The LC3 Concept: HEALTH PROFESSIONS EDUCATION FOR 21st CENTURY HEALTH CARE
LC3, or the Longitudinal Chronic Care Course, is both a Humanities course and a disruptive innovation in health profession education.
Traditionally, medical education has overwhelmingly focused on the preparation of clinicians for the diagnosis and management of acute disease. And for good reason. The American health care delivery system itself was organized in the late 1800s primarily to diagnose and treat acute, and often untreatable, life-threatening diseases. The remarkable advances in medical science and the astonishing successes of the 20th century have led to the control or eradication of many acute and lethal childhood diseases. Ironically, while Americans are living longer lives today than ever before, longevity’s price is often a lifetime struggle with one or more chronic and progressive diseases. In fact, today 90 million Americans have a chronic disease of which 30 million have diabetes. Paralleling epidemic rates of obesity and sedentary lifestyle, 25% of adults are “prediabetic” and, by 2050, one third is predicted to have the disease. Furthermore, one in four people aged 65 years and older have developed type 2 diabetes (T2DM), and this number is expected to climb rapidly in the coming decades. Around the globe, diabetes now affects 382 million people and by mid-century the aggregate of people with diabetes and prediabetes is predicted to reach 1 billion.
Over the past 30 years, exponential growth of new T2DM cases has placed burdensome demands on 21st century health care providers who are practicing, and being taught to practice, within a 19th century organizational structure. Students of the health professions are still primarily educated and trained in acute-care hospitals and clinics where hands-on experience is brief and episodic. There is inadequate opportunity to learn about the natural history of chronic, progressive disease; the continuum of care and its cost effectiveness; the impact of chronic disease on the patient and their family. Ideally, longitudinal contact provides health professions students with real opportunities to establish effective long-term relationships with people living with one or more chronic diseases as well as with their families. Accessing direct exposure across the full care cycle of chronic disease offers students an appreciation of the unique and individualized temporal courses as well as of the impact of education and lifestyle change that is needed for such patients to achieve and maintain wellness.
It is essential that we prepare our students to one day provide “21st century health care”. As such, the Western Diabetes Institute’s integrated practice unit (IPU) provides an ideal setting for students to learn the skills that will be necessary for them to deliver high-value care to people with diabetes and other chronic diseases. There are essential competencies (see table below) in which students need to become proficient. Students need to learn to provide whole-person care; arrange care with other professionals; integrate technology in the care of their patients; measure clinical outcomes; and how to manage patients with chronic conditions across the total cycle, including acute care, disease prevention, and end-of-life. Students need real-life experiences that include training in professionalism, accountability and empathy.
The LC3 begins with the pairing of a patient being evaluated in the one-stop shop in the IPU at Western Diabetes Institute with a health professions student. This pairing is designed to promote a partnership to last for the entire four years of the student's undergraduate professional education. Students function as an essential part of the patient’s core collaborative therapeutic alliance, or CoreCTA, to help serve as health coaches and to more deeply understand the myriad challenges posed by diabetes and multimorbidity. Students are expected to engage their paired patient in every aspect of their lives. This longitudinal engagement aids the patient with improved medication adherence and lifestyle changes and enhances the student’s understanding of the patient’s real world and how one lives with chronic disease and pursues a state of wellness.
LC3 consists of monthly meetings for training in cultural awareness; healthy patient communication skills; social factors affecting patients; protected health information; and research. Students existentially learn the importance of healthy living and how nutrition and exercise are essential components. The skills that students gain during this course will be sustainable and invaluable.
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