LIC 101: What’s an LIC?
If you are reading this as a practicing physician today, it is likely that you and most of your colleagues trained in a traditional block model for your clinical medical education – one where you spent a month or two rotating through all of the fundamental specialties at the various training hospitals affiliated with your medical school. That system worked well enough for a long time, so why change it? And what is it changing to? At the University of Colorado School of Medicine, the clinical curriculum is changing to be 100% LIC-based. We’ll discuss what that means here:
A Longitudinal Integrated Clerkship (LIC) is a Clinical Preceptorship in Which Students:
Participate in comprehensive care of patients over time.
Engage in continuity relationships with preceptors.
Meet core clinical competencies across multiple disciplines simultaneously.
Basic Tenets of LICs:
The organizing principle of the LIC is continuity: continuity with a learning cohort of peers, with specialty-specific mentors, and with patients.
Students spend an entire year within a site or system; through this longitudinal experience, they become immersed in their preceptors’ healthcare teams and earn entrustment of responsibilities over the arc of the year.
Students work with preceptors in each specialty providing longitudinal teaching, mentorship, and evaluation.
Students develop a cohort of patients from all specialties that they follow through primary care, subspecialty clinics, inpatient, and emergency settings.
Through these relationships with patients, students see patients’ experiences of health and illness evolve over the course of the year.
Students develop a learning community with a stable peer group over the course of the year.
What are the Goals in Creating an All-LIC Clerkship Curriculum at the CU School of Medicine?
Provide students with authentic roles in patient care and on medical teams sharing patient care responsibilities with faculty.
Provide ample opportunity to experience the whole illness through transitions in care supporting a broad view of disease, patient experience, and health care systems.
Allow students to receive most of their teaching from excellent faculty who can provide meaningful feedback and support growth.
Development of a progressive didactic learning structured time for the integration of basic science, clinical application, evidence-based medicine, social science, humanism and ethics, and systems-based practice.
Support personal and professional well-being through minimization of the negative hidden curriculum and strong peer and mentor support.
How is the Clinical Learning in an LIC Structured?
Students participate in shortened inpatient “immersions” in surgery, medicine, OB/GYN, pediatrics and psychiatry.
Remainder of the year dedicated to longitudinal, integrated clinical experiences with preceptors.
Ample unstructured time for independent learning, follow up with cohort patients, career exploration, and professional development.
Weekly small group didactic and workshop series focusing on core clinical topics as well as basic science health & society integration.
How Do Students Perform in the LIC Model?
Students meet all competencies and objectives in a comparable fashion to traditional block clerkships.
Students score equivalently to slightly above average scores on standardized exams.
Students pursue a wide range of career interests including internal medicine, pediatrics, med/peds, psychiatry, OB/GYN, family medicine, general surgery, emergency medicine, surgical sub-specialties, radiology, dermatology and more.
Students participating in LICs have equal or better performance than their peers in traditional block rotations on:
Standardized exams
Clinical assessments
Sub-internships
National board examinations
Student Humanistic Outcomes:
Students participating in LICs show improved measures of patient-centeredness and empathy as compared to peers participating in traditional block rotations.
Notably, students in traditional block models had an erosion of patient-centeredness, while students in the LIC had statistically significant enhancement in patient-centeredness by the end of the year. Importantly, that difference was sustained when re-visited with repeat measurements 4-6 years after the completion of medical school.
