University of Colorado’s LIC Program

Medical school hasn’t changed much over the last few decades. However, the longitudinal integrated clerkship (LIC) program at the University of Colorado, Boulder, Colorado, has changed the way medical students experience their clinical rotation year, which may have wide-ranging implications not only for its students but for the healthcare system as a whole.

The school is the first major US medical school to fully transition from the block model to adopting an all-LIC program to train tomorrow’s doctors.

“With the clinical block model, you’re fully immersed in one thing, and then you leave it and forget it,” said Jennifer Adams, MD, professor of medicine and the assistant dean of medical education, clinical clerkships at the University of Colorado School of Medicine, Aurora, Colorado. Adams created the LIC program at the University of Colorado. “With the LIC, you form a panel of physicians you follow longitudinally throughout the year.

“At the beginning of the year, a student is placed with a preceptor in every specialty — pediatrics, surgery, and internal medicine — and they work with them every single week for a day or a half-day and meet patients who need ongoing care in those settings,” said Adams. “If a student is treating a patient in internal medicine who is sent to the emergency room, the student will follow that patient. Or if the patient breaks her arm, the same student will see that patient through orthopedics.”

A New Curriculum

While the LIC has been used internationally for decades, it started to catch on with US medical schools in the mid-2000s. The University of Colorado began its LIC at Denver Health, Denver, Colorado, in 2014 with eight students. In 2017, after several years at Denver Health and several other sites, the school decided to go all-in and started planning the transition.

“In 2021, the school launched an entirely new curriculum that included the LIC,” Adams told Medscape Medical News. “Now we have 16 different sites…the idea is that by partnering with our institutions, there’s really a win/win. The institutions have a lot more buy-in, and we figure out a proposal that works for them and the next generation of physicians we’re training.”

“We focus our curriculum on access to care and health equity and disparities, with a goal of creating a workforce pipeline,” Adams said. “For example, we have a LIC at our children’s hospital that attracts students who are interested in child health advocacy and trains our future pediatricians.”

Impact on Medical Students

At the heart of the LIC is the idea that patients’ healthcare needs are complex and cross over different specialties, so medical students should do the same. Students learn about medicine through the “patient lens.” And research shows that students strongly prefer this model. “Students get a mentor or coach who watches their skills develop and can push them to get better all year — someone who is just as invested in their success as they are,” says Adams.

In addition, we significantly accelerate student skill development. “We produce much better doctors at the end of the year than we ever did with the block model,” she says. Research shows that the LIC students score higher on factors like patient-centeredness and empathy — and that persists for many years into their practices. 

Challenges of the Program

The LIC requires more faculty than the traditional block model — the school scaled its faculty fourfold and now has 2000 faculty members. “When it’s just us in the university hospital, it was a much more predictable playing field,” she says. “The complexity is enormous, and one of the things we work hard at is comparability. I have 200 medical students in 16 different sites, and my job is that all 200 finish and pass the same tests and learn the same clinical skills…whether you’re in a tiny rural access hospital, a big university hospital, or at Kaiser. Everyone is trained and ready to deliver the same curriculum.”

An unexpected benefit has been the program’s positive impact on the faculty. “Having a medical student reminds you of why you went to medical school,” she says. The block model burdens faculty more, but with the LIC model, students add real value to the physicians’ practices, she added.

Reforming Healthcare

Abraham M. Nussbaum, MD, MTS, the chief education officer at Denver Health, recently wrote about his experience with the LIC program. His book, Progress Notes: One Year in the Future of Medicine, follows seven students through their LIC experience. With the LIC program, “you learn from the textbook of the body and the textbook of the community,” says Nussbaum. “Your job is to follow the patients where they go and see what they see.” This better equips students to make the most critical choice in their lives as doctors — choosing their specialty. And more LIC students are choosing to go into underserved areas.

Adams is studying how the LIC leads students to have higher levels of patient-care ownership and civic-mindedness. “We’re looking at commitment to community,” she says. “We’re interested in meeting a healthcare system’s needs…Traditional medical schools have thought ‘just get the students to graduation,’ and I think our responsibility is a long game. What do our communities need? What does society need? And how can we shape physicians to meet that need?”

And it’s the doctors of the future who will shape healthcare. “Typically, in the last 20-30 years, when people think about healthcare reform, it is about reforming it from the top down, or ‘what can I do as an individual clinician to avoid burnout,'” adds Nussbaum. “The future is our students, and the question becomes, how do we train our students differently to push these systems to be better? The LIC is the most evidence-based way to do that.”

Kelly K. James is a freelancer, content manager, and author of The Book That (Almost) Got Me Fired: How I (Barely) Survived a Year in Corporate America. She covers health/wellness, business/career, and psychology topics from her home in the Chicago suburbs.