Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system.

The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers.

Diabetic polyneuropathy. Risk factors, patterns of presentation, diagnosis, and treatment.

Diabetic symmetrical distal neuropathy or diabetic polyneuropathy is the most common form of diabetic neuropathy and a leading cause of neuropathy in the United States. Complications include pain, loss of ambulation, and risk for amputation. Recognizing the typical pattern of presentation and risk factors for diabetic polyneuropathy is essential for making the correct diagnosis and determining appropriate workup and need for neurologic consultation. Intensive glucose control is the only therapy proven to prevent or slow the progression of diabetic polyneuropathy. Supportive therapies, including pain management and podiatric care, can improve quality of life and prevent chronic ulcerations.