An Coiste Feabhais Acadúil
The Committee on Academic Quality Improvement
The Academic Quality Assurance Programme 2005 - 2006
REVIEW OF
FACULTY OF MEDICINE AND HEALTH SCIENCES
FINAL REPORT
1st September 2006
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Faculty of Medicine and Health Sciences: Quality Review Report 2005–06
Introduction
This report arises from a visit by a Review Group to the Faculty of Medicine and
Health Sciences on 6th – 9th June, 2006. The review was informed by the Faculty’s
own Self-Assessment, by additional documentation made available by the Faculty and
the Quality Office during the visit, from meetings with a variety of members of staff
drawn from the Faculty, the University and Health Service management, and also with
students. In addition, the Review Group toured various buildings which accommodate
the Faculty.
The Review Group comprised: Professor John G. Simpson (Chair), Associate
Dean (Medical Education), University of Aberdeen; Professor Peter L. Bradshaw,
Professor of Health Care Policy, University of Huddersfield; Dr. Siun O’Flynn,
Director of Medical Education, University College Cork; Dr. Pat Morgan, Senior
Lecturer in Biochemistry, NUI Galway; and Dr. Jim Duggan, Lecturer in Information
Technology, NUI Galway acting as Rapporteur.
The report is structured to cover the following main topics:
1. The Faculty of Medicine and Health Sciences
2. Aims and Objectives
3. Organization and Management
4. Programmes and Instruction
5. Scholarship and Research
6. Community Service and The Wider Context
7. Summary and Concluding Remarks
8. Comments on the Methodology of the Review Process
1.
The Faculty of Medicine and Health Sciences
The Faculty of Medicine and Health Sciences has a long and excellent record in
delivering Medical Education: this now extends to Nursing, with Occupational
Therapy and Speech and Language Therapy as new and rapidly developed disciplines.
The Faculty is made up of 19 departments, some of which have major responsibilities
in other Faculties. The Faculty is also closely dependent on the Health Service for
facilities for practical training and there is significant teaching input from health
service staff for undergraduate students.
The Faculty has in the recent past responded well to a number of new
opportunities, undergoing significant growth and change in the process. There are a
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number of challenges on the horizon, from higher education and the health service,
with clear implications for the Faculty.
2.
Aims and Objectives
The Faculty has a series of high-level mission and objective statements appropriate to
its roles and linking clearly to those of the University. There is also an Academic Plan
from 2003, which covers strategic issues and has an operational component. From
those timescales indicated in the Plan, it is clear that there have been delays in a
number of the proposed changes and initiatives.
From our visit, it was also apparent that the members of staff, despite a
considerable esprit de corps within individual disciplines and overall excellent
interpersonal interactions, do not yet think of themselves as belonging to a unified
Faculty with a shared identity. Colleagues have not yet begun to envisage how they
can capitalise on the existing structure, in particular on its multidisciplinary nature,
with the opportunity for innovation that this presents.
There have been some very major changes in the Faculty since the Plan was developed
and more are imminent. We are aware, for example, that the University itself is at an
advanced level of planning for major organisational, structural and managerial change,
which includes a move to a schools structure and a strengthening of the role of deans,
and there are a number of health service changes also on the horizon. Clearly, a new
Faculty strategy is required, and in order to progress action on formulating this
strategy, the Review Group recommends that:
3.
1.1
The Faculty must develop a clear and coherent Strategic Plan to identify
priorities and also its specified timescales and resource implications. The
Plan must be developed by widespread consultation within the
constituency, taking full account of the multidisciplinary nature of the
Faculty and considering the wider context within which the Faculty
operates. The Plan must form the basis of the Faculty’s operational
planning and will need to be kept under systematic review.
1.2
We believe a Faculty Strategy Away Day that involves relevant Senior
Staff, is facilitated appropriately, and expertly by experienced
Management Consultants, is the best way to kick-start the process and
that such an event would be of considerable help in beginning to
establish a sense of Faculty identity amongst all of its staff.
Organisation and Management
All members of the review group recognised the achievements of the Faculty of
Medicine and Health Sciences to date and were impressed with the evidence of
expertise, talent and collegiality amongst the constituents. This is a tremendous legacy
of an outgoing Dean, who has served a lengthy term but has only been fulltime since
September 2005. Strong leadership has instilled loyalty and commitment throughout
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the Faculty. The change of personnel at such a crucial senior level, with an incoming
Dean, is also an ideal opportunity to reflect on the Faculty Strategic Plan, clarify and
refine the role and responsibilities of the Dean, the organisational structures in the
