The Longitudinal Model

A lot of people have asked me what I mean when I say I'm doing a "longitudinal program" for my third year of medical school. Usually I say that instead of doing all eight clerkships in separate 4-8 week blocks, we do them all at the same time. Plus, we follow "continuity" patients all throughout the year, and we have ethics meetings, and we have half days to explore other areas of medicine, and we do radiology, cardiology, and emergency medicine, plus, we do...

So, bottom-line I'm not drawing a good picture of what I'm doing out here in Asheville (mostly because I'm not totally sure yet!). But we do have Orientation this week, and our schedules have begun to pop up on our Google Calendars, so now I can give you a better idea of what the year is going to be like. We started off in the "traditional" model; I spent 6 weeks in Surgery and 6 weeks on OB/GYN (the other traditional clerkships are Family Medicine, Internal Medicine, Outpatient Medicine, Psychiatry, Pediatrics, and Neurology). Surgery was a wee bit different in that we weren't working with residents, only attendings. Still our first three months were more traditional, but now in October we begin our unique curriculum. So here is a typical week in Asheville, NC...

• Monday - in the mornings I am working in Family Medicine. Basically, as I understand it, I will be working with one of the docs in the clinic seeing patients, or we will be in the hospital if my doc is rounding at Mission. Shadowing is a thing of the past, as I will be taking the history, performing the physical, creating an assessment and plan, and then meeting with my attending to present the patient and my course of action. My plan will be accepted, tweaked, or thrown out, depending on the accuracy of my assessment. As trust builds with each attending, I will be able to take on more and more responsibility for my patients. Certain patients will become part of my "continuity of care" population. I will follow-up on these patients in the clinic, at referrals, at the hospital, and in the emergency department (we will be getting more information on this in the upcoming week, so we're all still a little uncertain as to how this will work). I have a new phone number specifically dedicated to these patients, and will take on the responsibility of being their care provider and advocate. I will work with the same attending all year in order to facilitate my own continuity.
• Tuesday - every other Tuesday afternoon I will be in Cardiology. Cardiology is not actually one of the "traditional" clerkships that most students take, but we are lucky enough to build in time with an outpatient group. No matter what I choose to practice, I will see congestive heart failure, heart attacks, and many other common cardiovascular abnormalities every day. I realized how important this block will be for me when I was describing a heart beat to my intern on OB/GYN as "lub, dub, SQUEAK! lub, dub, SQUEAK!" These hours will be well spent.
• Wednesday - in the mornings I am in outpatient Internal Medicine, and then we will all congregate in the lecture hall for afternoon didactic sessions. We will have lecturers from all the specialties, starting with Internal Medicine, Emergency Medicine, and Pediatrics this October. Other didactics are interspersed throughout the week, sometimes occurring immediately before or after a morning or afternoon clinic day. For example, I know that on Fridays I will be having Psychiatry group learning sessions before my afternoon shift. We also have Radiology lectures on Friday mornings at 7am, and Master Clinician Series teachings once a month. Two weeks out of the year we will drop everything and spend the entire week in Inpatient Medicine. This allows us to see what IM is like in the hospital, and care for patients on the floor and in the ICU.
• Thursday - Pediatrics in the morning and Neurology in the afternoon. Again, these follow a similar teaching style and development of continuity of care. For Pediatrics, I believe we are spending 6 months in a primary care clinic and 3 months in "specialty" Pediatrics (Cardiology, Neurology, etc.). And just like with Internal Medicine, we will take 2 weeks out of our schedule to spend a week in Inpatient Pediatrics, continuing to develop our inpatient skills.
• Friday - I will spend each afternoon in outpatient Psychiatry. As I understand it, the patients are aware that students will be part of their care on Mondays and Fridays. We are also extremely lucky to work in Adolescent Psychiatry later in the year.
• Weekends - about 3x per month we work 5 hour shifts in Emergency Medicine. Typically these are scheduled on the weekends, but a number are scheduled throughout the week. There will be a lot of time dedicated to skills development and emergency management. This year we will get academic credit for our work in the ED, which is a huge bonus because it gives us an extra 4 weeks of flexibility as fourth years.
• Free Blocks - as you may have noticed, there are typically 2-3 free mornings/afternoons a week. These are used to hone our skills in other clinics and to read about our patients. Also, as we begin to pick up continuity of care patients, we will follow them to their other appointments and procedures. We will also be rounding on these patients in the hospital in the mornings if any of them are sick enough to need inpatient care. Otherwise we can use free blocs to beef up our knowledge in other specialties. I am looking forward to spending more time on Trauma Surgery and additional sessions in Radiology, just to start. As I begin to see where my weaknesses are, I can fill in some of the gaps. For example, if I realize that my eye exam knowledge is lacking, I can spend a day in Ophthalmology. So these free blocks will fill up quickly!
• Group Meetings / Ethics Discussions - interspersed throughout the weeks we will continue to have group meetings and discuss ethics cases. As you can see, while there is free time each week, there is also a ton going on. Apparently, past classes have experienced the highest levels of internal stress in October, as they tried to figure out where to be, what to study, and how to start assimilating massive amounts of information. I'm sure our group will be no different.

Whew. Basically we were told by last year's group to check our Google calendar every morning so we know where we are supposed to be. Things can change on a moment's notice. So, actually I think my initial explanation of the longitudinal model was indeed correct. Instead of doing all eight clerkships in separate 4-8 week blocks, we do them all together at the same time. Plus...


For a video presentation on the program, see our YouTube video here!