UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE

T U S C A L O O S A L O N G I T U D I N A L C O M M U N I T Y C U R R I C U L U M

T U S C A L O O S A R E G I O N A L C A M P U S

C C H S . U A . E D U / T L C 2

Urgent appeals for reform of clinical medical education call for a move away from the traditional, block-rotation model to a hands-on learning approach that is more patient-centered than specialty-centered, and that appreciates the profound impact social factors have on health and illness. The Tuscaloosa Regional Campus of the University of Alabama School of Medicine is addressing the need for change in clinical undergraduate medical education with the Tuscaloosa Longitudinal Community Curriculum (TLC²). TLC² is the innovative, community-immersion, longitudinal integrated clerkship for third-year Tuscaloosa Campus students that emphasizes a strong foundation in clinical medicine and that promotes self-directed learning and professional development.

A NEED FOR CHANGE

“One of the major benefits was seeing patients over a long period of time. You get to see what it looks like when the patient presents with asthma for the first time and then how things unfold with treatment. You get to see if what you told them the first time was what they needed to hear. You get to get better at those things because you can see when you fail.”

—KAY RAINEY, MS4

TLC² students learn clinical medicine, in part, by developing a panel of patients that they follow and care for over nine months, through various disciplines and in all settings, including primary care and specialty clinics, hospitals, emergency rooms and nursing homes. Students learn to care for patients as people instead of as merely a procedure or disease process, and they become integrated members of the health-care team. The traditional clerkship model is typically limited to single, isolated encounters with a patient, but longitudinal clerkship students are also able to follow the patient’s progress and see how clinical decision making impacts the patient’s health. TLC² students have the benefit of seeing how patients respond to treatment and how health and disease evolve over time and in the context of social and cultural influences.

PILOT TLC² STUDENT

1. Take part in the comprehensive care of patients over time;

2. Meet core clinical competencies across multiple disciplines;

3. Form long-term relationships with mentoring physicians;

4. Appreciate the resources available or lacking in community settings;

5. Understand and experience the broader professional roles of physicians.

LONGITUDINAL CLERKSHIP STUDENTS BUILD CLINICAL SKILLS AND CONFIDENCE AS THEY:

Students work with preceptors at University Medical Center in Tuscaloosa and at practices in rural and urban communities across Alabama. With years of experience running community-based family medicine and rural rotations, Tuscaloosa faculty work with a network of Alabama physicians to find the right sites and preceptors for students.

“I really appreciate the long-term relationships I built with my patients. I got to know them on a more intimate level than if I had been on an eight-week rotation. Caring for a patient during her pregnancy, then being able to deliver the baby, was an experience I'll never forget."

—ELIZABETH JUNKIN, MS4 PILOT TLC² STUDENT

TLC² prepares future physicians pursuing any specialty with a superior general professional education and is ideal for students interested in family medicine, pediatrics and internal medicine, as well as other community-oriented careers, including emergency medicine, general surgery, OB/GYN and psychiatry. TLC² students also receive elective credit for a unique course that integrates population medicine, health policy and physician leadership. The Tuscaloosa curriculum is modeled after well-established LICs, including those at the University of Minnesota and Harvard Medical School. Research shows that LIC students are more satisfied with their clinical education, are competitive residency candidates, perform as well or better on standardized tests of knowledge and skills, have deeper connections with patients and attain and sustain higher levels of patient-centered attitudes.

A TLC² student may start by following a pregnant patient in obstetrics, help deliver the baby, then follow the newborn through well-baby checks and continue to care for the mother.

PATIENT 2

A TLC² student might see an adult patient at an initial visit, accompany him to specialty consults, assist in surgery on the patient, then see him back in the primary care doctor's office for follow-up visits.

PATIENT 1

Following the care of patients over nine months lets TLC² students build relationships with both their patients and their preceptors. This results in a meaningful experience for students, who become part of a health-care team, which is less likely to happen under a traditional block schedule.

TIME

LONGITUDINAL INTEGRATED CURRICULUMInstead of following a traditional block schedule, TLC² students follow and care for patients through the

nine-month experience. This may take them through various disciplines and settings simultaneously, including primary care and specialty clinics, hospitals, emergency rooms and nursing homes.

