Longitudinal integrated clerkships optimize cognitive load to support identity formation 

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Published: Mar 30, 2026
Keywords:
professional identity formation, longitudinal integrated clerkship, cognitive load theory, undergraduate medical education

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Ann Poncelet
University of California San Francisco
https://orcid.org/0000-0002-0520-6978
Maria Wamsley
University of California San Francisco
https://orcid.org/0000-0002-9588-7622
Tali Ziv
University of California San Francisco and Kaiser Permanente East Bay
https://orcid.org/0000-0001-8198-0917
Darren Nichols
University of Alberta
https://orcid.org/0000-0002-7366-0494
Arianne Teherani
University of California San Francisco
https://orcid.org/0000-0003-2936-9832
Justin Sewell
University of California San Francisco
https://orcid.org/0000-0003-4049-2874
Lindsay Mazotti
University of California San Francisco and Sutter Health
https://orcid.org/0000-0003-4462-378X
Nardine Saad Riegels
University of California San Francisco and Kaiser Permanente, Oakland
https://orcid.org/0000-0002-6019-7891
Jill Konkin
University of Alberta
https://orcid.org/0000-0002-7266-4282

Abstract

Background


Clerkship years form and re-form medical students’ professional identities. Evidence suggests that students in longitudinal integrated clerkships develop along a unique path. How the longitudinal integrated clerkship (LIC) model impacts professional identity formation is a rich area for discovery. The purpose of this study is to explore the lived experience of becoming a physician during the core clerkship year with former LIC students across different LIC models and contexts. 


 


Methods


This qualitative study used a hermeneutic phenomenological frame. Former students of three different programs were invited to participate. Seventeen volunteers were interviewed using a semi-structured guide. Transcripts were read holistically, then analyzed, by the co-principal investigators with regular discussion with each other and the study team and with periodic return to the transcripts to ensure the emerging narratives remained true to the participant voices. Cognitive Load Theory was chosen as a novel framework to interpret the participant description of the LIC as creating space to learn and space to become.


 


Results


Longitudinal relationships with the teachers allow teachers to tailor experiences to the student and removes the pressure on students to perform which optimizes intrinsic load and decreases extraneous load. Relationship continuity with patients and teachers mitigates stress and burnout further decreasing extraneous load. Optimizing intrinsic load and decreasing extraneous load provide students with cognitive bandwidth to reflect on and develop their professional identity (i.e., germane load).


 


Discussion


LIC continuity principles and resulting longitudinal relationships are fundamental and support professional identity formation regardless of LIC model or context through their impact on cognitive load.  

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How to Cite
Poncelet, A., Wamsley, M., Ziv, T., Nichols, D., Teherani, A., Sewell, J., … Konkin, J. (2026). Longitudinal integrated clerkships optimize cognitive load to support identity formation  . Education for Health, 39(1). Retrieved from https://educationforhealthjournal.org/index.php/efh/article/view/495
Issue
Vol. 39 No. 1 (2026): Vol. 39 No. 1: January-March 2026
Section
Original Research Paper
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Creative Commons Attribution 4.0 International license

Author Biographies

Ann Poncelet, University of California San Francisco

Ann Poncelet, MD, FAAN is Professor of Neurology, Department of Neurology, and Director of the Haile T Debas Academy of Medical Educators, University of California San Francisco, San Francisco, California, USA

Maria Wamsley, University of California San Francisco

Maria Wamsley, MD is Professor of Medicine, Department of Medicine and Director of the Program for Interprofessional Practice and Education, University of California San Francisco, San Francisco, California, USA. 

Tali Ziv, University of California San Francisco and Kaiser Permanente East Bay

Tali Ziv, MD is a Senior Physician at Kaiser Permanente, East Bay, Oakland, California, USA and Associate Professor of Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA. She directs the University of California, San Francisco - Kaiser Permanente, East Bay Longitudinal Integrated Clerkship.

Darren Nichols, University of Alberta

Darren Nichols, MD is Associate Professor, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada. 

 

Arianne Teherani, University of California San Francisco

Arianne Teherani is Professor of Medicine, Director for Program Evaluation and Education Continuous Quality Improvement, and Education Scientist in the Center for Faculty Educators, University of California, San Francisco, School of Medicine in San Francisco, California, USA.  

Justin Sewell, University of California San Francisco

Justin Sewell. MD, PhD, MPH is Professor of Medicine, Department of Medicine, University of California, San Francisco, School of Medicine in San Francisco, California, USA.  

Lindsay Mazotti, University of California San Francisco and Sutter Health

Lindsay Mazotti, MD is Professor of Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, and Chief Medical Officer, Medical Education and Research, Sutter Health, Emeryville, CA. 

Nardine Saad Riegels, University of California San Francisco and Kaiser Permanente, Oakland

Nardine Saad Riegels, MD is Associate Professor of Medicine, Department of Medicine, University of California San Francisco, San Francisco, California and Assistant Physician-in-Chief of Education at Kaiser Permanente, Oakland, California, USA. 

Jill Konkin, University of Alberta

Jill Konkin is formerly Professor, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.  She is the senior author on this paper but is deceased.  I am the lead author and submitting on her belhalf and have given my email for correspondence (Ann Poncelet)