Faculty and the interaction between all of the above and NUI Galway executive
management structures.
Reorganisation of Faculty of Medicine and Health Sciences structures and
operating procedures must develop against a background of:
o changing NUI Galway structures and the prospect of competitive tendering for a
graduate entry programme in medicine;
o Emerging links with the Penang Medical College, which would allow up to 60
Malaysian students per annum to start their medical studies in Galway before
returning to Malaysia for their senior years
o the ongoing requirement to develop post graduate programmes; imminent PRTLI
funding;
o Possible changes in funding systems to Nursing; and, increasing student numbers
in most of the Faculty programmes, most notably Medicine.
Because of the importance of organisation and management structures to the future of
the Faculty, the Review Group will comment on the following key aspects of
organisation and management structure:
1. Faculty Integration
2. Role of the Dean and integration with senior university management
3. Integration with central university functions
4. Pooling of resources
5. Buildings and accommodation
6. Student interactions
(1) Faculty Integration
At present, the “Faculty” serves a predominantly medical school function and
consequently the organisational structure of the Faculty is dominated by the
organisational structures of the Medical School. The Departments of Nursing,
Occupational Therapy and Speech and Language Therapy have developed clear
administrative and organisational structures. The benefits of functioning as a cohesive
and coherent group are apparent to all, but perhaps most evident to these later
additions to the Faculty. All Faculty stakeholders however, do appreciate the necessity
of a Faculty structure. Staff appear to have a very clear view of their responsibilities in
the context of their department affiliation, but need the same clarity to be defined in
relation to their role within a faculty structure. All stakeholders indicate a broad
support for the move to school structures, but the review group also noted the
concerns expressed about the potential impact of this restructuring on the role of the
departments, and the autonomy and integrity of disciplines.
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NUI Galway as an institution must recognise that departments or schools in the
Faculty of Medicine and Health Sciences are in a somewhat unique position in that
demand from outside forces requires a rapid response, more so than in many other
Faculties in the institution. If not enabled in this fashion, these elements of the Faculty
will may not compete satisfactorily in national competitive tendering processes since
other institutions currently have this infrastructure in place.
Administrative support of the work of the Faculty is to some extent divided
between the Faculty Office and a number of central offices. The Faculty Office
essentially functions as the hub of the medical programme administration and as a
channel for central communication with and from the other departments. The resource
allocation to the Faculty Office is utterly inadequate to support both workloads. This
was a recurrent theme. Certain departments felt they would be better served by direct
communications with central offices as the under resourced Faculty office seems
unable to process information in the timely fashion they desire. There seems to be a
lack of clarity among the staff in the Faculty Office regarding the distinction between
Faculty workload and administration specific to the medical programme. It is clear
there is a considerable collective staff resource in terms of experience in the Faculty
Office, and that there is a risk of de-motivation and lack of effectiveness, unless
boundaries are established, ideally identifying and allocating staff to either medical
programme administration or Faculty administration.
(2) The Role of Dean and Integration With Senior University Management
The current Dean is leaving a sound foundation for his successor, and has been
supportive to all departments within the Faculty, however, many of his current duties
specifically relate to the Medical School, and some of them involve a high time
commitment, given that he is the interface for Medical students in difficulties. It also
surprised the Quality Review group, that a Dean in such an important Faculty in the
NUI Galway Institute structure was not an integral member of the Senior University
Management team. It is clear that unless the Dean in this Faculty is systematically
involved in high-level decision-making processes at an institutional level, the
constituents in the Faculty will suffer.
The Review group questions whether the expectations of outcome, articulated
by many staff members, from the appointment of a Director of Strategic Development
are realistic and certainly the configuration of the post surprised some reviewers. The
allocation of resource to this essential function is welcome and must be preserved,
however the skill set required to deliver strategic objectives will inevitably vary over
time and a rotating Vice Deanship or equivalent rotating academic appointment, with
adequate secretarial/administrative support, may be more appropriate.
(3) Integration with Central University Functions
The reviewers were presented with some information regarding Faculty expenditure,
but no information regarding Faculty income, i.e. a one-sided balance sheet. The
