Longitudional Integrated Clerkships (LICs)

[Luftwaffle]

So my school offers a few different clerkship tracks (tracks we have to decide on before actually starting M1) , including an LIC track. I wanted to see what people’s experiences with those have been like/if they recommend the experience. I’m having a hard time deciding if I want to do the LIC clerkship track or stick to the traditional clinical rotation schedule.

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[ndafife]

So my school offers a few different clerkship tracks (tracks we have to decide on before actually starting M1) , including an LIC track. I wanted to see what people’s experiences with those have been like/if they recommend the experience. I’m having a hard time deciding if I want to do the LIC clerkship track or stick to the traditional clinical rotation schedule.

Had some friends who enjoyed it at my school.
Positives:
1. Lots of built in free time to the schedule to explore specialized interests (N=1 here so it really depends on how your school schedules their LIC)
2. Build year long relationships with preceptors = lots of hands on experience
3. Take the shelf exams all together twice - really prepared to take Step 2 CK right away at the end of 3rd year

Negatives:
1. Tough for inpatient specialties. When you're only with surgery or IM one day a week it is pretty hard to get used to following a patient throughout their hospitalization
2. Need to be pretty self directed with studying. You need to make sure not to save all the studying for the end.

 

[curbsideconsult]

In theory it's nice, but LIC gets old really quickly. Even if you're certain you're going to do outpatient medicine for the rest of your life, it's not worth spending an entire year in LIC. Also, what if you get through half the year on LIC and you realize that you don't want to do outpatient medicine?

As for shelves, I can't fathom doing well on certain shelf exams without doing the corresponding block. You may be different. Maybe you can do just fine with inpatient-oriented clinical questions without experience in the hospital setting, but I couldn't do it.

I vote for the traditional block schedule. If you get some elective time, try to do an outpatient elective in FM or IM. This way you'll get plenty of experience for both inpatient and outpatient.

 

[Mad Jack]

LICs are universally hated by the students I have encountered

 

[Quantal Reasoning]

Longitudinal integrated clerkships are up there with PBL and flipped classrooms as some of worst ideas to grace medical education.

 

[Med Ed]

So my school offers a few different clerkship tracks (tracks we have to decide on before actually starting M1) , including an LIC track. I wanted to see what people’s experiences with those have been like/if they recommend the experience. I’m having a hard time deciding if I want to do the LIC clerkship track or stick to the traditional clinical rotation schedule.

The only reliable source of information about the LIC track will be students at the school who have gone through it (or are in it now). If you're on the fence then stick with the traditional schedule.

 

[mehc012]

LIC is awful.
And I say this as a fan of PBL, even.
Down with LIC!!

 

[Terps1011]

Just finished my 3rd year on an LIC curriculum and I LOVED it! I was one on one with all my outpt preceptors and have my own crew of patients who saw me. Got to do all the extra things in clinic (30+ paps, 1 IUD, few colpos, few joint injections, few skin lesion removals, etc). We have 15weeks inpt built in and at our program there are very few residents so i was first assist on almost all surgeries. We have a lot of open time to explore other things so i filled this with research and extra time in the OR/OBGYN clinic! Everyone except one person that i know that did the LIC at our campus loved it. We also had the perk of no call, only one weekend of required clinical time all year, and only one week of nights. As others said we too took the shelves all at the end of third year so i was ready to take step 2 1 week after finished third year ( took it last week!). I assume LICs are school dependent to some extent but i couldn't have enjoyed it anymore than I did!

 

[Luftwaffle]

LIC is awful.
And I say this as a fan of PBL, even.
Down with LIC!!

What don't you like about it?

 

[Luftwaffle]

Just finished my 3rd year on an LIC curriculum and I LOVED it! I was one on one with all my outpt preceptors and have my own crew of patients who saw me. Got to do all the extra things in clinic (30+ paps, 1 IUD, few colpos, few joint injections, few skin lesion removals, etc). We have 15weeks inpt built in and at our program there are very few residents so i was first assist on almost all surgeries. We have a lot of open time to explore other things so i filled this with research and extra time in the OR/OBGYN clinic! Everyone except one person that i know that did the LIC at our campus loved it. We also had the perk of no call, only one weekend of required clinical time all year, and only one week of nights. As others said we too took the shelves all at the end of third year so i was ready to take step 2 1 week after finished third year ( took it last week!). I assume LICs are school dependent to some extent but i couldn't have enjoyed it anymore than I did!

