1. Evaluation of LIFT
Longitudinal Integrated Flinders
Training
Gayle Roberton
2. Presenter Disclosure
• Faculty: Gayle Roberton
• I have no conflict of interest to disclose
3. Rationale
• All other Year 3 placements at Flinders
consist of half-year or full year
longitudinal placements and have been
shown to be educationally sound
• Based on 2 programs in USA that have
done longitudinal placements in urban
teaching hospitals
• Will these models work at FMC or will
we have to adapt?
4. LIFT 2013
• Pilot of 8 students at FMC, 4 in Alice
Springs
• Longitudinal – panel of patients followed
for the whole year
• 50-100 patients hoped for
• Integrated – all disciplines at the same
time
5. Preceptors
• Each student had one preceptor in each
discipline
• Medicine, surgery, paediatrics,
psychiatry, obstetrics and gynaecology
–once per fortnight in outpatient clinic
• Emergency department – weekly
• GP – weekly for 6 months
6. Students
• Follow patients in their panel to:
– Other outpatient appointments
– Inpatient wards and visit daily
– GP appointments if possible
• Meet new patients in:
– Outpatients with preceptors
– ED
7. LIFT Evaluations
• Assessment of Learning by Roberton,
Heddle, Schuwirth
• Feedback from Clinicians
• Feedback from Students
• End of year Exams and consequent
place in class
8. The Clinical Reasoning Test
• 10 Scenarios
• For example: Jennifer James is 38 years old and
presents to ED with a severe headache that started
suddenly 6 hours ago. She has vomited twice in that
time and says that the light hurts her eyes. BP is
150/80, HR is 105, RR is 22 and temperature is
38.8C
9. Test Analysis
Pre-Test Post-Test
LIFT Mean score: 59.00
(SD=16.71)
Within LIFT
students between
post and pre-test
(p=0.004)
Mean score: 71.69
(SD=8.53)
Within Pre-Test
Comparison of LIFT and
NON-LIFT students
(p=0.659)
Within Post-Test
comparison of LIFT
and NON-LIFT
students (p=0.659)
NON
LIFT
Mean score: 59.70
(SD=11.59)
Within NON-LIFT
students between
post and pre-test
(p=0.018)
Mean score: 70.93
(SD=6.34)
11. Clinician Comments
• Strengths
– Relationship with the student
– Ability to monitor the student’s progress
– Most said they were confident in their
ability to assess the student’s clinical ability
and professional behaviour
12. Clinician Comments
• Weaknesses
– Outpatients only with no inpatient contact
– Not enough clinicians in all disciplines for
70 students
– Consultant teaching only with no
involvement of Junior Medical Staff in the
teaching
13. Summary
• Clinical Reasoning Test showed no
significant difference
• Significant increase in class rank for
LIFT students
• Clinician-student relationship valued
Hinweis der Redaktion
The existing longitudinal placements are all community based General Practices with access to local general hospitals with some visiting specialists.
The test consisted of ten clinical scenarios and the students were asked write down the two most likely pathophysiological processes to explain the presenting symptoms with reason(s) for choosing that process. They were then asked to provide two likely diagnoses within each pathophysiological process. It was designed to elicit ability in making clinical associations and decisions rather than just subject recall.
To disentangle effects in a clear and visible way we decided to perform 4 individual tests of significance. In this case we used Wilcoxon rank sum for the dependent-samples comparison (pre versus post-test) and a signed ranks test for the independent-samples comparisons (LIFT versus non-LIFT students) because of the low numbers of students and because we wanted to explore the significant and non-significant effects.
In conclusion the test picks up the learning effect, but in these groups there was no difference in effect of the LIFT clerkships versus the traditional block rotations.
Average increase in class rank for LIFT students was 18.8 places compared to the rotation cohort of 1.2 places
Mann Whitney U Test had a significance of 0.027
