Longitudinal clerkship vs. Traditional medical curriculum

It’s been a while since the last update and our time on the Longitudinal Clerkship is moving on apace. Here are some views on the difference between an LC and the more conventional medical curriculum.

“tailor the week to the student’s needs”…

Seeing up to 20 patients myself in three days of GP is busy…it opens up lots of learning opportunities, identifies holes in your knowledge and creates space for reflection. However, this comes at the expense of other things – like assessments! The beauty of the LC though, is the flexibility to adapt the programme and tailor the week to the student’s needs. For example, through discussion with my tutor and practice manager, I now have a single slot every week that is fenced off for Mini-CEXs, Case Based Discussion and general PPD topics. We’ll both see the same number of patients in the day, but things have been tweaked a little to run more efficiently – this is a small change that makes a big difference – which can only be afforded by the flexibility of this new curriculum model.

…Secondary Care

Previously, I spent most of my time bouncing between outpatient clinics and ward rounds whilst in Raigmore. This was good for honing practical skills and experiencing various aspects of specialist care. However, more recently I have set up a number of mini-placements in various departments of the hospital. As a student with an enthusiasm towards acute care specialties, I was able to spend a full day in ICU – attending to some really ill patients and putting my long-forgotten physiology/biochemistry knowledge to the test. The great advantage of the LC is being able to arrange your own clinical attachments be it for personal/career interest or to fill in learning gaps. I hope to soon visit Paediatrics, Psychiatry, O&G and A&E as part of my involvement in secondary care.

Skillset…

Something I hadn’t appreciated before embarking on the LC were some of the skills and qualities we would develop throughout the year. The Scottish CMOs report, ‘Realistic Medicine’ really pedals the importance of communication, conversation and organisation. I really like the quote in the report:

The single biggest problem with communication is the illusion that it has taken place.” George Bernard Shaw.
 Relative to the conventional Dundee programme, I will see upwards of 500 patients in GP myself – handing over each and every case to my GP tutors throughout my time here. Furthermore, I write about 2-3 referrals per week to secondary care. No matter which career path I end up taking, the skills I will acquire from these forms of communication will prove hugely advantageous as all doctors are involved in handover and multidisciplinary care. I would have some exposure to these skills within the traditional programme but the constrained nature of 10x four-week blocks means that I wouldn’t get to see the result of the referral or the long-term impact on the patient and clinical team.

 

 

Q&A…

Q: Do you feel your colleagues have a better knowledge grasp because they focus on the same block for weeks at a time?

A: Yes, they probably do. You would expect a student who is studying cardiology for a week to be in the mind frame of cardiology – we can’t be that focussed because General Practice is General! However, I think their expertise is transient by the time finals come around and preparing for 5th Year and FY. We see a little of every speciality throughout the entire year, slowly topping up our memory banks rather than being intensely involved in one speciality for a month before forgetting it all in time for finals.

Q: What elements of the curriculum are you missing out on?

A: This is a hard one. The quick answer is, I dont think there are any big areas we don’t experience. Most of medicine can be seen through the community, (I see my fair share of paediatrics, psychiatry and medicine in GP). Our secondary care time allows us to catch up on the things you naturally won’t see in GP (surgery & acute care for example). Of course there will be some super-specialist things we don’t see in the Highlands as the service isn’t provided here. However, what I think is just as important and to answer a question with a question – what do we experience on the LC that your typical medical student won’t?

Comments are closed.