Answer to "Why should I do a LIC?"

Whatever the longitudinal integrated clerkship (LIC) model, the key players for student learning are the patient, the student and the preceptor, sometimes referred to the ‘’learning triad’’.  The following video from the PISCES programme at the University of California San Francisco (UCSF) reveals how the programme was valued by these three players (https://www.youtube.com/watch?v=HSR3W9Evwr4&feature=youtu.be). From the patient’s perspective, the student becomes a third party in the patient-doctor relationship, adding to patient care.

a) What’s in it for the patient?

Patients benefit from having a students connected with them over time.  They feel as if they have an additional doctor caring for them, and appreciate the student serving as a conduit to their own doctor.  The student facilitates access to care, transitions of care, coordination of care and helps with communication between providers and services. They also feel the student helps translate what is happening to them into a language they understand and they appreciate the student getting to know them as a person, that the student understands their concerns and perspectives, and supports their wellbeing.  The student serves as an advocate for their needs which also benefits their care.  Patients like being a partner in the student’s training and feel ownership and pride for the student’s journey to becoming a physician.  They also feel more empowered in their own care as a result of the student’s participation in their care. 

 

There is also a future impact on patient care in two domains:  1) LIC students trained in rural or other underserved settings are more likely to practice there and the LIC model has been applied specifically to address workforce shortages, and 2) LIC graduates are more patient-centered and this persists into residency and practice.

References

Gaufberg E, Hirsh D, Krupat E, Ogur B, Pelletier S, Reiff, D, Bor D. 2014. Into the future: Patient-centredness endures in longitudinal integrated clerkship graduates. Med Educ. 48:572-582.

Halaas GW, Zink T, Finstad D, Bolin, K,  Center B. 2008. Recruitment and retention of rural physicians: Outcomes from the rural physician associate program of Minnesota. J Rural Health 24:345-352.

Hudson JN, Knight PJ, Weston KM. 2012. Patient perceptions of innovative longitudinal integrated clerkships based in regional, rural and remote primary care: A qualitative study. BMC Fam Pract.13:72.

Hudson JN, Weston KM. 2014. The benefits of longitudinal relationships with patients for developing health professionals: the longitudinal student–patient relationship. In: Higgs J, Croker A, Tasker D, Hummell J, Patton N, editors. Health practice relationships. Rotterdam (The Netherlands): Sense Publishers; p. 211–218.

Poncelet AN, Wamsley M, Hauer KE, Lai C, Becker T, O'Brien B. 2013. Patient views of continuity relationships with medical students. Med Teach. 35:465-471.

Poncelet AN, Hudson JN. 2015. Student continuity with patients: a systems delivery innovation to benefit patient care and learning. Healthcare 3:607-618.

Walters L, Greenhill J, Richards J, Ward H, Campbell N, Ash J, Schuwirth LW. 2012. Outcomes of longitudinal integrated clinical placements for students, clinicians and society. Med Educ. 46:1028-1041.

b) What’s in it for the student?

According to LIC students and graduates, a LIC workplace-based learning environment offers many opportunities for successful student learning during the clerkship year. Students have highly rated the following benefits from a LIC programme: continuity with preceptors, patients, place and peers, along with integration of and flexibility within the curriculum. Part of the success of a LIC is that the student is known to the patient and the preceptor, and is invited into the patient’s care as an authentic provider.  By the end of the year, LIC students are spending more time performing direct patient care activities alone (25%) compared to traditional block rotation students (7%).

When taking on more responsibility for their own learning in the flexible, integrated curriculum of a LIC, students may initially feel disorientated. However positive outcomes are realised over time.  It is reassuring for students that LIC graduates have academic results equivalent to, and in some cases, better than those of their peers who receive clinical education in traditional block clerkships (TBCs). Continuity of the student-preceptor relationship has been valued to facilitate incremental progressive feedback, and knowledge acquisition.  Students in LICs were able to take on increased responsibility with patients, facilitated by continuity with patients, and were reported to have well-developed patient-centred communication skills, and understanding of the psychosocial contribution to medicine.  There is now a body of literature supporting these and other positive outcomes (see question 12). 

References

Hauer KE, Hirsh D, Ma I, Hansen L, Ogur B, Poncelet AN, Alexander EK, O’Brien B. 2012. The role of role: learning in longitudinal integrated and traditional block clerkships. Med Educ. 46:698-710.

Latessa RA, Swendiman, RA, Parlier AB, Galvin SL, Hirsh DA. 2017. Graduates’ Perceptions of Learning Affordances in Longitudinal Integrated Clerkships: A Dual-Institution, Mixed-Methods Study. Acad Med. 92(9):1313-1319.

O’Brien BC, Poncelet AN, Hansen L, Hirsh DA, Ogur B, Alexander EK, Krupat E, Hauer KE. 2012. Students workplace learning in two clerkship models: a multi-site observational study. Med Educ. 46:613-624.

Walters L, Greenhill J, Richards J, Ward H, Campbell N, Ash J, Schuwirth LW. 2012. Outcomes of longitudinal integrated clinical placements for students, clinicians and society. Med Educ. 46:1028-1041.

c) What’s in it for the preceptor?

Preceptors across settings are drawn to this model of training because of the longitudinal relationships and the opportunity to shepherd a student’s development into a physician during this core clinical year.  Community physicians relish the chance to have the learners work with the whole population of patients in ambulatory settings.  They participate because of a commitment to their patients, their communities and their profession and see a direct connection to recruiting new physicians into their communities. Having learners embedded in their practices is perceived as good for morale and that it raises the status of their practice.  Although both rural and academic physicians feel the burden of being responsible for their students’ training over the course of the year, they also find it to be deeply rewarding and feel invested in the success of their students.  They also appreciate reciprocal learning with their students.  In addition, community preceptors value access to University resources and having a greater relationship with the University. 

References

Hudson JN, Weston KM, Farmer EA. 2011. Engaging rural preceptors in new longitudinal community clerkships during workforce shortage: a qualitative study. BMC Fam Pract.12:103.

Hudson JN, Weston KM, Farmer EA. 2012. Medical students on longterm regional and rural placements: what is the financial cost to supervisors? RRH. 12:1951 (Online).

Walters L, Prideaux D, Worley P, Greenhill J. 2011. Demonstrating the Value of Longitudinal Integrated Placements to General Practice Preceptors.  Med Educ. 45:455-463.

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