Adoption and Variability of Longitudinal Integrated Clerkship Curricula in U.S. Allopathic Medical Schools: A Comprehensive Review

Adoption and Variability of Longitudinal Integrated Clerkship Curricula in U.S. Allopathic Medical Schools: A Comprehensive Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adoption and Variability of Longitudinal Integrated Clerkship Curricula in U.S. Allopathic Medical Schools: A Comprehensive Review Abigail Ellstrom, Amirmohammad Shafiee, Carl Berghult, Joseph Mellberg, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7078074/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Longitudinal Integrated Clerkships (LICs) represent an innovative approach to medical education, offering continuous clinical experiences that contrast with traditional block rotations. In an LIC curriculum, students participate in comprehensive patient care over extended periods, developing ongoing relationships with patients and clinicians while simultaneously meeting core clinical competencies across multiple disciplines. This model typically spans 6-12 months, with students dividing their time among different specialties throughout the week, allowing them to follow patients longitudinally and gain a deeper understanding of patient-centered medicine. Many medical schools are also adopting additional longitudinal clinical experiences. Some assign first-year medical students to an outpatient clinic, providing early clinical exposure. Others offer electives for students pursuing primary care that allow them to develop continuity with patients through extended clerkship experiences. This study aimed to assess the current landscape of LIC implementation across United States (U.S.) medical schools. Methods: We conducted a comprehensive survey of all accredited allopathic medical schools in the United States, examining their curriculum models with a focus on LIC implementation. Data was collected on the prevalence of LIC programs, types of models used, and average length of programs. Results: Approximately 64% of U.S. allopathic medical schools offer some form of longitudinal integrated clinical education. The majority of these programs were mandatory for students (80%), while the rest were offered as an elective option. The programs ranged from being incorporated in exclusively preclinical years, exclusively clinical years, or both. The average length of an LIC program was identified to be 16 months. One-third of LIC programs implemented a traditional longitudinal integrated clerkship system, while the rest incorporated longitudinal clinical experiences through a clinic attachment, a patient attachment, or some combination of the two. Conclusion: There is a trend towards increased adoption and diversification of LIC models in U.S. medical schools. When compared to a previous analysis, schools are integrating LICs earlier. The majority of schools have the LIC curriculum span through preclinical and clinical years. This shift reflects growing recognition of the benefits of LIC experiences in medical education. Future research should focus on long-term outcomes of LIC programs, strategies for overcoming implementation challenges, and standardization. Clinical trial number: not applicable Longitudinal Integrated Clerkship medical education curriculum clinical rotation Figures Figure 1 Introduction The Longitudinal Integrated Clerkship has been an evolving product of the medical education system for over 100 years. The LIC has various adaptations, but at its core, it focuses on integrating multiple specialties of medical care over a more continuous timeline when compared to traditional medical student block rotations. As medicine continues to become more specialized, the LIC curriculum is an attempt to continue training well-rounded physicians. The traditional medical school curriculum adopted by most medical schools today has its roots dating back to the early 20th century. As medicine evolved into various specialties each with its own board certification, the block rotation curriculum was born. The concept focused on building upon two years of preclinical textbook coursework by spending 4–8 weeks in each specialty for a year as a third-year medical student. In their final year, medical students would spend their time in further subspecialized rotations of their choosing as they hone in on a specialty in which they intend to practice. While there are certainly advantages to the traditional model, critics point out the lack of integration and hyper-segmented focus on training. The LIC model attempts to bridge the gap between specialized medicine and developing well-rounded physicians. Due to the nature of medical education, some degree of pre-clinical coursework will always be necessary; however, many adaptations of the LIC curriculum engage students in direct patient care much earlier. Today, some curriculum models have students interacting with patients as soon as their first week of medical school. The LIC curriculum is not only focused on making physicians more adaptive but also more well-rounded communicators as they start developing the intangible skills required to be a great physician. The focus on early clinical experience highlights this push. As students progress to the clinical aspect of their medical education, the LIC model seeks to build upon the foundation from the preclinical period. In many cases, students will continue their clinical experience from the pre-clinical years while integrating other experiences. It is during this time many students will likely start to gain more exposure to inpatient medicine, surgical procedures, and the emergency room. While LIC adaptations are relatively new, they have been progressing for decades. A shift in medical education began to appear in the late 1900s when schools started integrating problem-based learning (PBL). However, clinical rotations still mostly remained at the backbone of medical school curricula. In the early 2000s, there was no turning back as big names started to adopt models of the LIC curriculum including Harvard Medical School. Over the past quarter century, the trend continues as more schools continue to adopt aspects of the innovative curriculum including schools such as the University of California, San Francisco and the University of Pittsburgh. Additionally, medical schools such as the Burnett