Undergraduate Medical Training Financial Accountability & Quality Enhancement Annual Report’ 2013/14 UCL Medical School UCL Medical School is committed to excellence in undergraduate and postgraduate education and has a strong reputation for teaching informed by cutting-edge research. The School has a distinguished cadre of academic staff who are at the forefront of international research in biomedical sciences, medical education and clinical medicine. The Medical School aims to provide the seamless high quality education of medical students from admission to graduation; to enhance the status of learning and teaching within the Medical School; and to support and advise on the relevant facilities and resources underpinning medical education. It also provides postgraduate education locally, nationally and internationally and promotes scholarship and excellence in medical education delivery and research. 2 Status of this report This report has been prepared for the sole use by HE NCEL, and no responsibility is taken by the Medical School to any director / member or officer in their individual capacity, or to any third party. 3 Contents Summary Introduction Detailed Report A. Student number time series information to highlight future bulge and fallow intakes Student population as at 1 December 2013 Forecast for Autumn 2014 intake Number of qualifiers in summer 2013 B. Summary of SIFT expenditure against budget C. Reporting of quality assurance exercises QA of Clinical Placement Providers QA of the MBBS Programme D. Summary of developments, innovations, best practice to include significant future changes to the curriculum or any other important achievements Developments and innovations Appendix 1 - Management Plan arising from the last QABME visit Appendix 2 - Internal Quality Review 2013-14 (not yet available, deadline December 2014) Appendix 3 – Medical School governance – organograms - MBBS Academic Leadership - MBBS Vertical Modules Leadership - MBBS Leadership Clinical Placements - MBBS Faculty Tutor, Student Support and Foundation Training - MBBS Committees and Chairs Appendix 4 - Medical School governance - statements - MBBS Academic Leadership - MBBS Vertical Modules Leadership - MBBS Leadership Clinical Placements - MBBS Faculty Tutor, Student Support and Foundation Training - MBBS Committees and Chairs 4 5 Introduction Detailed Report A. Student number time series information to highlight future bulge and fallow intakes Student population as at 1 December 2013 Table 1 Student Population by year group and by Home / EU and Overseas as at 1 December 2013 Year Group Home/EU Overseas Total Population Year 1 303 23 326 Year 2 303 19 322 New Year 3 (IBSc) 259 28 287 New Year 4 334 36 370 New Year 5 325 11 336 New Year 6 358 16 374 6 Forecast for Autumn 2014 intake Table 2 Forecast for Autumn 2014 intake by year group and by Home / EU and Overseas Year Group Home/EU Overseas Total Population Year 1 TARGET FIG 298 24 322 Year 2 314 23 337 New Year 3 (IBSc) 298 18 316 New Year 4 356 30 386 New Year 5 330 36 366 New Year 6 334 12 346 Number of qualifiers in summer 2013 Table 3 Number of qualifiers in Summer 2013 Number qualified, repeating or failed Qualified 367 Repeating ( from Jan 2014) 3 Failed 0 Did not complete / withdrew 0 Total 370 comprises 355 in Final Year from Sept 2012 and 15 re-sitters from Jan 2013. 7 370 B. Summary of SIFT expenditure against budget Table 4 Summary of SIFT expenditure 1 April 2013 to 31 March 2014 Budget Elements FTE BUDGET ACTUAL VARIANCE IN LONDON SIFT SLA Trusts Barking, Havering and Redbridge University Hospitals NHS Trust 7.85 319,081 319,081 £0 Barnet and Chase Farm Hospitals NHS Trust 29.98 1,242,804 1,242,804 £0 Barnet, Enfield and Haringey Mental Health NHS Trust 11.85 492,470 492,470 £0 Camden and Islington NHS Foundation Trust 47.78 2,023,597 2,023,597 £0 0 0 0 38.74 1,628,548 1,628,548 5.91 263,084 263,084 Moorfields Eye Hospital NHS Foundation Trust 5.2 227,612 227,612 £0 North East London NHS Foundation Trust 0.22 8,934 8,934 £0 North Middlesex University Hospital NHS Trust 32.40 1,347,328 1,347,328 £0 Royal Brompton and Harefield NHS Foundation Trust 1.31 56,859 56,859 £0 197.18 8,509,861 8,509,861 £0 1.02 1.12 41,580 48,017 41,580 48,017 £0 223.42 158.50 10,037,611 6,658,640 10,037,611 6,658,640 Central London Community Healthcare NHS Trust Central and North West London NHS Foundation Trust Great Ormond Street Hospital for Children NHS Foundation Trust Royal Free London NHS Foundation Trust Royal National Orthopaedic Hospital NHS Trust Tavistock and Portman NHS Foundation Trust