The Continuity Principle: Longitudinal Relationships with Panel Patients
“Some of my preceptors would intentionally try to schedule patient follow-ups for when I would be there…it allowed me to get a lot of longitudinal contacts without having to rearrange my schedule a lot. And I really got to develop longitudinal relationships with people.”
— Student
“It was an incredible learning experience because you could follow them on the inpatient wards, you help coordinate their care as an outpatient, and you were there when they came to follow in clinic. You knew so much more about their case.”
— Student
“If you have a patient that you really want the student to see, you can try to work around their schedule a little bit and utilize that [self-directed learning time]. It took me a couple of years to feel really comfortable asking the students when their [self-directed learning time] was and now I try to take advantage of it when it's appropriate.”
— Preceptor
Facilitating longitudinal relationships between patients and students helps create an optimal learning environment. Students, patients, and preceptors benefit from increased student engagement in patient care. In this section, we provide tangible strategies for preceptors to engage student participation in longitudinal care and discuss the unique value of students in a longitudinal integrated clerkship.
Strategies to optimize student participation in longitudinal care:
Identify a few cohort patients early in the year that students should add to their panel.
“Good” cohort patients are often those that have multiple comorbid conditions or other conditions that require frequent follow-up.
Many patients with complex social situations or those that you worry are getting lost in the system can benefit from the extra attention an LIC student can provide.
Intentionally schedule patient follow-up visits on days the student will work with you, if convenient for the patient.
Update your outlook calendar or indicate in EHR when student is working with you.
This extra step goes a very long way for students by helping them have patient continuity which improves their efficiency in clinic.
Students can personally walk and check-out patients at front desk.
Help students engage with your hospitalized patients.
If notified of an ED visit or hospital admission, forward notification to student to alert them in case they can round on patient and report back to you.
Students have some self-directed learning time in their schedules that can sometimes be used to rearrange their schedule to see a cohort patient for follow-up in your clinic, meet them for a sub-specialty appointment, etc.
Your LIC coordinator can help you or your student with this.
Advocating For and Empowering Student Role:
Support student engagement with patients through follow-up phone calls, particularly in 2nd half of the year.
Route lab results to students and discuss results so they can call the patient. Teach student how to document that they provided test results, etc.
If it would be beneficial, connect students to see patients in specialty care even if they have not met them in primary care.
CC students on communication with specialists to keep students informed.
If possible in the EHR, find a way to note that the student is on the care team (e.g. make an addendum in your note to contact student for hospital admissions, have student add themselves to care team in EPIC, etc.).
As much as possible, include students on all patient care messages to sub-specialists, other care team members, etc.
