PSYCHIATRY AND ETHICS UNIT
(TEACHING)
ANNUAL REPORT
JULY 2012
0
Contents
Introduction ...................................................................................2
Report on Central Teaching ...........................................................3
Examinations in 2011-12 ................................................................4
Ethics ..............................................................................................6
Annual Report for Gloucester Academy ........................................7
Annual Report for AWP NHS Partnership Trust .............................9
Annual Report for Somerset Academy.........................................11
Student Feedback 2011-2012 ......................................................13
Final Site by Site Totals, Units 1-3, 2011/12 .................................16
Site Teaching Timetables for 2011-12 ..........................................19
1
Introduction
When I look back to my presentation to all the year 3 students in
September last year, my aim was to inspire and encourage the wisest
and most thoughtful to consider Psychiatry; not just as a Unit to tick off
but as the most holistic of medical sciences that we are all privileged to
practice. Since that time there have been many personal and systemic
peaks and troughs. Progress is being made, but inevitably in these
austere times, there are many challenges, but we must not lose sight of
the importance of encouraging and motivating the best of the next
generation to consider psychiatry and perhaps more importantly to ensure that ALL our students
are encouraged to think and practice in an integrated way that never neglects the human and
emotional journey that we are all on. And so to a summary of the year. The major innovation in
2011/12 was the introduction of the new Direct Observation of Clinical Skills (DOCS) exam, in
response to GMC and external examiner feedback. This necessitated a change in some aspects of
the teaching with a focus on the rehearsal and development of clinical skills, as well as preparation
of new style vignettes. On the whole and with hard work from all those involved, the change has
been relatively seamless, and the new exam is seen as a major improvement on our previous
assessment. There is still work to be done to optimise further, but we can all feel pleased with
what has been achieved so far. The challenge will be to develop this further whilst being mindful
that our aim is not to prepare Psychiatrists, but foundation year doctors. As a result of the nature
of secondary care (and its funding and focus on SMI) we have perhaps moved to far away from the
common and “milder” mental disorders; a major aim for the next year will be to ensure that we
focus more on these, and this will necessitate optimum collaboration with our Trust teaching
deliverers, at a time when there is much uncertainty in their structure, functioning and leadership.
Within this we must ensure that students see patients and learn from them as Osler said: - “He
who studies medicine without books sails an uncharted sea, but he who studies medicine without
patients does not go to sea at all.” On that note I should also add that the “retro” step that we
took last year of giving the students a textbook (PRN Psychiatry) has been an unqualified success
and other Schools are likely to follow suit!
Dr John Potokar, Teaching/Unit Lead
2
Report on Central Teaching
This consists of one day of teaching, usually on the 2nd Friday of the attachment. It was comprehensively
changed this year, to give students the opportunity to have an overview of the therapies available in
psychiatry, delivered by specialists in these areas. Psychotherapeutic (AM) and pharmacological (PM)
treatments are covered, as well as Dr Evans’ highly respected mind/body lecture bridging the two parts of
the day.
Some tweaks have been made following early feedback from the students to both parts of the day with
feedback improving. Thus, quantitatively, the last two were as follows (the marks for the 3rd unit are the
key ones for pharmacology, as this is the lecturer who will continue delivering these for 2012-2013).
Psychological
Treatments 1
Unit 3: 3.9
Unit 4: 3.7
Psychological
Treatments 2
3.8
3.5
Mind & Brain
4.3
4.1
Pharmacological
Treatments 1
4.4
2.7
Pharmacological
Treatments 2
4.3
2.8
Qualitative feedback was generally good with no specific themes, apart from a wish to move the Day away
from Friday, particularly the afternoon lectures. Logistically, this has not proven possible for a variety of
reasons.
Therefore, there will be little change for the 2012/2013 talks. There will be a group of speakers, led by Dr
Andrew Clark, to provide the morning talks and role play on Psychological Therapies, with Dr Evans bridging
to the afternoon with his mind/brain talk, followed by Dr Melichar in the afternoon covering
Psychopharmacology.
Dr Jan K Melichar, Central Teaching Lead
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Examinations in 2011-12
The examinations for psychiatry and ethics in 2011-12 ran smoothly, predominately because of the
significant amount of work by the clinical lecturers and the administration staff.
There were some changes to the exams for this year, particularly in the clinical assessments and the
feedback to students.
Overall unit assessment scheme
The overall assessment consists of two parts; component A (clinical assessment) and component B (written
assessment).
Component A – the clinical assessment has one part: Direct Observation of Clinical Skills (DOCS)
Examination
Component B-the written assessment has three constituent parts:
Written Examination (EMQ/MCQ)
(50% of component mark)
Internal Psychiatry SSC
(33% of component mark)
Ethics Written Case
(17% of component mark)
Candidates must pass component A (40% of the total Unit mark) and component B (60% of the total Unit
mark) to pass the Unit. To pass component A students must receive a mark of at least 50%. To pass
component B students must receive a mark of at least 45% in each of the three constituent parts and a
mark of at least 50% for the component overall.
