DoME NEWS Issue 2, January 2008 DIVISION of MEDICAL EDUCATION Welcome to the second edition of DoME News, the termly newsletter from the Division of Medical Education that aims to keep medical school staff updated about developments in the medical school and the MBBS (undergraduate) curriculum and to enable sharing of good practice between medical educators. January is always a busy time of the year and 2008 is no exception. The MBBS Review and the Postgraduate Review processes consumed a great deal of energy and time towards the end of 2007 and following the consultatio n period, planning the implementation processes begins this month. Thank you to all members of staff who devoted so much time and thought to the recommendations working groups, thank you to all who replied in the consultation process and thank you in anticipation to those who become members of the implementation groups. The Academic Centre for Medical Education has metamorphosed within the new divisional structure to become the education research and staff development unit within DoME. Headed by Dr Deborah Gill, ACME has recently said ‘goodbye’ to their second academic FY2 doctor and ‘hello’ to two new Clinical Teaching Fellows in Medical Education (see page 3). This edition also highlights some innovations in the curriculum within the SSC components and elsewhere (see page 6). We also introduce Laura Brammar, who has been doing some excellent work with our medical students in the area of careers and whose work should be relevant to all staff who come into contact with our MBBS students. Finally everyone at DoME wish you all a happy, prosperous and productive New Year. THE ACADEMY EDUCATORS OF MEDICAL This is a newly formed professional organisation for all involved in the education and training of medical students and doctors. Established in 2006, the Academy exists to provide leadership, promote standards and support all those involved in the academic discipline of medical education. The next open meeting of the Academy of Medical Educators is to be held on Tuesday 22 January 2007 at 1.30 at RIBA, 66 Portland Square, London W1B 1AD. Should you wish to attend the meeting, please email info@medicaleducators.org. For more information about the academy visit their website at: www.medicaleducators.org. The main role of the Division of Medical Education (DoME) is to provide the infrastructure for maintaining excellence in education in a research led medical school. DoME CONTACTS Director: Professor Jane Dacre ACME Lead: Dr Deborah Gill Admissions Lead: Dr Brenda Cross Curriculum Management & Assessment Lead: Prof Irving Taylor Learning Resources Lead: Ms Deirdre Wallace Medical Student Administration Lead: Ms Gaynor Jones Quality Assurance Lead: Dr Anita Berlin SIFT Office & Finance Lead: Prof Jane Dacre Welfare/Fitness to Practice Lead: Dr Peter Raven Divisional Manager: Heather Mitchell DoME, Level 4, Holborn Union Building, Archway Campus, Highgate Hill, London N19 5LW Tel: 020 7288 5209 Email: h.mitchell@medsch.ucl.ac.uk DoME News ~ Editor: Dr Deborah Gill ~ Layout & Design: Leonie Hayes Tel: 020 7288 5964 Fax: 020 7288 3322 Email: l.hayes@medsch.ucl.ac.uk URL: http://www.ucl.ac.uk/dome DIVISION of MEDICAL EDUCATION DoME NEWS included: One of the first priorities following the formation of DoME has been orchestrating the two major reviews of the MBBS programme and of Postgraduate Taught Courses. Commissioned by Professor Ed Byrne and lead by Professor Jane Dacre, Vice Dean and Director of DoME, these reviews aim to increase the clarity of purpose of both the MBBS course and our postgraduate courses and to ensure best practice in delivery of medical education. The review processes started in September with an open invitation for faculty members to be involved in a series of working groups to develop recommendations. A series of detailed meetings between the working group leads produced an overall report for each of the reviews which are available at http:// www.ucl.ac.uk/medicalschool/staff/mbbsreview/ and http://www.ucl.ac.uk/biomedicalsciences/postgrad-review/. • Creating an integrated and responsive medical school structure with the MBBS programme becoming part of the Faculty of Biomedical Sciences with a single management, financial and administrative structure • A clearly stated unifying aim for the MBBS course to ensure clarity of purpose and planning • Ensuring an integrated and flexible MBBS course that provides a relevant and up to date student experience • Improved support and recognition for teachers POSTGRADUATE REVIEW EDUCATION UCL is one of Europe’s top 10 Universities, and needs to maintain and improve that position. The provision of high quality postgraduate courses that are research led and evidence based is a central component of our vision. The overall aim of the review was to reflect on the strengths and weaknesses of the current provision of courses and to make recommendations for change. November and December saw the consultation period with an electronic consultation questionnaire and opportunities to comment on the recommendations