1. Conversion of traditional block rotation
education (TBR) in an Academic Medical
Centre to Longitudinal Integrated
Clerkship
W Heddle, G Roberton, M Slee, S
Mahoney, P Worley
Flinders University

2. Faculty/Presenter Disclosure
Slide 1
• Faculty: Bill Heddle
• Relationships with commercial interests:
– Grants/Research Support: Medtronic and ST
Jude for Cardiac Fellow
– Speakers Bureau/Honoraria: Pfizer,
Boehringer-Ingelheim
– Other: Clinical Device trials as co-investigator
for Biotronik and Medtronic

3. Background
• Flinders University School of Medicine commenced as 6 year
Undergraduate Entry program in 1974; changed to 4 year Graduate Entry
program in 1996, initially only at Flinders Medical Centre (FMC)(Academic
Medical Centre co-located with Flinders University Bedford Park Campus in
Adelaide, South Australia).
• Flinders Medical Centre is 500 bed hospital serving southern half of
Adelaide (total population 1.2 M) plus southeastern sector of rural SA, plus
liver transplant service for SA, plus Cardiothoracic Surgery for NT. Only
hospital with combined Obstetric/ Adult ICU/Neonatal ICU.
• Repatriation Hospital in 250 bed hospital 5 km from FMC and specialises in
Geriatrics, Rehabilitation, Psychiatry, and is the major Flinders University
training site for most allied health disciplines (very strong in IPE).

4. Background - 2
• Until start of PRCC in 1997, first major
clinical year was done as Block Rotations
(TBR), and this has continued at FMC.

5. Background (2)
• In 2013 and 2014 Longitudinal Clerkship
(Longitudinal Integrated Flinders Training
= LIFT) pilots of 8 students of 72 at FMC
and 4 students at Alice Springs (NTMP)

6. LIFT Pilots
• LIFT Pilot 1 (P1) in 2013
– Each student attached to an indiviudal preceptor in
Internal Medicine, Surgery, Paediatrics, O&G,
psychiatry, family medicine with clinics each fortnight
(weekly for family medicine for one semester)
– Educational Supervisor for group of 8 with weekly
“academic” tutorials to a prescribed schedule
– P1 was successful in terms of Academic Performance
(Roberton)

7. LIFT 1 Pilot
• Feedback
– Not possible to use for whole cohort of FMC
based students due to limited faculty in
Paediatrics and O&G
– Difficulty in longitudinal following of patients
due to silos of care
– Students and Preceptors valued longitudinal
relationship

8. LIFT Pilot 2 (P2)
• 2014
– Redesign to increase hospital Ward exposure and
arranged for Paediatrics, O&G, and psychiatry as 4 week
intensive blocks at end of semester 2
– Major barrier exam (MCQ and OSCE) at end of year 3
covering all specialties
– Unit attachments rather than consultants in medicine and
surgery
– As year evolved, students regularly attended antenatal
clinics and had Psychiatry tutorials to discuss mental
health conditions of their medical patients

9. LIFT Pilot 2
• Results
– Only preliminary but attachment to unit rather
than consultant has been problematic with
loss of continuity of preceptors
– Academic results not yet fully assessed

10. Proposed LIFT Pilot 3 (P3)
• 2015
– Attachments for one semester to a Medical and
Surgical Consultant for one semester, then different
(medical and surgical) Consultants for the second
semester
– Continued weekly academic program with
Educational Supervisor
– Continued antenatal clinics and Psychiatry tutorials
– 2 week Paediatric block mid-year

12. Additional changes
• Change from large “barrier exam” at end
of year 3 to Programmatic Assessment
• Extension of clinical clerkship well into
fourth (and final) year with plan for
rotations in paediatrics, psychiatry, O&G,
medicine and surgery in this year.

13. Questions
• Will the LIFT Pilot 2015 work and is it
applicable to whole FMC cohort (about 72-
80 students in 2016 ?
• Are changes required to enable this?

14. Proposed LIFT 2016
• As for 2015 but assessment changing to
Programmatic Assessment (as at University of
Maastricht – Cees Van der Vleuten) with Progress
Testing
• Continued academic program (2017) into year 4,
during which students will have specialty block
rotations in Paediatrics, O&G, Psychiatry, plus
specialty Medicine and Surgery