What are LCs?
Since the early seventies, medical schools in the United States began to develop “Learning Communities” (LC). Learning Communities have been defined in many formats and iterations, and are by no means restricted to the medical profession. A definition we found inclusive and sufficiently descriptive is one proposed by Bicket et al (1), which describes LC as “cohorts of students and faculty who collaborate towards common educational and social goals”. The “cohort” can describe small or large groups, in most cases longitudinal across the four years of medical school, led by the same group of faculty for each LC, and imbued with some form of “collegiate personality”, ranging from naming of LCs after leaders and giants in Medicine (such as Osler) to the development of collegial competitiveness in sports and social functions. In 44% of medical schools, which have LCs, a dedicated physical space is allotted to the LC, with amenities such as lounges, study rooms, and other interactive space modules (2).
The formation of academic societies, learning communities, colleges, houses, and other variations on the concept of breaking down large teaching institutions into more manageable units, socially conducive to closer ties among members, dates back at least 300 years. The idea seemed to have an attraction, which prompted its adoption even in small universities and colleges (3). In academic medicine, there has been a recent dramatic increase in the number of medical schools with LCs, ranging from newer schools to older prestigious ones, such as Harvard and Johns Hopkins (2). What is it about LCs that has made them increasingly attractive to medical schools? What do students specifically gain from the LC experience?
Learning Communities aim to enhance medical students’ personal and professional development by stimulating them to explore their values and beliefs and develop a solid cognitive and affective basis for their attitudes and behaviors as persons and as professionals. Learning Communities thus promote student wellness while being completely integrated within the medical curriculum. Students are expected to engage in reflection and to transform their experiences into learning and action to improve themselves and others. Learning Communities provide students with a venue for sharing their thoughts, feelings, and experiences with their peers and a faculty mentor in a safe, non-judgmental environment.
The majority of research into the phenomenon of the expanding creation of LCs points to the crucial gaps they fill in the formation of the “complete” physician. In particular, LCs provide a venue for the development of life skills for physicians many of which are already embedded and required in competency-based curricula (such as professionalism, leadership, group learning, communication, self improvement) and others that are not strictly defined as curricular requirements (1-4). In a survey of 18 US and Canadian medical schools which had implemented LCs in 2008 (2), some of the major benefits identified by medical education leaders at these schools included: early identification of students who need additional support; more intimate groupings among schools with large class sizes; allowing for meaningful relationships with faculty; creation of a culture of cooperation and collegiality and less emphasis on competitive behaviors acquired and sharpened during “pre-med” years; allowing pre-clinical students to interact with clinical faculty and student-to-student interaction and learning across the four years; filling gaps in the formal curriculum, and providing students a means for engaging in advocacy and social activities. The main challenges to the success of LCs include student and faculty engagement, time, space, resources, faculty participation, and defining areas of overlap/redundancy with the formal curriculum (2).
How do LCs work?
Review of existing models for LCs reveals significant variations in implementation depending on the expected goals. The most frequently employed model is that of a core faculty (usually more than 20, chosen for their superior teaching skills and demonstrated positive student rapport skills) each of whom would act as mentor for 5-7 students (the less the better) in each of the four years, who together would constitute his or her “College” or LC. In addition, each LC will have a seasoned senior physician as leader. LCs meet at the individual class level as well as a four-class group at regular intervals. In most schools, membership in LCs is mandatory as it has been found that voluntary participation often leads to failure (2). In many institutions, LC meetings and events are incorporated into the structure of the academic year and may fulfill certain curricular milestones or competencies.
