Comparability of Preceptor Assessment of Medical Students in a General Practice and Multispecialty Longitudinal Integrated Clerkship in a US Medical School.

Background: Continuity is the organizing principle of the Longitudinal Integrated Clerkship (LIC) and drives its outcomes. In a multispecialty LIC, students are paired with specialty-specific preceptors in each of the core clerkships approximately one half-day per week and work with each of these preceptors longitudinally throughout their clinical training. The general practice (GP) LIC differs in that students are primarily paired with full-scope generalist preceptors who teach the content of several specialties in one setting. It is unknown if assessments from a single preceptor teaching multiple specialties will include sufficient data for summative grading. The aim of this study was to demonstrate non-inferior assessment narrative quality and comparable clerkship clinical grades for students in an urban GPLIC compared to multispecialty LIC students at a United States (U.S.) medical school.

Methods: In 2022, 16 GPLIC preceptors assessed 6 students in pediatrics, obstetrics and gynecology, internal medicine, and family medicine, using forms that allowed assessment in multiple specialties concomitantly. Assessment forms included both comments and ratings of student performance of entrustable professional activities (EPAs) and other skills. Sixteen GPLIC assessment forms were matched to 16 multispecialty forms, deidentified, and evaluated for quality. Adequacy of assessment data was determined by the school's curricular and assessment deans who observed all clerkship grading committee meetings. Feedback on the assessment process was solicited from all 1164 LIC preceptors through an electronic survey at the end of the year.

Results: Overall comment quality did not significantly differ between the groups. There was no significant difference in word count or presence of EPA-specific comments between GPLIC and multispecialty LIC assessment forms. We found no difference in the presence of adequate assessment data between the two groups as judged by final grading committees. The clinical grade distributions of Honors, High Pass, and Pass were not significantly different, and no differences in preceptor feedback about the assessment forms were found.

Conclusion: This study demonstrates that in the inaugural year of an all-LIC curriculum at a US medical school, GPLICs, where preceptors concurrently assess students across multiple specialties, produce noninferior assessment data when compared to multispecialty LIC preceptors. These results suggest the feasibility for parallel GP and multispecialty LICs. This offers medical schools flexibility in expanding clinical training sites beyond traditional specialty-focused academic contexts, while maintaining comparability in assessment.