School of Medicine at Texas Christian University were opened and founded on principals of the innovative curriculum model. While the LIC presents many benefits to medical education, it also comes with its fair share of challenges. More clinical experience means more to juggle for the academic administration in terms of scheduling and communication. Additionally, students face challenges as they often spend more valuable time commuting to their various education experiences. The constant switching between experiences also makes it harder to develop relationships with preceptors when compared to the block model. However, these trade-offs are often seen as worth it to medical schools as they attempt to design the most effective curriculum for training future successful and well-rounded physicians. LIC programs, whether mandatory or elective, typically span 6 to 12 months but can last longer 1 – 5 . These programs have been successfully integrated across diverse settings, including rural, community, and urban environments, demonstrating their adaptability to various healthcare contexts. Throughout their experiences, students develop and demonstrate foundational clinical knowledge. By emphasizing sustained engagement, LICs improve continuity of care and foster meaningful relationships between students, patients, and clinical teams. This continuity enriches the student’s educational experience and forms the foundation for numerous educational and systemic benefits 6 . One such benefit is their ability to foster interprofessional learning. Interprofessional cooperation has been linked to improved patient outcomes 7 . Furthermore, LICs strengthen relationships between students and other healthcare team members while reducing hierarchical barriers among health professionals 6 , 8 – 10 . They have also been shown to improve patient advocacy within the healthcare system, exemplified by medical students clarifying complex topics to patients and ensuring appropriate follow-up care 11 . Given these benefits, this study aimed to explore the current landscape of LIC program implementation across medical schools in the United States to determine the extent of their adoption and identify national trends in LIC programs. Methods Study Design : This study utilized a descriptive, cross-sectional design to evaluate the presence of longitudinal integrated clerkship curricula across all allopathic medical schools in the United States. The dataset was compiled through the collection of publicly available information. Sources included medical school websites, program descriptions, online brochures, and published literature. The study aimed to identify the prevalence of LIC programs, their structure, duration, goals, and key features. Search Strategy : A comprehensive search was conducted to identify all accredited allopathic medical schools in the U.S. This was primarily completed using the Association of American Medical Colleges (AAMC) database. For each school, official websites were reviewed to identify information related to their specific curriculum and program features. Those with LIC programs or similar longitudinal clinical training models were documented accordingly. Exclusion Criteria : Osteopathic medical schools, international medical schools, and non-accredited institutions were excluded. This allowed researchers to maintain a focus on U.S. allopathic medical education curricula. Programs whose curricula did not include any aspect that may meet the definition of a longitudinal integrated clerkship were not included in the final analysis of programs’ length, structure, and goals. Data Extraction : Data were extracted by five independent reviewers using a standardized Excel sheet. Institution name, location, accreditation status, and initial year of accreditation were collected. Each program was assessed for the presence of a longitudinal clinical program. This data was stratified into three categories: 0 longitudinal clinical programs, 1 longitudinal clinical program, or 2 + longitudinal clinical programs. If applicable, the name of the LIC program was documented. Those with an LIC available were further evaluated. Information on the participation requirement (mandatory vs. elective) of the LIC program was identified. The specific structure of program was documented as it fit into one of three categories: Traditional LIC, Clinic Attachment Only, or Patient and Clinic Attachment. The length of the program and if it existed in preclinical years, clinical years, or both was recorded. Finally, the presence or absence of LIC program goals on the institutions’ websites were documented. Discrepancies between reviewers were resolved through discussion and consensus. Analysis : Descriptive statistics were used to analyze and summarize the data. Specific datapoints explored included the proportion of schools with LIC programs, the average length of programs, and the type of LIC model implemented. Results were displayed in graphic and narrative formats to allow for an accessible and comprehensive overview. Results The analysis of allopathic medical schools in the United States revealed that out of 158 institutions, there were 101 (64%) institutions offering a longitudinal clinical experience as part of their curriculum. In contrast, 57 (36%) do not currently offer an LIC program. The programs that did not offer any LIC curriculum adopted the traditional curriculum: two years preclinical classwork and two years of clinical rotations. Of these 101 longitudinal clinical experiences that programs have incorporated, approximately 80% were identified as mandatory for medical students at that institution. However, 20% were deemed an elective option (Table 1 ). Table 1. Program Qualities A little over one-third (37%) of programs implemented a longitudinal clinical experience in the preclinical years (typically the first and second years of medical school). Approximately 22% had LIC options in clinical years (typically the third and fourth years of medical school). While 42% had structured LIC opportunities throughout both the preclinical and clinical years (Table 1 ). A traditional LIC model refers to continuous clinical experiences where students work with different specialties throughout each week. Alternative LIC model refers to those with an elective LIC curriculum or clinical assignments in their first/second