University College London Hospitals NHS Foundation Trust Whittington Hospital NHS Trust, The £0 £0 8 £0 £0 £0 Sub Total Budget Elements 762.48 32,906,026 £0 32,906,026 FTE BUDGET ACTUAL VARIANCE 45.53 1,770,036 1,770,036 24.64 972,940 972,940 44.99 1,745,024 1,745,024 1.34 50,408 50,408 0.27 10,376 10,376 0 0 0 £0 17.18 696,396 696,396 £0 133.95 5,245,180 5,245,180 £0 431,845 431,845 £0 1,707,135 1,707,135 £0 856,500 856,500 £0 2,995,480 2,995,480 £0 OUT OF LONDON SIFT SLA Trusts BASILDON AND THURROCK UNIVERSITY HOSPITALS NHS FOUNDATION TRUST EAST AND NORTH HERTFORDSHIRE NHS TRUST LUTON AND DUNSTABLE HOSPITAL NHS FOUNDATION TRUST NORTH ESSEX PARTNERSHIP NHS FOUNDATION TRUST SOUTH ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST Surrey and Sussex Healthcare NHS Trust WEST HERTFORDSHIRE HOSPITALS NHS TRUST Sub Total £0 £0 £0 £0 GP Education and Infrastructure (inc Small and Tasked GP) GP Clinical Placement £0 143.06 GP Facilities Sub Total 9 Other (Non Recurrent) 4.33 173,117 158,717 14,400 Medical School Direct* 1.79 71,563 59,841 11,722 6.12 244,680 218,558 26,122 Sub Total NB: * Providers may claim after the end of the budget year. CLINICAL TOTAL Clinical Total 1,045.61 41,391,366 FTE and income data based on what providers’ received according to information from HENCEL. 10 41,365,244 26,122 Budget Elements FTE BUDGET ACTUAL VARIANCE ADMIN BUDGET SIFT Co-ordinator 158,478 158,478 £0 Training for Teachers 117,837 117,837 £0 Patient Database administrator 15,173 15,173 £0 Simulated patients 26,778 26,778 £0 Clinical Skills Tutors 140,018 140,018 £0 £0 £0 Admin Total 458,284 458,284 £0 Total 41,849,650 41,823,528 26,122 11 C. Reporting of quality assurance exercises QA of Clinical Placement Providers i. Executive summary of the Medical School’s QA of Clinical Placement Providers in 2013/14 Quality Assurance Unit The purpose of the Quality Assurance Unit (QAU) is to ensure that high standards within teaching and learning processes for undergraduate medical programmes are recognised and rewarded, and problems identified and addressed. The Unit has oversight of all quality assurance and enhancement of the MBBS programme, including clinical placements. It was established in 2006 in response to recommendations made by the GMC, recognising that the area of quality assurance was not adequately resourced within the Medical School. The QAU employs a range of strategies to create a picture of the students’ educational experience across the whole curriculum. The QAU works in conjunction with the SIFT Office to ensure financial accountability. A Quality Assurance Project Officer was employed to carry out a full review of the School’s QA processes during 2013-14 and the recommendations of this review relating Trust QA visits have been implemented. The implantation of the recommendations to student feedback take place during 2014/15 and details of those recommendations are provided below. Student Feedback The QAU gathers feedback from students throughout the programme using a bespoke, on-line student evaluation questionnaire for each module. Data can be analysed by module and NHS site or GP practice. Status reports are produced using this data and are supplied at regular intervals to various Teaching Committees. Following the aforementioned QA review, the on-line student evaluation questionnaires will be conducted at more timely intervals in order to ascertain more meaningful and relevant data. The use of new survey software is also being piloted as a means of trialling a more intuitive system with greater reporting functions. Trust QA visits – summary The QAU workload has expanded; in particular the mandatory QA reporting processes, and the resources associated with the historic visiting procedures was viewed as excessive. The GMC encourage a process of self-evaluation for both medical schools and providers of clinical placements. The Medical School follows a structure similar to that of the GMC; an annual, self-assessment exercise by trusts, triangulated with online student feedback and focused visits. This self-assessment tool, the Medical Education Providers’ Annual Return (MEPAR) was previously completed by our main DGHs and providers. A recommendation of the QA review was to roll out the MEPAR to all of our providers, including our 3 main central sites. The QA will visit any Trust that do not submit their MEPAR. In line with the QA review, the QAU has started a process of attending the Undergraduate Teaching Committees of their DGH education providers as a means of visiting Trusts in a resourceful way. It is anticipated that this will take place ever three years. 