Clinical assessment (Component A)
The clinical exams have used the viva format for many years. It was decided to change the format this year
for a number of reasons. Firstly the psychiatry exam committee had been concerned for a number of years
that some students, who were not weak candidates, failed the exam and that some borderline students,
who might have passed in other units, failed psychiatry. Secondly, the GMC had indicated that vivas were
not the most appropriate method of examining students and that more standardized methods should be
introduced. Thirdly, the external examiner suggested that the clinical examinations should assess clinical
skills as well as knowledge. Fourthly, other medical schools are changing their examinations. Given this
background DOCS were introduced.
DOCS (Direct Observation of Clinical Skills) are similar to an OSCE (Objective Structured Clinical
Examination) but have fewer stations. The DOCS in psychiatry consisted of three stations with each station
having a stimulated patient (ie an actor with a standardized history of a mental disorder).
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Each station lasted 15 minutes which included 1 minute for the candidate to read the instructions, 12
minutes to perform the allotted task and 2 minutes to transfer to the next station (and for the examiner to
decide the marks). The candidate moved directly from one station to the next and completed three
stations in total. Thus the whole assessment took 45 minutes for each candidate. There was a single
examiner at each station, and so each candidate was assessed by three different examiners.
The candidate was marked across three domains, by the examiner, at each station and there was also a
mark from the actor. The domains were approach to the patient, knowledge (asking the correct questions)
and approach to the task (final summary) patient. Each domain was 30% of the mark for the station with
the final 10% being the actor’s mark. Each of the three stations contributed a third of the overall mark.
Given that this was a new examination, there was concern about the whole process, particularly the
marking. In the event, all the exam days went well and the feedback from the students and examiners was
positive. The marks were very similar with the previous year’s viva and there were no major differences
between the units.
Summary statistics of DOCS mark distribution for Psychiatry DOCS 2011-12 (and unit 4 viva 2011)
Unit 4 –May 12
Unit 3-Mar 12
Unit 2-Jan 12
Unit 1-Nov 11
Viva (Jun11)
Number of
students
62
62
64
60
62
Mean mark
(SD)
64.4 (4.8)
65.2 (5.5)
65.2 (4.8)
63.1 (4.6)
64.2 (8.5)
64.4
65.4
65.1
62.7
64.5
51.8-73.9
51.6-78.3
51.3-78.0
51.7-75.1
50-86
Median
Range
The main area of concern was that there were no fails in the clinical assessments (compared to 6 in
2010/11, 7 in 2009/10 and 8 in 2008/09). On this point there was reassurance from the external examiner
who reported that the assessments, in her view, were probably too difficult.
Written assessment (Component B)
Changes to the written assessment were less that those to the clinical assessment. The main change to the
end of year written examination was the use of the Angoff method as a form of criterion referencing. This
had been piloted last year. The clinical academics continued to have some concern about criterion
referencing in general with somewhat limited evidence that it was any more reliable that norm referencing.
However, given that the university and the GMC have indicated that criterion referencing should be used, it
was used this year. The result was that every candidate passed the end of year written exam (norm
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referencing would have resulted in one candidate, who was more than 4 standard deviations below the
mean, failing the examination).
Given the change to the clinical assessments, in particular the loss of the long case, the iSSC was altered
slightly so that the presentation started with a brief description of a case from which the main topic came.
This was reflected in a minor adjustment to the marking scheme.
There were no significant changes to the ethics assessment.
Marks to the students
Bristol University has fared badly in recent years in the students’ survey and one area of concern has been
feedback. The Year 3 committee therefore decided that marks should be given to the students as soon as
was possible after each exam. For psychiatry, marks are now available for each student individually after
each DOCS exam. The available marks are the total for each station and the overall total for the clinical
exam. For the written exam, the marks are available for the combined MCQ/EMQ, the iSSC and ethics.
Changes for next year
Changes for the coming academic year will be limited due to the significant changes this year. There will be
some minor alterations of how the different parts of the exams are combined. There will also be some
modifications of the DOCS. The setting of the MCQ/EMQ paper should be easier as the University joins
with other universities in producing a large bank of questions which participating universities can use.
Thanks to the clinical lecturers, the administrative staff, the examiners and the actors for a successful year
which was very satisfactory given the significant changes made to the assessments.
Dr Tim Amos, Examinations Lead
Ethics
Owing to maternity leave for Dr Ainsley Newson, Dr Natasha Hammond-Browning took over as Ethics
element Lead in January 2012. Kerry Gutridge will be replacing Natasha from September 2012 to January
2013, it is expected that there will be a new person in a permanent role from January 2013 onwards.
