Postgraduate Diploma & Masters In Health Sciences (Primary Care): Review Group Report
0
An Coiste FeabhaisAcadúil
The Committee on Academic Quality Improvement
The Academic Quality Assurance Programme, 2006–2007
Review of
Department of General Practice
Postgraduate Diploma and Masters in Health Sciences
(Primary Care)
Final Report
April 16th, 2007
Postgraduate Diploma & Masters In Health Sciences (Primary Care): Review Group Report
1
This report arises from a visit by a review group (RG) to the Postgraduate Diploma
and Masters in Health Sciences (Primary Care) in the Department of General Practice
(DGP), National University of Ireland, Galway on 12-13th February, 2007. The
programme had already prepared and submitted a Self Assessment Report (SAR) that,
with other documentation, was made available to the Group in advance of the visit.
The Review Group consisted of: Professor Christine Bond (Department of General
Practice and Primary Care, University of Aberdeen, Scotland), (Chair); Professor
Colin P. Bradley (Department of General Practice, University College, Cork); Dr.
Philip Crowley (Department of Health and Children, Ireland), Dr. Dympna Casey
(Department of Nursing and Midwifery Studies, NUI Galway); and Dr. Michael P.
Carty (Department of Biochemistry, NUI, Galway) acting as rapporteur.
The report is structured to cover the following main topics
Aims and Objectives
Organisation and Management
Programmes and Instruction
Scholarship and Research
Community Service
The Wider Context
Summary and Concluding Remarks
This course is an important component of the strategy of NUI, Galway to provide
outreach to the community, and fills a unique and continuing regional and national
need. This is particularly true as there are no competing courses available, either in
the region or nationally. This course was originally developed as a collaboration
between the Department of General Practice and the North Western and Western
Health Boards; this close interaction continues with the Health Services Executive
(HSE), following restructuring of the Health Service. The RG was impressed by the
commitment of staff in delivering the course, and by the enthusiasm of the students
and graduates of the course, who reported positive experiences.
1. Aims and Objectives
The Aims and Objectives were outlined in detail in the SAR. However, the RG feels
there is a need to articulate the broader objectives of the course, for example in terms
of how the course contributes to the professional development of individual students,
and how it fits into the wider context of ongoing developments in the HSE as well as
in healthcare generally in Ireland. This will have implications for the choice of
research project topics, and for the application of learning to the professional context.
The RG also noted that the Aims and Objectives outlined in different parts of SAR
were not always consistent. In this regard there is a need to differentiate between
teaching objectives and behavioural and learning outcomes. It would be of benefit to
redraft the course objectives to define, using a standard taxonomy, to what level
students should achieve various outcomes.
Postgraduate Diploma & Masters In Health Sciences (Primary Care): Review Group Report
2
These broader Aims and revised Objectives should be made explicit in the course
brochure and other recruitment materials. A clear articulation of the Aims and
Objectives of the course is important for marketing the course to potential students,
once HSE funding is reduced from 100% to 50% and personal payments will be
required by incoming students. The RG share the concern of the programme about the
impact of this decrease in external funding on the course, and feel that the revisions of
the Aims and Objectives would strengthen any case to University management for
funding to support this ongoing programme into the future.
Recommendations
1. Articulate broader course Aims.
2. Revise Objectives to be consistent and to specify behavioural outcomes.
2. Organization and management
Location
Components of the course are delivered in Sligo to accommodate participation of
students from the former North West Health Board area who provided essential
support to the initiation and continuation of the course. Other components are
delivered in the Clinical Sciences Institute in NUI, Galway. The accommodation and
library facilities in Galway are satisfactory. Teaching in Sligo is now delivered in the
Education Centre of Sligo IT as satisfactory accommodation could not be provided by
St. Angela’s College heretofore. In view of further developments at St. Angela’s
College, the RG feel that the option of seeking appropriate facilities there should be
re-examined. This would be an important illustration of the links between
NUI,Galway and St Angela’s College, and, given that payments are having to be
made to Sligo IT, should enable more efficient use of limited resources.
Steering Committee
The Steering Committee has been an important influence on the development of this
course and has provided a vital governance function. Its current composition reflects
the geographical focus of the course and local HSE structures. It will need to evolve
as these change. Student representation on the Steering Committee has been a vital
positive feature and when not present has proven to be a something of a deficiency.
