Longitudinal Integrated Clerkships
By Thea Swenson, MD, @doctor.thea
My experiences with a hybrid LIC curriculum at the Veterans' Affairs hospital.
In a longitudinal integrated clerkship (LIC) curriculum, the goal is for medical students to form longitudinal relationships with patients and preceptors. There are different types of LICs–some curriculums have students split their time among different services on different days of the week. Others keep a blocked schedule but have students remain at the same location (such as the VA or a rural hospital) throughout.
As a third-year medical student, I was part of the VA longitudinal curriculum. Mine was a hybrid between the traditional clinical blocks and the strictly longitudinal program. I spent 6 months at the VA for my core rotations (internal medicine, surgery, neurology, psychiatry) and 6 months rotating through different sites for my other rotations (OB/Gyn, pediatrics, family medicine). Here are some things you should keep in mind if you’re considering a similar program:
SAME EHR, SAME HOSPITAL SYSTEM, SAME HEALTHCARE STAFF
After 6 months, I was an expert in navigating a government hospital and the lost art of CPRS (which is the VA EHR system). Seriously, though, every system has its own peculiarities. Though setting up a printer and working the paging system can feel more involved at the VA, the logistics quickly became second nature. After a few months, I was able to help “onboard” incoming interns rotating at the VA for the first time. Since VA training is part of nearly every residency program, the more familiar you are with it in medical school, the easier time you’ll have as a resident.
THERE IS GOOD TIME AT THE VA…
…for learning, thinking, and grabbing lunch. This is a pro and a con. Certain things are comparatively slower than at the University Hospital, like morning labs and discharge plans. This can be a big reason why some avoid the VA entirely. As a student or an intern, you might view this as an impediment to your learning or your workflow. Or, you might view it as an opportunity to really dive deep, master specific pathologies, and get to know your patients really well. It takes a certain personality and zen to thrive at the VA.
BREAD AND BUTTER PATHOLOGY, BUT LOTS OF IT
Most veterans have common community health problems; they just have a lot of them (hypertension, hyperlipidemia, coronary artery disease, COPD, various cancers). Every now and then, you will see a zebra, but not as many as you would see at a University Hospital. For training purposes, I believe that working up the bread and butter complaints and managing common problems is the foundation for being a good doctor. Some trainees think otherwise, as this can become mundane and less exciting than working up Lupus or diagnosing progeria. Lastly, you may have to study more for your board exams (because boards tend to test you on zebras), but you may also have more time to study.
THE VA IS A LEARNER FRIENDLY ENVIRONMENT
The VA is a great place to be a learner. The nurses are very nice and helpful. The patients are very grateful and respectful. And the residents and attendings seem to want you there and value your contribution. Everyone knows you are a student, but no one seems to care. Even if you try just a little, you will find a lot of ways to help out. And the more you try to help out, the more fun you will have and the more you will want to help. It is a great opportunity to shine while taking some of the load off of your overworked interns and residents.
I argue that a hybrid curriculum is the best of both worlds, and I wouldn’t have wanted it any other way. As an aspiring physiatrist, training at the VA was especially relevant for my future. More than that, I had many opportunities as a student at the VA that my classmates did not have as students in a big hospital–procedures such as thoracenteses, paracenteses, peripheral IV insertions, intubations.
Lastly, some say that longitudinal curriculums are the future of clinical rotations. However, until residency rotations mirror LICs, I think it is better preparation to follow a blocked schedule. If you’re interested in having some continuity and are okay with bread and butter pathology, then I think a hybrid VA training program like the one I was a part of is a great compromise.
Thea Lananh Swenson, MD is a second-year PMR&R resident at Vanderbilt University. She is passionate about lifestyle medicine, healthcare technology, and medical student education. She hopes to specialize in sports medicine.
Follow her on Instagram, @doctor.thea, to follow her journey through residency and into sports medicine.