LICs and the Double A MC

In mid-November, I attended the American Association of Medical Colleges annual meeting known as “Learn, Serve, Lead 2014” in Chicago. It was my first trip to both the “Double A MC” and Chicago – what a lovely and fascinating city! Some down time included a boat architecture tour and some great jazz at a bar in place from the 30’s whose patrons included Al Capone (the Saskatchewan connection). I will be going back.

The conference had some great keynote speakers including Alan Alda who spoke on communicating science and medicine, and emphasized the importance of empathy and clarity in communicating both.

Some of the challenges we have had provincially to get a Strategy for Patient Oriented Research initiative into CIHR relate to our challenges in communicating what science can do for our provincial healthcare system. Something else we all must work on, I believe.

Another keynote speaker was Mahzarin R. Banaji, one of the authors of Blindspot: Hidden Biases of Good People. She is a spellbinding speaker with an important message based on rigorous neuroscience and cognitive psychology research. This reminds me of the work on cognitive and affective bias in diagnostic reasoning and the work we did at Dalhousie with Dr. Pat Croskerry. I am interested in hearing from faculty members who have an interest in this topic.

However, it was the workshop on Longitudinal Integrated Clerkships (LIC) that I think was a historic moment for the AAMC. I am sure many are familiar with LIC’s but for those who are not it is an entirely different model for teaching clinical medicine and for structuring third year.

While Australian’s and Canadian’s (UBC, U of A, U of C, NOSM and Dalhousie) are noted leaders in this model, it has been spreading rapidly throughout the world in the last 10 years. A number of new medical schools have gone with the LIC model as their sole method of teaching third year (e.g. NOSM).

The LIC has its curriculum organized on a longitudinal and integrated basis. It is distinguished by the absence of traditional discipline-based rotations. Models vary, but students are often based in a family practice for two  or three half-days per week and have additional clinical experiences with other disciplines and in hospitals scheduled through the rest of the week.

Students are encouraged to follow their own bank of patients over time, and benefit from the continuity of supervision as preceptors see their clinical skills develop over the entire year.

Models are often based in rural communities, but urban models are also successful (Harvard, UCSF). The salient features have been summarized as continuity of patient care, curriculum, supervision and empathy!

I have attended meetings of the Consortium of LIC’s (CLIC) since 2008.  There is no doubt there is a counter-culture aspect to this group who truly believe they are going to profoundly change clinical education. And to their credit, they have been meticulous in doing the medical education research to prove their point. Repeatedly evidence has been documented that LIC students do as well or better on objective standardized testing (and some evidence for better long-term retention).

Furthermore, these learners have better clinical skills and greater preservation of the empathy they had when they entered medical school. Anecdotally it is noted that many program directors search out LIC candidates at CaRMS time. And for our communities and our funders, there is lots of evidence LIC students choose more generalist careers and rural practice settings.


This workshop was remarkable in that AAMC and LCME (the American accrediting body) would not often be described as counter-culture. All of the above was presented together by faculty members from such disparate place as Harvard University and the University of South Dakota and summed up by Dr. Dan Hunt, a noted accreditor for the LCME and medical educator.

Dr. Hunt helped with the launch of the Northern Ontario School of Medicine where all the students do an eight-month LIC in third year.  With a red hat on, representing LCME, Dr. Hunt stated LCME “does not care” what model of clerkship a medical school uses. With a blue hat, on representing himself, Dr. Hunt wholeheartedly endorsed the LIC as an excellent and possibly better way of teaching third year.

The traditional rotation-based clerkship was certainly perfectly designed for John Hopkins Hospital in 1910 and obviously has continued to serve us well as evidenced by the personal experience of many of us. However, I do believe we are approaching a “the world is not flat moment” around the best approaches to clinical teaching in UGME.

Last year we had a pilot of an LIC in Prince Albert and we have decided to take some time this upcoming year to refine that model. We will look to our strategic plan for distributed medical education to identify where we should establish LIC’s in Saskatchewan.

I invite faculty members and students to apprize themselves of the literature on LIC’s and enter into a discussion about the role of LIC’s here in our CoM.