TUSM-MMC Program Longitudinal Integrated Clerkship
Need: To fill vacant medical positions in Maine's rural medical facilities.
Intervention: The Tufts Maine Track LIC program offers clerkships in rural medical facilities, exposing medical school students to the positives and possibilities that rural practices have to offer.
Results: The program has seen an increase in students' interest in practicing in rural Maine. The majority of participants have pursued medical careers in one of the six core specialties studied during their clerkship.
One unique aspect of the Tufts Maine Track program is its
option for 3rd year clerkships. Students may choose
between the traditional block model or the
Longitudinal Integrated Clerkship (LIC). Students
completing the traditional block schedule spend 6 to
8-week rotations at MMC in the six core clerkships
(pediatrics, obstetrics & gynecology, psychiatry,
internal medicine, family medicine, and surgery). The
Tufts Maine Track LIC program differs in that all of the
core clerkships are completed in a consecutive 9-month
longitudinal rotation in a community setting, most of
which are rural. Approximately half of the Maine Track
students choose the LIC program.
The following rural Maine medical facilities host Tufts
Maine Track LIC students:
The program's innovative pedagogical approach allows
students to achieve the same standards required of all
TUSM students while emphasizing continuity as an
underlying theme. For example:
Continuity of patient care: Students
are assigned a panel of patients whom they follow
throughout their clerkship. The program's longitudinal
approach allows students to be involved in the care of
their patients over an extended period of time.
Continuity of supervision and
education: Students work longitudinally with a
core group of faculty over the course of the clerkship.
Students establish one-on-one relationships with their
faculty who have a clear understanding of the students'
educational trajectory, prior experiences, and
Lectures, case presentations, and group activities are
conducted monthly at rotating LIC sites. Students are
required to interrupt their 9-month experience to travel
to the group sessions and to MMC for most of their exams.
This video explains more about the TUSM-MMC partnership,
highlighting the first class of medical students to enter
the Main Track program:
Each host hospital is responsible for securing
housing for the students, including internet access and
snow removal services.
Every rural training site has a designated site
director who works with other site directors to create a
full, instructive experience for each student.
Twenty students in each Maine Track class are given
an annual scholarship of $25,000, which significantly
reduces their overall tuition costs.
TUSM and MMC offer ongoing faculty development at
each training site.
Unlike many LIC programs around the nation, the Tufts
Maine Track LIC program offers all six core clerkships at
To date, 362 physicians over 10 classes have
graduated from the Maine Track Program.
45% of alumni who have completed training report they
are now practicing in Maine.
47% of all Maine Track graduates have chosen a
specialty related to primary care (family medicine,
internal medicine, and pediatrics).
To date, scholarships have been awarded to a total of
281 Maine Track students. This substantial financial
support from scholarships continues to open doors for
Maine students, allowing them to learn and serve in the
communities that helped raise them.
27% of Maine Track graduates have matched to Maine
Medical Center for their residency training.
Since 2013, the number of medical school applications
from Maine residents has almost tripled.
Approximately 50% of Tufts Maine
Track students are placed in the LIC Program for their
core clerkship year.
Despite the smaller size of many of the participating
hospitals, the wide range of experiences available at
each site has deflated the argument that core medical
education cannot be completed in rural areas. Preceptors
and site directors have additionally attested to seeing
their students develop a sense of ownership of their
patients and their care, largely due to the hands-on
experience that rural practices offer.
The Tufts Maine Track program not only benefits students,
but also the attending physicians and their host sites.
Physicians report that their students' inquiries have
kept their medical perspectives fresh and minds sharp.
Several TUSM faculty have accepted positions at rural
training sites because of the opportunity to teach
medical students, benefiting the students, facilities,
and rural communities. Host sites have also expressed
that becoming an academic teaching center has energized
staff as they practice with the enhanced purpose of
creating an optimal learning environment for their
As is common with LIC programs, the "fire hose"
approach of studying all six core specialties
simultaneously makes the initial adjustment to clinical
medicine difficult for students.
Since most rural host sites are assigned only two
students, it is difficult for students to measure their
rate of advancement in comparison to their peers.
The distance from program administrators and fellow
medical school students has resulted in some students
feeling isolated in their rural host site locations.
Ensure that there is a strong core of services
provided at each host hospital in order to provide
exposure to a variety of medical fields.
Choose host sites where there is more than one
physician so that teaching responsibilities may be
Check that logistical arrangements are in place,
including student support services such as access to
medical care from clinicians who do not serve as
Connect with other LIC programs. Tools and resources
can be shared to strengthen curriculum.
Allow adequate time for planning. The Maine Track
program spent two years preparing for the program before
Expect a period of adjustment. Since the Tufts Maine
Track LIC program model is very different from
traditional methods, it may be exhausting for preceptors
and students at first. This adjustment time is normal and
will become increasingly easier.
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.