Program enables early clinical exposure for medical students

Every October brings a new opportunity at the Virginia Tech Carilion School of Medicine for first-year students to experience clinical care in ambulatory sites across the Roanoke area through a program called the Longitudinal Ambulatory Clinical Experience (LACE).

The program is designed to introduce medical students to health care in sites other than inpatient facilities. Each student is assigned to a physician at an ambulatory care site and works with them over the next 14 months.

“We wanted to create an early ambulatory experience that was community based,” said Cynda Johnson, former dean of the school who created the program along with Mark Greenawald, former associate dean for student affairs. The program was put in place with the charter class in 2010. “It has morphed several times over the years, but the important thing is that it continues to benefit our students with early experience with clinical care and teams.”

The impact

“For many of the students, it’s the first time they actually go into an exam room with a doctor and a patient,” said Hugh Craft, VTCSOM associate professor of pediatrics, who has been a LACE preceptor for more than 10 years. After shadowing Craft for several encounters, his students are then ready to take a patient’s medical history and conduct a basic physical exam on their own.

Craft’s current LACE student, Nicki Rohani, Class of 2027, was nervous at first but has valued the experience. “It’s really nice because I’m getting that actual direct patient contact by myself,” she said. “I really appreciate him letting me do that.”

Josh Perez, Class of 2027, added, “LACE has been one of the most important experiences for me during medical school. It has offered me opportunities to practice my clinical skills right as I was learning them and kept me curious about different disease processes.”

“It’s encouraging for our faculty preceptors to be able to invest in our early learners,” said Tarin Schmidt-Dalton, associate dean for clinical science and skills, years 1 and 2. “It gives the students the why and the motivation to keep studying hard in medical school.”

Craft said, “We want the students to get something meaningful out of the experience. They’re curious. They’re impressionable. And they are always asking us questions that we have to scratch our heads about.”

Patient presentations

As students enter their second year, they are required to choose one of the patients they have seen with their LACE preceptor, write up the patient’s medical story, and present their patient case to an audience of peers and faculty.

Johnson continues to attend the LACE presentations.

“It’s one of my favorite retirement things to do withs the students,” she said. “It makes me very proud to see how well they’re doing and excited that they’re going to be the doctors of the future.”

Students are randomly paired across various disciplines.

“It’s not designed to be a mentorship for specialties of interest,” Schmidt-Dalton said. “The intent is for students to learn more about being in a clinical environment and working with an interprofessional team.”

The community perspective

LACE also gives students a personal glimpse into the community they have recently joined.

“They start to recognize the social determinants of health that impact our patients. They develop a greater appreciation for the barriers that our patients struggle with and the consequences of health disparities,” Schmidt-Dalton said.

For the first time this year, LACE students were trained on electronic medical record documentation. In addition, the program is woven into a new course called Community and Clinical Immersions and is packaged with a variety of other activities where students visit clinical and community sites.

“Most importantly, LACE continues to provide early medical students opportunities to catch a glimpse of their end goal,” Schmidt-Dalton said. “They are here to become physicians and care for patients and the communities they serve.”