sent to as wide a range of staff and students as possible. A series of roadshows also attempted to widen the audience and allow an alternative opportunity to feedback on recommendations. The degree of engagement in this process was excellent and the information collected in the reviews and the consultation exercises are being collated and an implementation plan is being devised at the Faculty Senior Management Group, hopefully to begin the implementation phase in the Spring. Recommendations of the review process include: THE MBBS REVIEW Although RF&UCMS is recognised as an excellent Medical School and we pride ourselves on the quality of our graduates we must keep abreast of changes in the world of medicine and in medical education to ensure our graduates are as prepared as possible for practising medicine in the 21st Century. • a more coherent education strategy • central coordination of postgraduate education and associated finance • modularisation to allow a core and options model for taught course provision • better branding and marketing for all our courses • support and recognition for teachers We would like to thank everyone who worked so hard on the review process and those who took the time to read the report and to comment on the recommendations. Now all we need to do is the simple task of implementation of the final recommendations…… Recommendations of the review process ASSESSMENT DATES FOR YOUR DIARY FINALS OSCEs—10th to 13th June 2008 YEAR 3 OSCEs—30th & 31st July 2008 New examiners always welcome. Please contact Sabine Morris (year 3) sabine.morris@medsch.ucl.ac.uk or Tim Cook (year 5) t.cook@medsch.ucl.ac.uk if you would like to volunteer for this important role. Tel: 020 7288 5964 Fax: 020 7288 3322 Email: l.hayes@medsch.ucl.ac.uk website: http://www.ucl.ac.uk/dome 2 DIVISION of MEDICAL EDUCATION ACME NEWS teaching fellow taking an out of programme period for the next two years. She will continue to do one clinical session as a paediatric SpR at UCLH. Luci qualified from Leeds in 2000 and has been a paediatric trainee since 2002. She has a postgraduate certificate in medical education from UCL. Her education research interests include the use of standardised patients in training for postgraduate doctors and assessment. Her main role at ACME will be with the G M C Performance Procedures Project but she will also be involved in year 4 assessments staff development and a whole host of ACME activities. WELCOME TO BOB AND LUCI The Academic Centre for Medical Education is delighted to introduce two new members of staff who we hope will be with us for the next two years. Bob Klaber has joined us as a part time clinical academic teaching fellow which he will combine with a half time role as a SpR in paediatrics at the Whittington Hospital. Bob trained at Cambridge, Barts and the London and has been a paediatric trainee in London since 2001 . He has a post graduate certificate in medical education from Queen Mary College. His education research interests include the experiences of adolescents in medical education and handover as an e d u c a t i o n opportunity. Whilst at ACME he will have responsibility f o r s t a f f development, Peer assisted learning and year 5 examinations. We are delighted to welcome two such experienced teachers to our team and hope to provide the time, encouragement and inspiration for them to develop their education research profiles. Luci Etheridge has joined us at ACME as a full time clinical academic GOODBYE TO DR MEL GARDNER ACME are sad to say goodbye to our academic FY2 doctor who rotated to our department for four months as part of her academic FY2 programme. Mel was well known to us here at ACME as she had been one of our peer tutors and a keen teacher on the student led ‘Sexpression’ programme. During a hectic four months at ACME Mel was very much thrown in at the deep end and became involved in a wide range of teaching activities from 1st year medical students right up to consultant level. She was a PDS tutor, a TIPS facilitator, and lectured in large group settings. She was involved in the Dick Whittington and GMC research projects. my training. The department was friendly, collaborative and productive; it was impossible to walk down the corridor or have a tea break without having a useful conversation that ended up leading to another bit of interesting work !” Mel said, “ it was a fantastic experience to be involved in lots of aspects of medical education. It has hugely influenced my career plans and I hope to gain a qualification in teaching and return to the department later in Tel: 020 7288 5964 Fax: 020 7288 3322 Email: l.hayes@medsch.ucl.ac.uk website: http://www.ucl.ac.uk/dome 3 DIVISION of MEDICAL EDUCATION CURRICULUM UPDATE ANNUAL REPORT TO THE GMC ICCM We are in the process of completing our annual ‘Quality Assurance of Basic Medical education’ (QABME) report to the GMC. It will report on our progress with the curriculum changes that the GMC visitors suggested and highlight areas of good practice and innovation. The main areas they wanted us to work on were: provision