Answer to "What is critical to the success of a LIC?"

Relationships, and attention to the organizing principle of continuity, are critical to the success of a longitudinal integrated clerkship (LIC).    

Considerable investment in relationship-building is a critical part of building the foundations for a successful LIC. The leader and members of the LIC team must develop and nurture positive relationships with all those who will facilitate the student experience and learning.  For a new LIC programme this is up-front and ongoing work, building relationships with students, patients and their community, health professionals, healthcare practice and institution managers, academic colleagues and policy makers. Early adopters of change should be acknowledged and valued, while the concerns of those with initial reservations need to be addressed.  All these relationships require ongoing support to ensure programme success and durability.  


Continuity, rather than fragmentation, is the organising principle of a LIC, driving the outcomes for LIC students, patients, preceptors, peers, communities, and local healthcare systems.  LIC programme leaders and preceptors must assist students to facilitate and gain from continuity experiences. The continuity principle is aligned with the learning theory that can be used to underpin the LIC model: Lave and Wenger’s Community of Practice. The student, legitimised by the preceptor(s) as a learner in each Community of Practice, moves from peripheral to central participation as his/her competence and confidence progresses during the longitudinal programme.  Continuity overrides many specific details of a programme.  It is best to leverage the strengths of any local context to support continuity, and worry less about ensuring a diversity of experiences that may interfere with the opportunity to build key relationships. 


Hirsh DA, Ogur B, Thibault GE, Cox M. 2007. “Continuity” as an organizing principle for clinical education reform. N Engl J Med. 356:858–866.

Hudson JN, Farmer EA, Weston KM, Bushnell JA. 2015. Using a framework to implement large-scale innovation in medical education with the intent of achieving sustainability. BMC Med Educ.15:2.

Hudson JN, Poncelet AN, Weston KM, Bushnell JA, Farmer E A. 2017. Longitudinal integrated clerkships. Med Teach. 39(1):7-13.

Lave J, Wenger E. 1991. Situated learning: legitimate peripheral participation. Cambridge (UK): Cambridge University Press.