General Assessment: The Ethics Element continues to run smoothly. The standard of ethics case reports by
students continues to be good and some were outstanding, we had a high number of distinctions this year.
Feedback on case reports continues to be made available to students on an ‘opt-in’ basis, drawn to
students’ attention in the handbook. However, we are looking at changing this to an automatic system of
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informing the student of their feedback as the current system is time consuming to the administrator and
not all students ask for feedback, including the weaker students who may need this. In future, all students
will be sent their feedback once it becomes available, without their mark. Any students who have failed
will be contacted and offered a face to face meeting to discuss the feedback. A record will be kept of those
students who do/not take up this option. Grades will no longer be released by the Centre for Ethics in
Medicine.
Academy teaching has run smoothly and I would like to take this opportunity to formally thank all the
academy ethics element co-ordinators and tutors for making the 2011/12 iteration of the course a success.
Note on changes since last APR report: None that I am aware of.
Points of Note: Fortunately I was able to hold an informal Away Day with the majority of the academy
ethics tutors in April 2012. This was a very informative session where the tutors discussed teaching
methods and suggested alterations to the content of the tutorials. This has been taken on board and will
be largely incorporated into the new updated teaching materials.
Unfortunately it was not possible to hold the 2012 ‘Training the Trainer’ Ethics Away Day due to time
tabling/work constraints of both the ethics element lead and academy ethics element co-ordinators. The
running of this event will be attempted again for 2012/2013 although it is envisaged that similar problems
will be encountered. However, the ethics element lead remains available to offer advice and support for
academy tutors and leads.
2 students failed Ethics this year and are resitting.
Looking ahead to 2012/13
Continuing good relations with ethics tutors is foreseen and support provided through regular contact and
advice.
Dr Natasha Hammond-Browning, Locum Ethics Lead, June 2012
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Annual Report for Gloucester Academy
We had 45 students this year and the following are the highlights from 2011/12:
Changes in Personnel
Dr Attila Sipos left 2Gether NHS Foundation Trust for the sunnier climes of Basel, Switzerland in March
2012. We also lost Dr Ian Parnell, a dedicated and well respected education supervisor & internal iSSC
examiner, who retired this year. We would like to extend our thanks for a job well done as well as our best
wishes on their future endeavours. I was appointed to the task of filling Dr Sipos’ considerable shoes and
took on the unit coordinator role in February 2012.
Introductory Lecture Week and Weekly Tutorials
The introductory week of lectures was generally successful and well received. The students found the
sessions informative and many said it helped prepare them for their psychiatric block. A few complained
about the length of the day as they had to sit through up to 5 different sessions in a day. A couple of
students also complained about the intensity of the week and stated their preference for the lectures to be
spread out across the attachment. However, most students preferred the introductory week to remain.
The single 2½ hour MSE role-play session introduced 2 years ago was expanded to 2 consecutive sessions
per attachment this year. These sessions aim to develop students’ interview skills with a focus on eliciting
relevant psychopathology and information to perform a risk assessment. In each session, the students were
divided into 2 groups; each with a facilitator (consultant psychiatrist or higher trainee) and a professional
actor who played various patient roles. The expansion allowed every student the opportunity to be in the
“hot seat” at least once. Feedback has been excellent with students wanting more of the same as well as
having an additional session at the end of the attachment for exam practice.
Clinical Placements
We have continued to run a clinical placement system, which allocates students to individual Educational
Supervisors across the three localities in our county. Students were allocated to specific teams (either
inpatient or community) and were swapped round halfway through their attachment. Sessions with the
Old Age & Learning Disability teams were timetabled into their schedule. Students were encouraged to
explore other psychiatric sub-specialities and contact numbers/e-mail addresses were given in their
welcome packs.
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SIFT money was used to pay for a PT nurse, based with the Hospital Liaison Team. In return, our students
were allocated to spend a day with the team. The student starts his/her day with a 1 to 1 session with
either the consultant or team manager who goes through a 45 minute tutorial on Deliberate Self Harm and
Risk Assessment. The student then shadows a member of the team on the rounds through A&E and the
general hospitals. Feedback has been excellent and the Director of Medical Education has reassured me he
will continue to support this.
Junior Doctor Mentoring Scheme
This scheme assigns each medical student to a junior doctor in their locality, who is able to offer additional
support during their placement. The scheme is generally well received though unfortunately, it did not
happen for students in Unit 3. The main reasons include the departure of the junior doctor coordinating
this, as well as a significant change in junior doctors during the change over period.