prevailing opinion of staff was that the information presented was inaccurate in
places. Currently Faculty staff, most especially the Medicine cohort, is inwardly
focussed and not optimally harnessing resources at the centre, for example –
admissions, exams and records, library, computer centre. The specific and
occasionally unique Faculty needs are not communicated to these central agencies
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(including Admissions, Examinations, Records, Library and Computer Services).
Collectively functioning as a Faculty to advocate the necessary changes will improve
services for all Faculty constituents.
(4) Pooling of Resources
The review group has concerns that current operating procedures and structures, e.g.,
committees, are not optimally configured to pool resources – be they physical
facilities, personnel or expertise - and as a result there is not a formal integrated
interdisciplinary agenda in a faculty where there is considerable scope for same.
Resources are unevenly distributed and this is an inherent barrier to
interdisciplinary planning and collaboration. There is a history of inadequate funding
in medical education, which contrasts with ring fenced funding to Nursing,
Occupational Therapy, and Speech and Language Therapy. This difference in funding
models forces these groups, who might naturally lean towards each other, to function
independently.
(5) Buildings and Accommodation
The accommodation for the Faculty, spread across three sites, is variable in its quality
and fitness for purpose. The Clinical Science Building, which is also where the Dean
and Faculty Office are located, is essentially the “medical school”. Here, teaching
facilities are just appropriate for the current number of medical students in their
clinical years, but the library, available study space and new clinical skills area, like
the research facilities in this building, are essentially inadequate. This is a critical
issue in light of projected expansion in the medical undergraduate programme.
Nursing, Occupational Therapy, and Speech and Language Therapy occupy the
spacious and state of the art Áras Moyola Building. The preclinical departments are
housed on the central campus in cramped and inadequate facilities, where the Orbsen
Building, which provides excellent research facilities encompassing some of the
faculty’s most successful research units, is also located.
(6) Student Interactions
The students’ experience of the Faculty is uniformly positive and this is supported by
NUI Galway students’ surveys. Staff are to be commended on this significant
achievement. There is evidence that certain departments (most notably Occupational
Therapy) have more transparent processes for identifying a student in difficulty than
others. All have a forum for expression of student views with a student affairs or class
representatives remit. There is less clarity of procedure for individual students who
have needs beyond those which can be reasonably facilitated by a class representative.
In this situation, some departments are very dependent on opportunistic interactions
with tutors or relatively junior staff. The onus is on students to identify a suitable staff
member to consult with, and this is potentially fraught with problems if student and
staff numbers expand. There are examples of good practice and mentoring structures
in some departments and these should be developed in all Faculty departments/
schools. There is a real need to prescribe processes to recognise and support students
in academic and personnel difficulty in anticipation of a future where the current
intimate relationships may not be so easy to preserve.
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Recommendations to Faculty and University:
3.1
The University must give an early commitment as to funding for the
expansion plans for the Clinical Science Institute, in order that the
University can position itself as a national leader in the area of Medical
Training, and so fulfil the demands that will be placed on it by the
Fottrell Report.
3.2
The resource allocation to the post of Director of Strategic Development
should be retained, but the configuration of the post should be reviewed
in line with the revised Faculty Strategic plan.
3.3
Clarity of resource allocation should stimulate a critical Faculty review of
the return generated by top slicing, especially as Faculty staff and
students clearly do not engage these central resources to the same extent
as other NUI Galway faculties.
3.4
Faculty should consider the total human resource at administrative level,
and clearly define members of staff with responsibility for overarching
faculty administration, and those responsible for medical programme
administration. It is the impression of the reviewers that there is scope to
commission certain workload from the current faculty office to
departmental level. This restructuring should also be seized as an
opportunity to deploy and optimise intranet communication and
electronic communication as there seems to be a reliance on hardcopy
communication, and all noted the annual workload involved in producing
student handbooks.
3.5
Faculty should consider the collective needs, in terms of clinical skills
teaching, of all undergraduate and post graduate students as this would
present an ideal opportunity to pool and strategically plan resources.
Considerable benefit might accrue from a sub committee at Faculty level
to review the needs of all departments in this regard to: 1. optimize
