Learning through longitudinal patient care-narratives from the Harvard Medical School-Cambridge Integrated Clerkship.

PURPOSE Most medical schools value and seek to create opportunities for students to learn through experiences in the longitudinal care of patients. A number of innovative programs have made longitudinal care the central experiential component of principal clinical year education.The authors sought to identify ways in which learning through the longitudinal care of patients in an innovative longitudinal integrated clerkship contributes to the education of students in their principal clinical year. METHOD The authors reviewed 16 narratives written by 14 of the 38 students from the first four years of the Harvard Medical School-Cambridge Integrated Clerkship, 2004-2007, to identify important aspects of learning from longitudinal care. RESULTS Students reported that the clerkship structure created a dynamic learning environment that helped them to more broadly learn about their patients' diseases and experiences of illness. Students described feeling deeply connected to "their" patients, which transformed their roles and inspired their reflections. With more thorough knowledge of their patients over time, they felt they made important contributions to their patients' care, not only in providing emotional support but also in bridging gaps in the delivery of services and in motivating deeper exploration into relevant medical and social issues. Students reported that their connections with patients over time inspired a sense of idealism and advocacy. CONCLUSIONS Organizing learning in the principal clinical year around longitudinal patient care seems to offer significant advantages for learning and professional development.