Future developments & challenges
Changes in how mental health services in Gloucestershire are provided as well as in medical staff work
patterns continue with the implementation of “Fair Horizons” in April 2012. As yet, there has not been
significant impact on teaching though the changes in team bases has led to a few students in Unit 4 having
difficulty contacting their allocated education supervisor/community teams. We plan to look into our
current structure this summer to adapt to these changes.
From the next academic year, once software issues have been resolved, students in Gloucestershire will be
loaned iPads for the duration of their psychiatric attachment. Applications related to psychiatry, psychiatric
notes and textbooks as well as links to on-line education resources will be enabled on these devices.
Students will be able to access lecture/tutorial materials & handouts as well as the means of saving the
material to a personal account or to have them printed. We are also looking into the possibility of using
“Facetime” as a means of communication between the students and me.
Dr Seng Hoong Tan, Unit Coordinator, Gloucester Academy
Annual Report for AWP NHS Partnership Trust
Clinical Teaching Fellow
The Clinical Teaching Fellow, Dr Kate Seddon, completed her time with AWP on 30 June 2012. Kate has
been a great asset and will be missed. Dr Nicola Taylor has been appointed to the Clinical Teaching Fellow
post and she begins on the 1 August 2012. I look forward to welcoming and working with her.
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Educational innovations across AWP:
- Further development of mentorship scheme for students during the Unit. Mentors are generally junior
doctors to provide a further opportunity to develop themselves as educators. This continues to run well
in some sites and is receiving positive feedback from both mentors and students. The mentors have
started to meet up for peer supervisions and the aim is to evaluate this formally over the next few
months.
- Ongoing development of educational resources - including creation of guides for teachers, database of
teachers and development of the undergraduate section of the intranet.
- We have created the new post of Associate Undergraduate Unit Tutor (AUUT). The Associate Unit Tutor is
a formal, extended role and is aligned to recognised educational standards. Senior trainees apply for the
role through a competitive process. They share the tutor’s responsibilities, with a focus on developing
new learning approaches and opportunities. We have 6 AUUTs currently appointed – acting in all sites
except Devizes.
- Kate Seddon and Liz Anderson have a poster accepted at the AMEE conference in Lyon this August on the
AUUT and Mentorship Programme.
- Ongoing work developing educational supervisors across the Trust. Workshops have now been run at the
majority of sites and a draft document outlining the roles and responsibilities of the Educational
Supervisor has been developed.
- Continuation of the Educational Programme for teachers of medical students within AWP. We have now
run all 3 modules multiple times and plan to develop this further Kate Seddon and Liz Anderson
presented a Poster about this programme at the Association for Medical Education Europe (AMEE)
conference in August 2011.
Sites
AWP employs 6 site tutors: Eva Dietrich (North Somerset), Catherine Thompson (South Bristol), Sian
Hughes (South Gloucestershire), Martin Marlowe (Bath), Hugh Herzig (North Bristol) and Kumar Selvarajah
(Devizes). Dr Selvarajah and Dr Dietrich leave us at the end of this academic year and we will be advertising
for replacements. The site tutor posts in South Gloucestershire and Bath will also be re-advertised in July
as these are three yearly posts and they are up for renewal.
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There has been a common challenge across the sites, namely the redesign of services (changing from sector
teams to teams based on specialties or functions), educational supervisors moving or reducing in numbers
and reducing number of inpatient beds. A challenge for all sites is to provide an educational experience for
the student where the student can feel part of a team (as would be the case in an apprenticeship model
with a consultant in a team) and an educational experience where the student can move to other teams to
gain a wider and more standardised let of clinical experiences (eg inpatient and community, general adult
and later life etc). Educational supervisors now work in specialist functional teams and we will need to find
new ways of providing diverse clinical teaching and experiences.
SIFT Budget
It did not prove possible to restructure the SIFT budget as this would have destabilised some posts. I have
now been informed that this is no longer the case and I am in the process of putting together a briefing on
a proposed budget, the principles of which have been agreed. Hopefully this can now be completed for the
next financial year.
RIO
Much work went into trying to get students a RIO card so that they could access the electronic patient
record. The logistics of this were onerous and unsuccessful. A survey of medical students confirmed this.
The Trust is looking into providing a RIO reader for second opinion approved doctors (SOADs) and may
consider this option for medical students too. We do not plan to repeat the attempt to get RIO access next
academic year.
Conclusion
AWP has undergone a major re-design of services in the second part of the academic year. Despite this,
there has been ongoing development in education provided by AWP. The biggest challenge facing us is in
the next academic year is to provide good and standardised clinical teaching.
Dr Geoff Van Der Linden, Associate Director of Medical Education (undergraduates), AWP NHS
Partnership
Annual Report for Somerset Academy
This year we have had 30 students.
