An Coiste Feabhais Acadúil
The Committee on Academic Quality Improvement
The Academic Quality Assurance Programme – 2003-2004
REVIEW OF
THE DEPARTMENT OF MEDICINE
FINAL REPORT
23rd April 2004
This report arises from a visit by a review team to the Department of
Medicine on 10th to 12th March, 2004. The Department had already prepared
and submitted a 'Self Assessment Report' that, with other documentation,
was made available to the review team well in advance of the visit.
The review team consisted of: Dr Paula O'Leary, Department of
Medicine, NUI, University College Cork (Chair); Professor David Hadden,
Royal Victoria Hospital, Belfast, Professor T. J. McKenna, Royal College of
Physicians, Dublin, Dr John Laffey, Department of Anaesthesia, NUI, Galway
and Professor Andrew Erskine, Department of Classics, NUI, Galway, acting
as Rapporteur.
The report is structured to cover the following main topics
1. Aims and Objectives
2. Review of Progress since 1998 Review
3. Organization and Management
4. Programmes and Instruction
5. Scholarship and Research
6. Community Service
7. The Wider Context
8. Summary and Concluding Remarks
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The review group expresses thanks to the members of the department and to
the Quality Office NUIG for facilitating this quality review process. The
tremendous advances at the Department of Medicine since the last review are
acknowledged by all.
1.
Aims and Objectives
The aims and objectives of the Department of Medicine as presented in the
Self-Assessment Report are appropriate. They are clearly set out and the
department has a coherent vision of where it is going. Our report outlines
areas that need attention to ensure success.
2.
Review of Progress since 1998 Assessment
a) On the Part of the Department of Medicine
1. The Department has implemented a series of staff meetings, which appear
to be functioning well. In addition there are regular meetings of
departmental committees.
2. The Faculty Core Curriculum Reform Committee is in the process of
making recommendations to the Faculty on curricular change. The
Department of Medicine has a strong input into the curriculum reform
process.
3. The Department has instituted both formal and informal student feedback
programs. Staff-student committees have been instituted and students are
represented on faculty committees. In addition, in the current academic
year the Department has met with its fourth and final year students
individually. These meetings appear to be working well and the students
expressed satisfaction with the feedback system.
4. The students appear satisfied with their increased opportunities to make
oral presentations within the Department.
b) On the Part of the Registrar and the CFA
1. The Review group recognises the excellent progress that has been made in
relation to the appointment of staff with substantial protected academic
time in the Department of Medicine.
2. A system of honorary appointments for clinical teachers has not been
established. The Review group recognises the central role of the Clinical
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Lecturers in the teaching of undergraduate medical students within the
Department. The establishment of a promotional track for Clinical
Lecturers is a matter of the highest priority.
3. The University has provided one Clinical Tutor but additional tutors are
urgently required. The Review group supports the provision of additional
Clinical Tutors to the Department of Medicine.
4. The Review group recognises that the University has provided substantial
funding to enable the development of the Department under its new
Professor.
5. The status of the ‘affiliated hospitals’ must be reviewed as a matter of
urgency. The Medical Faculty and the University should apply to the
Government to designate these hospitals as teaching hospitals a matter of
urgency.
6. It had been originally proposed that a representative of the Western
Health Board be co-opted onto the Governing Authority. The Review
group understands that alternative arrangements are in effect to facilitate
co-operation between the University and Health Board. It is important
that an effective liaison group continues to function between the
University and the Health Board, and that this liaison should function at a
number of managerial levels
7. Student feedback appears to be effectively collected and analysed within
the Department. There does not appear to be a centralised service for the
collection and analysis of student feedback on teaching, administration
and assessment.
2.
Organisation and Management
Chair of Medicine
The review group recognises that the international profile of the leading
clinical professorial departments has undergone a major change. The status
of such departments is judged on the quality and extent of their research.
However these departments are also required to maintain a major presence in
the organization and provision of undergraduate and postgraduate teaching,
in the delivery of patient care and to provide leadership in the Faculty of
Medicine. It is not possible for the Head of the Department of Medicine to
deliver personally all of the departmental activities. However the Head of
Department should be involved in all areas and delegate substantial
responsibility as appropriate to senior departmental members, e.g. associate
professors, senior lecturers. Therefore for the continued very high level of
achievement to be sustained and developed in all areas, including the major
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research establishment, the appointment of additional senior faculty members
will be required. The present profile of the Department of Medicine conforms
to a high standard but this will not be sustained without additional senior
appointments.
Clinical Lecturers
The increase in student numbers envisaged in the Academic Plan of the
Faculty, the need to improve staff:student ratios, and the changes in work
practices of Consultant Physicians envisaged in the Hanley Report and of
doctors in training under the European Working Time Directive all constitute
serious threats to the delivery of clinical teaching within the Department.
