What is LIFT?
The Longitudinal Integrated Foundation Training (LIFT) model aims to improve clinical progress and patient-centred practice, as well as the quality of the educational experience. As opposed to receiving one 4-month block of general practice training as Foundation Year 2 trainees, LIFT trainees experience two sessions per week (1 day) in general practice throughout their two years of Foundation training. This runs alongside 4 days each week in the traditional 4-month hospital block placements, experiencing 6 other placements across the 2 year training programme. The general practitioner supervising the trainee will be the Educational Supervisor for the whole two years of training.
This model was based on the work of Professor David Hirsh (Harvard Medical School) which showed the value of longitudinal integrated clerkships. For a greater understanding of the theoretical background, please view this short youtube video.
How do trainees benefit?
Trainees have benefited from the educational support and broader clinical exposures offered by experiencing primary care at this stage, and acknowledge the benefits of having a consistent supervisor for the two-year programme.
Practical skills such as consultation skills, developing management plans, communication and administrative activity have benefited from time in the primary care environment.
What do trainers think?
Supervisors consider LIFT trainees at FY2 to be “more aware of the patient journey” and “the primary and secondary care interface” than their counterparts who are following the traditional training route. They continue to have “surpassed expectations”, possessing superior consultation and communication skills, greater understanding of medical conditions from their early development and treatment by GPs through to acute stages requiring specialist care in the hospital environment, “excellent” clinical knowledge, are more able to treat patients “holistically”, and excel at providing essential referral and hospital discharge information. They are generally “more autonomous than a traditional FY2”.
“….. [they have] reached a level of independence so to speak, that we would not normally see from our foundation trainees in the old scheme…..”
LIFT trainees now additionally have a better understanding of the roles of the wider GP practice team than others. They are aware of their colleagues’ “strengths” and when it is useful to involve them in patient care. This can include the nurses, physiotherapists, and health visitors amongst others. The team gives pastoral support as well as their supervisor(s), having now “got to know them well”, developed friendships, and often formed social as well as working relationships with colleagues.
What are the challenges?
This scheme may not be for all trainees and is tailored for trainees who are looking at a career in general practice and there is evidence that trainees who train in a LIFT scheme are more likely to continue to GP training. Acute trusts can feel that they are losing manpower in FY1 but the rotations chosen allow them to gain manpower in FY2 and HEE is working with employers to design on-call rotas, maintain experience in FY1 and manage compensatory rest.
This is a novel programme aimed at trainees planning a career in general practice. It gives trainees benefits in terms of longitudinal experience in general practice and maintains the other skills gained in Foundation training.
LIFT Feedback Form:
How does a FY1 trainee differ from a GP specialist trainee?
The FY1 doctors participating in the LIFT programme are not learning to be a GP so have a different curriculum and competencies. They are not independent practitioners so need a higher level of supervision. The FY1 trainee will be present in the community setting for 2 sessions per week.
Can FY1 LIFT trainees carry out home visits?
FY1 trainees should not be doing acute home visits at the request of the patient as these are felt to be too high risk for a doctor in the early stages of their training.
What about travel expenses for foundation trainees travelling to the GP practice?
Foundation trainees are employees of the acute trust. They are entilted to claim for travel from their base hospital to their GP practice. Claims for travel can be made via the local arrangements of the employing acute trust.
Who will be the foundation trainees educational supervisor?
The GP practices involved in the LIFT scheme have agreed to undertake the education supervision instead of the employing acute trust. You will have clinical supervisors in your placements in your employing acute trust.
Can an FY1 trainee carry out acute telephone triage?
Acute telephone triage is believed to be too high risk for doctors at this stage of their training in the primary care setting. They can undertake phone calls to patients that they are involved with on a more chronic basis if the trainee and supervisor believe this is appropriate.