There are no major problems to report. The students have had a variable interest in Psychiatry. All have
succeeded in passing the unit. As usual, some have engaged better with the subject than others. As is
frequently the case for this unit, students are somewhat wary of a psychiatric placement at the start but
often say they have enjoyed it at the end and will consider Psychiatry as a career.
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The students are based in Taunton where they live in the Canonsgrove Hall of Residence and have at least
around one day a week in Taunton. They start with an induction which includes learning on the RIO
computer system in the first week. They then have seven weeks’ medical practice being placed in Taunton,
Bridgwater, Wells or Yeovil.
During the placement they spend one day a week in Taunton with weekly case presentations, some formal
instruction, OSCE practice, expert patient led sessions, and Ethics teaching. Some of the required activities
are delivered through the timetable, for example instruction and experience of ECT, Learning Difficulties
and Child & Adolescent Psychiatry. Some of the teaching days in Taunton involve the use of expert patients
and carers which this year have included patients with schizophrenia, bipolar disorder, anorexia and
learning difficulties and carers.
This placement concentrates as required on Adult Psychiatry but all students have experience of Old Age
Psychiatry and Child & Adolescent Psychiatry through timetabled clinics.
The placement feedback from formal teaching and tutor support is generally good. Students tend to
appreciate the opportunity of having formal instruction on what they should learn and opportunities to
practise OSCE-type scenarios. They also enjoy seeing the patients.
The students’ perceptions of their educational supervisors on the clinical placement have been somewhat
varied. Some of the educational supervisors are highly rated and seen as very supportive but others were
less well rated.
Problems delivered in the clinical component of the course include:
(1)
The shrinking number of inpatient beds. Inpatient treatment is now provided on three sites –
Wells, Yeovil and Taunton. Students naturally would prefer to be based in Taunton but it has
not been possible and some have therefore been involved in travelling long distances.
(2)
An additional complication this year, and particularly for the last group of students, has been
that the inpatient facility for adults was closed in Taunton and moved to Bridgwater, only
moving back in May, causing a great deal of disruption.
(3)
Most psychiatry care is delivered in the community. Students always find it difficult to travel,
particularly to the outlying units.
(4)
Many of our Consultant colleagues have changed jobs this year with retirements and reorganisation, often disrupting student placements. The overall number of Consultants has
declined but the workload has not and some Consultants are less keen to prioritise time for
teaching.
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(5)
It is very difficult for students on a short placement to find their “way around” particularly as
care is delivered in a multidisciplinary ways by different people in different locations and at
different stages of care. Many staff are also part-time which is an added difficulty.
I have been trying over time to improve the quality of placements but this has meant chasing educational
supervisors based outside of Taunton. Attempts to get colleagues to commit to have students in their
clinics in advance are difficult to arrange as people find it difficult to plan ahead. The Consultant involved in
Drugs & Alcohol is on long term sick leave.
I am trying to timetable more and more of the activities with some success. I have also started to ensure
that case presentations are done formally on days of teaching in Taunton so everybody gets the chance to
present once or twice and also I have started to allow time to ensure that I observe all the students
interviewing patients rather than relying on the Consultant supervisors to do these tasks. This ensures that
all students give at least one or two case presentations and are observed interviewing patients.
Parts of the students’ assessments involve presentation of a topic of interest allied to Psychiatry to an
audience. Students say they generally enjoy this and the topics are usually well presented and interesting.
Students have a chance to present initially to the Post Graduate Educational Meeting and they can use the
feedback from this to improve their presentation which usually is a few days later.
A student this year has failed their SSC presentation which are often of a good standard and variable
content.
Dr Jackie Rossiter, Unit Co-ordinator for Somerset Academy
Student Feedback 2011-2012
Written end of placement feedback was received from 242 of 248 students (97.6%). The feedback
questionnaire was reviewed and shortened from previous years, and an important new addition was the
inclusion of comment boxes for students to capture experiences not covered by the multiple choice
feedback questions. Students in the first three units completed this revised version of the paper-based
feedback administered in previous years. A new medical school feedback policy was introduced towards
the end of the academic year, requiring units to administer centralized web-based feedback, and amend
existing questionnaires to include mandatory questions for the General Medical Council. Consequently, the
Unit 4 feedback was not directly comparable to the previous units in the academic year. The quantitative
summary in this report therefore summarizes feedback collected from Units 1 to 3 of the academic year
(reported by 184 of 186 students). Unit 4 feedback is not included in the quantitative summaries below
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due to a different methodology and wording of questions. However, the qualitative themes at the end of
this report include those received from all units including Unit 4.
As in previous years, four endpoints have been used to compare performance across units and sites. A
fifth qualitative section is included at the end of this report, reflecting themes arising out of student
comments in free text responses to the new questionnaires in all units.
1) Average Score for ‘Supervision and Monitoring by Consultant’ (Rated as 1=Poor, 2=Satisfactory,
3=Good, 4=Very Good, 5=Excellent).
