Answer to "What are common LIC challenges that can be anticipated?"

Maintaining continuity is foundational to the longitudinal integrated clerkship (LIC) model of clinical training.  Logistics and contextual factors that impair continuity can be a challenge.  These factors include multiple sites and the need for travel, inability to schedule follow up patients with the students, and jamming the schedule with other activities.  The effects of these factors can be mitigated by using technology to connect the learner with the patients, communication between visits and active efforts by the preceptor to include the student in the patient’s care. 

Every site, whether primary care or subspecialised, will not have every kind of patient that would be optimal for core training.  Planning for swaps with other subspecialists in the urban academic setting, the use of simulation and brief immersion experiences in other settings can mitigate the impact of this, but it must be weighed against any loss of continuity with the core preceptors and clinics. Having adequate numbers of faculty from specific disciplines or in remote sites can be a limiting factor.  In settings with traditional based, and longitudinal integrated, clerkship students, competition for resources and patients should be anticipated with processes to mitigate this as much as possible.  The illness episode of certain disciplines such as surgery may not support patient continuity but be a very rich setting for preceptor continuity. Having inadequate space and technology infrastructure can also be problematic.  Faculty development is also very important to ensure the preceptors and others in the health care context understand the programme, the learning goals, their own role in learner assessment and support of effective LIC teaching. 

Students in rural settings can experience isolation, and many programmes will send students in pairs and facilitate connection using technology-enabled virtual peer groups.  Learning multiple disciplines in parallel is stressful at the beginning of a LIC, and students can be proactively supported in terms of developing effective learning strategies as well as emotionally.  Longitudinal relationships between learners and preceptors is very powerful, but can be challenging when there are personality conflicts or when there is a student or preceptor with challenges and these need to be addressed early.  Maintaining professional boundaries with preceptors and patients should also be proactively supported, and closure and hand off of care at the end of the year can be hard for patients and students.  Students also can find getting all of their core grades at the end of the LIC hard, even though the quality and quantity of the feedback across the year is substantial.  As might be anticipated, students will also worry about whether they are getting “as good training” as their peers.  Outcomes data and mentoring from LIC graduates can be very helpful to allay their concerns.

References

Brooks K, Wamsley M. 2016. Continuity with Faculty-Preceptorships In: Poncelet AN, Hirsh D, editors. Longitudinal Integrated Clerkships: Principles, Outcomes, Practical Tools and Future Directions. North Syracuse, NY: Gegensatz Press; p. 45-54.

Ellaway R, Graves L, Berry S, Myhre D, Cummings BA, Konkin J. 2013. Twelve tips for designing and running longitudinal integrated clerkships. Med Teach. 35(12):989-95.

Heddle W, Gayle Roberton G, Mahoney S, Walters L, Strasser S, Worley P. 2014. Challenges in Transformation of the “Traditional Block Rotation“ Medical Student Clinical Education into a Longitudinal Integrated Clerkship Model. Educ for Health 27(2): 138-142.

Heddle W, Lager J. 2016. The LIC in an Urban Academic Medical Center. In: Poncelet AN, Hirsh D, editors. Longitudinal Integrated Clerkships: Principles, Outcomes, Practical Tools and Future Directions. North Syracuse, NY: Gegensatz Press; p. 165-178.

McKinley SK, Theodore P, Ghosh A.  2016. Operative Care in the LIC. In: Poncelet AN, Hirsh D, editors. Longitudinal Integrated Clerkships: Principles, Outcomes, Practical Tools and Future Directions. North Syracuse, NY: Gegensatz Press; p.115.-122.

Sherman K, Hansen L. 2016. Rural Community LICs. In: Poncelet AN, Hirsh D, editors. Longitudinal Integrated Clerkships: Principles, Outcomes, Practical Tools and Future Directions. North Syracuse, NY: Gegensatz Press; p.185-194.

Smith B, Ellaway R, Alegria D, Bokser S. 2016. Technology for and in LICs. In: Poncelet AN, Hirsh D, editors. Longitudinal Integrated Clerkships: Principles, Outcomes, Practical Tools and Future Directions. North Syracuse, NY: Gegensatz Press; p.147-156.

Wamsley M, Hansen L. 2016. Continuity with Patients. In: Poncelet AN, Hirsh D, editors. Longitudinal Integrated Clerkships: Principles, Outcomes, Practical Tools and Future Directions. North Syracuse, NY: Gegensatz Press; p. 37-44.

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