A Case Study of Student Wellness during A Longitudinal Integrated Clerkship Affected by System-level Disruption

Objectives: Longitudinal Integrated Clerkships (LICs) promote educational continuity, professional identity formation, and community-based care, and are widely used in rurally focused medical education. While their academic resilience has been noted during systemic stress less is known about how such stress affects the personal lives and well-being of LIC students. Using the COVID-19 pandemic as a case study, we examined how disruption impacted student wellness. Methods: We conducted a mixed-methods case study using an anonymous online survey (n=32) and follow-up focus groups with students, faculty, and staff resulting in descriptive statistics for quantitative data while qualitative data was analysed thematically. Results: Students reported reduced physical activity, increased substance use, and worsening mental health. Barriers to care included stigma, lack of anonymity, and dual-role relationships in small communities. Many avoided formal supports, relying instead on peers and local administrative staff who felt overstretched and under-prepared. Central university services were often seen as remote or inaccessible. Seven themes emerged, relating to health impacts, support types, and the integration of central and local systems. Conclusions: The findings reveal a vulnerable underside to LIC placements. While academic learning continued, student wellness suffered. The personal cost of community-based training must be acknowledged if LICs are to meet their goals in workforce development and social accountability. Supporting student wellness is not just a moral duty, but a practical necessity. A hybrid model of local and centralized support, stigma reduction, and access to independent mental health care is essential to sustaining learners in community settings.