What is the history of PCLT?
It came out of a call by the Chancellor of Duke Medical Center to train physicians in primary care. A group of faculty and students met as an advisory group to determine the plan for the leadership curriculum.
Why longitudinal integrated clerkships?
The LIC provides continuity with several physician preceptors at once, continuity with patients, and opportunity to develop clinical skills over time in the same clinical settings. Duke chose to use the LIC model to allow students to see the health care system through patients’ eyes. LICs have been researched extensively. Students in LICs have close clinical supervision, perform equal to peers academically, maintain empathy toward patients, and do well getting residency positions.
What is the difference between the longitudinal integrated clerkships of the PCLT and the LIC?
Focus– PCLT focuses on primary care and population health. LIC offers experience for any career path.
Duration – PCLT is a four-year curriculum. LIC is the clinical year only
Longitudinal Integrated Clerkship
Both PCLT and LIC students:
- have an approximately 8-month longitudinal integrated clinical experience
- participate in a weekly seminar
- meet together for a longitudinal behavioral health seminar
- Have requirements in Urgent Care and Emergency Room care
PCLT students during the LIC also:
- participate in group prenatal care and have the opportunity to attend the deliveries of the babies from the group
- are placed with primary care providers to complete requirements in medicine and pediatrics and family medicine
- participate in a 7-day Orientation to the Durham Community
- give a half day of service to a community agency of their choice that is serving an underserved population
- complete a QI project with one of their primary care clinics
- receive didactic sessions on population health improvement
- continue leadership training with peer teaching during the seminar
Who are the PCLT staff? Who should I contact with a question?
Susan Rogers is the Program Coordinator. It's usually best to e-mail both with a question. E-mail Barbara Sheline, PCLT Director, with any questions about the curriculum.
How is the first year different from the standard Duke curriculum?
PCLT students participate in a 2 ½ day Pre-Orientation to start their leadership training. Their leadership training continues during the rest of first year through weekly group meetings, monthly dinner discussions and a service project fall and spring. PCLT students provide each other with peer feedback regarding leadership skills. They participate with the traditional track students in all other aspects of the first year curriculum.
What does the second year look like?
PCLT students participate in a 7-month Longitudinal Integrated Clerkship (LIC) where they learn medicine alongside faculty in their clinics in family medicine, pediatrics, general internal medicine, and gynecology. In addition, PCLT students serve a community agency working on health issues one half day each week during LIC. Students follow pregnant patients through pregnancy and delivery in a Centering model of group prenatal care. They follow patients to surgery, therapy, and specialty visits. They meet weekly in the Primary Care Seminar to share experiences and learn clinical medicine topics.
PCLT students complete an orientation to the Durham community and learn about community engagement.
There are inpatient immersions in internal medicine, neurology, surgery, psychiatry, and pediatrics. PCLT students attend a Behavior Health Seminar as well as population health seminars each designed especially for PCLT with primary care in mind. PCLT students attend the Clinical Skills Foundation and Clinical Skills Course with students in the traditional track
How is the second year graded?
Grading is the same as in the traditional system, with shelf exams weighing the same. Students will receive most of their evaluations from faculty rather than from residents.
How will shelf exams work?
Shelf exams are spread throughout the year to be taken at appropriate times for the students' learning.
How will the second year experience affect the residency application process?
Duke’s PCLT graduates report that they have been extremely successful at getting their top choice of residency positions. Longitudinal clerkships are becoming more common and thus more known to residency programs. The students report programs in general being open and curious about the LIC during residency interviews.
Research expectations during third year
Third year research must include two major facets: (a) a population health improvement focus, meaning that the research conducted can help lead to the improvement, over time, of health outcomes of a particular group(s) of individuals, including the distribution of such outcomes within the group(s); and (b) community/stakeholder component, meaning that the project must include activities in which community/stakeholder partners (i.e., people who care about and/or may be impacted by the results of the research) are given an opportunity to provide input in one or more phases of the research (i.e. design, implementation, evaluation, dissemination). Students may pursue additional degrees (e.g., MPH) provided that the research conducted during this degree also has a population health improvement and community-engagement focus.
What does the fourth year look like for a PCLT student?
PCLT fourth year requirements include a sub-internship, critical care requirements, radiology, and the Capstone Course. Otherwise, PCLT students choose their fourth year electives based on their learning needs and interests.
What residency and fellowship options may students pursue?
Residencies leading to the following careers are acceptable as primary care careers for PCLT:
- Family Medicine (adults, children, pregnant women, minor surgery)
- Primary Care Pediatrics (children only)
- General Internal Medicine (adults only)
- Medicine/Pediatrics – primary care (adults and children)
- Obstetrics and Gynecology – general practice
- Pediatric/Psychiatry – general practice
- Medicine/Psychiatry – general practice
- Geriatrics – primary care
Post-residency, Adolescent Medicine, Preventative Medicine, Geriatric Medicine, and Palliative Care would be some of the acceptable Fellowship choices. Others can be considered.
What happens if students choose not to pursue a Primary Care career path?
Students are tracked for five years after graduation from medical school. If they choose to enter a non-Primary Care field during that time, students must re-pay their scholarships.