of sufficient choice in the curriculum; integration of the curriculum, particularly across the two faculties; and a dedicated staff responsible for education quality. SSC provision has been transformed under the lead of Peter Raven and David Bender, ably assisted by Tim Cook. Integration is a major theme of the MBBS review recommendations and we now have a Quality Unit headed up by Anita Berlin, the Sub Dean for Quality and Ann Glasser, QA Officer. Anita and Ann have made a huge difference to the way in which evaluation data is gathered and acted upon and have maintained close links with the GMC visitors. We feel very confident that the annual report will be welcomed by the GMC as evidence of good progress. The Quality Assurance Unit website is a well maintained and informative site that covers many areas of quality and assurance that affect teaching, from medical student feedback to QA SIFT visits. Keep an eye on the website as they will be posting information on how to apply for this year’s Excellence in Medical Education Awards early in the New Year http://www.ucl.ac.uk/medicalschool/ quality/ The Introductory Course in Clinical Methods is the three week programme that all new clinical students complete as an introduction to learning in the clinical environment. The transition from classroom to clinical setting is a huge leap for most learners and the aim of the ICCM is to ease this transition and prepare them with foundation skills in clinical examination and medical interviewing. The course comprises of introductory lectures, skills centre based sessions led by peer tutors and ward based session to reinforce the skills learnt. The current system is difficult for some firms to fit into their timetables and does not give the students a sense of ‘belonging’ to a firm. In 2008 we will be trying a new approach where the timetable for students is based firmly within the firm’s activities and the students ‘peel off’ for lectures and skills centre sessions. We hope this model will encourage students to see more patients and to be around on the wards when learning opportunities are possible. For further information contact Sabine Morris sabine.morris@medsch.ucl.ac.uk or Adrian Wagg a.wagg@ucl.ac.uk ing and the Medical School should be prepared to devolve this responsibility to these adult learners who are within months of becoming qualified professionals. The scheme will now be piloted in the 2008-9 session. CLINICAL PRESIDENT, UCLU Hello! My name is Andrew Wilson, a 4th year medical student and the Clinical President of UCL Student’s Union (UCLU) for 2007-8. Next year will see the beginning of a new era in staff-student partnership and coconstruction of the curriculum. Given the recent changes to the Year 5 programme, the amount of time available for revision for Finals has been reduced to just two nerve-wracking weeks. Earlier this year, I proposed to the Education Committee to establish a “floating” Personal Study Week (PSW) for final year students in which they could spend a week in self-directed study in preparation for Finals. There will be some restrictions on when students can take their PSW (specifically not in the first or last week of any given rotation), and the School and the Union are working together to thrash out the fine print in the New Year. My goal ultimately is to ensure that UCL remains one of the very best places to study medicine. Please do get in contact if you would like to discuss any matter that affect students. Andrew Wilson, PhD I believe that students should be encouraged to take responsibility for their own learnTel: 020 7288 5964 Fax: 020 7288 3322 uclu-clinical.president@ucl.ac.uk Email: l.hayes@medsch.ucl.ac.uk website: http://www.ucl.ac.uk/dome 4 DIVISION of MEDICAL EDUCATION CURRICULUM UPDATE subjects taught are of a practical nature this was noted by the team and the decision was made to review the course. ALL NEW DR WHO! BACKGROUND: For the last three academic years the DR WHO (Workshop for House Officer Preparation) course has been delivered to all final year medical students by the clinical skills team. The course delivers teaching on care of the critically ill patient. This is important preparation for both clinical practice and the short station OSCE’s. The course has always proved very popular with the students. In fact much of the main elements of the DR WHO course are now introduced in the 1st year of phase 2 during critical care week. This means that the majority of final years attending the course in 2007-2008 are already familiar with the theory and main priorities of caring for the seriously ill patient. With this in mind and in response to feedback the DR WHO course has been given an overhaul! ALL CHANGE: The new course is aimed at a larger number of students, anything up to 48, and is delivered during their A&E attachment. The lectures have been omitted but the students are provided with a pre-course reading pack which includes all the relevant theory and a quiz to help revision. All the main elements of the course that remain are now delivered in a very practical, scenario