years of medical school. For example, a few programs offer specific tracks, often in primary care, that incorporate longitudinal patient care experiences. When exploring the type of program available at each institution, one-third had a clinic assignment option. This was typically structured as one session every other week with a local primary care clinic. Only 6% of programs had students assigned to a specific patient as the extent of their longitudinal patient care experience. Thirty-three (28%) had both a clinic and a patient assignment. Finally, 39 (33%) programs evaluated had incorporated the traditional Longitudinal Integrated Clerkship curriculum (Table 1 ). With regards to length of these programs, the average length was 16 months. The program lengths ranged from 2 to 48 months long (Fig. 1 ). Six of the programs ranged were 6 months or less (6/101, 6%). Thirty institutions had a program that ranged from 6 months to 1 year (30/101, 30%). Fourteen ranged from 12 to 18 months (14/101, 14%). Fourteen ranged from 18 to 24 months (14/101, 14%). One ranged from 24 to 30 months (1/101, 1%). Eleven ranged from 30 to 36 months (11/101, 11%). Twenty-three ranged from 42 to 48 months (23/101, 23%). And finally, one program lasted longer than 48 months (1/101, 1%). Discussion The findings of this study reveal that longitudinal integrated clerkships and similar curricula are increasingly being adopted across allopathic medical schools in the United States, with 101 institutions offering some form of LIC. A previous review identified 98 longitudinal programs within 69 schools 12 . There has been a substantial increase in the number of allopathic medical schools implementing some form of longitudinal clinical experience for medical students in the past seven years. These programs vary significantly in structure, with some schools integrating longitudinal clinical experiences into the first two years of medical education, others in the final two years, and some spanning the entire four years. Additionally, some are mandatory, while others are offered as an elective. The models of LIC range from emphasizing patient or clinic attachments, to the traditional LIC structure. This diversity reflects the adaptability of the LIC model to different institutional goals. The LIC model has been recognized in medical education for its ability to foster meaningful learning experiences for medical students. One of the key strengths of LIC is its emphasis on continuity of care, which allows students to follow patients over time and across different clinical settings. This has shown to enhance students’ understanding of disease progression, patient-centered care, and social determinants of health 4 , 13 , 14 . By immersing medical students in a consistent clinical environment, LICs promote the development of strong mentoring relationships with preceptors, which can significantly enhance professional identity formation 15 . Authentic clinical experiences early in training have shown to benefit confidence, clinical reasoning skills, and preparedness for residency 9 , 16 , 17 . The longitudinal clerkship model allows for students to build trusting student-patient relationships, and begin to embody an integral role in the patient’s health experience 18 . Furthermore, the longitudinal nature allows students to observe and participate in the management of chronic conditions, which is an increasingly important role of most all specialties 19 . The variability in LIC implementation identified in this study highlights the flexibility of the model to meet the needs of different institutions and student populations. For example, programs that integrate LIC into the first two years of medical school may provide students with early exposure to clinical practice and thus reinforce basic science learning through connecting theory to practice. Conversely, programs that focus on the final two years may allow students to consolidate their clinical skills and prepare for board exams and residency in a more immersive and realistic environment 4 . Despite its many benefits, the LIC model is not without challenges. Implementing LICs requires significant institutional commitment, including the allocation of resources for faculty development, curriculum design, and administrative support 20 . Additionally, the success of LICs depends on the availability of clinical sites and preceptors who are willing to engage in longitudinal teaching relationships 21 . These challenges may explain why some institutions offer these longitudinal experiences as elective rather than mandatory programs. Limitations : The reliance on publicly available information and self-reported data from institutions could introduce inaccuracies, particularly for programs that are newly established or undergoing changes. Additionally, the study does not explore the quality or outcomes of these specific LIC programs, such as student satisfaction, clinical performance, or long-term career impacts, which limits the ability to draw conclusions about the effectiveness of different LIC models. The study focuses exclusively on allopathic medical schools, excluding osteopathic and international institutions, which may limit the generalizability of the findings. These limitations highlight the need for further research, including qualitative studies and longitudinal assessments, to provide a more comprehensive understanding of LIC programs in the U.S. Conclusion The growing adoption of LIC curricula in allopathic medical schools in the United States reflects the recognition of its potential to enhance medical education. The variability in implementation observed in this study underscores the adaptability of the LIC model to different institutional contexts and educational goals. By providing students with opportunities for continuity of care, authentic clinical experiences, and strong mentoring relationships, LICs can play a critical role in preparing future physicians to meet the complex demands of modern healthcare. Future research should explore the long-term outcomes of LIC graduates, including their performance in residency and their ability to provide patient-centered, value-based care. Abbreviations LIC Longitudinal integrated clerkship U.S. United States PBL Problem Based Learning AAMC Association of American Medical Colleges Declarations Ethics approval and