With the start of the 2018-2019 academic year, we are introducing a longitudinal integrated clerkship (LIC) experience at Regions Hospital. Dr. Paula Skarda, Associate Program Director for Internal Medicine, has been the driving force behind this major project.
The guiding principles for the LIC are those that also define the culture of HealthPartners and Regions Hospital. They are based on patient-centered care and longitudinal relationships with patients by focusing on multidisciplinary teams in both acute and chronic care settings. Dr. Skarda has invested much time and effort into enlisting the participation of all the teaching services, including Internal Medicine, Surgery, Obstetrics/ Gynecology, Psychiatry, Emergency Medicine, and Neurology. While some models of integrated clerkship spread each of the required rotations throughout the year and others concentrate the required rotations in shorter timeframes, we have chosen to design a hybrid model with clusters of required rotations spread across three-month blocks with inpatient and outpatient involvement throughout the year. Medical students will continue to rotate through all the rotations that medical students have always done. However, instead of block rotations where a student is on a rotation for four weeks, then leaves the rotation and his/her patients (usually forever), they will maintain close relationships and provide continuity of care throughout the year.
Medical student education has continued to evolve as we expand our teaching beyond merely the acquisition of knowledge to participation and development of multidisciplinary teams. Further, the Carnegie Foundation for the Advancement of Teaching found that medical education tended to be inflexible, overly focused on the inpatient clinical experience with inadequate attention to patient populations and healthcare systems and inadequate opportunities to work with patients longitudinally. [Cooke M, Irby DM, O’Brien BC. Educating physicians: a call for reform of medical school and residency. San Francisco, CA: Jossey-Bass; 2010.] It was recommended that programs move towards integration of knowledge, experience, and standardization. In particular, longitudinal clinical experiences were recommended as a method of integrating formal and experiential knowledge. [Pouncelet AN et al. Creating a Longitudinal Integrated Clerkship with Mutual Benefits for an Academic Medical Center at a Community Health System. Perm J 2014; 18:50-56.]
Here is an example schedule for students for a 1 week period:
Each student will acquire a “panel” of patients and will be considered part of the treatment team for the year. For example, if on day #1 a student sees Patient A in the Ob/Gyn clinic and then weeks later, Patient A gets admitted to the hospital for a procedure, the student will be notified and she can attend the surgery. If one of our home care physicians makes a visit to Patient A six months later, the student will be notified and can accompany the home care physician on this visit.
Throughout the year, LIC students will also be doing quality improvement projects related to the care of their patients and/or multidisciplinary care. They will have the ability to attend any of the numerous daily and weekly lectures at Regions Hospital, in addition to their required basic lectures. They will have mentoring and role modeling by faculty to integrate and emulate the values and culture of HealthPartners and Regions Hospital, which will stress excellence, compassion, partnerships, and integrity.
Students participating in longitudinal integrated clerkships report that their participation inspires commitment, advocacy, and idealism. We expect that our new LIC program will be a major contributor to the development of physicians of the future.