based fashion to encourage self directed and group learning. Students are split into 3 groups of 12-16 in the morning and the day starts with an introduction and review of knowledge. This is facilitated by going through the quiz. After that each group rotate around three 70 minute workshops- DRABCDE, Airway management, Initial cardiac arrest management and defibrillation. Each group is facilitated by a Clinical Skills Tutor. The previous one-day course contained two lectures and small group workshops. In the morning students learnt how to assess and treat a critically ill patient using the DR ABCDE (danger, response, airway, breathing, circulation, disability, exposure) assessment tool. This took the form of a large group lecture followed by the students being split into small group for a scenario based workshop. In the afternoon the students, in groups of approximately 10, practice scenarios which bring all the components together and focus on team skills and clinical management of a cardiac arrest. The morning also included a small group workshop revising airway management. In the afternoon students revised cardiac arrest management by having a lecture on the ALS algorithm and a scenario based workshop which included management of pre, peri & post cardiac arrest problems. So far there have been 5 courses, attended by 180 students, and another 5 courses targeting the remaining final year students are planned for 2008. The feedback has been excellent, with comments such as: Each small group was facilitated by a Clinical Skills Tutor or DoME lecturer with Resuscitation Council membership, who taught the same group in each workshop. ‘A well taught day revising extremely useful topics’ ‘Mentors know their stuff and teach enthusiastically’ Feedback included comments such as: In addition the clinical skills team very much enjoy delivering a more interactive style of course, and hope to use the feedback towards a follow up DR WHO study. ‘This is the best day I have spent in medical school in the last 5 years’. However feedback also showed that the lectures were less well accepted than the practical and small group sessions. As the Tel: 020 7288 5964 Glenda Baillie Clinical Skills Tutor Fax: 020 7288 3322 Email: l.hayes@medsch.ucl.ac.uk website: http://www.ucl.ac.uk/dome 5 DIVISION of MEDICAL EDUCATION SHARING GOOD PRACTICE 2 students this month. I am based at UCL three days a week and am a v a i l a b l e f o r appointments all day. Either, 20 minute quick query/application form checks or for one hour career discussions every Tuesday, at UCL Careers Service, ULU Building, Malet Street. To book a 20 minute appointment call 020 7866 3600 and ask for a 'Medical Query' or email us at careers@ucl.ac.uk to arrange an hour long discussion. Medical students are always welcome to visit the Career Service library. Please see www.ucl.ac.uk/careers for more information. CAREER ADVICE My name is Laura Brammar, I have been working as a Careers Advisor at UCL since February 2007. I have a role in developing future careers provision within the Medical School. In addition to my work at UCL I also provide Careers Consultancy for C2 Careers, University of London to external clients including the BMA and London Deanery. I am a member of both the National Medical Careers Advisers' Network and of The Association of Guidance and Careers Advisory Services (AGCAS). I work with clients on career direction, electives, application and interview skills and provide advice on part-time work and volunteering opportunities. I have worked successfully with medical students completing their FY1 applications and will start an SSC in Career Management Skills for Year Mental Health, Community Widening Participation. STUDENTS CHOICE IN THE MBBS CURRICULUM These changes are popular with teachers and students and allow teachers to do something different or communicate a particular enthusiasm of theirs to students. If you would like to know more about becoming an SSC provider please contact Tim Cook t.cook@medsch.ucl.ac.uk The GMC recommends that students spend between 25 and 30% of their total curriculum time pursuing subjects they have selected themselves. These choices need to be relevant to their personal and professional development as doctors and need to show sufficient breadth so that each student covers a range of areas and develops a range of competencies during their chosen activities. Much of this activity takes place in designated periods of curriculum time; student selected components (SSCs). Dr Peter Raven is the chair of the SSC education subcommittee and has been working over the last year or so to increase the number and range of SSCs available to our students. Tim Cook, the administrator for SSCs, has created a dedicated SSC home page on the Medical School’s Intranet site https://www.ucl.ac.uk/ medicalschool/current-students/courseinformation/ssc/ (UCL username & password required). This increase in focus on student choice has resulted in a number of innovative SSCs including: -Teaching and Learning (Institute of Education) in Phase 1 - Foreign Languages