consent to participate: Not applicable Consent for publication: Not applicable Availability of data and materials: All data used and analyzed in this study is publicly available Competing interests: The authors declare that they have no competing interests Funding: Nothing to declare Authors' contributions: AE, AS, CB, JM, and WS performed data collection from medical school curriculum websites, analyzed the data, constructed figures, and were major contributors in writing the manuscript. All authors read and approved the final manuscript. Acknowledgements: Not applicable References Ogur B, Hirsh D, Krupat E, Bor D. The Harvard Medical School-Cambridge Integrated Clerkship: an innovative model of clinical education. Acad Med. 2007;82(4):397–404. Hirsh D, Worley P. Better learning, better doctors, better community: how transforming clinical education can help repair society. Med Educ. 2013;47(9):942–9. Alliance for Clinical Education. Background, definitions, history. In: Poncelet A, Hirsh DA, editors. Longitudinal Integrated Clerkships: Principles, Outcomes, Practical Tools, and Future Directions. North Syracuse (NY): Gegensatz; 2016. pp. 1–8. Worley P, Couper I, Strasser R, et al. A typology of longitudinal integrated clerkships. Med Educ. 2016;50(9):922–32. Hirsh D, Singh TA, Saravanan Y, Walters LK. Learning in longitudinal integrated clerkships. In: Dent J, Harden R, Hunt D, editors. A Practical Guide for Medical Teachers. 6th ed. Edinburgh (UK): Elsevier; 2021. pp. 101–8. Gupta S, Howden S. Context and mechanisms of interprofessional learning during a longitudinal integrated clerkship. J Interprof Care. 2022;36(3):413–8. 10.1080/13561820.2021.1904850 . Barr H, Helme M, D’Avray L. Interprofessional education review in progress. Health Soc Care Educ. 2013;2(1):37–8. 10.11120/hsce.2013.00012 . Myhre DL, Woloschuk W, Pedersen JS. Exposure and attitudes toward interprofessional teams: a three-year prospective study of longitudinal integrated clerkship versus rotation-based clerkship students. J Interprof Care. 2014;28(3):270–2. 10.3109/13561820.2013.829425 . Walters L, Greenhill J, Richards J, et al. Outcomes of longitudinal integrated clinical placements for students, clinicians, and society. Med Educ. 2012;46(11):1028–41. Gupta S, Howden S. Medical students’ perceptions of ‘community’ in a longitudinal integrated clerkship. Educ Prim Care. 2020;32(3):157–65. 10.1080/14739879.2020.1850211 . John J, Brown ME. The impact of longitudinal integrated clerkships on patient care: a qualitative systematic review. Educ Prim Care. 2021;33(3):137–47. 10.1080/14739879.2021.1980438 . Gheihman G, Jun T, Young GJ, et al. A review of longitudinal clinical programs in US medical schools. Med Educ Online. 2018;23(1):1444900. 10.1080/10872981.2018.1444900 . Hirsh D, Gaufberg E, Ogur B, et al. Educational outcomes of the Harvard Medical School–Cambridge integrated clerkship: a way forward for medical education. Acad Med. 2012;87(5):643–50. Adams JE, Ard C, Cunningham JM, et al. Preliminary workforce outcomes of an urban longitudinal integrated clerkship. Acad Med. 2023;98(12):1420–7. 10.1097/ACM.0000000000005447 . Teherani A, Irby DM, Loeser H. Outcomes of different clerkship models: longitudinal integrated, hybrid, and block. Acad Med. 2013;88(1):35–43. Lin-Beckford S, Osman NY, Krupat E, Hirsh DA. An exploratory study of goal orientations of traditional block and longitudinal integrated clerkship students. Med Teach. 2023;45(11):1275–82. 10.1080/0142159X.2023.2216362 . Gupta S, Howden S. Medical students' experiences of a longitudinal integrated clerkship: a threshold concepts analysis. Educ Prim Care. 2021;32(6):336–43. 10.1080/14739879.2021.1939796 . Dodsworth A, Munro K, Alberti H, Hirsh DA, Paes P, Illing J. Patient outcomes in a Longitudinal Integrated Clerkship: a systematic literature review. Med Educ. 2023;57(9):820–32. 10.1111/medu.15013 . Norris TE, Schaad DC, DeWitt D, Ogur B, Hunt DD. Longitudinal integrated clerkships for medical students: an innovation adopted by medical schools in Australia, Canada, South Africa, and the United States. Acad Med. 2009;84(7):902–7. Hudson JN, Weston KM, Farmer EA. Engaging rural preceptors in new longitudinal community clerkships during workforce shortage: a qualitative study. BMC Med Educ. 2012;12(1):1–10. Poncelet AN, Bokser S, Calton B, et al. Development of a longitudinal integrated clerkship at an academic medical center. Med Educ Online. 2011;16(1):5939. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7078074","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":507568007,"identity":"6686f7ff-95b2-4fbe-aac6-2c739d051ee1","order_by":0,"name":"Abigail Ellstrom","email":"","orcid":"","institution":"Anne Burnett Marion School of Medicine at Texas Christian University","correspondingAuthor":false,"prefix":"","firstName":"Abigail","middleName":"","lastName":"Ellstrom","suffix":""},{"id":507568008,"identity":"d8b28172-2e3f-4c99-9dd8-5ed86d30469b","order_by":1,"name":"Amirmohammad Shafiee","email":"","orcid":"","institution":"Anne Burnett Marion School of Medicine at Texas Christian University","correspondingAuthor":false,"prefix":"","firstName":"Amirmohammad","middleName":"","lastName":"Shafiee","suffix":""},{"id":507568009,"identity":"9b094360-a3b0-474f-b976-c981a050ef35","order_by":2,"name":"Carl Berghult","email":"","orcid":"","institution":"Anne Burnett Marion School of Medicine at Texas Christian University","correspondingAuthor":false,"prefix":"","firstName":"Carl","middleName":"","lastName":"Berghult","suffix":""},{"id":507568010,"identity":"81d9c92a-bb72-4cf8-b851-60643380194a","order_by":3,"name":"Joseph Mellberg","email":"","orcid":"","institution":"Anne Burnett Marion School of Medicine at Texas Christian University","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Mellberg","suffix":""},{"id":507568011,"identity":"229665ef-39c5-4669-85ac-d1c637a8f7fe","order_by":4,"name":"Winston Scambler","email":"","orcid":"","institution":"Anne Burnett Marion School of Medicine at Texas Christian University","correspondingAuthor":false,"prefix":"","firstName":"Winston","middleName":"","lastName":"Scambler","suffix":""},{"id":507568012,"identity":"04810e00-3bfd-49cc-9648-5432ec56484d","order_by":5,"name":"David Shau","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYBACeyA+wANiSQDxByBmYyegxbABSQvjDJAWZgJaDA4ACZgWZjCDoJbjZwwPvGG4wyA/u/mZtM2vbfJ8zAyMHz7m4NFyJsfg4ByGZwwGd46ZSef23TZsY2Zglpy5DZ/D0hIO8zAcZjCQSABq6bnNCNTCxsyLT8v5ZxAt8jPSv0lb9ty2J6zlRvIBsBaGGzlm0gw/bicS1GI44/GBg3MMDvMY3MgptuxtuJ3cxszYjNcv9vyJzR/eVByWAzps440ff27bzm9vPvjhIx4tUOdBooaBsQ1MNhBSjwz+kKJ4FIyCUTAKRgoAAEOIUR7Wh8v5AAAAAElFTkSuQmCC","orcid":"","institution":"Anne Burnett Marion School of Medicine at Texas Christian University","correspondingAuthor":true,"prefix":"","firstName":"David","middleName":"","lastName":"Shau","suffix":""}],"badges":[],"createdAt":"2025-07-08 21:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7078074/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7078074/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90541059,"identity":"04aa5756-64e0-48c5-9689-2d3a9a005ddf","added_by":"auto","created_at":"2025-09-03 23:55:18","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":124623,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of Programs by Average Length.