LICs in the UK: why do we need our own definition?

Dear Editor, May we thank you for publishing several interesting and relevant articles this year on the topical and increasingly important innovation, ‘Longitudinal Integrated Clerkships/placements’ (LICs) [1–3]. As the authors of these articles assert, we may uniquely have an educational intervention that is popular with supervisors, advantageous to students academically as well as enabling them to be more patient-centred, and potentially beneficial to patients. However, we note a tendency in the commentaries of our esteemed colleagues to suggest that the United Kingdom (UK) is unique in the world and the LIC ‘sits awkwardly within our UK health and education systems’ [3,p.149] and we need ‘guidance on what constitutes an LIC within a UK context’ [1,p.293]. As authors of both papers acknowledge, there is a wellestablished, international definition of LICs that included UK authors [4]. We would humbly suggest that simply because few comprehensive LICs in the UK have been attempted, particularly across whole year groups, this does not therefore signify that we need our own unique definition. We have developed in our institution a fully comprehensive (encompassing most of the year’s learning outcomes), longitudinal (more than six months), integrated (across primary and secondary care placements) clerkship in our penultimate year for 370 students. Although not without its teething problems – particularly during the Covid-19 pandemic – the innovation is now well established and we would wholeheartedly encourage other institutions to follow suit. Full evaluation of our LIC including student surveys and qualitative work with students, tutors and patients has been undertaken and the results are currently being analysed. Let’s not put this potentially amazing innovation on the ‘too difficult’ pile and seek to change the definition of LICs to fit what seems easier and more feasible. If LICs truly have the benefit for teachers, students and patients that the evidence suggests, then surely our students – as well as our teachers and patients – deserve the full benefit of comprehensive LICs.