In view of this the RG recommend that consideration be given to the implementation
of a deputising arrangement for those occasions when the nominated student
representative cannot attend.
Modularisation and Linkage to Other Courses
The Postgraduate Diploma course is offered only as an entire programme, although
the Primary Care module is also offered as part of a Postgraduate Diploma for
practice nurses. The course providers recognise that the course might have more
appeal to established general practitioners (a key potential market for them) and
others if it could be offered as separate modules. This would also enable more
linkages to other courses offered by the University. However, on balance, they feel
that allowing participants from other courses or students committing to single
modules rather than the whole course to join many different modules would disrupt
Postgraduate Diploma & Masters In Health Sciences (Primary Care): Review Group Report
3
the group dynamic among the multi-disciplinary participants which is such a central
and positive feature of the current course. This view was strongly endorsed by the
students that the RG met. Therefore, the RG does not recommend any deviation from
this policy at this time but recognise that this is something that needs to be kept under
review. In view of the large number of nurses taking the course the RG recommends
they seek Category 2 accreditation with An Bord Altranais.
Organisation
It was clear that this is a very well-run course. Students are provided with
considerable amounts of documentation, as well as having access to an extensive and
effective virtual learning environment, namely Blackboard. Communication with
students is accorded a high priority and relationships with course organisers are
excellent. The capacity of course providers, though, is clearly being stretched in their
efforts to provide such a quality service to students. This severely limits their
capacity to provide for contingencies, such as tutor illness, that might arise and is also
constraining their capacity to expand to meet a demand for places on the course.
In this regard, administrative support is also stretched, and voluntary overtime has
been required to prepare materials for the course. Given the increased availability and
utilisation of electronic resources by staff and students, the practice of supplying hard
copies of all materials should be reviewed.
Funding
There is a certain lack of transparency in the relationship between revenues raised by
the course and funding available to the DGP for running the course. It seems to be
accepted by both the Faculty and the University that resources accruing to the DGP
may not be an entirely fair reflection of its postgraduate education activity. The
course was acknowledged as being consistent with the University’s strategic aim of
reaching out to its region and very worthy of support on that basis. There is also a
clear threat to the financial viability of the course from the likely reduction of HSE
contribution to student fees from 100% to 50%. An application to the Academic
Planning and Resource Committee for extra support would seem to be justified by the
need to better resource the course as it now stands. The Committee may also need to
assist the DGP withstand any downturn in potential applicants that might ensue from
a reduction in HSE support to participants, for example by alleviation of fees charged.
Recommendations
1. The option of providing the Sligo components of the course in St. Angela’s College
should be re-examined.
2. The composition of the Steering Group be kept under review to accommodate both
the changing geographical coverage of the course and changing HSE structures.
3. A deputising arrangement be instituted to ensure student representation at every
Steering Committee meeting.
4. The policy of offering the course only as a whole and not as individual modules
and, thus, not linking to other courses be kept under review.
5. An application should be made to An Bord Altranais for Category 2 accreditation.
Postgraduate Diploma & Masters In Health Sciences (Primary Care): Review Group Report
4
6. An application to the Academic Planning and Resource Committee should be made
to increase resources available to the DGP to provide the course, as well as for
assistance in withstanding any change in funding policy from the HSE.
3. Programmes and Instruction
There is clear evidence that the course is meeting student need. It includes a range of
relevant delivery methods which are well received by the students and have clear
commitment from the Course Team. Particular strengths are good use of both small
group teaching and online teaching via Blackboard. The multidisciplinarity of the
student body and the ethos of team-working developed during the course are to be
particularly commended. The RG would compliment the Course Team on an
innovative and relevant course. and have the following specific comments to make
which it hopes will further enhance the course and ensure its future viability. For
clarity, those comments that are specifically relevant to the Masters in Health
Sciences (Primary Care) are outlined in separate section below.
The Group Project
The students have reported enthusiastically on their experience of the group projects.