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7078074/v1/9ad284fd5303cb07a3221072.jpeg"},{"id":102919770,"identity":"5d9f0d35-8cc4-4495-88e7-921e68c206e9","added_by":"auto","created_at":"2026-02-18 12:11:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":486746,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7078074/v1/fd9eeb4e-205a-46f1-bf61-db65b88f6fd6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adoption and Variability of Longitudinal Integrated Clerkship Curricula in U.S. Allopathic Medical Schools: A Comprehensive Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe Longitudinal Integrated Clerkship has been an evolving product of the medical education system for over 100 years. The LIC has various adaptations, but at its core, it focuses on integrating multiple specialties of medical care over a more continuous timeline when compared to traditional medical student block rotations. As medicine continues to become more specialized, the LIC curriculum is an attempt to continue training well-rounded physicians.\u003c/p\u003e\u003cp\u003eThe traditional medical school curriculum adopted by most medical schools today has its roots dating back to the early 20th century. As medicine evolved into various specialties each with its own board certification, the block rotation curriculum was born. The concept focused on building upon two years of preclinical textbook coursework by spending 4\u0026ndash;8 weeks in each specialty for a year as a third-year medical student. In their final year, medical students would spend their time in further subspecialized rotations of their choosing as they hone in on a specialty in which they intend to practice.\u003c/p\u003e\u003cp\u003eWhile there are certainly advantages to the traditional model, critics point out the lack of integration and hyper-segmented focus on training. The LIC model attempts to bridge the gap between specialized medicine and developing well-rounded physicians. Due to the nature of medical education, some degree of pre-clinical coursework will always be necessary; however, many adaptations of the LIC curriculum engage students in direct patient care much earlier. Today, some curriculum models have students interacting with patients as soon as their first week of medical school. The LIC curriculum is not only focused on making physicians more adaptive but also more well-rounded communicators as they start developing the intangible skills required to be a great physician. The focus on early clinical experience highlights this push.\u003c/p\u003e\u003cp\u003eAs students progress to the clinical aspect of their medical education, the LIC model seeks to build upon the foundation from the preclinical period. In many cases, students will continue their clinical experience from the pre-clinical years while integrating other experiences. It is during this time many students will likely start to gain more exposure to inpatient medicine, surgical procedures, and the emergency room.\u003c/p\u003e\u003cp\u003eWhile LIC adaptations are relatively new, they have been progressing for decades. A shift in medical education began to appear in the late 1900s when schools started integrating problem-based learning (PBL). However, clinical rotations still mostly remained at the backbone of medical school curricula. In the early 2000s, there was no turning back as big names started to adopt models of the LIC curriculum including Harvard Medical School. Over the past quarter century, the trend continues as more schools continue to adopt aspects of the innovative curriculum including schools such as the University of California, San Francisco and the University of Pittsburgh. Additionally, medical schools such as the Burnett School of Medicine at Texas Christian University were opened and founded on principals of the innovative curriculum model.\u003c/p\u003e\u003cp\u003eWhile the LIC presents many benefits to medical education, it also comes with its fair share of challenges. More clinical experience means more to juggle for the academic administration in terms of scheduling and communication. Additionally, students face challenges as they often spend more valuable time commuting to their various education experiences. The constant switching between experiences also makes it harder to develop relationships with preceptors when compared to the block model. However, these trade-offs are often seen as worth it to medical schools as they attempt to design the most effective curriculum for training future successful and well-rounded physicians.