in Phase 1 & 2 - “Balint Group” SSCs - Clinical Hypnosis - Introduction to Complementary Therapies - Self-Organised SSCs in Y5 – 38 final year students are organising these in 2007-08, including for example Forensic Medicine, Bioethics, Tropical Medicine, Community Tel: 020 7288 5964 Fax: 020 7288 3322 Paediatrics, OOH AARGH ER Ooh Aargh ER! is the brand new SSC for 2nd years that has been devised by clinical skills tutors, Glenda Baillie and Catherine Phillips from the Clinical Skills team. This eight week course takes a look at most aspects of emergency care, focusing on rapid response and management in the out of hospital environment. The SSC has been developed to link theory to practice by creating emergency situations that have been adapted from real life. After ensuring the students have a firm grip on the theory the onus is placed on working through a scenario to develop their practical skills. This course also gives the students a very useful insight into what is to come in their third year and provides a good foundation for future learning. Ooh Aargh ER has been designed to be interactive and fun and so far the feedback has been tremendous, with suggestions that it should be longer! It ends on a crescendo with a trauma moulage based on the ATLS model which puts all the hard work and new skills to the test. For information contact Glenda Baillie at g.baillie@medsch.ucl.ac.uk Catherine Phillips, Clinical Skills Tutor Email: l.hayes@medsch.ucl.ac.uk 6 website: http://www.ucl.ac.uk/dome DIVISION of MEDICAL EDUCATION TPDU NEWS Photos l to r: Jane Richardson; Dr Deborah Gill; Leonie Hayes, Ricky Kemp. Below: Carol Parker THE TEACHING AND PROFESSIONAL DEVELOPMENT UNIT ability and suitability of courses at UCL and beyond for those wishing to develop further their knowledge and skills as medical educators. The Teaching and Professional Development Unit (TPDU), led by Jane Richardson, is a unit within the Academic Centre for Medical Education (ACME) responsible for a range of staff development initiatives and courses for teachers involved in delivering the MBBS programme at the Medical School at UCL. The TPDU also works with a range of postgraduate groups on a consultancy basis providing training and support for foundation school programmes, doctors in training and other healthcare professionals, GP and consultant educators. As well as teacher training and professional development in education this includes specialist communication skills, team working, appraisal, professional development, risk and complaints management, ethics and law in clinical practice. The remit of the TPDU includes the delivery of the teaching training (TIPS) project, associated short courses; the one to one training of individual teachers, support on curriculum development and the support and training of students who act as peer tutors in the MBBS programme. In addition to running basic teaching training (the TIPS Course) twice monthly, we also run courses on clinical and bedside teaching, teaching large groups, teaching ethics and law and teaching communication skills. We provide expert advice for those involved in curriculum planning, teaching delivery and assessment. We also provide assistance for those who wish to apply for membership of professional bodies such as the Higher Education Academy and can advise on the avail- If you are interested in attending the TIPS courses or would like more information on these courses please contact Ricky Kemp; r.kemp@medsch.ucl.ac.uk If you would like to discuss your individual or departmental requirements in relation to teaching training and professional development in an educational context please contact Jane Richardson; j.richardson@medsch.ucl.ac.uk students at any one time. Students will be able to review lectures with slides and audio, recorded from the lecture, on the UCL Moodle site where course handouts are also currently available. It is hoped that this will enhance our students learning experiences, and expose them to new and exciting ways of communication. MEDICINE & VIDEOCONFERENCE TEACHING Media Resources have installed a completely new video conferencing facility which links all three teaching campuses together, providing a potential communications link to anywhere in the world. The taught course in ‘Medicine and Uses of Medicine’ for year 3 students started using this facility in October 2007. This has allowed a uniform core curriculum to be delivered by one lecturer to all three teaching sites, engaging 360 medical Tel: 020 7288 5964 Fax: 020 7288 3322 X Cont. page 8 Email: l.hayes@medsch.ucl.ac.uk website: http://www.ucl.ac.uk/dome 7 DIVISION of MEDICAL EDUCATION TPDU NEWS XKey features of the new videoconference set-up include: • All sites can hear and see each other • The system can transmit video, audio and data Presentations/DVD/Visualisers • Instant control can be given to any participating site • Each session can be recorded and archived for later viewing of facilitators teaching the course. The first of these was delivered on 19th September 2007. A number of significant changes were