They have gained important experiential life-long learning in team working; one
student who felt other members of her group were not working well particularly
commented on her personal satisfaction in improving group functioning so that the
ultimate delivery of a report and presentation were achieved. Another student
reported that geographical distance between group members presented some logistical
problems but the RG agree with the Course Director that multidisciplinarity within
groups is a greater priority. This should be explicitly explained to the students. The
RG welcome the proposed introduction to the course of some theoretical approaches
to effective team working.
The RG had some minor prior concerns that each group member received the same
mark for the project with no moderation to reflect their individual contribution. This
could be derived from facilitator feedback or from peer assessment. However the
students seemed accepting of this and the RG therefore recommend the current system
be retained but that the percentage mark allocation for the Group assignment could be
reviewed (see below). However the students indicated that feedback from the
facilitator to the group on the process of teamworking within their group would be
helpful.
E-tivities
The students reported the positive benefits of engaging in the e-tivities, the quality
and quantity of individual participant contributions and the supportive and
constructive staff input. They spent 4-5 hours per week on the e-tivities and it may be
appropriate to reflect this input in the percentage mark allocated to the e-tivities. It
was noted that those without either easy access to broadband, or competence in
computer skills were disadvantaged. The need for both of these, as well as the
workload involved, should be made clearer in the course materials.
Postgraduate Diploma & Masters In Health Sciences (Primary Care): Review Group Report
5
Health Promotion and Sociology
The enthusiastic contribution from the Departments of Health Promotion, and
Political Science and Sociology were welcomed by the RG as bringing in a different
disciplinary perspective to the teaching and introducing new theoretical models for
the students to reflect on in their practice. It is commended that module leaders
contribute to ongoing review of the curriculum to ensure its relevance. There were
some students who commented on the dominance of medical GP focus in many of the
examples used in teaching materials. Whilst this was not universal, the Health
Promotion and Sociology components are important counters to this. Other ways of
delivering a more generic primary care focus should be borne in mind when
reviewing modules.
Another generic topic which could be usefully introduced would be the management
of change, which would support students taking back, and implementing, new
learning to their working environment. This might be delivered as an additional etivity. It was also noted that formal teaching on Health Service Management, once a
component of the course, had been dropped and its re-introduction could be usefully
considered given the background of some students.
Assessment
The RG felt that the range of assessment methods used were somewhat limited in
their scope, with the majority of the marks being allocated across reflective essay
assignments and the group project. As noted earlier, consideration should be given to
re-allocating these marks, such that the e-tivity attracts a greater percentage which
would reflect workload, and the group project attracts a lesser percentage. In order to
add a further mode of assessment, a reflective portfolio should be considered. The
students reported that their participation in the course had an immediate benefit to the
way they worked professionally. Reflecting on this in a formal way would reinforce
their learning and allow them to gain formal credit for this important activity.
The RG discussed with some individual module leaders the extent to which they
applied the course regulations by penalising students who submitted late assignments
or exceeded word limits. Whilst staff reported that late assignments did not seem to
be a problem, other than in occasional extenuating circumstances, there seemed some
inconsistency between modules in the extent to which students were penalised for
exceeding word limits. There should be a clearly stated policy on this agreed across
all modules to avoid disadvantaging students. It may be that to reflect specific
disciplinary paradigms, assignment lengths should vary across different modules.
It was noted that the Course Team had responded to earlier comments from external
examiners and the students about both the sufficiency of, and timing of, feedback on
assignments. Whilst the former had now been satisfactorily addressed and was
reported by students to be “good and fair”, the latter issue was not fully resolved. The
current policy is for students to produce a ‘practice’ essay early in the course
(September) which would be marked with full feedback. The vast majority of
students had taken advantage of this and found it a very useful experience, but
commented that the delay between this and feedback from the next essay in January
was too long and they would prefer to submit at least one assessed essay at an earlier
Postgraduate Diploma & Masters In Health Sciences (Primary Care): Review Group Report
6
point. The RG recognised that the Course Team were aware of the issues but would
ask them to further consider the timing of assessments, and also allow any change to
be experienced by several yearly cohorts before further radical change.
The marks achieved by the students were high across all modules with no evidence of
borderline pass-fail, which might have been expected. It was noted that a few
students withdraw from the course each year, largely due to changed personal
circumstances. It was noted and commended that plagiarism was taken seriously and
that new methods of detection using commercially available software were supported
by CELT, and were being introduced.
