An Coiste FeabhaisAcadúil
The Committee on Academic Quality Improvement
The Academic Quality Assurance Programme 2002 – 2003
REVIEW OF
THE DEPARTMENT OF ANAESTHESIA
Final Report
11th June 2003
Department of Anaesthesia: Review Group Report
This report arises from a visit by a review team to the Department of Anaesthesia on
the 11th-13th February, 2003. 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.
Four Departments were reviewed during the visit: Anaesthesia, Otorhinolaryngology,
Ophthalmology and Radiology. A number of generic issues pertaining to all were
identified and are also discussed in this report.
The review team consisted of: Professor Brian Kavanagh, Dept. of Critical Care
Medicine, Hospital for Sick Children, Toronto (Chairperson); Professor Helen Carty,
Department of Radiology, Royal Liverpool Children’s Hospital; Professor John
Reynolds, Head of Department of Surgery, Trinity College Dublin, and Dr. Geraldine
Gaffney, Department of Obstetrics & Gynaecology, NUI, Galway; and Dr.Iain
MacLabhrainn of the CFA acting as rapporteur.
The report is structured to cover the following main topics
1.
2.
3.
4.
5.
6.
7.
1.
Aims and Objectives
Organization and management
Programmes and Instruction
Scholarship and Research
Community Service & Wider Context
Summary and Concluding Remarks
Generic Issues
Aims and Objectives
The Departmental aims are clear and comprehensive. The statement of objectives
with respect to clinical focus and standards of teaching was supported through this
review process, and the engagement of a critical mass within the Department in
teaching and research has been effected in an impressive fashion. The ambition of the
Department in biomedical research is progressing rapidly and is achievable.
The aims and objectives were developed as a result of consultation between the
Department , undergraduate and postgraduate students and trainees, and nursing and
paramedical colleagues. These are revised on an annual basis.
2.
Organization and management
The Department is critically and strategically organised, and is well led. The Acting
Head of Department is clearly an able and effective leader in this role with support
from his colleagues, and throughout this review there was clear evidence of a united
team presenting and supporting a shared vision of a modern University Department of
Anaesthesia.
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Department of Anaesthesia: Review Group Report
There is scant existing University structure or space supporting existing Department
activity. There is no administrative support, and a reliance for administrative duties
on health board administrative staff. A small laboratory incorporating a makeshift
office is located in the Medical Sciences Building.
3.
Programmes and Instruction
3.1 General
There is a traditional approach to teaching in the Department, with a high number of
scheduled didactic lectures and tutorials. This is apparently also the norm across
other courses in the Faculty. Curricular reform, in which the Faculty is currently
engaged, should look at teaching methods, the use of a variety of resources and the
potential development and use of self-study materials. A Faculty teaching and
learning strategy should be considered with specific recommendations regarding
student feedback (to ensure consistency and comparability) and support for staff to
develop their teaching skills.
Teaching booklets containing relevant course materials, references, etc, as produced
by the Department of Anaesthesia, were felt to be examples of good practice and their
production should be encouraged across all Departments.
The teaching timetable requires clarification and adjustment to match assessment and
attachments with the teaching blocks in a more satisfactory way and some attention
needs to be paid to the fact that the lecture/teaching programme isn’t always able to
be fulfilled given the inevitable tension between clinical and academic
responsibilities.
There is an evident need for an adequately equipped clinical skills laboratory that
could be shared with the other small Departments to ensure that the students have
ample opportunity for self-study and supervised practical sessions outwith the busy
health board accommodation.
3.2 Specific Issues
We have summarised our findings and comments in the form of a SWOT analysis for
the Department.
Strengths
The teaching programme in the undergraduate curriculum is comprehensively
presented (Appendix III of the Self Assessment Report) in an exemplary booklet. The
aims and objectives are set out along with clear lines of responsibility for different
aspects of the programme such as critical care, pain and perioperative medicine. In
the Fifth medical year a series of Didactic Lectures is delivered, and in the Final year,
the students complete a one-week Clinical Clerkship which they must pass in order to
be eligible to sit the Final Medical examinations.
The medical students we met were complimentary of the teaching programme and the
consultant teachers, and emphasised the value of the attachment for clinical skills
training with mannequins.
A consensus view was that a one week attachment was of insufficient duration.
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Department of Anaesthesia: Review Group Report
Further strengths include the clear commitment of many in the Department to
teaching and formal feedback mechanisms indicating high student satisfaction with
teaching content and methods.
Weaknesses
The principal weakness is the lack of sufficient contact time between student and
teacher, particularly with respect to clinical skills training. The exigency in expanding
the clinical skills training period for the undergraduate in a modern curriculum is
evident, and this demands University support. Currently the clinical skills facility is
principally funded by soft funds, and there is insufficient quantity and quality of aids
and teaching material.
The Department of Anaesthesia is strategically weakened through its curriculum time,
which, although not insignificant, is not formally assessed. This could immediately
and simply be rectified if the Department was allocated a fixed component of the
Final examination in Surgery, and involvement in the Final Clinical examinations.
