We welcomed Professor David Hirsh from Harvard to discuss LICs

Professor David Hirsh with, from L-R, Dr Megan Brown, Professor Gabrielle Finn, Rebecca Leckonby (MBBS student on our LIC), Dr Judith Matthews and Annie Noble-Denny (University of Bristol)

In December, Professor Gabrielle Finn from our Health Professions Education Unit (HPEU), in partnership with the school’s Academy of Primary Care, welcomed Professor David Hirsh of Harvard University Medical School’s Academy of Educators to deliver a high-profile and thought-provoking seminar on the development and success of the innovative Longitudinal Integrated Clerkship (LIC) medical education model. David was instrumental in establishing the LIC model for medical education, back in 2003, to help reconnect the patient and the student in clinical training settings. Research has demonstrated that rebuilding these relationships helps ensure better learning. Furthermore, involvement with such training can facilitate students’ advocacy role as well as increasing future doctors’ sense of duty and commitment towards their patients.

This theory draws on the 1910 radical study into US medical education by Abraham Flexner. As part of a wide-ranging reform of medical education in the US, he identified the need to support continuity of service and facilitate closeness to patients as a means to develop compassionate, patient-centred medical professionals. Similar issues had been identified by David and his team at the turn of the 21st century with evidence suggesting a decline in professionalism, “patient-centredness” and empathy of medical students, especially those entering their core clinical years. Most interestingly, this was particularly evident in medical students, rather than other healthcare professions and was most pronounced in areas of the US which were greatest underserved by medical professionals and high areas of deprivation. There was, therefore, a need to restructure the medical education model to address these issues.

The model has proved popular and LICs in US universities and other parts of the world are now over-subscribed. Students have appreciated being more involved in seeing patients both before diagnosis and after discharge through multiple connections with the same patients. This continuity in education has helped generate positive reciprocal relationships whereby the patient matters to the student and vice versa. We are witnessing similar feedback in our LIC. David outlined that to help facilitate continuity in education, a new curriculum structure was required. The curriculum was, therefore, opened up over the whole year, rather than it being delivered in the traditional clinical specialism “block” format. David suggested that it’s a peculiar quirk of medical education that students learn in discreet themes; whereas teaching in schools, more generally for example, is structured to build knowledge over the course of the year.

In addition, David highlighted some recent evidence from the US that suggests an LIC approach may actually produce measurably improved health outcomes for patients. We would hope to see similar in the UK.

In addition to David’s presentation, Dr Kevin Anderson, Director of Primary Care Education and Academic Lead for our LIC, outlined how the LIC model has been adapted in our medical school, focusing on primary care. Dr Megan Brown also presented her on-going doctoral research into the development of medical professional identities, focusing on LICs at a number of medical schools around the world.

It was great to meet David, entertain him at our York campus, and discuss our exciting ideas for the future of the LIC model at the medical school focusing on the exciting opportunities in primary care.

Professor David Hirsh with Dr Kevin Anderson and Dr Megan Brown.

Further reading

Bartlett, M, Muir, F. A new model of undergraduate clinical education. Br J Gen Pract. 2018;68:216–217.

Brown ME, Anderson K, Finn GM. A Narrative Literature Review Considering the Development and Implementation of Longitudinal Integrated Clerkships, Including a Practical Guide for Application. Journal of medical education and curricular development. 2019.

Crampton, P, McLachlan, JC, Illing, JC. A systematic literature review of undergraduate clinical placements in underserved areas. Med Educ. 2013;47:969–978.

Hauer, K.E., O’Brien, B. and Poncelet, A.N. Longitudinal, Integrated Clerkship Education: Better for Learners and Patients. Academic Medicine. 2009;84:821.

Hirsh, D., Holmboe, E. and ten Cate, O. Time to Trust: Longitudinal Integrated Clerkships and Entrustable Professional Activities. Academic Medicine. 2014;89:201-204.

Illing, JC, Crampton, PES. Collaborative relationships and learning in rural communities. Med Educ. 2015;49:852–854.

McKeown, I, Parekh, R. Longitudinal integrated clerkships in the community. Educ Prim Care. 2017;28:185–187.

Strasser, R, Hirsh, D. Longitudinal integrated clerkships: transforming medical education worldwide. Med Educ. 2011;45:436–437.

Worley, P, Couper, I, Strasser, R. A typology of longitudinal integrated clerkships. Med Educ. 2016;50:922–932.