\u003c/p\u003e\u003cp\u003eLIC programs, whether mandatory or elective, typically span 6 to 12 months but can last longer\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. These programs have been successfully integrated across diverse settings, including rural, community, and urban environments, demonstrating their adaptability to various healthcare contexts. Throughout their experiences, students develop and demonstrate foundational clinical knowledge. By emphasizing sustained engagement, LICs improve continuity of care and foster meaningful relationships between students, patients, and clinical teams. This continuity enriches the student\u0026rsquo;s educational experience and forms the foundation for numerous educational and systemic benefits\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOne such benefit is their ability to foster interprofessional learning. Interprofessional cooperation has been linked to improved patient outcomes\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Furthermore, LICs strengthen relationships between students and other healthcare team members while reducing hierarchical barriers among health professionals\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. They have also been shown to improve patient advocacy within the healthcare system, exemplified by medical students clarifying complex topics to patients and ensuring appropriate follow-up care\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Given these benefits, this study aimed to explore the current landscape of LIC program implementation across medical schools in the United States to determine the extent of their adoption and identify national trends in LIC programs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eStudy Design\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eThis study utilized a descriptive, cross-sectional design to evaluate the presence of longitudinal integrated clerkship curricula across all allopathic medical schools in the United States. The dataset was compiled through the collection of publicly available information. Sources included medical school websites, program descriptions, online brochures, and published literature. The study aimed to identify the prevalence of LIC programs, their structure, duration, goals, and key features.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSearch Strategy\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eA comprehensive search was conducted to identify all accredited allopathic medical schools in the U.S. This was primarily completed using the Association of American Medical Colleges (AAMC) database. For each school, official websites were reviewed to identify information related to their specific curriculum and program features. Those with LIC programs or similar longitudinal clinical training models were documented accordingly.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eExclusion Criteria\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eOsteopathic medical schools, international medical schools, and non-accredited institutions were excluded. This allowed researchers to maintain a focus on U.S. allopathic medical education curricula. Programs whose curricula did not include any aspect that may meet the definition of a longitudinal integrated clerkship were not included in the final analysis of programs\u0026rsquo; length, structure, and goals.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eData Extraction\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eData were extracted by five independent reviewers using a standardized Excel sheet. Institution name, location, accreditation status, and initial year of accreditation were collected. Each program was assessed for the presence of a longitudinal clinical program. This data was stratified into three categories: 0 longitudinal clinical programs, 1 longitudinal clinical program, or 2\u0026thinsp;+\u0026thinsp;longitudinal clinical programs. If applicable, the name of the LIC program was documented.\u003c/p\u003e\u003cp\u003eThose with an LIC available were further evaluated. Information on the participation requirement (mandatory vs. elective) of the LIC program was identified. The specific structure of program was documented as it fit into one of three categories: Traditional LIC, Clinic Attachment Only, or Patient and Clinic Attachment. The length of the program and if it existed in preclinical years, clinical years, or both was recorded. Finally, the presence or absence of LIC program goals on the institutions\u0026rsquo; websites were documented.\u003c/p\u003e\u003cp\u003eDiscrepancies between reviewers were resolved through discussion and consensus.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAnalysis\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eDescriptive statistics were used to analyze and summarize the data. Specific datapoints explored included the proportion of schools with LIC programs, the average length of programs, and the type of LIC model implemented. Results were displayed in graphic and narrative formats to allow for an accessible and comprehensive overview.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe analysis of allopathic medical schools in the United States revealed that out of 158 institutions, there were 101 (64%) institutions offering a longitudinal clinical experience as part of their curriculum. In contrast, 57 (36%) do not currently offer an LIC program. The programs that did not offer any LIC curriculum adopted the traditional curriculum: two years preclinical classwork and two years of clinical rotations.\u003c/p\u003e\n\u003cp\u003eOf these 101 longitudinal clinical experiences that programs have incorporated, approximately 80% were identified as mandatory for medical students at that institution. However, 20% were deemed an elective option (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Table 1. Program Qualities\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003cimg width=\"260\" height=\"229\" 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\" alt=\"image\"\u003e\u003c/p\u003e\n\u003cp\u003eA little over one-third (37%) of programs implemented a longitudinal clinical experience in the preclinical years (typically the first and second years of medical school). Approximately 22% had LIC options in clinical years (typically the third and fourth years of medical school). While 42% had structured LIC opportunities throughout both the preclinical and clinical years (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eA traditional LIC model refers to continuous clinical experiences where students work with different specialties throughout each week. Alternative LIC model refers to those with an elective LIC curriculum or clinical assignments in their first/second years of medical school. For example, a few programs offer specific tracks, often in primary care, that incorporate longitudinal patient care experiences.