Opportunities
There is a great potential to expand across other disciplines in strategic projects, in
particular, the development of clinical skills programmes for undergraduates and
interns. There is an evident need for an adequately equipped clinical skills laboratory
that could be shared with the other small Departments and sub-Departments to ensure
that the students have ample opportunity for self-study and supervised practical
sessions. This would be envisaged as a key project for the new Professor in
association with the Chair in Surgery and Medicine.
Threats
The principal pressures are generic and related to increased student numbers without
commensurate investment in infrastructural support for teaching.
Lack of
representation at Faculty management level due to an historic back-seat role in the
Faculty may compromise the negotiating ability of the Department through a difficult
fiscal period.
4.
Scholarship and Research
The Department of Anaesthesia is currently positioned within the Department of
Surgery.
The NUI, Galway, University College Hospital, and the Western Health Board, are in
prime position to foster the previously unrivalled opportunity for clinical and basic
research in the health sciences. There are several indigenous strengths that permit the
Department to develop a reasonably ambitious research strategy. The National Centre
for Biomedical Engineering Science, the predominantly molecular-focused research
strategy of Professor Tim O’Brien and the Department of Medicine, and the
opportunities for funding through the Health Research Board, the Wellcome Trust,
Science Foundation Ireland, the European Union’s (VI) framework all represent a rich
potential resource for research within and between Departments. This is underpinned
by necessary strengths in computing, library and information technology.
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Department of Anaesthesia: Review Group Report
Resources for research development also include the patient workload, new capital
projects, the development of new services, including cardiac surgery and radiation
therapy, and the appointment of new consultants with records of academic
achievement and with an enthusiasm and determination to succeed academically.
With regards to the current situation in the Department of Anaesthesia, we are keen to
emphasise that there is at best a meagre resource in place for research, and this is
through indirect contribution from the University rather than direct support.
In terms of publications in peer-reviewed journals, the Department and its associates
have published at a reasonable level in appropriate specialist journals. Most of the
work to date has focused on clinical studies and reports. The Department has not as
yet made contributions to textbooks for undergraduates or postgraduates. No higher
degrees have emanated from the Department from work performed at NUI (Galway),
although two graduates are currently pursuing research towards a Doctorate in
Medicine at University College Dublin and in the United States.
The Department has a clear and impressive strategy for research. There are three
major themes, namely in regional anaesthesia, critical care, and experimental models
of acute lung injury (and gene therapy). The lead investigators in these areas are Dr
Brian Kinirons, Dr Deirdre Grady and Dr John Laffey respectively. The latter has
generated a significant amount of peer-reviewed research funding through the Irish
Lung Foundation and the Yamanouchi European Foundation. The quality of the
research contribution of Dr Laffey may merit special mention. He has established
intramural collaboration with Professor Tim O’Brien in molecular research and
extramural links with Professor McLaughlin in the Department of Physiology in
UCD. He has produced several contributions to high impact factor journals in his
area of research interest, and thus established an international reputation. His
knowledge and expertise in the area of molecular understanding and therapy of lung
injury is an area rich in grant potential for the foreseeable future. Moreover,
experience in molecular techniques opens up avenues of exploration, and this is
currently being harnessed in the study of the pathogenesis of pre-eclampsia. One
postdoctoral fellow is currently working in the laboratory.
5.
Community Service & the Wider Context
The Department plays an active role in the wider medical and health community in
the region via such activities as Antenatal Teaching Classes, Ambulance In-Service
Training Programmes, ACLS Courses and training in hyperbaric medicine.
Representation on health board and professional committees and other organizations
is also testimony to their level of community involvement.
6.
Summary and Concluding Remarks
The Department of Anaesthesia, one of the largest in the faculty, presented a detailed
and comprehensive report about their activities. The Department has critical mass
with respect to teaching, and is well led, organised and enthusiastic, with a clear
academic vision. There has been no University Professor within the Department for
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Department of Anaesthesia: Review Group Report
two years, and filling the Chair will give considerable momentum to the research
vision and potential of the Department.
The following is a summary of the recommendations of the review group:
1.
Undergraduate Teaching
Students are demanding more contact time with Anaesthesia and this should be
supported. A longer module within Anaesthesia is best complimented by formal
assessment and linkage to University support with a clear and distinct pay and
non-pay budget.
2.
Curriculum Reform
The Professor or Head of Department, or designate, should represent the group
on the Curriculum Committee. Key strategic priorities may be the development
of a Clinical Skills Laboratory, and vertical integration with pre-clinical sciences,
in particular, Physiology.
3.
Professorial Appointment
This should be a full Chair (6:5) with a principal commitment to the development
of the research and teaching strategy. Administrative support is essential and
expansion of office and laboratory space within the Clinical Sciences Institute
will be required.
4.
Tutor
The review panel recommended the appointment of a university-funded clinical
tutor, as is the case with the Departments of ENT and Ophthalmology.
5.
Relationship with Department of Surgery
The relationship between the Department and the option for its further
development either alone, in its existing relationship with Surgery, or in a new
Department or Division such as Medicine, was discussed. This was considered to
be outside the remit of this review, but the general consensus is that the long-term
strategy should be to establish an independent academic Department developed
through expanded curriculum time, research and scholarship.
