Longitudinal Integrated Clerkships Position Medical Students as Leaders

By: Mariya Kalashnikova, medical student, Class of 2015, Keck School of Medicine, University of Southern California

As a medical student, I spend a great deal of time imagining the future health care system in which my classmates and I will practice. How much time will I spend seeing patients? With what types of health care professionals will I work closely? Most important, what types of skills do I need to develop now to be successful in the future?

We are training in a time of great uncertainty about the long-term landscape of American health care, and that has caused both learners and educators to question whether the current medical education system is adequately preparing students for future practice. Great changes are underway in undergraduate medical education (UME) with principles like patient quality and safety, interprofessional education, and competency based assessments guiding the way forward. Two original studies in Academic Medicine by Myhre and colleagues and Woloschuk and colleagues highlight another innovation in UME–the longitudinal integrated clerkship (LIC)–establishing the similar academic performance of students who complete a LIC compared to their classmates in a rotational-based clerkship (RBC). Accompanying these studies are two commentaries, which apply the principles of continuity to the evaluation of entrusted professional activities and the reintegration of medical students as active participants in health care teams.

As I read the articles, I was encouraged by the value that the LIC places on the learner as leader, urging students to take ownership over their medical training.

I completed my third year in a RBC and, on virtually every clinical team, my role was predefined by others, rather than shaped by my actions. Every day I was told when and where to show up, what to do, and when to leave, positioning me as a passive consumer rather than a driver of my training. In contrast, I spoke with a friend who completed a LIC at another institution, and he described a much less prescriptive training experience. His third year was spent working in a number of simultaneous clinical environments where he was tasked with figuring out what his role was and how it could evolve over time. Rather than acting out a pre-set script, he was constantly evaluating and revising his position in the health care team based on the demands of the task at hand. Alongside his clinical reasoning and physical exam skills, my friend also developed an ability to adapt to new clinical scenarios and embrace uncertainty.

It may be that the “hidden” curriculum of the LIC, which instills in students the values of autonomy, resilience, and flexibility, is the key to preparing them to act as physician leaders in an uncertain future. Leadership means different things to different people, and not all future physicians need to, or want to, run hospitals or corporations. However, my classmates and I will undoubtedly face unprecedented challenges in our careers that push us to think and act outside of our comfort zones. We may find that to solve tomorrow’s problems we will need a completely different set of tools than those we’ve gained in our medical training. However, our biggest choice will be whether to shrink back and let others shape solutions for us or to champion change and rethink our positions in the health care system. It is here that the LIC seems to offer its graduates the largest benefit–teaching them early on that their roles as physicians are not static and that they can stand up and redefine the health care system, rather than be defined by it.

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