university of california, san francisco school of medicine Longitudinal Integrated Clerkships STFM 2011 Conference on Medical Student Education

university of california, san francisco school of medicine Challenges in block rotations in Third Year Erosion of relationship with the patient, the inpatient team, faculty and the course of illness. Lack of authentic roles in patient care. Lack of exposure to undiagnosed patient. Minimal opportunity for longitudinal pt. care Fragmentation of medical care (e.g. inpatient/outpatient, specialty clinics/services, 80 hour work week, shorter attending rotations). Limited observation of skills, professionalism, communication. Lack of continuity between rotations regarding skills development across third year.

university of california, san francisco school of medicine Key Guiding Principles for Improving Clinical Core Continuity with patients/populations Continuity with faculty; Mentoring Continuity with peers Continuity of site / learning about health care systems-outpatient continuity sites Authentic roles in patient care Relevant core curriculum Experience with “undiagnosed” patients

International Consortium of LICs (CLIC) 2007 Longitudinal Integrated Clerkships are those having the central element of clinical education where medical students: 1) participate in the comprehensive care of patients over time 2) have continuing learning relationships with these patients' clinicians, 3) meet, through these experiences, the majority of the year's core clinical competencies across multiple disciplines simultaneously. university of california, san francisco school of medicine Definition of LIC

university of california, san francisco school of medicine Longitudinal Integrated Clerkships Consortium of Longitudinal Integrated Clerkships CLIC Medical schools in Australia, Canada, Great Britain, South Africa, and United States

university of california, san francisco school of medicine Longitudinal Integrated Clerkships 2010-”Muster” Global Community Engaged Medical Education conference- Adelaide, Australia 180 delegates from many countries: Australia, Canada, Great Britain, United States, Nepal, Papua New Guinea

university of california, san francisco school of medicine Longitudinal Integrated Clerkships Urban Academic Medical Center (UCSF) Urban Community (Harvard/Cambridge Hospital) Rural Community Hospital -Yankton, S.D., N. Dakota, Minnesota,WWAMI.etc Rural Distributed (Northern Ontario Medical School) Rural Track-Flinders, Australia

university of california, san francisco school of medicine Longitudinal Integrated Clerkships Particularly effective in rural communities, where students can be assigned for entire year. In several countries-Australia, Canada, Great Britain--preceptors are usually paid and communities make investments in the future

university of california, san francisco school of medicine Longitudinal Integrated Clerkships LIC viewed as a model to address health needs in underdeveloped and “developed” countries. This model is appreciated as a means to engage students early in their training as a mechanism for recruitment for future practice

university of california, san francisco school of medicine Longitudinal Integrated Clerkships Students positive about LICs Appreciate the continuity connection with the community, preceptors and patients

university of california, san francisco school of medicine Longitudinal Integrated Clerkships U. S. schools can learn from these models Model is particularly appropriate for Family Medicine—and FM can be good model of collaboration for LIC programs. Next CLIC conference: Yankton, S.D., Sept. 2011

university of california, san francisco school of medicine Longitudinal Integrated Clerkships Review article: Norris TE, Schaad DC, DeWitt D, Ogur, B, Hunt, D., and members of the Consortium of Longitudinal Integrated Clerkships. Acad Med 2009; 84: