Longitudinal Integrated Clerkships in Medical Education

Longitudinal Integrated Clerkships (LICs) provide medical students with a unique learning experience where they engage in comprehensive patient care over time, develop ongoing relationships with clinicians, and meet core clinical competencies across multiple disciplines simultaneously. Contrasting with traditional block clerkships, LICs offer an integrated approach that includes primary care experiences in various specialties. Additionally, LIC objectives encompass recognizing health system complexity, advocating for patients, addressing social determinants of health, and collaborating effectively within healthcare teams. Multiple dimensions of continuity in LICs benefit students, clinicians, and the community through improved job satisfaction, enhanced learning experiences, and more efficient patient care.

• Medical Education
• Longitudinal Integrated Clerkship
• Student Learning
• Healthcare Team Collaboration

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1. Longitudinal Integrated Clerkship Christine Ford, EdD

2. What is an LIC? Longitudinal integrated clerkships (LICs) have the following common core elements: Medical students participate in the comprehensive care of patients over time Medical students have continuing learning relationships with these patient s clinicians Medical students meet, through these experiences, the majority of the year s core clinical competencies across multiple disciplines simultaneously. (Consortium of Longitudinal Integrated Clerkships, 2007)

3. Traditional Block Clerkships Rotations are consecutive 4-8 weeks each NBME Weekly didactics Numerous faculty preceptors

4. McGovern Medical School LIC Integrated primary care experience with Internal Medicine, Family Medicine, Pediatrics, OB-Gyn, and Geriatrics 28 weeks long Begins with 4 week inpatient IM immersion 24 week ambulatory experience Takes place at LBJ 10 students

5. Clerkship Order for LIC Students

6. LIC Objectives In addition to meeting the established objectives for the Internal Medicine, Family Medicine, Geriatrics, Pediatrics, and OB-Gyn clerkships, LIC students will also: Recognize the complexity of the health system Advocate for patients within the health system Define the social determinants of health and address them effectively with their patients Recognize the role of quality improvement and safety in health care Reflect on their developing professional identity Demonstrate confidence in counseling patients on common ailments and preventive measures Collaborate for patient care with other members of the healthcare team

7. Multiple Dimensions of Continuity Patients Peer Learners Faculty Practice Setting Pedagogy

8. Benefits of LICs for students, clinicians, and community For clinicians For students -Improved reward-to-effort ratio and job satisfaction -Equivalent or better academic results -Develop community of practice among colleagues -Clinical mastery -Being part of the team -Work-ready graduates For communities -Altruistic, person-centered clinicians -Improved interprofessional practice skills -Workforce for underserved areas (Greenhill & Walters, 2014)

9. Didactics Weekly sessions/workshops Guest speaker on wide variety of topics Core teaching Reflection Supplemental content Simulations (extra) Online cases Access to didactics from traditional clerkship

10. Patient Cohort Acquired early in the experience Patient lists kept on EMR Patient mix with various diagnoses Follow clinic visits, surgeries/procedures (Ob/Gyn)

11. Feedback/Evaluation Regular meetings with faculty mentors Multiple midpoint evaluations Feedback cards and EPA forms

12. Exams and Grades Exams Internal Med Week 8 Ob/Gyn Week 13 Pediatrics Week 18 Family Medicine Week 24 Grades Separate grade for each discipline Same main grade components: national exam, clinical evaluations, online cases, simulation and SPs, didactic attendance

13. LIC Team Faculty Discipline Leads Internal Medicine: Robby Wesley Family Medicine: Bal Reddy Pediatrics: Amalia Guardiola OB-Gyn: Sara Holcombe Geriatrics: Cristina Murdock OEP Staff Christine Ford Dawn Morvant

14. Sample Student Schedule

15. Application Process Applications open today- due December 2 Available on OEP website Statement of interest Tolerance for ambiguity survey Good academic standing Interviews December 11 Determine participants by late December/early January* *Pending successful Step 1 performance

16. 2019 LIC Students Heba Ahmad Kylie Anthony John-Paul Bach Munir Buhaya Isabella Ciuffetelli Cynthia Coots Monica Herbst Isabella Taglialatela Ayana Taylor