The average score for 184 students completing the feedback was 3.6, which corresponds to an average
rating of Good to Very Good, and comparable to previous years (2010-11 3.8; 2009-10 3.8). The highest
average scores at individual sites were achieved by Weston (4.2, 16 students), Gloucester (3.9, 35 students)
and Southmead (3.7, 20 students).
As in recent years all 8 sites achieved an overall average score of 3.0 or more, compared with seven out of
eight in 2006-7 and four of eight in 2004-5. There was one instances of an average score for a unit at
Taunton dropping below the minimum standard target of an average score of 2.0 (compared to no
instances in past 3 years). The scores for individual sites were consistent across the units.
2) Average Score for ‘Overall Quality of Clinical Attachment’ (Rated as 1=Poor, 2=Satisfactory, 3=Good,
4=Very Good, 5=Excellent).
The average score for 184 students in 2011-12 was 3.6, similar to the previous year’s average of 3.8. This
also lies between ratings of Good and Very Good. Weston led the scores, achieving an overall average of
4.1 followed by Taunton (3.9, 24 students) and Callington Road (3.8, 30 students).
As in each of the last 4 years, all 8 sites achieved an overall average score greater than the predetermined
‘standard’ of 3.0. There were 3 occasions where sites dropped below this minimum standard target for an
individual unit (in 2010-11 and 2009-10 there were also 3 such instances).
A declining trend in ratings was noted for Devizes and Bath.
3) Percentage availability of twelve predetermined ‘essential’ activities /opportunities.
Twelve activities/opportunities have been judged as essential. The ‘opportunity’ to participate rather than
actual participation is assessed, in order that a site’s feedback would not be adversely affected should
students choose not to attend a particular activity offered. Two items from previous years have been
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revised for the current year. Overall in 2011-12, 89.6% of these essential activities were offered. This is
comparable to 2010-11 (90.9%), 2009-10 (90.6%) and 2007-8 (90.8%), and higher than in 2008-9 (89.5%)
and 2006-7(85.0%).
Based upon the above feedback from the first three units, two sites, Bath (81.4%) and Devizes (80.8%) did
not meet the 85% target (all 8 sites averaged above these criteria over past three academic years). The
best overall score was achieved by Southmead (94.9%), Taunton (94.4%) and Gloucester (93.7%).
There were seven instances of failing to meet the 85% target in a Unit – compared with two and five in the
past two academic years respectively.
A decline in ratings with each passing unit was observed for Devizes, an improving trend for Bath, and a
hint of a declining trend was noted for Callington Road. Other sites were consistent.
4) Percentage availability of all twenty-eight predetermined activities /opportunities.
This endpoint refers to a range of twenty-eight activities/opportunities, including the twelve ‘essential’
activities/opportunities listed above.
Overall, 85.3% of these activities were offered (c.f 84% in 2010-11, 82.6% in 2009-10, 80.0% in 2008-09, and
80.2% in 2007-8), with all sites scoring over the pre determined target of 70%. There was only one specific
unit where a site failed to meet the 70% target (Devizes Unit 3, 63.1%), the same as occurred in the past 4
years. The highest scores were at Taunton (92.7%) and Gloucester (90.2%).
5) Themes arising from qualitative feedback received from students
Qualitative written feedback was received from all Units and the main themes arising are summarized
below. Verbatim feedback has been passed on to site tutors for actioning specific issues. The points below
are an attempt to thematically summarise issues raised by two or more students independently:
Students have consistently stating enjoying the theory and clinical practice of Psychiatry, especially when
teaching was inspiring, and based in clinical situations. Consistently excellent feedback has been received
for providing Psychiatry PRN textbook and its content and readability has been highly rated. Students at all
sites have praised their site tutors for the support but some students have found it difficult to contact
educational supervisors and site tutors. Some specialist placements e.g. Liaison Psychiatry, Learning
Disability Day and Eating Disorders have received positive feedback from multiple students. Clinically
orientated teaching and experiences have received most positive feedback, and most complaints are about
the lack or not having enough of these. Related to this, some students have felt they had a lot of free time
and consequently felt the Psychiatry placement should be shorter.
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Students at almost all sites stated they would like more clinical experiences, and would like more day to day
contact with clinicians. They would like more exam practice nearer the end of the placement. Several
students across sites have been made feel unwelcome by psychiatrists as well as other clinicians, and felt
discouraged and left uninspired by this. Some chronic issues seem to be: a) access to wards and patients in
Southmead hospital wards b) Unwelcoming and unpleasant experiences have been reported by several
students throughout the year placed with the Bath Crisis Team c) In Devizes, several students felt unable to
access specialist clinics or teams such as Drug and Alcohol Services/Forensic unlike their peers in Bristol.