“Our curriculum has been very conventional for decades. The change with the TLC² curriculum is that it is more patient-centered than discipline-centered…and really allows students to build relationships with their patients while still meeting the same educational objectives that we’ve always had. The question is, why isn’t every medical school doing this? It clearly makes sense.”

—CRAIG HOESLEY, MD SENIOR ASSOCIATE DEAN FOR MEDICAL EDUCATION, UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE

“In traditional clerkships, students don’t have an

opportunity to form long-term relationships with their

clinical teachers. In TLC², the opportunity for a long-term

mentoring relationship allows for professional growth, and

students develop an enduring connection with their core medical practice and the

community.”

—THADDEUS ULZEN, MD ASSOCIATE DEAN FOR MEDICAL EDUCATION,

TUSCALOOSA REGIONAL CAMPUS

WHY IS THE UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE PURSUING A LONGITUDINAL COMMUNITY CURRICULUM? The Tuscaloosa Regional Campus leads the University of Alabama School of Medicine in addressing the need for a change in undergraduate medical education. Robust and growing research on the effectiveness of LICs has added to the rapid expansion of the model across the United States, Canada, Australia and elsewhere. TLC² also responds to the School of Medicine’s mission to address the primary care and community physician needs of the region.

WHAT ARE THE ADVANTAGES TO MEDICAL STUDENTS?

TLC² uniquely prepares students to provide and appreciate comprehensive and continuous care of patients over time. LIC students become self-directed learners, more patient-centered and have a more expansive clinical experience than students in traditional clerkships. Flexible scheduling enables students to accompany their patients to specialty care and in both ambulatory and inpatient settings, and promotes sustained community engagement and scholarly research.

HOW DOES TLC² COMPARE TO THE STANDARD UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE CURRICULUM?

TLC² students meet the same learning objectives, have the same required patient encounters, are graded using the same metrics, take the same standardized exams and have the same opportunity to earn honors as all University of Alabama School of Medicine students. TLC² students obtain these competencies over the entire third year instead of in separate blocks.

FAQ

WHAT DO RESIDENCY DIRECTORS THINK ABOUT STUDENTS WHO COMPLETE A LIC CURRICULUM?

Experience shows that students who complete a LIC curriculum are attractive residency candidates. Because of their long-term teaching relationships with LIC students, faculty can write personal and effective residency letters of recommendation based on first-hand knowledge of student growth and progress. LIC students graduate with strong, self-directed learning skills, better understand patient management and the consultation and referral system, and can effectively utilize community resources.

WHAT TYPE OF PATIENT POPULATIONS WILL STUDENTS WORK WITH?

Students see patients of all ages with medical needs across the spectrum of traditional and sub-specialty disciplines.

HOW ARE PRECEPTORS AND SITES SELECTED FOR STUDENTS?

Determining placement sites for students is a thoughtful, individualized matching process. Locations and principal preceptors will vary from year to year, and include University Medical Center in Tuscaloosa and rural towns and urban communities around the state. With years of experience running community-based family medicine and rural rotations, Tuscaloosa faculty use an extensive network of preceptor relationships and work with students to identify sites and preceptors that fit students’ personalities and needs.

ARE OTHER MEDICAL SCHOOLS USING THIS TYPE OF CURRICULUM?

Yes, some schools have been teaching this way for decades, and in the last five to 10 years many more schools, both in the United States and elsewhere in the world, have adopted longitudinal integrated clerkships (Brown University, Harvard University, University of California San Francisco, University of Wyoming, Texas A&M University and Duke University, to name a few).

T U S C A L O O S A L O N G I T U D I N A L C O M M U N I T Y C U R R I C U L U M

CONTACT:B R O O K H U B N E R

B H U B N E R @ C C H S . UA . E D U( 2 0 5 ) 3 4 8 -1 3 8 4

Students interviewing with the University of Alabama School of Medicine (uab.edu/medicine/admissions) who are interested in participating in TLC² should indicate the Tuscaloosa Regional Campus as their preference when asked to rank their campus choices. Campus preference does not affect admission status with the School of Medicine.

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