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

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