planning of a new Clinical Sciences institute and 2. optimize the use of
Áras Moyola.
3.6
The Schools structure represents a way in which departments with small
staff student numbers or cognate areas might operate within a Faculty
structure. The school as a budgetary and organisational unit has served
similar disciplines in other institutions well. The Quality Review Group
hesitated at prescribing a suitable school structure, but there are obvious
suitable elements within the Faculty with a critical mass sufficient to
create a school. There must be extensive consultation within and out with
the smaller critical masses prior to aligning themselves in a school
structure with cognate disciplines. Schools must have devolved
administration and budgetary structures to enable them to respond
quickly to necessary change demanded by outside forces. Schools would
still retain their executive management committees, curriculum
committees and student affair committee equivalents, however at Faculty
level corresponding umbrella structures should be developed to create an
infrastructure for interdisciplinary collaboration and planning i.e.,
identifying shared appointments, pooling all resources, and sharing
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expertise in educational and research endeavours.
3.7
The Dean of the Faculty of Medicine and Health Sciences should be a
senior member of the University Management team. The Dean should be
the line manager for the Heads of Schools or their equivalents in a
restructured Faculty of Medicine and Health Sciences. This must be
expedited in a timely fashion to ensure that the Faculty of Medicine and
Health Sciences in NUI Galway can compete on a national and
international stage.
3.8
The Dean should be provided, at least on a quarterly basis, with precise
details of income and expenditure relating to all faculty constituents (be
they schools or departments) including research grants and all details
regarding top slicing to the University centre.
3.9
The completion of suitable accommodation for basic medical science
teaching staff (Anatomy, Pharmacology and Physiology) is a priority and
the time lines for start and completion of this project must be established
immediately. Urgent review of the provision of accommodation available
for clinical skills teaching to medical students is necessary in light of the
imminent expansion in student numbers.
3.10
The Faculty should consider the inclusion of IT and technical support
personnel on some of the committee structures, especially curriculum
committee or appropriate sub groups.
3.11
The Review Group is of the impression that the medical
department/administrative group and future Faculty Office will benefit
from engaging in a series of structured encounters with central
administrative staff in the various central offices, most importantly
Admissions, Examinations, Library and IT in order to articulate their
requirements as user groups both at present and in the immediate future.
The Departments of Nursing, Occupational Therapy and Speech and
Language Therapies all appear to have been more effective in this regard
to date.
3.12
The Faculty office should review its operations in relation to specific
activities, e.g., admissions. There is a resource allocation for this activity
at the centre.
3.13
Departments should evaluate the mechanisms and structures in place to
document and react to student views and evaluation in order to protect
the impressive esprit de corps evident in the Faculty. All departments
should identify clear policies and procedures regarding mentoring
arrangements or their equivalent within the Faculty to support students in
difficulty.
4. Programmes and Instruction
The philosophical principles underlying the entire provision of the Faculty are to be
applauded, and the overall academic and professional aims and objectives of the
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provision are laudable in their entirety. Medical students enter with high points
profiles and this is to be welcomed, and the entry criteria for the other health
professional students is also encouraging. The Faculty, therefore, attracts good
students and has low attrition, and the overall quality of students and student
performance throughout the Faculty is commendable and is recognized by employers
who are keen to recruit NUI Galway graduates.
The student experience meets the expectations of the students and is of a high
quality and there is a unanimity within the student body on all programmes that they
would recommend Galway to other aspiring students as rigorous academically and
also as a pastorally caring Faculty. The Faculty is congratulated for the dynamism it
has shown in responding to service needs through the expansion in its course portfolio
and remarkable examples of course innovation are apparent in some parts of the
Faculty. The high quality of learning and teaching is present in abundance and the
Group believes that mechanisms for their recognition and reward are to be
encouraged.
There are a number of areas where the Faculty could improve its overall
approach to programs and instruction, and these are:
1. There is a lack of transparency and consistency in Programme Evaluation
Strategies and the approach to Quality Assurance (QA) in some parts of the
Faculty. These issues concern the guidance and the determination of student
achievement, but also the fulfilment of the expectations of Faculty, professional
bodies and employers. The key concerns for Faculty to consider include:

