Answer to "Are LICs different in in different regions (urban, rural), and should students have their own patient panel?"

Longitudinal integrated clerkships (LICs) successfully exist in a variety of regions, including community rural, remote rural, community urban and academic urban settings.  By necessity, the structure and details of each LIC are unique to each context in order to maximise unique affordances, meet programme goals and support the key continuities that drive the model. 

Two main structures have arisen: 1) a generalist model, and 2) a parallel streaming model. 

In the former, the learner is based in a general practice for the majority of the LIC and their patient panel are the patients in the practice.  Students also learn in local hospital inpatient settings, including the emergency department, or by following patients to other community health care services. The generalist model is most commonly seen in rural settings where the learner is placed in a rural community for their LIC. 

Learners in the parallel streaming model have multiple longitudinal preceptors from each core discipline, and in many programmes are expected to develop a longitudinal panel of patients whom they follow across settings within the health system for the duration of the LIC.  The numbers of learners in each programme/site is impacted by factors such as the number and quality of preceptors, size and focus of the practices, numbers of learners including non-LIC learners at that site, space and other resources.  Some programmes have the entire class in a LIC and for others, it is an elective or a selective for part of the class.

References

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.

Norris T, Schaad D, DeWitt D, Ogur B, Hunt D, and the Consortium of Longitudinal Integrated Clerkships. 2009. Longitudinal integrated clerkships for predoctoral medical students: An innovation adopted by multiple medical schools internationally. Acad Med. 84:902-907.

Poncelet AN, Hirsh D. 2016. Background, Definitions, History. In: Poncelet AN, Hirsh D, editors. Longitudinal Integrated Clerkships: Principles, Outcomes, Practical Tools and Future Directions. North Syracuse, NY: Gegensatz Press; p.1-8.

Worley P, Couper I, Strasser R, Graves L, Cummings BA, Woodman R, Stagg P, Hirsh D and the CLIC Research Collaborative. 2016. A typology of longitudinal integrated clerkships. Med Educ. 50(9):922-932

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