Recommendations:
1. Consider incorporating a mechanism of feedback to the students on the observed
group processes and ways in which these could be improved.
2. Consider the introduction of a reflective portfolio as a formal component of
assessment.
3. Consider the redistribution of marks across group work, e-tivities and essays and
include a new reflective portfolio.
4. Review timing of assignment submission to maximise benefit of feedback informing
subsequent assignments.
5. Consider developing a short computer skills training program/workbook for
students prior to commencing the programme.
Masters in Health Sciences (Primary Care) programme
This is an important programme which meets the needs of primary care practitioners
in HSE West. In total 14 students have completed the programme, and 6 students are
registered for the current year. The programme actively engages students and
enhances their potential to become life-long learners. The programme is rigorously
evaluated, with both formal and informal feedback obtained from numerous sources,
including tutors, external examiners and students. The assessment process appears to
be fair and transparent with students receiving good guidance as to what is required or
expected of them at the start of the programme. The calibre of students and their
work is reflected in the overall examination results in that 8 out of the 14 students,
who have completed the programme to date, have attained a first class honours award.
Students were very positive in their evaluation of the programme; they were enthused,
and clearly enjoyed the learning experience. Students formally meet with their
supervisors once a month and praised the commitment, availability and support of
supervisors. However, there appeared to be a lack of clarity in the documentation
provided as to the required word limit for the thesis. The RG were of the view that an
academic journal style paper of 5,000 words could not be considered equivalent to a
20,000 word report, thus introducing, in effect, two different assessment procedures.
The RG were of the opinion that the option of a 5,000 word academic journal style
paper is not sufficient for a stand-alone Masters Programme, and believe that a 20,000
word report is more appropriate, and on a par with Masters programmes in other
Universities.
Postgraduate Diploma & Masters In Health Sciences (Primary Care): Review Group Report
7
While the students have been very successful in their research placements, the
interdisciplinary nature of the course, and the variety of supervisory environments
could contribute to differences in the student’s experiences of supervision. One
approach to standardising supervision would be to take advantage of programmes
offered by CELT to support supervisors in this critical role.
The thesis dissertation topics are relevant and clearly related to the students areas of
practice. Having the flexibility and autonomy to choose their respective research
topics was clearly important to the students. A concern to both staff (SWOT analysis,
SAR) and students was the difficulty associated with disseminating the findings from
the thesis dissertations. It might be worth exploring the possibility of having a
postgraduate student conference where students from the programme have an
opportunity to showcase their work to fellow students, representatives from the HSE,
and other potential students who may be interested in pursuing this programme. It
may also be useful to request students to submit a briefing paper on their dissertation
as part requirement for their award. This could then be disseminated to relevant
personnel within the HSE creating an awareness of the calibre of the work being
completed by students and highlighting the relevancy and value of this programme.
Supervisors should also be encouraged to alert the HSE about potentially relevant
projects early on during the research period. Ways of enhancing partnership with the
HSE are also discussed in Section 5 (below).
Recommendations
1. Amend the handbook to clarify the word-length required for the Master's thesis, in
order to standardise the requirements for the Masters dissertation; review critically
the option of submitting an academic journal style paper as the sole assessment for
the Masters degree, taking into account accepted standards of assessment and best
national and international practice.
2. Encourage all research student supervisors to attend courses provided by CELT.
3. Include the submission of a briefing paper as part requirement for the award of
Masters in Health Sciences (Primary Care).
4. Hold a postgraduate student conference to disseminate and showcase their work.
4. Scholarship and Research
The RG feels that the group projects and the Masters research theses represent
potentially important contributions both to the DGP and to the HSE. As outlined in
Section 3 above, and Section 5 below, increased publication and dissemination of the
outcome of these projects should occur. A small number of students from this
programme choose to pursue the Ph.D. degree. This is to be encouraged, and should
facilitated within the Department, as it fits with the University strategy of increasing
Ph.D. numbers, and represents a means of adding value to the programme.
5. Community Service
The relevance of the Masters and Diploma courses to the community can mainly be
described in terms of the potential impact on practice and policy in the health
Postgraduate Diploma & Masters In Health Sciences (Primary Care): Review Group Report
8
services. Clearly the potential for annual cohorts of 16 health care practitioners or
managers in impacting on local health service delivery through their learning has a
potential cumulative significance. While a lesser number carry on to Masters level
they can still have a significant impact on many levels.
