Reflection on our first term of the LIC

We now approach the last few weeks of our first term doing the LIC. I thought it might be useful for others considering doing an LIC to hear some of the reasons why I have loved it at times, yet on other days have wished I’d stuck to the conventional fourth year. I hope it might help others to decide whether it’s right for them.

Part of a team

Firstly, the routine is a bit more like work. This makes me feel like I have more of a purpose than I did in third year doing conventional blocks. I enjoy being part of a team in primary care and feel I have a useful role.

I recognise that I am getting better at taking histories, identifying important information and using clinical reasoning to come up with differentials. I believe this is due to the sheer numbers of patients we see each week doing the LIC.

Equally, I believe the LIC is making me confident in summarising cases to senior colleagues in front of patients. I have found it easy to accumulate longitudinal patients and have had some positive experiences following them to appointments and continuing their care over time.

When not in primary care, we’re in hospital having teaching, following patients to appointments and spending time on the wards. I like that the Friarage is a small hospital where you can get to know staff. I feel I can walk onto any number of wards, recognise a familiar face and be supported to clerk patients and perform clinical skills. The time spent at James Cook hospital has given us a bit more exposure to some of the more acute presentations that you don’t always see in the Friarage hospital, which is helpful.

Busy schedule

I do, however, miss rotating around clinical specialties. I miss focusing in on one area of medicine and the feeling of covering a specialty thoroughly.  

In terms of logistics, the LIC involves a lot of travelling. I commute to GP three days a week, which takes up an hour of my day. This isn’t so bad, however combined with additional hospital appointments for longitudinal patients, and my commute home on the weekends, I do feel that I’m in the car a lot.

I am placed in Masham GP surgery. Whilst I feel lucky to be there because the staff are great, most the patients go to Harrogate Hospital when they’re admitted to secondary care. This means I’m travelling to a slightly less familiar hospital, where staff are unfamiliar with the LIC. I would be lying if I didn’t say this can be daunting.

Another aspect of the LIC I have found to be challenging is that you cannot entirely plan what is going to walk through the door in GP. This means that you aren’t necessary seeing patients relevant to fourth year outcomes every day. Due to a very full timetable and lack of ‘white space’, it can feel you just have no time to learn about the things we’re meant to learn about this year.

Learning curve

However we have been told about the ‘J curve’ students travel along whilst doing an LIC, where they dip before they exponentially improve in skill and knowledge. We all laugh and agree at this stage of the LIC we’re skimming the base of  the J curve!

For students considering doing an LIC, I would suggest reflecting upon the type of student you are before deciding either way. I think students considering doing the LIC need to be confident, able to manage a degree of uncertainty, flexible and motivated with regard to self-directed learning.

Ruth Barker

Author: Ruth Barker

I'm a 4th year medical student at HYMS taking part in the Longitudinal Integrated Clerkship (LIC). I'm a graduate, having studied and worked as a nurse previously. I chose to do the LIC as I felt it would develop my clinical reasoning, get me used to making decisions and also provide a bit more patient continuity. The idea of rural GP really appeals to me being a farmer's daughter and a keen runner and cyclist.

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