Longitudinal Integrated Clerkships offer an opportunity for MD students to participate in the comprehensive care of patients over time

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“The longitudinal format of the LInC program is helping me develop a broad foundation for any specialty that I pursue in the future.”

Justin Lam, LInC student

Justin Lam engages with a patientClerkship has always been the time when students roll up the sleeves of their white coats to apply their skills and knowledge in a clinical setting. Launched in 2014-2015, the Longitudinal Integrated Clerkship (LInC) gives students the opportunity to participate in clerkship in a new and innovative way.

LInC students work longitudinally with a small number of preceptors, following a patient panel of 50-75 patients through their experiences in all core clerkship disciplines simultaneously, rather than moving from one discipline to the next, as in the block clerkship.

“We piloted LInC with seven students in the FitzGerald Academy at St. Michael’s Hospital,” explains our Clerkship Director, Dr. Stacey Bernstein, who led the introduction of LInC at U of T. “The program’s success and the positive response from students and preceptors led to its expansion in 2015-2016 to include Sunnybrook and North York General Hospital at the Peters-Boyd Academy, and Michael Garron Hospital and Toronto Western at the Wightman-Berris Academy.” In 2016-2017, there will be a total of 27 LInC students, comprised of eight students at each of the FitzGerald and Peters-Boyd Academies and 11 students at the Wightman-Berris Academy with the addition of Mount Sinai Hospital. “To support the program’s ultimate goal of having 50 students (approximately 20 per cent of the class) in a LInC on an ongoing basis, we are excited to bring LInC to the Mississauga Academy of Medicine for 2017-2018,” Bernstein says.

Justin Lam is a student in the Wightman-Berris Academy currently completing his LInC clerkship at Toronto Western Hospital. Lam noted that there are no ‘typical days’ in LInC.  “Each day is different from the last,” says Lam. “One day I’ll be in pediatrics; another, I’ll spend the morning in family clinic and the evening in psychiatry. I really appreciate the variety as it keeps me on my toes and makes life more interesting.” He admitted that there was a learning curve, but within a few months he could feel the knowledge he was acquiring in the different areas of medicine begin to coalesce.

The prospects of forming strong relationships with patients attracted Lam to LInC. “Some of the most meaningful and memorable moments have been from the relationships I’ve formed with my patients,” he says. After meeting a patient in obstetrics during her checkup, Lam recruited her for his patient panel. Although the patient’s caesarean section was scheduled at a time that conflicted with a mandatory class, as luck would have it, Lam’s pager went off early, and he was able to not only attend her birth, but also scrubbed in and helped deliver the baby. Six weeks later he saw mother and baby for their post-natal visit, and has been in touch since.

Lam notes that this longitudinal experience connects to what he considers a core pillar of medicine: the therapeutic relationship between doctor and patient. “I think that relationships are a central part of the LInC program, part of its DNA, and I think that's what really distinguishes it from other models of education – it puts the medical student-patient relationship at its centre and builds outwards from that,” he said.

He also appreciates the potential to customize his education through LInC’s ‘white space’ – the 1.5 days per week that enables LInC students to engage in self-directed learning. Lam uses his white space time to pursue areas of clinical interest. One afternoon he might be on a house visit with a palliative care physician; on another, he could be at SickKids rounding on patients with the Paediatric Nephrology Team. Another day might see him accompanying a patient as she navigates the health care system from appointment to lab to pharmacy. He also uses the time for research, for activities such as coding transcripts or meeting with his supervisor to discuss future work.

Learn more about LInC.

Students describe the best part of the LInC experience:

What was the best thing about the LInC program?

In partnership with the Wilson Centre, we look forward to welcoming faculty, administrators and students from schools around the world who have a Longitudinal Integrated Clerkship (LIC), as well as those who are interested in learning more about them as the University of Toronto hosts the 2016 Consortium of Longitudinal Integrated Clerkships in October 2016. View conference details and registration information.

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