There was clear evidence of the potential for people studying for the diploma
becoming enthused and carrying on to significant pieces of research. Talking to the
students made it very clear that their personal work was being greatly enhanced by the
experience of stepping back and reflecting on practice and particularly sharing
practice with practitioners from many fields. They described how they had changed
their mindset at work and had become much more analytical in practice. This is
especially reassuring in the light of previous evaluation and self evaluation that had
raised some questions about the relevance of learning to the work of the participants.
The fact that the HSE funds the programme, and that theses are agreed with line
managers, means that there is HSE buy-in to the course and, potentially, to its
product. The topics that were selected for group work, reflective essays, health
promotion topics and theses were all drawn from individual work practice and the
positive potential that this creates for practice improvement is significant. The choice
of topics for all areas of course work including ‘e-tivities’ was impressive and highly
relevant to individual practice and regional and national policy.
Having said all of this, the potential for work and policy impact is not spelled out in
the course SAR, in the course description and objectives, or in the publicity material
for the course. This positive selling point could be highlighted to a far greater degree
in order to attract students to the course and to raise the positive profile of the course
with the local health services and HSE.
Furthermore, the impact of the written outcomes from the group work, essays, health
promotion proposals and theses appears to fall short in realising its potential to
influence local practice and the wider policy arena. While it has been explained that
this course is not so focussed on research publication in peer-reviewed journals,
clearly more of the theses should gain such publication. Aside from peer-reviewed
journals, there are many other forms of non-reviewed publication including Forum
and the national media that could be targeted in order to increase the impact of pieces
of written work. Other practice based work should be undertaken with a clearer
commitment to write into the work how its impact will be maximised on the
workplace, either locally or in a wider context. Part of this will involve discussing
work with line managers in advance, and getting buy-in from them to act on project
results where appropriate.
The DGP could in its discussion with the HSE get high-level support for this
approach. The other way that the DGP could enhance its support to get project work
into practice and to support continuing enquiry amongst the past pupils of the course
would be to create firm ongoing links with students. This could take the form of an
alumni group or some channels of ongoing links with past pupils that could nurture
their continuing contribution to knowledge development. As a start to this process
Postgraduate Diploma & Masters In Health Sciences (Primary Care): Review Group Report
9
past pupils could be invited into DGP research seminars. The practicality of the DGP
maintaining links with students would need to be examined by the DGP and discussed
with each cohort of students as they prepare to exit the programme they are on.
Overall, the potential for the courses to impact on front-line practice is significant but
could be enhanced by a more systematic approach to ensuring that this happens.
Recommendations
1. The documents and brochures that currently describe the Diploma and Masters
should draw much greater attention to the impact of course learning on practice and
policy.
2. The Department should investigate more effective mechanisms to optimise the
impact of course learning and outputs on health service policy and practice.
6. The Wider Context
The major issues to be addressed by the Course team are (i) the implications of the
reduction in funding from 100% to 50% on the attractiveness of the course to its
target market, and (ii) improved integration of skills and competencies developed by
students on the course into professional practice, and into the operation of the HSE.
7. Summary and Concluding Remarks
Overall, the RG commends the staff of the programme and the Department for their
commitment in developing and delivering the course, and for the quality of the
students and their enthusiasm for the course. This course fills a unique regional and
national need. To continue the success of the programme, its aims and objectives
should be more clearly articulated. This will be become more critical as external
funding for students on the course decreases. In this context, continued integration of
learning outcomes into the professional practice of individual graduates, and into the
operation of the HSE is also critical. Improved dissemination of the research
activities of students of the course will also enhance the profile of the programme
with a key stakeholder, namely the HSE.
8. Comments on the Methodology of the Review Process
1. In terms of accommodation, transport and logistics, the Review visit was very well
organised by the Quality Office.
2. The RG required more time with course directors
3. The RG required more time with students
Professor Christine Bond (Chair)
Professor Colin P. Bradley
Dr. Philip Crowley
Dr. Dympna Casey
Dr. Michael P. Carty (Rapporteur)
April 16th, 2007.