Learning outcomes are not always explicit. In consequence, the way in which
these inform programme content in some instances needs clarification

The determination of assessment strategies should specifically address learning
outcomes and be part of a coherent approach to curriculum design
development and delivery. Some parts of the Faculty seemingly determine
assessment tasks in a manner that is detached from other curriculum
development activities, whereas assessment strategies must always be integral
to curriculum design.

Measures to ensure uniformly high levels of assistance in feedback, course
information, study skills and related student support should be assured in all
programmes of study
2. The reward of achievement is inconsistent and the Faculty should attend to the
following:

Standard setting should be sufficiently explicit to inform grading decisions.

Module descriptors should enable student performance to be calibrated in
accordance with NUI norms and with comparator programmes.

Where it occurs, the prevalence of ‘planned mediocrity’ results in failure
to recognize excellence by a systematic rule to rarely award a grade of over
70%. This results in failure to use the full range of marks available and a
diminution of merit and of honours worthiness. The ultimate result of this
is the potential impairment of students’ career prospects internationally.
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3. A number of programmes in the Faculty depend on input from the Basic Science
departments. This teaching must at all times be optimally integrated with the
learning outcomes of the respective programmes. The students do not feel that this
is currently the case as they are combined with other groups for lectures. Student
representatives in Nursing, Occupational Therapy, and Speech and Language
Therapy all identified a need for small group teaching in the Basic Sciences, and
this has obvious resource implications.
4. The Faculty is encouraged to review its timetables with a view to maximising the
space utilisation available to it.
5. Several innovations will impose new demands on QA processes that require
careful anticipation

The new Medical Curriculum

The exponential growth in medical student numbers

The recruitment of students to Medicine with fewer entry points.
Based on these observations, and keeping in mind the overall goal which is to find
ways to answer the question “how does the faculty become even better”, the Review
Group makes the following recommendations in the area of Programmes and
Instruction:
4.1
5.
The Faculty should establish as matter of some urgency, crossdisciplinary formalized QA procedures and systems. These might
include:

A Curriculum or Teaching and Learning Committee that sets the
parameters and the standards and processes for the design,
implementation and evaluation of all taught provision throughout
the Faculty.

QA procedures should communicate National University of
Ireland standards to all relevant stakeholders and should have
explicit definitions to enable the calibration of student
performance at points of progression and at the point of exit.
4.2
The provision of Basic Sciences requires appropriate funding for the
delivery of Anatomy, Physiology and Pharmacology and each taught
module should also be subject to systematic QA scrutiny.
4.3
Inter-professional opportunities for teaching and learning should be
developed to capitalise on the skills repertoire of the whole Faculty.
Examples include Clinical Skills acquisition for Medical and Nursing
students, and the joint provision in fields such as Behavioural Sciences,
Human Communication and Ethics.
Scholarship and Research
The Review Group was very encouraged to observe the clear interest, enthusiasm and
commitment across the entire Faculty to the pursuit of a research agenda. It is fair to
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say that research across the Faculty is at different stages of development. There are
many reasons for this such as the newness of some Departments that historically have
lacked a scholarly tradition. Their ability to engage in research has also been hindered
by the demands of new programme design and introduction, and by heavy teaching
workloads. The Faculty has strong and established links with other Faculties, for
example, the collaboration with Science and Engineering in the National Centre for
Biomedical Engineering Science (NCBES).
The Faculty has had notable successes on the research front including

