A (re)Introduction to the Longitudinal Clerkship
I am about to finish my third year of medical school, which I’ve spent in a program that is very different from the traditional model of education for students in their clinical years. It is called a “longitudinal integrated clerkship,” which is meant to differentiate it from the traditional block clerkships in which students spend discrete amounts of time in particular disciplines like Internal Medicine, Obstetrics, Neurology and Pediatrics. Instead, we spend time in all of the core disciplines throughout the entire year. We also follow a number of patients through the healthcare system and participate in their care in many different venues.
I like to say that the clerkship has three layers.
The first layer is my regular weekly schedule. Every morning at seven we have rounds in which the twelve students in the program meet to discuss cases with experienced clinicians. These may be Medicine, Surgery, Pediatrics or Radiology cases. Following rounds, we have an outpatient clinic schedule, so that unless I have somewhere else to be (see below) I am in Neurology clinic on Monday morning, Psychiatry clinic on Monday afternoon, OB/GYN clinic on Tuesday, Pediatrics clinic on Wednesday morning, Medicine clinic on Wednesday afternoon and so on. There are student-led tutorials on Thursday afternoons where we cover core topics in a developmental sequence. Friday afternoon we have Radiology teaching or “Core Group,” time for reflection and learning skills of humanistic medicine.
The second layer is our inpatient experience. We take call and work on the different inpatient services of the hospital throughout the year. For example, instead of going to my clinics this week, I took medicine call on Sunday night and will spend the next few days on the resident service with the medicine team. My role here is similar to a traditional student, I admit patients, present them at rounds and do my best to manage them through their stay with the oversight of the team. We have inpatient time in Medicine, Surgery, Pediatrics and Psychiatry and we take call on Labor and Delivery. We return to each service many times during the year.
The third layer of the clerkship is our longitudinal patients. Wherever we meet a patient- in clinic, while on an inpatient service, in the OR or in the ED- we add them to our “patient panel.” We log them online so that whenever they interact with the hospital system in the future, we can be present for it. We get emails about their scheduled clinic visits and get paged if they come to the hospital. This allows us to follow patients from the office to the hospital to follow-up appointments, or from prenatal care to delivery to Pediatrics clinic. We see them in multiple speciality clinics and over long periods of time. We have the opportunity to see the course of their illness and to build long term, meaningful relationships with them.
The schedule is packed, we can be paged at any time, and by the end of the year we could almost always be attending multiple visits at once. We learn to triage and choose what visits are important based on the needs of our patients and our learning needs. We see the work patients have to do to get care from multiple providers and we see all of these providers interact with the same patient in different ways. This gives us a unique perspective on the healthcare system.
There are many things that I have loved about my longitudinal clerkship- it’s a wonderful and rigorous training program. I’ll return to discuss the program in more detail in the future, especially when I can compare month-long fourth-year rotations. But for now let me say that one of the principle virtues of the program is that during the the third year of medical school, a turbulent time of identity formation for future physicians, we learn to identify not with a service, or a hospital, or a specialty, but with the patients that we care for. I know that I’ll carry this with me for the rest of my career.
