CLIC Conference 1
Dr Natalie Radomski and Professor Geoff Solarsh attended the Consortium for Longitudinal Integrated Clerkships (CLIC), International Conference, Big Sky Montana 29 September – 2 October, 2013. Natalie gives her impressions and an outline of her oral presentation.
Conference report
The theme of the CLIC conference was exploring ideas in medical education as they relate to longitudinal integrated clinical clerkship (LIC) programs. Approximately 190 delegates attended.
There is noticeable shift in emphasis from descriptive or exploratory research about LIC programs to a deeper level of research. Many research presentations aimed to compare educational outcomes achieved in LIC placements with mainstream ‘block style’ placements in hospital settings. It was interesting to note an increasing focus on defining what counts as a Longitudinal Integrated Clerkship (LIC) for research and program evaluation/comparison purposes. Three core criteria are used to distinguish LICs from other longitudinal/ integrated medical education programs. To ‘qualify’ as a LIC students must:
- be actively involved in comprehensive healthcare activities over time (more than 6 months)
- have continuing learning relationships with clinicians and patients over time
- be able to meet the majority of their required clinical competencies across multiple disciplines simultaneously
Questions about how to evaluate student contributions to comprehensive care in a meaningful were raised in a number of presentations. As far as I could tell, rigorous measures/methods have not yet been identified/applied.
A range of conceptual lens/theoretical frameworks such as actor network theory, complex adaptive systems and socio-cultural learning theories are being applied to LIC research studies (e.g. Exeter Peninsular Medical School Program).
Concepts such as ‘primary care medical home’, ‘patient-centred medical home’ and ‘extra-mural hospitals’ were discussed in several plenary and oral presentations. These descriptors were new to me and may provide useful search terms when investigating comprehensive health care models from an international perspective. Key elements of these models included: a focus on addressing complex chronic healthcare needs, improving patient access to the health system, fast tracking health care, interprofessional teamwork/coordinated care, quality of care and patient safety. New healthcare roles were also described as part of the medical home model including ‘transition navigators’ – practitioners employed by a particular unit/hospital to assist patient access/continuity of care.
A number of suburban LIC models are in development. These initiatives aim to replicate the three definitional elements of LICs in a different context.
Outcomes resulting from conference attendance
- The positive feedback received about our Whole-of-Practice supervision model has been encouraging. Several people commented that the study and unit of analysis used was ‘novel’. I am currently working on a journal article with Pam Harvey, Dennis O’Connor and Kylie Cocking for submission to MJA.
- I have also prepared Faculty learning and teaching grant application for 2014 seed funding to progress Whole-of-Practice teaching methods (Team application with Geoff Solarsh, Pam Harvey, Dennis O’Connor and Kylie Cocking). The application will be submitted at the end of November. If successful these seed funds will be used to prepare a larger Office of Learning and Teaching funding application in 2014.
- I recently facilitated a SRH Journal Club discussion about the graduate outcomes achieved from the Minnesota RPAP program drawing on recent site visit and Zink et al. article below.
References of interest from CLIC conference
- Hirsh, D., Walters, L., & Poncelet, A., (2012). Better learning, better doctors, better delivery system. Possibilities from a case study of longitudinal integrated clerkships. Medical Teacher, 34, pp.548-554.
- Teherani, A., Irby, D., & Loeser, H. (2013). Outcomes of different clerkship models: Longitudinal integrated, hybrid, and block. Academic Medicine, 88, pp.35–43.
- Zink, T., et al. (2010). Efforts to graduate more primary care physicians who will practice in rural areas: Examining outcomes from the University of Minnesota-Duluth and the Rural Physician Associate Program, Academic Medicine. 85(4), pp. 599-604.
Oral presentation
Whole-of-Practice Teaching Models in Rural General Practice: Not just filling the Gaps
Co- authors:
Ms Pam Harvey, Lecturer, North West Rural Medical Education Unit, Monash University School of Rural Health
Professor Geoff Solarsh, Head, North Victorian Regional Medical Education Network, Director, Bendigo Regional Clinical School, Monash University
Dr Dennis O’Connor, Senior Lecturer, Year 4 GP Discipline Leader, Bendigo Regional Clinical School, Monash University
Ms Kylie Cocking, Research Assistant, North West Rural Medical Education Unit, Monash University School of Rural Health
Brief Oral Presentation Introduction/Rationale:Sustaining rural general medical practices as settings for curriculum innovation is a growing priority. Much research has focussed on clinical apprenticeship models of teaching with ‘GP supervisor-patient-student’ interactions as the unit of analysis. Relatively little attention has focused on whole-of-practice teaching models that recognise the educational contributions of clinicians and practice administration staff.
This paper presents findings from a qualitative study investigating how rural General Practice staff are operationalising a 36-week undergraduate Community-based Medical Education (CBME) program in their healthcare settings. The program is located in north-western Victoria, Australia and is in its fourth implementation year.
Methodology: 18 semi-structured interviews were conducted with GP supervisors, practice nurses, allied health clinicians and practice administrators in five rural practices. Thematic analysis aimed to identify how the CBME program was evolving in each Practice setting and the day-to-day educational contributions shaping curriculum implementation. A GP program coordinator focus group considered whole-of-practice themes and implications for CBME sustainability.
Results: Our findings highlight a diversity of informal and formalised educational activities, workplace structures and supervisory relationships that supported CBME program implementation in the General Practices. The proactive approach taken by practice administrators in facilitating student integration within the practice environment, in monitoring student learning and in adapting CBME activities for the local setting were recurring themes.
Conclusions: This study challenges narrow definitions of General Practice teaching and reveals a more nuanced, group approach to educational supervision and program development. This is not to displace the central role that GP supervisors have in facilitating clinical learning – but to see teaching encounters within a bigger framework of educational engagements, relationships and program responsibilities. Given increases in GP-based teaching across the vocational training continuum, it may be helpful to consider how whole-of-practice approaches to CBME placements can be recognised and advanced.