Problems with organization such as incorrect timetables and repeated rearranging of teaching sessions has
been highlighted for some placements, and has come up on several occasions at Callington Road. RIO cards
to access clinical notes arrived too late or not at all for several students on AWP placements at Southmead,
Blackberry Hill Hospital, Bath and other AWP sites. Internet access has been an issue at some sites (Bath,
Devizes). Community based work and long distances and driving has been raised as an issue for out of
Bristol placements.
Although the overwhelming majority of students reported enjoying psychiatry, the above qualitative
feedback provides a rich resource of ideas for improvement of individual sites and the organisation of the
block to ensure our students’ time in Psychiatry is a positive and enjoyable learning experience.
Final Site by Site Totals, Units 1-3, 2011/12
In total 184 of 186 students completed the feedback questionnaires in Units 1-3. A further 58 out of 62
students completed a new online questionnaire in Unit 4 but since the questions were not identical,
summary scores below include only unit 1-3.
Tables 1 & 2 are based on ratings of 1-5, where 1=poor, 2=satisfactory, 3=good, 4=very good and
5=excellent.
16
Table 1: Average score for “supervision and monitoring by consultant” (min standard 2.0)
Rank
Site
Unit 1
Unit 2
Unit 3
AVERAGE
2011-12
Average
2010-11
Average
2009-10
Average
2008-9
1
Rank
201011
8
Weston
4.2
4.3
4.2
4.2
3.2
4.1
3.9
2
7
Gloucester
3.9
3.9
3.8
3.9
3.6
3.6
4.1
3
2
Southmead
4.0
3.6
3.5
3.7
4.0
3.7
3.4
4
1
Callington
3.9
3.5
3.6
3.7
4.2
3.8
3.4
5
3
BBH/Fromeside
3.6
3.4
3.6
3.5
3.9
3.2
3.2
6
6
Taunton
3.5
1.9
4.1
3.2
3.7
4.1
3.7
7
4
Devizes
3.7
2.8
2.8
3.1
3.8
4.2
4.1
8
5
Bath
2.8
2.5
3.7
3.0
3.7
3.9
3.9
Table 2: Average score for “overall quality of clinical attachment (min standard 3.0)
Rank
Rank
201011
Site
Unit 1
Unit 2
Unit 3
AVERAGE Average Average Average
2011-12
2010-11 2009-10 2008-9
1
8
Weston
4.5
3.8
3.8
4.1
3.3
4.1
4.2
2
3
Taunton
3.9
3.8
4.1
3.9
3.8
4.1
3.6
3
1
Callington
4.3
3.3
3.9
3.8
4.3
3.5
3.1
4
7
Southmead
3.8
3.4
4.2
3.8
3.5
3.9
3.6
5
4
BBH/Fromeside
3.9
3.2
3.9
3.6
3.7
3.4
3.3
6
2
Gloucester
3.5
3.9
3.3
3.6
3.9
3.6
3.7
7
5
Bath
3.5
2.8
2.8
3.1
3.7
4.1
3.7
8
6
Devizes
4.2
3.0
1.8
3.0
3.6
3.4
3.7
17
Table 3: Percentage saying yes as to whether each of 12 essential activities took place during their
attachment. (Predetermined target 85%)
Rank
Rank
201011
Site
Unit 1
Unit 2
Unit 3
AVERAG
E 201112
Averag
e 201011
Averag
e 200910
Averag
e 20089
1
6
Southmead
97.1
96.9
90.3
94.9
90.7
88.1
87.8
2
2
Taunton
93.8
95.8
93.8
94.4
93.4
93.8
88.1
3
4
Gloucester
88.2
95.1
97.2
93.7
91.5
91.3
93.8
4
3
Callington
92.4
89.0
87.5
89.6
92.4
90.9
88.4
5
8
BBH/Fromeside 91.7
92.6
80.7
88.7
87.5
86.6
88.6
6
1
Weston
95.8
91.7
76.4
87.5
93.5
96.1
89.2
7
7
Bath
77.8
81.9
84.5
81.4
87.7
87.7
89.9
8
5
Devizes
91.5
83.1
68.1
80.8
91.5
90.3
89.2
Table 4: Percentage saying yes as to whether each of all specified activities took place during their
attachment (Predetermined target 70%)
Rank
Rank
201011
Site
Unit 1
Unit 2
Unit 3
AVERAG
E 201112
Averag
e 201011
Averag
e 200910
