Exploring a New Model for Clerkships: A Visit to Hudson Headwaters Health Network

This blog post is the first in a series of posts written by students in our new Longitudinal Integrated Clerkship (LIC) at Hudson Headwaters Health Network. Read posts by Khaled al Tawil ’19 and Sunit Misra ’19.

uvmmedicine blogger Holly Bachilas '19
uvmmedicine blogger Holly Bachilas ’19

When I first heard about the Longitudinal Integrated Clerkship (LIC), I rejected it as an option for me.  I was open-minded when it came to the idea of a new way to complete the clerkship level of the curriculum, but it seemed so unlike the vaguely formed visions of my third year of medical school that I had trouble seeing myself as a participant. However, after meeting leaders for the program and learning more about the model – where students go to one location for the entirety of their clerkship year, and focus on one group of patients as they navigate the healthcare system – I began to see the potential benefits.

Going into my first year at the University of Vermont College of Medicine, I didn’t question the traditional route – spend the first few semesters in the classroom and then get out onto the wards to begin applying my knowledge. I would spend a month or so at a time on different rotations, take exams, and start to become comfortable interacting with patients and families, which would all lead up to deciding what kind of doctor I wanted to be. So, when I overheard some classmates talking about a program where you stay in one location, see patients in the primary care clinic, and then follow them around wherever they go – to the emergency department, to the hospital, to the operating room – I was skeptical. Would you really be exposed to everything you needed to learn? What if it was terrible and you were stuck there for a year?

My perceptions began to change, however, once our class heard from the folks actually preparing to run this program. They seemed like nice people. They seemed like they had thought a lot about the potential benefits of a program like this. They talked about the unique opportunity to form long-term relationships with patients and preceptors, and the increased exposure you would have as one of a handful of students in a place where there are no fourth-years or residents ahead of you. They discussed the flexibility in the schedule that would allow you to investigate what you wanted to see and retain more of what you were learning. My mind began to open.

I realized that fear of the unknown had been the main motivator in my initial impulse to dismiss this new opportunity. I also reluctantly realized that the times in my life that have been the most valuable and growing have been the times when I’ve stepped outside of my comfort zone. So, I contacted the nice people at Hudson Headwaters Health Network, the New York site for UVM’s LIC, and asked if I could come check it out. They, of course, said yes.

The drive from Burlington to Glens Falls, N.Y. takes you down country roads, past farms, and through stereotypically New England towns complete with white-steepled churches and brickface general stores. It also takes you past the rural homes and businesses of people who historically have lacked access to medical care. Hudson Headwaters Health Network began in the 1970s as a single health center seeking to meet the medical needs of this community as old-time family doctors in the area started to retire. It has since grown into 17 heath centers scattered throughout the Adirondack region. As someone who is strongly interested in rural family medicine in the future, it was easy for me to begin to see how a year in this community would be invaluable.

Over the course of my day in Glens Falls, I was shown around two brand new (very spiffy) health centers in which primary care providers work with on-site behavioral health workers, care coordinators, and specialists (ranging from obstetrics to nephrology to infectious disease). I was also introduced to the nearby Glens Falls Hospital where a wide range of inpatient and surgical services are provided. There is also a decent view of the nearby West Mountain ski area from an upper floor lounge. The town of Glens Falls itself was beautiful: a wide variety of shops and restaurants mixed with parks, libraries, and outdoor recreational opportunities. I left feeling like I had a more tangible sense of what life in Glens Falls might look like.

On the (equally scenic) drive home, I had time to think about some of the challenges that might come with a program like this. Obviously, being the first year of the program, there will be some administrative and logistical details to iron out, and the first few months will likely be a period of huge adjustment – both for students and for preceptors. But, after meeting with the folks at Hudson Headwaters and seeing their dedication to making this program succeed, I feel like regardless of how things begin, there will be people to help it continually improve. I got the sense that students will have increasing responsibilities, but always with a backbone of support from mentors on-site and from UVM.

The LIC will not be the best program for everyone, but as someone interested in rural medicine, learning in a system designed to care for these patients is a huge benefit. And I’m starting to think that regardless of what you want to end up doing, the experience of getting out of your comfort zone and learning to thrive in the unknown will be invaluable.

What are your thoughts about this topic?