MD Programme Longitudinal Integrated Clerkship - underlying principles and more

Background

The traditional structure of core clinical education entails a block model in which students rotate among clerkships, 4 to 8 weeks at a time, in disciplines such as internal medicine, paediatrics, surgery, obstetrics & gynaecology, etc. (Fig 1). These rotations are primarily hospital based. However, due to a global shift towards shortened inpatient stays and increased ambulatory care, several medical schools in Australia, Canada, South Africa, and the United States have adopted a restructured learner- and patient-centered model under the umbrella of longitudinal integrated clerkships (LIC) with more focus on outpatient clinical experiences. Though no two LIC models are identical, key features include longitudinal continuity of learner relationships with faculty preceptors and peers, longitudinal care of patients, and concurrent integrated exposure to multiple disciplines in tandem (Fig 1). Outcomes from these experiences have routinely demonstrated that students in LIC perform at least equally in terms of academic performance to peers in traditional block clerkships, display enhanced patient-centered attitudes and develop meaningful relationships with faculty.

LIC at Duke-NUS

At Duke-NUS, we developed a hybrid LIC beginning in the 2014-2015 academic year with 6 students, complementing the Core Clinical Clerkships. We believe that a longitudinal and integrated learning approach employed within a collaborative community can enhance student learning. The underlying principles of our LIC model stipulate that the participating students will:

•  Experience longitudinal relationships with a cohort of faculty, peers, and a small number of patients;
•  Obtain exposure to undiagnosed acute/chronic patient encounters; and
•  Demonstrate ownership of clinical education complemented with self-directed, faculty-guided, and peer-to-peer learning.

To this end, participating LIC students alternate between weeks of “Inpatient Immersion” (as part of existing Core Clerkships), and “Outpatient” experiences (Fig 2). The outpatient period entails a mix of integrated clinical experiences (e.g. Paediatrics, Obstetrics & Gynaecology, Family Medicine, and Psychiatry), self-directed learning, as well as weekly/biweekly half-day Core Sessions. The latter are facilitated by members of an inter-disciplinary LIC Core Faculty, and involve student-led, faculty-guided case presentations, collaborative learning, knowledge drills, and simulation exercises. The assessment scheme for the LIC entails a multi-faceted developmental approach to participating students’ yearlong learning experiences mapped to program goals, and aligned with a series of Entrustable Professional Activities envisioned for year-2 medical students at Duke-NUS.

Consortium of Longitudinal Integrated Clerkships (CLIC) Conference

The Duke-NUS medical education community is privileged to host CLIC Conference 2017 for the first time in Asia.