Clinical Lecturers/Consultant Physicians provide a very valuable resource to
the Department of Medicine. However, while noting recent improvements in
support from the Department of Medicine, it is clear that this group's
contribution is not appropriately recognised. Three particular problems were
identified:
•
There is an absence of promotional opportunity to recognise high
quality teaching and research.
The review group strongly
recommends that there should be a promotional pathway for those
Clinical Lecturers who make a major contribution to teaching in the
clinical departments in a manner which will be recognised
internationally, e.g. Clinical Professor. The review group also strongly
recommends that there should be a promotional pathway for those
Clinical Lecturers who have demonstrated a major commitment to
research.
This will be indicated by supervision of candidates
undertaking graduate degrees, e.g. MD, Ph.D., and/or publication in
international peer-reviewed scientific journals. Promotion should be
to a level which will be recognised internationally, e.g.
Research/Associate Professor. The criteria used for promotion should
be clearly defined and widely-circulated.
•
There is dissatisfaction with the distinction in salary terms between
statutory lecturers and clinical lecturers without obvious differences in
the teaching delivered. If a distinction is to be maintained, the
rationale for the difference between statutory and clinical lecturers
should be clearly defined.
•
The lack of teaching infrastructure in Merlin Park was identified as a
problem. The establishment of a Faculty of Medicine designated area
at Merlin Park, as it is presently constituted, with video conferencing
facilities and appropriate online library access is recommended as is
the appointment of a clinical tutor to organise teaching activities. It
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would appear that additional consultant appointments are required to
meet service and teaching demands. Job descriptions should recognise
protected academic time and allow the restructuring of existing
contracts to accommodate protected academic time (3/8 - 2/9
sessions).
Doctors in training
While the contribution of SHOs, registrars and specialist registrars to the
teaching of medical students is significant, this is not recognised in any
manner by the University. Reduction in the working hours of doctors
associated with the European Working Time Directive is likely to reduce
significantly the opportunity to provide this level of teaching. This should be
considered within the context of an increasing requirement for teaching as the
planned expansion in student numbers occur.
The Faculty of Medicine should consider some form of recognition, possibly
by the appropriate use of an honorary title, e.g. Instructor in Medicine. There
is an urgent need to anticipate a reduced level of teaching input both
absolutely and in relation to increased student numbers. The appointment of
Clinical Tutors under the supervision of the Department of Medicine is
recommended.
Affiliated Hospitals
The strategic decision to base more clinical teaching in affiliated hospitals will
partially resolve these problems. However, this can only occur if these
hospitals are properly resourced and supported by the University. There
exists an urgent need to re-designate these hospitals as ‘Teaching Hospitals’
in order to maintain and enhance their links with NUI Galway. Advances are
already being made to affiliated hospitals by other medical schools which
would jeopardise the position of Galway students. Teaching and
administrative staff and infrastructural development (dedicated teaching
space and IT support) must be provided by the University in these hospitals.
Administration and Support
Our meeting with the University's Assistant Secretary identified an
incongruity in the staff and FTE allocations attributed to the department.
Clarification is required to ensure appropriate levels of funding. This needs
immediate action.
The duties and responsibilities of staff within the Department are, in general,
clearly understood. The workload of the administrative staff, and in
particular on Ms Una O’Connor, is excessive and further administrative
support is urgently required. There is a need for dedicated administrative
support for the Department’s educational programme in order to meet the
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growing staff and student population and the new courses being developed
within the Department.
The extensive change that the Department has undergone in recent years has
necessitated changes in the roles of the Department’s technical staff. In recent
months, the Centre for Medical Informatics has been incorporated into the
Department. This integration process has necessitated changes in the roles of
technical staff within the Centre for Medical Informatics, and is still in
progress.
The review group wishes to reinforce the importance of non-clinical academic
staff within the Department, and recognise the need for high level scientific
staff such as Research Scientists to facilitate the scientific function of the
Department. The efficiency of this group would be enhanced by the creation
of central facilities, such as core technologies, purchasing, technical and
administrative support. There is a need for the development of appropriate
career structures within the University for senior scientists, such as those
currently working within the Department.
The Management System
The management system within the Department’s laboratories appears to
function well and involves the participation of all sections of the staff within
the laboratory.
With regard to clinical teaching, communication with clinical teachers at all
sites associated with the Department is in need of improvement. The
enhancement of IT facilities, the provision of access (especially online) to the
resources of the University library and the placement of a key person at each
site to co-ordinate clinical teaching are viewed as priority issues.
The review group recognises the difficulties that exist in linking the hospital
and University computer systems. However, students must be provided with
access to computers and to the University Network and library facilities
within the Clinical Sciences Institute, at Merlin Park Hospital and at the
affiliated hospitals.
Student Feedback
The review group recognises that students have an appropriate mechanism
for the expression of their views and to provide feedback. In fact, the
Department should be regarded as a model of best practice within the
Medical Faculty in this regard.
3. Programmes and Instruction
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The Review group recognises that the primary focus of the Department, and
the objective of every one of the educational programmes that it provides, is
optimal learning and self-development by every student.