\u003c/p\u003e\n\u003cp\u003eWhen exploring the type of program available at each institution, one-third had a clinic assignment option. This was typically structured as one session every other week with a local primary care clinic. Only 6% of programs had students assigned to a specific patient as the extent of their longitudinal patient care experience. Thirty-three (28%) had both a clinic and a patient assignment. Finally, 39 (33%) programs evaluated had incorporated the traditional Longitudinal Integrated Clerkship curriculum (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eWith regards to length of these programs, the average length was 16 months. The program lengths ranged from 2 to 48 months long (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Six of the programs ranged were 6 months or less (6/101, 6%). Thirty institutions had a program that ranged from 6 months to 1 year (30/101, 30%). Fourteen ranged from 12 to 18 months (14/101, 14%). Fourteen ranged from 18 to 24 months (14/101, 14%). One ranged from 24 to 30 months (1/101, 1%). Eleven ranged from 30 to 36 months (11/101, 11%). Twenty-three ranged from 42 to 48 months (23/101, 23%). And finally, one program lasted longer than 48 months (1/101, 1%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study reveal that longitudinal integrated clerkships and similar curricula are increasingly being adopted across allopathic medical schools in the United States, with 101 institutions offering some form of LIC. A previous review identified 98 longitudinal programs within 69 schools\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. There has been a substantial increase in the number of allopathic medical schools implementing some form of longitudinal clinical experience for medical students in the past seven years.\u003c/p\u003e\u003cp\u003eThese programs vary significantly in structure, with some schools integrating longitudinal clinical experiences into the first two years of medical education, others in the final two years, and some spanning the entire four years. Additionally, some are mandatory, while others are offered as an elective. The models of LIC range from emphasizing patient or clinic attachments, to the traditional LIC structure. This diversity reflects the adaptability of the LIC model to different institutional goals.\u003c/p\u003e\u003cp\u003eThe LIC model has been recognized in medical education for its ability to foster meaningful learning experiences for medical students. One of the key strengths of LIC is its emphasis on continuity of care, which allows students to follow patients over time and across different clinical settings. This has shown to enhance students\u0026rsquo; understanding of disease progression, patient-centered care, and social determinants of health\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. By immersing medical students in a consistent clinical environment, LICs promote the development of strong mentoring relationships with preceptors, which can significantly enhance professional identity formation\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAuthentic clinical experiences early in training have shown to benefit confidence, clinical reasoning skills, and preparedness for residency\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. The longitudinal clerkship model allows for students to build trusting student-patient relationships, and begin to embody an integral role in the patient\u0026rsquo;s health experience\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Furthermore, the longitudinal nature allows students to observe and participate in the management of chronic conditions, which is an increasingly important role of most all specialties\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe variability in LIC implementation identified in this study highlights the flexibility of the model to meet the needs of different institutions and student populations. For example, programs that integrate LIC into the first two years of medical school may provide students with early exposure to clinical practice and thus reinforce basic science learning through connecting theory to practice. Conversely, programs that focus on the final two years may allow students to consolidate their clinical skills and prepare for board exams and residency in a more immersive and realistic environment\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDespite its many benefits, the LIC model is not without challenges. Implementing LICs requires significant institutional commitment, including the allocation of resources for faculty development, curriculum design, and administrative support\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Additionally, the success of LICs depends on the availability of clinical sites and preceptors who are willing to engage in longitudinal teaching relationships\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. These challenges may explain why some institutions offer these longitudinal experiences as elective rather than mandatory programs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe reliance on publicly available information and self-reported data from institutions could introduce inaccuracies, particularly for programs that are newly established or undergoing changes. Additionally, the study does not explore the quality or outcomes of these specific LIC programs, such as student satisfaction, clinical performance, or long-term career impacts, which limits the ability to draw conclusions about the effectiveness of different LIC models. The study focuses exclusively on allopathic medical schools, excluding osteopathic and international institutions, which may limit the generalizability of the findings. These limitations highlight the need for further research, including qualitative studies and longitudinal assessments, to provide a more comprehensive understanding of LIC programs in the U.S.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe growing adoption of LIC curricula in allopathic medical schools in the United States reflects the recognition of its potential to enhance medical education. The variability in implementation observed in this study underscores the adaptability of the LIC model to different institutional contexts and educational goals. By providing students with opportunities for continuity of care, authentic clinical experiences, and strong mentoring relationships, LICs can play a critical role in preparing future physicians to meet the complex demands of modern healthcare. Future research should explore the long-term outcomes of LIC graduates, including their performance in residency and their ability to provide patient-centered, value-based care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLIC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLongitudinal integrated clerkship\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eU.S.