CLIC Leap Day 2024 - Consortium of Longitudinal Integrated Clerkships

Over the past several decades healthcare has increasingly been conceptualized as a series of independent transactions that can be distributed nearly randomly among healthcare workers: The resulting fragmentation of care is ubiquitous and has been at odds with the fundamental relational nature of medical care.  

How would healthcare differ if the infrastructures, policies and technologies upon which care delivery is based were reoriented to prioritize relationships at every level? In this presentation, drawing from the commentary, Radical Reorientation of the US Health Care System Around Relationships, wherein 3 foundational recommendations are presented: 1. Structurally prioritize continuity of relationships, 2. Make room for relationships by removing sludge from the system, and 3. Realign reimbursement and research to prioritize relationships. Implementation tactics are provided to guide organizational leaders, policy makers, technology vendors and other stakeholders. 

• Describe one consequence of a transactional conceptualization of healthcare.
• Identify at least 2 tactical approaches to prioritize relationships within the physical structure, team structure, scheduling approach and/or technology within a work unit. Plan to bring home at least 1 change to remove sludge from the daily work of clinicians in your unit.
• Become inspired about the possibilities of reclaiming the joy in medicine.

Background
The benefits of Longitudinal Integrated Clerkships (LIC) in addressing workforce maldistribution have been established. However, medical students are not usually placed in areas that are most at need. This study explored the ideas and experiences of colleagues running successful LIC programs in small rural and remote communities.

Methods
Participants were attendees of the Personally Arranged Learning Session titled ‘How small is too small’ at the 2021 annual conference of the Consortium of Longitudinal Integrated Clerkships. The session was recorded with participants’ consent and recordings transcribed verbatim. Data was coded and analysed using a thematic analytical process.

Results
Participants (n = 11) explored definitions of “small community” for LICs and acknowledged variation in these due to context and student expectations. Issues related to successfully running LICs in rural and remote communities were discussed, with three main themes generated. 1) Fostering links explored the importance of intra- and inter-community networks to support curriculum and learning objectives, maintain effective preceptorship, and emphasize interprofessional learning. 2) Building trust examined how stable services, curriculum alignment, and delivering on promises affects student and community trust in LIC programs. 3) Creating change investigated the importance of building the education capacity of local sites through preceptor training and support, establishing supporting infrastructure, and securing community buy-in.

Discussion
If LICs are to increase medical workforce in areas most at need, placement of medical students in small communities should be supported. The authentic nature of learning opportunities in an LIC should align with placement in these small communities. This study identified that the development of broad networks, student and community trust, and community education capacity are key to the success of LIC programs in small communities.

• Understand social accountability as an equity-oriented health policy strategy in health professional education, health care service delivery and health research.

• Identify knowledge translation strategies, tools and approaches for system transformation towards a social accountability strategy.
• Describe practical examples of implementing a social accountability strategy at the Northern Ontario School of Medicine University, Health Sciences North (academic health sciences centre) and the Centre for Social Accountability (research institute) amongst other experiences.

Background
The benefits of Longitudinal Integrated Clerkships (LIC) in addressing workforce maldistribution have been established. However, medical students are not usually placed in areas that are most at need. This study explored the ideas and experiences of colleagues running successful LIC programs in small rural and remote communities.

Methods
Participants were attendees of the Personally Arranged Learning Session titled ‘How small is too small’ at the 2021 annual conference of the Consortium of Longitudinal Integrated Clerkships. The session was recorded with participants’ consent and recordings transcribed verbatim. Data was coded and analysed using a thematic analytical process.

Results
Participants (n = 11) explored definitions of “small community” for LICs and acknowledged variation in these due to context and student expectations. Issues related to successfully running LICs in rural and remote communities were discussed, with three main themes generated. 1) Fostering links explored the importance of intra- and inter-community networks to support curriculum and learning objectives, maintain effective preceptorship, and emphasize interprofessional learning. 2) Building trust examined how stable services, curriculum alignment, and delivering on promises affects student and community trust in LIC programs. 3) Creating change investigated the importance of building the education capacity of local sites through preceptor training and support, establishing supporting infrastructure, and securing community buy-in.

Discussion
If LICs are to increase medical workforce in areas most at need, placement of medical students in small communities should be supported. The authentic nature of learning opportunities in an LIC should align with placement in these small communities. This study identified that the development of broad networks, student and community trust, and community education capacity are key to the success of LIC programs in small communities.

Background:
Over 25 years ago the Riverland health service in South Australia began its partnership with Flinders University to create a Type C rural LIC, the Parallel Rural Community Curriculum (PRCC).
Despite educational success, most graduates of the PRCC chose to work outside the region and local clinical research remained negligible and passive. 

What we did:
In February 2021, the Local Health Network created the Riverland Academy of Clinical Excellence (RACE) as its vehicle for taking responsibility for training its own health professional workforce, prosecuting its own relevant clinical research agenda, and utilising both these elements for quality improvement.

Lessons learned:
Building on the educational experience gained through the medical student LIC, RACE gained accreditation as a residency provider and has recruited 26 new doctors into its residency program.
This increase of 25% in the region’s medical workforce then enabled the clinicians to contemplate research and development.
Building on residents with interests in public health, RACE formed a Public Health Unit. Journal clubs and Grand Rounds have begun. There is an expectation that all medical students and residents will undertake regular quality improvement audits.
RACE has become a preferred rural health service partner by Flinders University clinical researchers. The region’s clinicians are now chief investigators on four nationally competitive (NIH equivalent) clinical research grants linked to the region’s clinical priorities. 

Discussion:
LIC inspired residency programs can augment the workforce and research potential of LIC medical student programs in small rural LICs. In Australia, these residency programs must be led by the local health service, requiring a commitment from leaders to an academic mission which also generates a local clinical research capability. None of this would have happened if the small rural LIC had not planted the seed of what was possible.

• Develop principles of collaborative, multi-national medical education research.
• Consider and identify approaches to specific collaborative efforts.
• Identify means and processes for collaborative conversation and communication.