The current arrangement within the Department of Surgery could be enhanced
through a defined involvement in the curriculum and assessment. The likely
appointment of the new Chair in Surgery within the next year presents
opportunities to establish a new arrangement.
6.
Research
There is a clear potential to establish this Department as a leading academic
research centre.
The academic talent, drive, strategy and vision already exists within the
Department and it would be anticipated that the new Chair will have a major
commitment to realise the considerable research potential of the position. It is
essential that the Chair has protected academic time, and it would be desirable if
the position can be strengthened by the immediate appointment of a tutor and
with the possibility of a further senior lectureship in the future.
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Department of Anaesthesia: Review Group Report
7.
Generic issues pertaining to all four Departments
Throughout the review process, several ‘generic’ issues became apparent to the
review panel, who were responsible for reviewing the Departments of
Otorhinolaryngology, Anaesthesia, Radiology and Ophthalomology.
1. Full-time Dean.
The Dean of the Faculty is a part-time position. The external members of the
panel believe that a full-time Dean is required at NUI (Galway), and indeed this
common need in all Irish Universities at this time is widely recognised.
2. Departmental Budgets
The system of linking Departmental credit and budget to the curriculum-linked
student FTE disadvantages the Departments under review, in particular Radiology
and Anaesthesia who are not formally represented in final medical assessment
process. A review of Departmental budget support is urgently required.
3. Curriculum Review Committee
The structure of the curriculum review committee is small and does not appear to
represent many Departments that are not distinct elements in the traditional
curriculum. This is inappropriate, and reflects (apart from medical informatics) a
binding of undergraduate teaching to the traditional medical degree construct
(Bachelor of Medicine, Bachelor of Surgery, etc).
It is particularly important that the Departments of Anaesthesia and Radiology are
represented on the curriculum review committee, as the academic opportunities of
these Departments will evolve through greater ownership of curriculum time and
content, both in the clinical years and through linkage with pre-clinical disciplines
such as anatomy, physiology and pharmacology.
4. Faculty Research Strategy
All Departments should be welcomed as members of the faculty research
committee
5. Skills Teaching and Facilities
The teaching facilities that we visited were uniformly archaic; the space
facilities for teaching need to be developed along modern lines. There
particular opportunities for all Departments involved in this review process
this theme should be driven through cross-Departmental strategy within
Faculty and curriculum review group.
and
are
and
the
6. Communication, Transparency, & Concordance in Perceptions
The panel was struck by some discordance in perspective as portrayed by the
Dean compared with that portrayed by some of the consultant staff.
7. Student Numbers
The panel was concerned that the plans for increased student enrolment were not
accompanied by adequately developed plans for teaching space and resources
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Department of Anaesthesia: Review Group Report
8. Academic Contracts
There were serious staff contract issues in two of the four Departments reviewed.
9. Arrangement with Department of Surgery
The nature of the affiliation between the Department of Surgery and the Departments
of Otorhinolaryngology, Ophthalmology, Radiology and Anaesthesia is unclear, and
has been that way for a considerable time. There is an urgent need to revisit this
problem and establish an actionable and measurable agreement between Surgery, for
those Departments that would remain within the Department of Surgery. The expected
appointment of the Chair in Surgery in the near future may assist in establishing such
arrangements.
10. Stipend for Clinical Lecturers - potential for creative development
An approach to financial issues, suggested by Dr Flynn, was that Departmental
clinical lecturers’ stipends be pooled and directed to the Departments for academic
purposes. The panel viewed this as imaginative and creative.
11. Training the Teachers
The consultant staff need to be offered, and to engage in, formal processes designed to
learn and maintain teaching skills.
12. Academic Promotion
The consultant staff need to be offered a process of academic promotion for teaching
and or research, based on validated and accepted criteria. There is no incentive, aside
from a stipend that is essentially negligible relative to overall income, for consultants
to teach medical students, and from what the panel can discern, many consultants do
not teach.
Comments on the Methodology of the Review Process
1. Staff from the Departments and the quality office were considerate and efficient.
2. By and large, the documentation submitted was good, well structured and clear.
3. It was felt by the review group that the number of Departments under consideration
on this single visit was too large and future reviews of these units should be
organized differently.
4. It was felt that the absence of input from the Department of Surgery provided the
review group with a number of difficulties. Furthermore, the rationale presented
that a review was inappropriate in the absence of a Head of Department was not an
opinion shared by the review group, insofar as a review may be a critical source of
information for a new appointment.
5. Given the number of Departments and the amount of documentation required, the
group would have benefited from a dedicated administrative assistant.
6. The lack of adequate modern facilities for the review group was also problematic
and the provision of networked computer access, printer, telephone etc, would
have aided the process.
Professor B. Kavanagh(Chair)
Professor H. Carty
Professor J. Reynolds
Dr. G. Gaffney
Dr Iain Mac Labhrainn (Rapporteur)
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(11th June 2003)
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