So your experience seems to encompass a lot of the pros I've heard about it at my school, though the limited call thing is definetely unique to your campus

 

[Terps1011]

So your experience seems to encompass a lot of the pros I've heard about it at my school, though the limited call thing is definetely unique to your campus

Yah i think we luck out in that regard. Our LIC campus scores higher on step 2CK and has a higher step 2CS pass rate too, we also take it 2 months earlier on average! Do you have a student a year or two above you that you can ask about the LIC at your campus?!

 

[mehc012]

What don't you like about it?

It's honestly all of the normal downsides of 3rd year, only accentuated.
It's already frustrating/tiring switching services every few weeks, just when you've learned them. Switching multiple times per week? Even worse. Each session seems like starting over, almost, and it's mentally tiring. Plus, it exacerbates the 'not experiencing everything before scheduling AIs issue', at least for some very unlucky folks at my school with how our schedules are set.
You're more out of sync with your classmates, and the didactics you do don't correlate to what you're seeing in clinic as well as they do when you're on a dedicated rotation.
Evals are even more of a nightmare than usual.

Basically, take any complaint people have about normal 3rd year and compound it.

 

[CharmanderMD]

I loved LIC. We have it for half a year during 3rd year.

Pros (at least at my school):
- About five months with the same ATTENDING means they get to know you very well and trust you a lot as time goes on which results in more meaningful rec letters for residency
- Free time to explore other interests (great if you’re interested in neuro, radiology, etc.). One of my friends, for example, is going into CT surg and got to spend half a year one on one with a CT surgeon and he could use free spaces to get extra OR time
- You really keep up your knowledge on all specialties at once. I had LIC second semester and barely had to study for step 2 as a result
- free time for yourself. It’s great having extra time to study or sleep, especially when afternoons on traditional blocks often consist of just wait around with residents for a new admission
- you get well acquainted with all aspects of outpatient medicine among all fields. I felt it was extremely helpful with getting good at history and physical and preparing for CS as the patients are usually able to provide a detailed history and participate in all aspects of the exam. For OB it was great seeing women in every stage of pregnancy and life in general. As someone who isn’t going into surgery it was great to see the outpatient side more and understand when surgical consults are necessary.

As for cons I don’t have much to say. Some of my classmates didn’t like it but they were usually the people that don’t like anything. I will say I had the better side of the coin though having LIC second semester instead of first.

 

[ed*26]

At my school we are longitudinal for part of the year. I haven't gone through it yet, but it seems like the biggest downside is the schedule is a lot more rigid. We just got our schedules, and a decent chunk of my class is stuck with some of the important cores (like surgery or medicine) at the end of the year with no option to switch. We do have a lot of freedom for our elective time, but I have no idea what people who want to go into surgery or IM are going to do if they haven't completed the core yet, especially since you have to schedule aways and AIs in the middle of third year.

 

[mehc012]

At my school we are longitudinal for part of the year. I haven't gone through it yet, but it seems like the biggest downside is the schedule is a lot more rigid. We just got our schedules, and a decent chunk of my class is stuck with some of the important cores (like surgery or medicine) at the end of the year with no option to switch. We do have a lot of freedom for our elective time, but I have no idea what people who want to go into surgery or IM are going to do if they haven't completed the core yet, especially since you have to schedule aways and AIs in the middle of third year.

Yeah, this has been a problem at my institution, too. Also, remember that freedom for elective time doesn't really help you much if the major prereq rotations (IM, surg) happen AFTER it, as your options will be decidedly limited by that.

 

[Luftwaffle]

Yah i think we luck out in that regard. Our LIC campus scores higher on step 2CK and has a higher step 2CS pass rate too, we also take it 2 months earlier on average! Do you have a student a year or two above you that you can ask about the LIC at your campus?!

I do, I’m using this thread to generate specific questions to ask them actually. Thank y’all for the insights tho!