12 Informal, light touch visits to some of the DGH education providers have been conducted by the Final Year lead, which include discussion of feedback on fourth year placements and resources. (see below, section ii.) The Academic Lead for Year 5 also conducted curriculum so cued visits to four site during the summer term of 2013/14. The aims of these visits are to: share developments and review feedback ensure the quality of educational provision meets the requirements laid out in the Learning & Development Agreement, Tomorrow’s Doctors 2009, QABME report and any other guidelines issued by the School, the GMC, the SHA, College and the QAA; promote good relations with the Trust through dialogue, feedback, and support share good practice ii. Description of the process used Attending the Undergraduate Teaching Committees has enabled UCL and its providers to sustain positive working relationships and is a suitable vehicle for ensuring a constructive dialogue continues between both parties. This approach differs from the light touch visits which take place for years 5 and 6 and are a way of encompassing all years, with a more strategic focus. The light touch visits have been carried out by the Final Year Lead and team. These visits aimed to offer support to our NHS partners and maintain good relations. They followed a standard structure: meeting students to gather feedback, followed by a meeting with the Undergraduate Tutor, key clinical teachers and administrative staff. The Medical School Librarian and Academic Support Manager attended these meetings, and carried out a comprehensive review of library and IT resources. The MEPAR submission deadline has recently passed the results are currently being collated and analysis carried out. Initial findings indicate that the DGHs are meeting the required standards in teaching and supporting our students. Much of the information gathered has been useful in identifying areas of good practice and/or concern. The MEPAR for 2013/14 was refined and tailored using the data from the previous MEPAR, enabling us to check the progress made within Trusts and to understand where further enhancements have been made using the last year. Information gathered within the MEPAR has helped the School to inform the 2013/14 MSAR. 13 Table 5 Overview of status of site visits and reviews of hospital trust Site Date last visited Type of visit Luton and Dunstable Summer term 2014 Extended Luton and Dunstable Spring term 2014 Focused Luton and Dunstable Summer term 2014 Focused* Lister Spring term 2014 Focused Lister Summer term 2014 Focused* Barnet Autumn term 2013 Focused Barnet Summer term 2014 Focused* Queens Summer term 2014 Focused* North Middlesex Spring term 2014 Focused Basildon Spring term 2014 Focused Watford Spring term 2014 Focused Comment Extended = continuation of the Trust Undergraduate Teaching Committee led by the QA SIFT team Focused = final year with limited review of fourth year Focused* = Year 5 visit to discuss curriculum matters 14 iii. Strengths and areas in need of improvement in each trust visited The following information is derived from the information provided by the sites at the visits in combination with online student feedback for sites and MEPAR submission. Table 6 Overview of status of site visits and reviews of hospital trust Trust visited Luton and Dunstable (Extended) Luton and Dunstable (Focused*) Lister Strengths Areas in need of improvement Strong relationship between the Undergraduate Tutor, Undergraduate Administration and students. To implement the consent form for use by medical students (e.g. for intimate examinations under anaesthetic) Medicine attachment is really good; teaching always happens as planned, consultants are very keen to teach, there is a lot of bedside teaching Experience on ward rounds with some FY1s was variable Informal teaching is very good; no timetable clashes and timetabled sessions have all gone ahead as scheduled Main concern of students is wifi access (Focused*) ‘Excellent’ teaching Barnet and Chase Farm (Focused and MEPAR) Queens Student Evaluation Questionnaires are used and disseminated to relevant areas. Feedback sessions take place with Undergraduate Tutors, Undergraduate Administrators and students. They have an FY1 Buddy system in place. Administration on the Barnet site is noted to be very good Travel between the two sites is provided by a shuttle bus with extended timetable and improved public transport system. We need to review whether this is sufficient for the students (especially working