NK, Lincoln YS, eds.

Strategies of Qualitative Inquiry. 3rd ed. Thousand Oaks: SAGE, 2008:1-43.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77-101. https://doi.

org/10.1191/1478088706qp063oa

Saidin K, Yaacob A. Insider researchers: Challenges and opportunities. Proceed ICECRS 2017;1(1):849-854.

https://doi.org/10.21070/picecrs.v1i1.563

Illing JC, Morrow GM, Rothwell née Kergon CR, et al. Perceptions of UK medical graduates’ preparedness for

practice: A multi-centre qualitative study reflecting the importance of learning on the job. BMC Med Educ

;13(1):1-12. https://doi.org/10.21070/picecrs.v1i1.563

Frambach JM, Manuel BAF, Fumo AMT, van der Vleuten CPM, Driessen EW. Students’ and junior doctors’

preparedness for the reality of practice in sub-Saharan Africa. Med Teach 2015;37(1):64-73. https://doi.org/10

.3109/0142159X.2014.920490

Teherani A, Irby DM, Loeser H. Outcomes of different clerkship models: Longitudinal integrated, hybrid, and

block. Acad Med 2013;88(1):35-43. https://doi.org/10.1097/ACM.0b013e318276ca9b

Latessa RA, Swendiman RA, Parlier AB, Galvin SL, Hirsh DA. Graduates’ perceptions of learning

affordances in longitudinal integrated clerkships. Acad Med 2017;92(9):1313-1319. https://doi.org/10.1097/

ACM.0000000000001621

Cruess SR, Cruess RL, Steinert Y. Supporting the development of a professional identity: General principles. Med

Teach 2019;41(6):641-649. https://doi.org/10.1080/0142159X.2018.1536260

Wald HS. Professional identity (trans)formation in medical education: Reflection, relationship, resilience. Acad

Med 2015;90(6):701-706. https://doi.org/10.1097/ACM.0000000000000731

Playford DE, Nicholson A, Riley GJ, Puddey IB. Longitudinal rural clerkships: Increased likelihood of more

remote rural medical practice following graduation. Career choice, professional education and development.

BMC Med Educ 2015;15(1):1-9. https://doi.org/10.1186/s12909-015-0332-3

Konkin J, Suddards C. Creating stories to live by: Caring and professional identity formation in a longitudinal

integrated clerkship. Adv Health Sci Educ 2012;17(4):585-596. https://doi.org/10.1007/s10459-011-9335-y

Greenhill J, Poncelet AN. Transformative learning through longitudinal integrated clerkships. Med Educ

;47(4):336-339. https://doi.org/10.1111/medu.12139

Brown MEL, Ard C, Adams J, O’Regan A, Finn GM. Medical student identity construction within longitudinal

integrated clerkships: An international, longitudinal qualitative study. Acad Med 2022;97(9):1-30. https://doi.

org/10.1097/ACM.0000000000004732

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Copyright (c) 2023 F Coetzee, S van Schalkwyk, I Couper