REMEDI, a world class research institute for regenerative medicine

Successful funding of research projects in the Nursing Department

Formal recognition by the University of The Centre for Health Services
Research

Successes in the Millennium Fund and applications to the Health Research
Board for research funding in the area of therapy research.
Lecturers in the Faculty expressed serious concerns about a perceived devaluing of
teaching in comparison to research, and the overall impression is that promotion to
senior levels solely depends on success in gaining research funding.
Within this context, the challenge for the Faculty as a whole is to build upon
staff interests and successes, and optimally exploit the interdisciplinary potential for
Faculty-wide collaborative research. In order to assist in the achievement of this, the
Review Group recommends the following:
5.1
The Faculty takes advantage of the opportunity for collaborative research
across departments through the deployment of a more formalised
Research Committee, reporting to Faculty, which sets goals and takes
action to advance the Faculty’s research agenda.
5.2
The Faculty explores opportunities to communicate research with
colleagues in different Departments. One way of achieving this is to have
a Faculty research day (a possible model for this is the Engineering
Faculty Research Day at NUI Galway), with posters from researchers and
invited talks on common research problems across the Medical and
Health Sciences.
5.3
The Faculty develops an interactive web site to promote and give a
greater profile to the Faculty’s research.
5.4
The Faculty uses existing structures by working closely with the
Research Office in order to seek supports for new staff (workshops, etc.).
5.5
The University takes action to ensure that staff, who measurably excel in
teaching and educational development, can also avail of promotion
opportunities.
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6.
Community Service and the Wider Context
The Faculty is clearly aware of the important role it can play in serving the wider
community. The means of achieving this goal vary across the departments in the
Faculty.
The newer departments of Nursing, Occupational Therapy, and Speech and
Language Therapy are engaged in service learning with the Community Knowledge
Initiative, in Ireland, Zambia and Kenya. The pre-clinical departments are involved in
raising the profile of science and medicine through school visits and through liaison
with Galway Youth Services. Across a wide range of clinical departments, there has
been a commitment to provide information and support to the wider community
through guest lectures, support for general practitioners, involvement with voluntary
agencies such as Croí and Breast Check Ireland. The Faculty has supported the
medical students in raising both the profile and funding to support the Voluntary
Services Abroad Society. Members of the Faculty, particularly in areas of Health
Promotion have also been involved in framing the national agenda.
The Faculty has developed important links to other Universities and the Health
Service Executive. Important collaborations have recently been established with the
University of Ulster, which should benefit both institutions. A memorandum of
understanding has been signed between the Faculty and the Health Service Executive,
and the Review Group would like to compliment both parties on the excellent
working relations that have been developed between them.
The Faculty is unique in the University in the complexity of its interactions
with external bodies, which include the Departments of Health, and Children and
Education and Science, and the various accreditation bodies for the large number of
programmes offered within the Faculty. The intense competition between
Universities to respond to external demands for new courses, including those
generated through the Fottrell report, requires a quick response and clear leadership
from the University in order to realize these opportunities. If the infrastructure is not
in place, then the Faculty will not succeed in competing for these additional students.
Therefore, the Review Group makes the following recommendation.
6.1
7.
The Faculty communicate the urgency of their needs to the University
and that the University responds appropriately and quickly in order to
seize these opportunities.
Report Summary and Concluding Remarks
The Review Group welcomed the opportunity to visit the Faculty, meet its staff and
students, and was greatly impressed with very notable esprit de corps of all they met,
and with the openness encountered in all meetings. The Faculty has a significant
compliment of talented and dedicated staff, and is producing good graduates through a
diverse range of teaching and learning programmes, and has clearly demonstrated
excellence – to national and international standards – in teaching and research. The
Faculty is also at a turning point - a critical point in its development - with exciting
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new opportunities opening up in terms of increased student numbers and the
opportunities offered by Government commitments to fourth-level education.
It is clear to the Review Group that in order for the Faculty to take advantage
of this once-off opportunity, action should be taken to implement what is
recommended in our report. In particular, the Faculty must “think as a faculty”,
optimise their structures and procedures, and look for ways to leverage their interdisciplinary strengths in both teaching and research. The University also must realise
the strategic opportunity that now presents itself, and thus ensure that the Faculty gets
all the support and resources at a strategic and operational level, in order that the
Faculty fulfils its potential, and maintains and enhances NUI Galway’s position as a
centre of excellence for teaching and research in the Medical and Health Sciences.
8. Comments on The Methodology of the Review Process
1. Acknowledging the time constraints and the very many other important matters
being dealt with, the Review Group considered that more consultation and analysis
of the present position would have been appropriate in the self-assessment
document.
In particular, the SWOT analysis could have been more
comprehensive, there was no mention of the Faculty’s Strategic Plan, and there
was lack of integration of information from all areas of the Faculty.
2. There was a lack of information, until requested, on the income/expenditure for
the Faculty.
3. The Review Group were very appreciative of the frank and open dialogue with all
members of the Faculty.
4. The Review Group was glad that it availed of the opportunity to meet the HSE
manager and regretted that there was no opportunity to meet the hospital
consultants and GPs as a group.
Professor John G. Simpson (Chair)
Professor Peter L. Bradshaw
Dr Siun O’Flynn
Dr Pat Morgan
Dr Jim Duggan (Rapporteur)
1st September 2006
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