When creating our curriculum we examined the challenges facing physicians in the future. We wanted to ensure our students learned how to treat the whole patient. The best way to accomplish this is to follow patients over time. For instance, diabetes patient care is a lifetime process that includes counseling, dietary education, laboratory tests and monitoring, treatment with insulin or drugs, and occasional crises requiring hospitalization. In a hospital-based clerkship, the student would only see the diabetes patient when in crisis. Taking care of extremely sick patients in the hospital doesn't always prepare students for the holistic management of patient care. That's why we decided to use a new model -- the longitudinal integrated clerkship (LIC). It allows students to learn the medical specialties simultaneously rather than separately. We also decided our students would complete a yearlong clerkship in a community clinic (outpatient setting) versus a hospital. The LIC model is more patient-oriented and nurtures stronger doctor-patient relationships by enabling students to:
- provide continuity of care over a 12-month period;
- nurture meaningful relationships with patients and their families, faculty, residents, and the entire health care team; and
- attain the majority of the year's core clinical competencies across multiple disciplines simultaneously.
In a community clinic setting, students will start examining patients under a physician's supervision. After the student takes the patient's history, conducts a physical exam, decides on the diagnosis and if laboratory or imaging studies are needed, determines a treatment plan, the student and faculty member discuss the case, and then the faculty member sees the patient and checks the student's work. This learning by experience and guidance ensures excellent patient care and tremendous learning for the student. Students also will have the opportunity to follow their patient to the hospital setting if they become seriously ill.
Our students will gain valuable experience working with health care teams, which are essential for good patient care. We also will provide supervised learning experiences for UNLV nursing and physical therapy students and College of Southern Nevada and Nevada State College students who are pursuing other health care professions.
We intend to use the LIC model with all 60 of our students. To give our students a jump-start, we will implement the curriculum during the last two months of their second year. We are confident this will prepare them to determine their specialty by the end of their third year. It also gives them time to do an additional elective in a specialty they find interesting.
During their fourth year, our students will complete three months of hospital rotations, including two sub-internships and a rotation in the ICU. The sub-internship will allow students to manage a small group of hospital patients under the supervision of faculty and residents. They also will have an additional five months of electives designed to prepare them for residency training.
Currently, schools
in the U.S., Australia, Canada and South Africa have established LIC programs, and more than a 100 schools have joined an international consortium to discuss and explore this teaching option. We believe the LIC is transformative for medical schools and students alike. We can't wait to implement the model here.