Model of introducing LCs in the first year of a new curriculum:
The American University of Beirut (AUB) initiated major curricular reform in 2013 with the launch of the Impact Curriculum. One of the principal novelties in this curriculum is the introduction of LCs to Medicine I students as part of a new curricular thread entitled “Becoming a Doctor”, which runs over the four years of medical school. Highlights of this new LC module are presented here as a possible model for schools embarking on a new LC experience:
The course is conducted in a small group format, whereby 7 or 8 students are matched with a faculty mentor for the whole year. There are no formal lectures and all learning takes place through interaction and discussion. The group meets regularly during the year (at 2-4 week intervals). Sessions are informal and relaxed. Each session is dedicated to a topic relevant to the personal and professional development of students, and usually revolves around assigned readings or personal experiences of the members of the group. Students are asked to engage in reflection and discussion of personal views, issues, texts, videos, events or other matter pertaining to the topic of the session.
The main form of assessment takes place during the session and is based on attendance and the extent of preparation, participation and contribution of the students to the discussions. Students are assessed for their communication skills, professionalism, personal development, and cognitive skills according to pre-set rubrics. In addition, students are expected to make 2 written contributions of a reflective nature related to personal and professional development and or topics encountered in this course.
Learning Outcomes can be discerned from the actual sessions, which cover the following topics over the academic year: Introduction to the new Impact Curriculum; Students meet mentors; Learning Styles; Giving and Receiving Feedback; Teamwork; Metacognition; Time management and goal setting; Competition, cheating and peer pressure; Emotional Intelligence; Becoming Better: using reflection to develop expertise; The profession of medicine and the ends of medicine; Wrap-up: what I learned in Learning Communities: students indicate the 2-3 most important lessons/concepts they learned in this course. The course also incorporates two “open sessions” in which students report in writing and reflect on experiences they are having in medical school
The LCs also fulfill the following curricular competencies
Communication Skills Expectations
- Attend classes and be punctual
- Be prepared and fulfill responsibilities promptly
- Demonstrate a collegial and respectful attitude towards peers and faculty
- Demonstrate initiative and willingness to provide help to and share information with others
- Demonstrate honesty and integrity
Personal Development Expectations
- Contribute to and promote group discussion and teamwork
- Provide constructive and specific feedback to peers
- Listen actively
- Convey information and explain reasoning clearly
Cognitive Skills Objectives:
- Seek and accept feedback
- Recognize limits and demonstrate humility
- Exhibit leadership qualities
- Respect, acknowledge and seek to understand other people's viewpoints
- Demonstrate depth and breadth of knowledge
- Demonstrate critical thinking and problem solving skills
Who has adopted LCs?
Today, the Learning Communities Institute (4) boasts a membership of 52 medical schools, including all the leading medical schools in the USA and Canada. This represents an exponential growth over the past 5 years when the number of schools with LCs was just 18 in 2008 (2). The Institute, founded at the University of Iowa Carver College of Medicine in 1998, is “…. a group that values and supports the active presence of learning communities (LCs) based in health professions schools”.
Does Every Medical School Need One?
The endorsement of LCs as a principal tool for molding the character of the young physician is clear from the number and quality of US and Canadian medical schools which have adopted LCs in their curricula. The intimacy, informality, and longitudinal continuity of the group experience are crucial to the needed safe environment in which students deal with the difficult transition to becoming a “good physician”. Does every medical school need one? Our is answer is a resounding yes.
- Bicket M, Misra S, Wright SM, Shochet R. Medical student engagement and leadership within a new learning community. BMC Medical Education. 2010,10:20
- Ferguson KJ, Wolter EM, Yarbrough DB, Carline JD, Krupat E. Defining and Describing Medical Learning Communities: Results of a National Survey. Acad Med. 2009; 84(11): 1549-1556
- Hafferty FW, Watson KV. The Rise of Learning Communities in Medical Education: A Socio-Structural Analysis. Journal of Cancer Education. 2007; 22(1): 6-9
Reviewed for February 2014 by
Kamal F. Badr MD
Associate Dean for Medical Education
Ramzi F. Sabra MD, MHPE
Assistant Dean for Undergraduate Medical Education
Director, Program for Research and Innovation in Medical Education (PRIME)
Faculty of Medicine
American University of Beirut