later/early shifts) A strong awareness of the Medical School policies and full compliance with UCLMS IT Standards. Feedback from Consent form for use by medical students (e.g. for intimate examinations under anaesthetic) is not used at present 15 (Focused* and MEPAR) North Middlesex students is used, particularly to inform the timetable Additional bedside teaching in Surgery Some students are having trouble contacting their Educational Supervisors for their Initial meeting Accommodation provision has improved. Wifi is now in the accommodation and there is wifi access across the whole site, students have a password to access the EMR (swipe cards are not required) Continued management of student expectations of some areas of bedside teaching (Focused) Basildon (Focused) Really useful induction day Watford (Focused) IT and accommodation were flagged as areas for improvement although work is was clearly underway to rectify this Excellent Clinical Skills teaching and A&E attachment 16 iv. Strengths / Areas in need of improvement for each Trust not visited The following information is derived from the information provided by the sites in combination with online student feedback for sites from the MEPAR submission where provided. Table 7 Strengths / Areas in need of improvement for each Trust Trust / date of last visit Strengths Areas in need of improvement Camden and Islington Foundation Trust Frequent presentations by Clinical Advisory Groups to consultants to ensure they are up to date with the Medical School curriculum and matter Strong ward teaching Suggestion of variable experiences. More teaching requested Royal Brompton Patients are informed about the presence of medical students as part of their standard literature Strong teaching IT upgrade although this is being updated Whittington Focus groups take place with the students to get additional feedback (outside of the Student Evaluation Questionnaires) More scheduled teaching requested by students University College Hospital Obstetrics & Gynaecology Organisation and scheduling was highly praised. Students valued the consultant and registrar led teaching. More bedside teaching requested Barnet Enfield and Haringey Mental Health Trust Students are granted access to the Trusts’ CPD activities whilst on placement Site-specific induction is provided UCL consent form needs to be used more widely CNWL Strong and clear relationship with students and patients- always introduced by name Positive student evaluation feedback Royal Free 17 More bedside teaching requested v. Common issues / Good practice As part of its review and reporting activities the QAU generates an annual summary of all good practice which will be made available on the website. Table 8 Common issues / Good practice Site Subject/Department Good practice CNWL Student Evaluation Questionnaires Always uses that feedback from students and ensures that is incorporated and embedded in changes and enhancement to its teaching Royal Brompton and Harefield Teaching High student to teacher ratio Barnet and Chase Farm Feedback Administration on the Barnet site is noted to be very good Medical students reported a general improvement in teaching since the reorganisation and following their feedback. North Middlesex Teaching Basildon Teaching and Administration The FY1 and FY2 doctors are very helpful to the students, and Radiology teaching was mentioned as “excellent” Twilight teaching is excellent Students report that administration is excellent 18 Watford Teaching and Administration FY doctors are very keen to teach Excellent admin, friendly and approachable 19 20 QA of the Medical School i.GMC: Medical Schools Annual Return (MSAR) 2013-14 All medical schools in the UK were again required to submit an Annual Return in December 2013. The General Medical Council has the statutory responsibility to set standards for basic medical education and to ensure that these standards are met. iii. Description of the internal governance processes of the Medical School The MBBS programme is managed through UCL Medical School, which is responsible for the leadership of MBBS educational strategy; curriculum development and planning; assessment policy and organisation; the setting and monitoring of standards and quality assurance; and for the MBBS Student Load Exercise and SIFT allocations. MBBS leadership roles within UCL Medical School include MBBS Sub Deans, Site Sub Deans and Student Support Tutors, each with responsibility for specific areas of MBBS management. Administrative support is provided by Medical Student Administration. MBBS