Longitudinal Integrated Clerkship versus Traditional Rotation-Based Clerkships: A Class-Wide Comparison

The longitudinal integrated clerkship (LIC) is an innovative alternative to traditional rotation-based clerkship (RBC) curricula in medical schools. However, comparing the educational value of the LIC model with the RBC is challenging. Prior LIC and RBC comparisons have included small numbers of students in the LIC who were in distinct geographies and clinical settings from students in RBCs, introducing significant confounders in the comparison.

Cooper Medical School of Rowan University had a LIC for the entire cohort of third-year students and then transitioned to a RBC curriculum at the same urban academic center in July 2022. This created an opportunity to compare these two curricular formats with entire cohorts of students at the same training site utilizing the same cohort of faculty preceptors.

There was no statistically significant difference in the United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge scores between the LIC (mean of 246.28, SD = 12.98) and the RBC curriculum (mean = 248.53, SD = 13.63). When comparing National Board of Medical Examiner (NBME) subject examination scores, there was no statistically significant difference except for Family Medicine, Internal Medicine, and Surgery, where LIC students scored higher. RBC students scored higher in history taking, physical examination, interpersonal skills, note writing, and total score in the Objective Structured Clinical Examination (OSCE) compared to LIC students. A similar proportion of students in the LIC entered primary care residencies (51%) compared with RBC students (55%).

The LIC model can be used for an entire cohort of medical students. This is evidenced by no statistically significant difference in USMLE Step 2 scores and NBME subject examination scores, except for three clerkships where LIC students scored higher. OSCE scores indicate that schools will need to ensure LIC students have opportunities to further develop their clinical skills and note writing.