Students
interviewed were enthusiastic and generally satisfied with the degree
programme they were undertaking
MB, BCh, BAO Programme
The evolving undergraduate curriculum is adapting to the changing needs of
medical education. The review group welcomes the formation of a
curriculum reform committee and recommends that is empowered to
institute agreed changes promptly.
The special study modules need particular attention and careful planning.
The Department needs to be clear that these modules can feasibly be
delivered, prior to embarking on this course of action.
There is a need to integrate Dermatology within the general medical
programme at a more appropriate point in the curriculum.
While students feel that the study programmes meet their needs following
qualification, there is, however, a perception from clinicians and recent
graduates that practical clinical skills should be developed to a higher level
by the time of graduation. A Clinical Skills Laboratory is necessary to achieve
this. We urge Faculty to address this need.
We had limited exposure to former graduates, but those we did meet gave a
very positive assessment of the quality of teaching received from the
Department.
Informatics
There are two phases when students are exposed to training in basic
informatic skills, first and fourth year. For some students there appears to be
little acquisition of the skill. To facilitate this the Review Group recommends
that all students should be required to prepare and give a Powerpoint
presentation and undertake a medical literature search at least once a year
throughout their programme.
The web-based programme under
development will enhance the educational experience and is supported by the
group.
Assessment
There is overall satisfaction with assessments. However students would
appreciate regular formative assessment and improved transparency of
allocation of marks. Some element of the curriculum such as procedural
skills, while clearly important for graduates, do not routinely form part of the
assessment process.
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Pastoral Care
The Department is to be congratulated on the initiation of interviewing all
students. The Review Group considers that, since the teaching of Medicine
occurs in the later years only, this initiation should be a function of the
Faculty of Medicine so that the benefits will be available to students in the
early years. The Review Group was concerned that approximately 10% of
students reported significant medical problems frequently associated with
stress. Recognition of this problem brings with it the responsibility for
remedial action.
We were advised by a non-EU student of a perception of an increased failure
rate in the Final Year examination among such students. Analysis of exam
data from the Department of Medicine for the past 2 years does not support
this statement. If the non-EU group are over represented in the tail of the
class, the review group would recommend that reasons for this should be
evaluated.
4.
Scholarship and Research
The Department of Medicine has an enviable success in its research activities,
establishing a reputation for itself as international medical research centre
which can attract graduate students and other researchers. There is very
considerable encouragement of the pursuit of new areas of research and
every suggestion that information about these activities is widely
disseminated.
The Review group applauds the department's achievement of the highest
international level of biomedical research; in this it is setting the standard for
cutting edge research in the discipline. The Department, under the leadership
of its Professor, has played a substantial role in shaping the development of
the new National Centre for Biomedical Engineering Sciences, an ambitious
multidisciplinary venture, in which the Medical, Science and Engineering
Faculties are co-operating. Within this the Regenerative Medicine Institute
(REMEDI) provides opportunities for full expression of the talents of this
outstanding scientific group. The university too should be applauded for
providing the necessary infrastructure.
This new Centre is opening up many new areas of research for graduate
students which had previously not been available in Galway. In our
meetings postgraduate students were very enthusiastic about their work and
happy with the supervisory structures. It is also valuable that medical
students can be involved in the Department's research projects in the summer
if they wish.
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It is important, however, that, while all this new research activity is going on,
other types of research are still pursued and valued, e.g. the Coeliac
programme, and the researchers are not left isolated. Although research
tends to focus around the head of department, efforts should be made to
broaden the research base, for instance by encouraging research by Clinical
Lecturers, e.g. through the provision of facilities and protected time.
5.
Community Service
In spite of the many other demands on their time members of the department
are actively involved in community service at all levels.
6.
The Wider Context
The Department of Medicine is a model of collegiality both within the Faculty
and the University.
It will doubtless facilitate fruitful national and
international collaboration.
7.
Summary and Concluding Remarks
The Department of Medicine is undergoing a major transformation. A new
form of genetically-orientated basic and applied research is progressing at a
rapid rate. The organisation and structure to support these activities will
need reassessment. Senior staff capable of taking on leadership roles within
the department are essential to this process.
The educational responsibilities of the Department are changing and
expanding. This activity is at a less advanced stage than the research
programme. A number of key issues must be addressed to facilitate the
educational endeavours of the Department. These include:
•
the establishment of a University-recognised promotional
pathway for Consultant Physicians participating in the academic
programme.
•
the university needs to assist Faculty in obtaining ministerial
orders to have the affiliated hospitals formally declared teaching
hospitals (originally proposed in 1998 review) with appropriate
technology, infrastructure and supporting personnel.
•
establishment of Clinical Skills Laboratory is essential.
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The overall impression of the review group was of a highly dynamic and
internationally competitive department.
Dr Paula O'Leary (Chair)
Professor David Hadden
Professor T. J. McKenna
Dr John Laffey
Professor Andrew Erskine (Rapporteur)
12 March 2004
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