\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited States\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePBL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eProblem Based Learning\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAAMC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAssociation of American Medical Colleges\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: Not applicable\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: All data used and analyzed in this study is publicly available\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding: Nothing to declare\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: AE, AS, CB, JM, and WS performed data collection from medical school curriculum websites, analyzed the data, constructed figures, and were major contributors in writing the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOgur B, Hirsh D, Krupat E, Bor D. The Harvard Medical School-Cambridge Integrated Clerkship: an innovative model of clinical education. Acad Med. 2007;82(4):397\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHirsh D, Worley P. Better learning, better doctors, better community: how transforming clinical education can help repair society. Med Educ. 2013;47(9):942\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlliance for Clinical Education. Background, definitions, history. In: Poncelet A, Hirsh DA, editors. Longitudinal Integrated Clerkships: Principles, Outcomes, Practical Tools, and Future Directions. 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Med Educ. 2023;57(9):820\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/medu.15013\u003c/span\u003e\u003cspan address=\"10.1111/medu.15013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNorris TE, Schaad DC, DeWitt D, Ogur B, Hunt DD. Longitudinal integrated clerkships for medical students: an innovation adopted by medical schools in Australia, Canada, South Africa, and the United States. Acad Med. 2009;84(7):902\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHudson JN, Weston KM, Farmer EA. Engaging rural preceptors in new longitudinal community clerkships during workforce shortage: a qualitative study. BMC Med Educ. 2012;12(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePoncelet AN, Bokser S, Calton B, et al. Development of a longitudinal integrated clerkship at an academic medical center. Med Educ Online. 2011;16(1):5939.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Longitudinal Integrated Clerkship, medical education, curriculum, clinical rotation","lastPublishedDoi":"10.21203/rs.3.rs-7078074/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7078074/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Longitudinal Integrated Clerkships (LICs) represent an innovative approach to medical education, offering continuous clinical experiences that contrast with traditional block rotations. In an LIC curriculum, students participate in comprehensive patient care over extended periods, developing ongoing relationships with patients and clinicians while simultaneously meeting core clinical competencies across multiple disciplines. This model typically spans 6-12 months, with students dividing their time among different specialties throughout the week, allowing them to follow patients longitudinally and gain a deeper understanding of patient-centered medicine. Many medical schools are also adopting additional longitudinal clinical experiences. Some assign first-year medical students to an outpatient clinic, providing early clinical exposure. Others offer electives for students pursuing primary care that allow them to develop continuity with patients through extended clerkship experiences. This study aimed to assess the current landscape of LIC implementation across United States (U.S.) medical schools.\u003c/p\u003e\n\u003cp\u003eMethods: We conducted a comprehensive survey of all accredited allopathic medical schools in the United States, examining their curriculum models with a focus on LIC implementation. Data was collected on the prevalence of LIC programs, types of models used, and average length of programs.\u003c/p\u003e\n\u003cp\u003eResults: Approximately 64% of U.S. allopathic medical schools offer some form of longitudinal integrated clinical education. The majority of these programs were mandatory for students (80%), while the rest were offered as an elective option. The programs ranged from being incorporated in exclusively preclinical years, exclusively clinical years, or both. The average length of an LIC program was identified to be 16 months. One-third of LIC programs implemented a traditional longitudinal integrated clerkship system, while the rest incorporated longitudinal clinical experiences through a clinic attachment, a patient attachment, or some combination of the two.\u003c/p\u003e\n\u003cp\u003eConclusion: There is a trend towards increased adoption and diversification of LIC models in U.S. medical schools. When compared to a previous analysis, schools are integrating LICs earlier. The majority of schools have the LIC curriculum span through preclinical and clinical years. This shift reflects growing recognition of the benefits of LIC experiences in medical education. Future research should focus on long-term outcomes of LIC programs, strategies for overcoming implementation challenges, and standardization.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable\u003c/p\u003e","manuscriptTitle":"Adoption and Variability of Longitudinal Integrated Clerkship Curricula in U.S. Allopathic Medical Schools: A Comprehensive Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 23:55:13","doi":"10.21203/rs.3.rs-7078074/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c1907c7-f25c-49b6-8180-90414d043510","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-18T12:10:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-03 23:55:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7078074","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7078074","identity":"rs-7078074","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}