The core third year of clerkship is a time when a large part of a medical student's clinical learning takes place. Although there have been relatively recent changes to when all of the rotations occur (all core rotations in third year as opposed to spread out over third and fourth year with electives), the format remained the same: distinct blocks of rotations lasting one to eight weeks, with a written (and sometimes oral) exam at the end of block. The student would then move on and learn an entirely new specialty in the next block.
However, beginning next year, there will be a trial of a new model of clerkship taking place. This model has already been implemented in many universities' satellite or rural programs for years, and has been described in a New England Journal of Medicine article (http://www.ncbi.nlm.nih.gov/pubmed/17314348), but this will be the first time being introduced to Toronto. The model is called the Longitudinal Integrated Curriculum (LIC), and as the name suggests, it is a departure from the classical block-style of clerkship. Instead, clerks will participate in clinics/shifts in various different specialties in a given week. For example, they may have a Medicine clinic on Monday morning, an Obstetrics clinic in the afternoon, and Emerg shift on Tuesday, a Family Medicine clinic on Wednesday, etc. This way, by the end of their third year, they will have had just as much exposure to all rotations, just spread out over the year instead of in discrete blocks.
In addition, there will be "panel patients" assigned to those in the program. These patients are ones who have agreed to participate in the program to have the clerk present at many of their appointments whenever they arise during the year. Some examples may include attending antenatal visits sequentially and then being present when the baby is delivered, or being present pre-operatively for a surgery, scrubbing in during the surgery and then seeing the patient post-operatively. This allows for a more "full" experience of patient encounters. There are other unique features of the program, including dedicated half-days off each week to consolidate learning and to keep with all reading and studying, and dedicated teaching time, in which didactic lectures will be given (to replace the teaching that is normally done in the beginning/middle of each block).
I see this new initiative as a bold new step that challenges the classic format of core clerkship. First, this model allows the clerks to participate in all specialties throughout the year and thus have a more well-balanced knowledge base by the end of the year. It is all too easy in the current model to forget the majority of earlier rotations by the end of the year, simply because the focus is shifted onto the new rotation. By keeping up with each rotation simultaneously throughout the year, it can prevent this issue, and potentially make things such as the iOSCE or even the licensing exam easier to study for. Additionally, the dedicated time set aside each week for teaching and for studying is an excellent time for clerks to rest, catch up and keep on track with the demanding schedule that third-year has to offer. Other advantages include the unique opportunity to follow a panel patient and build rapport with a patient early in clerkship (which is much more reflective of a career in medicine), and the possibility of having call on pre-determined, predictable days throughout the year to best accommodate the LIC schedule.
I think the LIC program can be a very advantageous program for the right cohort of incoming clerks. The addition of more outpatient medicine, and with the introduction of panel patients, this new model can offer a wonderful new perspective on clerkship for very academically conscientious and diligent clerks. The chance to participate in many clinics and to follow a panel patient throughout several specialties and over a year gives a very good glimpse of the diverse roles and case management that may be missed in the current block style of clerkship. As the first cohort of LIC students will be entering clerkship in August 2014, it will be exciting to see their experiences and receive first-hand feedback about this new model of clerkship.
- Anthony
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