When Jennifer Adams, MD, a dean at a Colorado medical school, heard about a new way to train aspiring physicians, she was skeptical. A decade of success helped dissipate her doubt.
The University of Colorado School of Medicine is the first in the nation to fully transition to a longitudinal integrated clerkship model. The school began piloting it at Denver Health in 2013, and after years of success, the university fully launched the LIC model in 2021.
Several other schools use the LIC model in conjunction with block scheduling, according to Dr. Adams, assistant dean for education at the Aurora, Colo.-based school.
"What's really novel about what's going on at the University of Colorado is that we decided to take this leap," Dr. Adams told Becker's.
For decades, med schools solely offered block scheduling during students' clinical years. For six to eight weeks, a student is placed in one specialty, such as pediatrics, takes an exam, then moves to another one. At the end of the school year, students are then tested on all, choose their specialty and continue their training.
"In contrast, in the LIC model, what we aim to do is weave those specialty training experiences together," Dr. Adams said.
For example, a student might be placed in emergency medicine on Mondays, obstetrics and gynecology on Tuesdays, et cetera. Students who went through an LIC schedule reported higher levels of patient-centeredness and empathy, and faculty preferred this model over block scheduling.
The clinical hours between block scheduling and LIC are equal, and test scores are similar. After one year, University of Colorado students begin concentrated, immersive learning.
For faculty, block rotations can feel like a "treadmill of teaching," Dr. Adams said, because teaching students every day for weeks on end can be draining — especially if you never see them again. The LIC model fosters stronger mentorship relationships, according to research.
On the other side, block rotations — coupled with persistent burnout in the healthcare industry — can manifest into mistreatment, Dr. Adams said.
"What [physicians] have seen modeled for them is mistreatment," she said. "They're exhausted, their defenses are down, and so they say something in reaction to [a mistake] and their reaction is outsized, is cruel, is abusive, and completely diminishes the students ability to learn.
"We can't learn when we're being mistreated. And this happens over and over again because the training environment is set up to create burnout and exhaustion."
This cycle can be broken with the LIC model, she said, which provides more time to build relationships among students, faculty and preceptors. Since the university has incorporated the new training model, levels of student mistreatment decreased and feelings of collegiality and civility increased.
Dr. Adams said the new schedule also removes silos in healthcare by showcasing the care continuum. For example, a former obstetrics patient might require emergency medicine months later.
"Patients interact in our healthcare systems in a really holistic way," she said. "Training our students to understand that experience and follow patients gives them a much more realistic idea of how medical care really occurs, and gives them a sense of what the patient experience is like. They become much more authentically involved in inpatient care and develop a role as navigator and advocate for their patients."
Patients also preferred the model, with one study finding some patients feel a sense of loss when LIC students were no longer involved in their care.