Averag
e 20089
1
1
Taunton
92.0
94.1
91.9
92.7
88.3
87.0
80.2
2
6
Gloucester
90.6
86.6
93.4
90.2
81.9
81.5
83.5
3
3
Callington
89.6
84.9
85.7
86.7
85.7
82.5
77.2
4
5
BBH/Fromeside
87.8
87.3
81.0
85.5
82.5
78.4
77.3
5
2
Southmead
87.1
83.0
85.1
84.9
86.3
83.9
81.5
6
8
Weston
86.9
94.6
73.8
83.9
80.6
91.2
84.6
7
4
Bath
75.0
73.2
81.4
76.5
84.1
79.3
80.3
8
7
Devizes
83.2
74.8
63.1
73.7
81.2
79.0
73.1
Dr Dheeraj Rai, Feedback/Quality Monitoring Lead
18
Site Teaching Timetables for 2011-12
Topic
Bath
Phen/Classification Week 1
Week 1
Callington
Road
Week 1
MSE/History
Taking
Week 1
Week 1
Week 1
Week 2
Intro
Substance Misuse
Intro
Affective Disorders
Intro
Anxiety Disorders
Intro
Old Age/Dementia
Intro
Schizophrenia
(2) Substance
Misuse
(2) Affective
Disorders
(2) Anxiety
Disorders
(2) Old
Age/Dementia
(2) Schizophrenia
Week 7
Week 1
Varies between
wks 3-8
Weeks 4/5/6/7
Within 1st 2
weeks
Within 1st 2
weeks
Within 1st 2
weeks
Within 1st 2
weeks
Within 1st 2
weeks
Within 1st 2
weeks
Weeks 4/5/6/7
Week 2
Tutorial wk 5
Roleplay Wk 2
Within 1st 2
weeks
Within 1st 2
weeks
Within 1st 2
weeks
Within 1st 2
weeks
Within 1st 2
weeks
Within 1st 2
weeks
Weeks 4/5/6/7
Weeks 4/5/6/7
Weeks 4/5/6/7
Week 3
Tutorial wk 3
Roleplay Wk 2
Weeks 4/5/6/7
Weeks 4/5/6/7
Weeks 4/5/6/7
Week 5
Week 5/6
Weeks 4/5/6/7
Weeks 4/5/6/7
Weeks 4/5/6/7
Week 4
Roleplay Wk 3
Weeks 4/5/6/7
Week 3
Week 3
Week 6
Week 4
Weeks 4/5/6/7
BBH
Week 1
Week 1
Week 2
Week 1
Devizes
Gloucester
Southmead
Taunton
Weston
Week 1
Week 1
Week 1
Week 1
WEEK 2
Week 1 &
Roleplay
Weeks 2 & 3
Week 1
Week 1
Week 1
WEEK 1
PLUS VIDEO
Week 1
Week 2 or 3
Week 2
Week 3
Week 2
Week 3
Week 1
Week 1
Week 1
Week 1
Week 1 & Wk 6
19
WEEK 4
Week 1
WEEK 2
Week 1
WEEK 3
Week 1
WEEK 3
Week 1
Week 5 &
revision
Week 2 &
revision
Week 3 &
revision
Week 4 &
revision
Week 1
WEEK 2
In supervision
In supervision
In supervision
WEEK 7 WORKSHOP
WEEK 7 –
Risk Assessment
Weeks5
Week 1
Week 2
Week 3
Week 1
Week 1
Exam
Prep/Revision
Weeks 7
On going
On going
Covered with
Clinical Tutor
Week 6
On going
Mental Health Act
Week 3
By the end of
Week 3
Covered with
Clinical Tutor
On going
Week 2 (varies) Week 1
Pharmacology
By the end of
Week 3
Week 3 (varies) Week 4 & 5
Week 1 &
throughout
Week 8
Week 3
Tutorial within
1st 4 weeks
Week 2
2 students a
wk over 3 wks
Video available
and advised to
visit ECT suite
Tutorial within
1st 4 weeks
Week 3
Specialist subjects
User
perspective
Therapies
week 3
Learning
Disability – ½
day on week 5
User
perspective
Throughout
Rethink
sessions
Learning
difficulties
Week 4 & 5
Learning
Disabilities –
students
attend in two’s
CAMHS
Extra tutorials
ongoing
Child & Family
– Students
attend
individually
Clinical
Psychologist –
wk 5
20
Every Monday
course tutor
WEEK 4
Week 7
ECT
DSH –
allocated day
with Liaison
Team
WORKSHOP
WEEK 5
Rethink
sessions
CAMHS
Video in the
first weekadvised to visit
ECT suite and
make contact
with Ben Ford
Wk 3 – Eating
Disorders
Wk 4 – Early
Intervention
Psychosis
Wk 4 –
Learning
Disabilities’
Day
Wk 5 – CBT
Wk 6 –
Personality
Disorder
Workshop
Perinatal wk 5
PTSD wk 4
Additional
Lectures Eating
Disorders/Child
& Family
Suicide &
Deliberate Self
Harm
21