made. We felt that the delivery of the course as it stood did not reflect that of large group teaching in three key ways: (1) Participants reported that being in a classroom rather than lecture theatre did not recreate the (often anxious) feeling of ‘performing’ in a large lecture theatre. (2) The previous groups of 12 did not in themselves constitute a large group audience – and so the occasion lacked a certain sense of realism. With the new infrastructure additional locations can be added to expand the system HELP WITH TEACHING USING VIDEOCONFERENCING (3) There was no role-modelling of how to teach a large group using interactive techniques in a lecture theatre. Teaching these concepts without actually demonstrating them had led to some scepticism amongst previous participants. Attending the TIPS 1 and TIPS 3 courses will provide you with key teaching skills that can be applied to this remote teaching facility. The new TIPS 3 course offers specific focus on the challenges of teaching large groups. Please contact Ricky Kemp r.kemp@medsch.ucl.ac.uk to express your interest in attending either NEW VENUE, NEW COURSE We moved the course to the new 125 seat lecture theatre in the undergraduate centre at the Whittington Hospital where we tripled participant numbers to 36. This new venue enabled us to theoretically and practically demonstrate good practice in large group teaching: • Using interactive techniques, i.e. show of hands, quiz format, partial handouts, role play. • Using video clips and live demonstrations of both effective and ineffective teaching practices. TEACHING • Facilitators:- Andrew Wilson (UCL), Glenda Bailie (Clinical Skills Centre, Royal Free Campus) Carol Parker, Bob Klaber (ACME) Improving clarity with signposting and linking the material to the TIPS 1 foundation course. • Using 4 different facilitators to show a diversity of presentational styles to allow participants to integrate individual aspects into their own teaching practice. GO LARGE TIPS 3 COURSE LARGE GROUP The aim of the course is to efficiently maximise your skills in presentation and delivery to large groups. Workshop topics include: • Interacting in a large group • Structuring your session to maximise learning • Preparing your materials, resources, audience and yourself • Developing & delivering an effective presentation The afternoon is dedicated to small group work where participants are asked to examine a number of situational problem-oriented teaching case studies, in small groups of 5-6. The opportunity is then offered for some course participants to present their findings to the large group, which was carried out with humour and enthusiasm! The day is set up as an exercise in situated learning - participants can then reflect on the experience and share their thoughts with the rest of the group. The new one-day TIPS 3 large group teaching course was designed using feedback from previous participants, and the reflection Tel: 020 7288 5964 Fax: 020 7288 3322 In all, the pilot course on 19th September Email: l.hayes@medsch.ucl.ac.uk website: http://www.ucl.ac.uk/dome 8 DIVISION of MEDICAL EDUCATION TPDU NEWS Our top TIPS for successful large group teaching: 2007 was an enjoyable day for participants and facilitators alike! Feedback from participants was on the whole positive: Previously, I found it difficult to know how to interact with a large group. You reemphasised the dynamics and methods in which this can be done. All the lectures with videos, the use of frameworks and encouraging audience participation were the best aspects of the course. The course has increased my confidence in initiating interaction and managing this process. I found the group work using case examples really useful, trying to think of possible techniques to manage a particularly difficult teaching situation. It really was excellent, interactive and fun! • Remember that a large group is simply a collection of smaller groups. • Prepare the audience for their role when you set tasks. If you manage your interactive tasks well, you are unlikely to lose control of the group. • Preparation is key to success – think about how you can break up your large group teaching session into a series of different sections and interactive tasks which combine together to deliver the key goals and learning objectives. Remember, enthusiasm FORTHCOMING DATES: is infectious! We look forward to welcoming you to our next large group teaching course. Two courses are planned Wednesday 9th April and Wed 16th July, 2008. I enjoyed the group work. It brought together all we’d learned, by using practical examples. Please contact Ricky Kemp r.kemp@medsch.ucl.ac.uk to secure a place. TIPS 1 COURSE DATES Thursday 31st January & Friday 1st February Tuesday 5th & Wednesday 6th February Thursday 7th & Friday 8th February Thursday 17th & Friday 18th April Thursday 8th & Friday 9th May Monday 19th & Tuesday 20th May Tuesday 24th & Wednesday 25th June Contact: Mr Ricky Kemp—r.kemp@medsch.ucl.ac.uk Tel: 020 7288 5964 Fax: 020 7288 3322 Email: l.hayes@medsch.ucl.ac.uk website: http://www.ucl.ac.uk/dome 9