An innovative program that enables third-year medical students to train in community settings over a period of months under the supervision of experienced primary care physicians will be piloted this spring at the College of Community Health Sciences.
The Tuscaloosa Longitudinal Community Curriculum (TLC2) will expose students to community medicine with longitudinal connections to patients and providers, and opportunities to experience the broader professional roles of physicians.
This education model, known as a longitudinally integrated clerkship or LIC, allows medical students to live and train in a community for a period of months, be involved in the comprehensive care of patients over time and to have long-term relationships with patients’ physicians. In the most common LIC model, students each have a principal preceptor and learn working with that physician through a variety of “threaded” experiences where students follow a patient through the health-care system, along with short intensive “bursts” of learning with a specific specialty physician, and even self-directed “mini blocks” with a teacher.
“What is fundamentally different about the LIC model is that medical students meet their required clinical competencies across multiple specialties simultaneously, longitudinally and in the community setting,” says College Dean Richard Streiffer, MD. This is different, he says, from the traditional separate and sequential discipline-specific block rotations, and from the largely hospital-centric experiences of the most medical school curriculum.
“It mimics the way physicians in practice themselves learn,” he says.
Students in TLC2 will experience full spectrum care in a community environment that is reflective of where most medicine is practiced. Students will participate in continuity of care of patients over weeks or months of a disease process, and see patients longitudinally and in multiple settings, including outpatient clinics, inpatient units, emergency rooms, nursing homes and patient homes.
“Students come to understand health and disease in the context of where their patients live and in the variety of locales where health care services are delivered,” Streiffer says. Students will also interact one-on-one with physicians in different specialties and with other health professionals.
While LICs have been part of medical education for some time, medical schools are beginning to create these programs as evidence of the effectiveness and benefits accumulates. Medical students who have participated in LICs say they feel better prepared to care for patients. Studies show that LIC students perceive better clinical education and access to patients, are more likely than students in traditional clerkships to understand longitudinal processes of chronic disease as opposed to simply managing episodes of care, and that the continuity with patients promotes patient-centered attitudes.
The length of the experience also allows time for students to become involved in the community, complete a community scholarly project, develop trusting and respectful relationships as a team member with physicians, clinic and hospital staff and patients, learn about the business of providing health-care services, and appreciate the rewards and challenges of primary care.
“One of the other benefits,” Streiffer says, “is that students who complete LICs enter primary care at a rate higher than traditional students, that being an outcome we want as it is consistent with the mission of our College.”
The College previously offered a 16-week, LIC-like program called TERM (Tuscaloosa Experience in Rural Medicine). Lauren Davidson Linken, MD, who will be an obstetrics fellow at the College next year, participated in the TERM program and says she did it “to see the medical field in a different way than I had previously seen at big tertiary care centers.”
“I was surprised by the variety of cases I was able to be involved with and the variety of physicians I was able to work with, all in one small town. I had the opportunity to work with family medicine, obstetrics, pediatrics, internal medicine, general surgery, dermatology and pathology,” says Linken, who is completing a family medicine residency at the University of Massachusetts.
She recalls a patient she cared for while in the TERM program. The patient was diagnosed with an incarcerated ventral hernia by her family physician and referred to a local surgeon. Linken assisted the surgeon with the patient’s consultation and scrubbed in for surgery. Later, she and the pathologist looked at the patient’s specimen slides under the microscope. This longitudinal, multidisciplinary, “threaded” experience is not feasible in the usual rotation model of medical student education.
“This experience came up in all of my residency interviews, and it was great to tell how I had been affected by the relationships I developed with my patients – relationships that can only develop in a continuity setting, a setting that does not exist in the standard medical school curriculum.”
The College’s TLC2, which will begin as a pilot program in May, will have other special curriculum components in primary care leadership, community engagement and population health that will be delivered through onsite and teleconferenced seminars throughout the nine-month experience. Admission to TLC2 is through a competitive selection process and limited to six students in the first year. Pilot placements are in both rural and urban Alabama communities.
The College, which also functions as a regional campus of the University of Alabama School of Medicine, provides the third and fourth years of medical education and clinical training for a cohort of School of Medicine students, emphasizing education that aligns with the College’s mission to improve the health of Alabama’s population and provide primary care physicians for the state. But TLC2 is not just for students interested in primary care.
“We know that this type of program will prepare future physicians with vigorous general professional clinical training,” Streiffer says, along with skills in community engagement, leadership and population health, enabling them to be highly qualified for residencies and future practice in fields in addition to primary care, including emergency medicine, pediatrics, general surgery, OB/GYN and psychiatry.