teaching is commissioned from the School of Life and Medical Sciences (SLMS) divisions and funded through HEFCEt and tuition fee income. Faculties and divisions are responsible for managing local delivery of teaching in accordance with UCL Medical School guidance, and for appointing MBBS module and assessment leads to manage the delivery of education within the Division. Administrative support for Faculty and Divisional roles is provided by Faculty and Divisional Teaching Administrators. SLMS faculties and divisions are responsible for co-ordinating and supporting teaching delivery by NHS colleagues, and for ensuring consistency of teaching and assessment across Hospital Trusts and PCTs. Teaching provided by trusts is funded through SIFT. Administrative support is provided by divisional Teaching Administrators and/or trust administrators. The new organisational structures and management roles for the MBBS programme can be seen clearly via the organograms in Appendix 3. Appendix 4 contains the booklets which explain the structures are subject to updates, final review and approval. D. Summary of developments, innovations, best practice to include significant future changes to the curriculum or any other important achievements Developments and innovations We introduced an entirely new curriculum in 2012 and so changes for 2014 are mainly final steps in planned implementation, revisions in response to evaluation and feedback and reviewing the priorities declared at the time of implementation, namely: •Having clear overall aims and objectives for the MBBS course •Improving integration across the course •Ensuring the programme takes a patient centred approach •Ensuring preparation for practice is a key feature of the course •Ensuring planned delivery is mindful of educational objectives and changes in the provider landscape Changes therefore have mainly been in these domains: Improving Integration: year 2 sees a new module called Reproduction, Genetic, Cancer which brings together isolated topic areas in the domain of the burgeoning field of genomics and personalised medicine. Improving patient centred care: there are a number of new developments: the ‘Ask one question’ intervention and taking part in NHS Change Day across the school which both concern small acts of kindness and patient orientation in contributing to the quality of the care patients receive; partly with the support of a grant by HENCEL a project to integrate people with experience of FGM and abortion into the women’s and men’s health curriculum; again partly supported by a grant from HENCEL, the introduction of Schwartz Rounds into the later years of the undergraduate curriculum. Preparation for practice: we have moved Finals to March to provide the opportunity for an ‘in-year resit’ and to introduce a preparation for practice SSC for 4 weeks for all students focused on day 1 competencies. We have also introduced a Leadership Activity for all final year students. Deliver mindful of objectives and provider landscape: the reconfiguration of the Royal Free Trust and the impending loss of acute cardiology services in the sector has required a rethink of what cardiology we teach and where. From January 2015 all students will attend the Royal Free Hampstead to experience acute cardiology ‘takes’ including acute catheterisation and students allocated to UCLH for cardiology will spend part of each week at the Royal Free Barnet site. As a medical school we have maintained our high student satisfaction in the National Student Survey despite radical changes to the curriculum and the consequent period of upheaval, have risen to 8th worldwide in the QS rankings of medical schools, have won a UCL Beacon Award for our work in patient engagement and have been awarded a prestigious Athena Swan Silver merit Award for championing the careers of women in STEM subjects. Dr Deborah Gill MBBS MRCGP EdD SFHEA Interim Director UCL Medical School Appendices Appendix 1 – Management Plan arising from the last QABME visit Appendix 2 – Internal Quality Review 2013-14 (not yet available, deadline December 2014) Appendix 3 – Medical School governance – organograms - MBBS Academic Leadership - MBBS Vertical Modules Leadership - MBBS Leadership Clinical Placements - MBBS Faculty Tutor, Student Support and Foundation Training - MBBS Committees and Chairs Appendix 4 - Medical School governance - statements - MBBS Academic Leadership - MBBS Vertical Modules Leadership - MBBS Leadership Clinical Placements - MBBS Faculty Tutor, Student Support and Foundation Training - MBBS Committees and Chairs