Impact of longitudinal integrated clerkships on national medical licensing examination (Japan) performance

Longitudinal integrated clerkship (LIC) represents an innovative clinical education model emphasizing continuity of patient care, supervision, and interdisciplinary learning. Previous studies have demonstrated educational advantages of LIC and its stable performance in institutional assessments; however, its impact on high-stakes national licensing examinations remains to be elucidated. In Japan, where the National Medical Examination is a critical summative assessment, evidence regarding the influence of clerkship type on examination outcomes is lacking. This study aimed to evaluate the effect of LIC participation on academic performance, compared with the traditional block rotation (TBR) model.

A retrospective cohort study was conducted at the University of Toyama. Medical students completed a mandatory 50-week TBR followed by a 24-week optional clerkship, during which up to 12 weeks could be taken as LIC across seven affiliated community hospitals. Students with missing examination data or who withdrew consent were excluded. Data collected included Computer-Based Test Item Response Theory (CBT-IRT) scores and results from the 118th and 119th National Medical Licensing Examinations. Analysis of covariance (ANCOVA) was used to assess the association between LIC participation and total, essential, and specific examination scores, adjusting for age, sex, and CBT-IRT performance.

A total of 119 students were included. In the 118th cohort, LIC students had significantly higher CBT scores, while in the 119th cohort, a greater proportion had repeated a year (both p < 0.05). After adjustment, no significant differences were observed between LIC and TBR students in total or component National Examination scores in either cohort.

The findings indicated that LIC participation was not associated with inferior outcomes on the National Examination after adjusting for baseline academic performance. These results suggest that LIC may be implemented without apparent detriment to academic outcomes in the context of Japanese medical education.