An Coiste FeabhaisAcadúil
The Committee on Academic Quality Improvement
The Academic Quality Assurance Programme 2002 – 2003
REVIEW OF
THE DEPARTMENT OF OPHTHALMOLOGY
Final Report
16th June 2003
Department of Opthalmology: Review Group Report
This report arises from a visit by a review team to the Department of Ophthalmology
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, Department of Surgery, St. James’s Hospital, Dublin and Dr. Geraldine
Gafney, 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.
Aims and Objectives
Organization and management
Programmes and Instruction
Scholarship and Research
Community Service
Summary and Concluding Remarks
Generic Issues
1.
Aims and Objectives
The stated Departmental aims (teaching) are generic, but are appropriate with respect
to the Department’s role and have been operationalised.
There are no stated research aims and no indication that the overall aims are regularly
revised or re-evaluated.
2.
Organization and management
The Department is organized along clinical and teaching lines. The Department head
has a university appointment as ‘Clinical Lecturer’, and does not believe that such a
position confers sufficient/appropriate authority to administer the undergraduate
teaching program
There is a serious and fundamental problem of contract/salary relating to the
appointment of the tutor which requires to be urgently resolved.
The relationship among the Departments of Surgery, Otorhinolaryngology,
Ophthalmology and the Faculty of Medicine are extremely confused. A request to be
considered as “separate” entities from the Department of surgery is not considered
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Department of Opthalmology: Review Group Report
fully appropriate by the review team but the management issues need to be resolved
with some attention given to budget allocations and responsibilities.
No administrative support is available from within the university and there is a
consequent reliance on Health Board employees to provide this service.
Whilst there is essentially no space provision by the university, and that available in
the hospital is felt to be inadequate for the purposes of teaching, there has been
considerable support for the purchase of teaching equipment and materials from the
university, although this is due to a legacy from previous management arrangements.
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 a number of Departments in the Faculty 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:
1. Teaching objectives were clear and relevant
2. The content was relevant and appropriate
3. Teaching aids are well resourced via a protected, identified budget
4. The clinical tutor position is a model of good practice and received praise
from the students.
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Department of Opthalmology: Review Group Report
5. The students are encouraged to participate in scholarship, in particular the
Duke-Elder Prize (UK & Ireland) which was won by a NUI, Galway student
last year.
6. The library facilities in the Clinical Sciences Institute are good.
Weaknesses:
1. Persistent inappropriate timetabling leads to cancelling of lectures and non
relevance of timing of the lecture course to attachments
2. inappropriateness of space being used to deliver student teaching. Archaic
teaching conditions.
3. clinical space is shared between teaching and clinical needs, causing
disruption of tutorials
4. this space is severely overcrowded and inadequate for student numbers
currently being taught. This will be exacerbated with any increase in student
numbers.
5. Over-reliance on use of patients with no use of clinical skills laboratory
6. some staff decline to participate in teaching programme because of perceived
lack of value arising from poorly defined contracts on appointment
7. tutorial groups are too large
Opportunities:
1. Dependent on clarification of position of tutor and clear line
responsibility/management of courses
2. Consolidating good teaching programme
3. Consider use of outlying clinics for basic clinical teaching
4. Review timing and place of end of year examination in relation to final degree
Threats:
1. Future development being hampered by poor communication and
appointments
2. Expansion of student numbers will lead to significant pressure on resources
and space.
3. Failure to clarify position of head of Department in relation to the University
appointment could place the teaching of ophthalmology in jeopardy
4.
Scholarship and Research
The Department has no background in research or scientific scholarship. The
undergraduate teaching programme is extremely well organized and is clearly the
priority of the Department.
The exigency within this Department is to consolidate the academic arrangement for
delivering the undergraduate course. The research dimension should reflect priorities
developed through the Department of Surgery and the Faculty of Medicine and Health
Science. The possibility of intercollegiate, or multicentre research might be an
appropriate model for a small Department.
The Duke Elder prize was won by NUI, Galway student.
achievement.
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This is a notable
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Department of Opthalmology: Review Group Report
5.
Community Service
Staff from the Department have given radio broadcasts and provide guest lectures to a
range of medical professionals. These activities are to be commended.
6.
Summary and Concluding Remarks
The Department, represented by Mr Kinsella and Miss Harney, has a tenuous
relationship with both the Department of Surgery and the Faculty. With respect to
undergraduate teaching, the Department conducts a well- organised module given in
the fifth medical year. Undergraduate teaching has been assisted by the appointment
of a clinical tutor and the course undergoes regular undergraduate appraisal There are
a number of problems within the Department that need to be addressed
1. The appointment of an academic head of Department is necessary with defined
responsibility for undergraduate course delivery. The head of Department
should also be given time to facilitate the development of research activities.
2. The clinical tutor model is highly effective and receives good student feedback.
The tutor’s contract of employment and absence of salary should be dealt with
as soon as possible.
3. There needs to be greater consultation between the Dean’s Office and the
Department about the timing of undergraduate lectures.
4. The lecture programme is not being fulfilled with the vast majority of lectures
being cancelled.
5. There are serious concerns over the pressures on the limited space for clinical
work that may partially be addressed by a change of teaching methods that
places less reliance on direct patient contact, but will increasingly pose
difficulties with rising student numbers.
6. The relationship to the Department of Surgery, as with the Department of
Otorhinolaryngology, should be clarified. The budgetary and administrative
arrangements should be maintained as a separate sub-section of the Department
of Surgery.
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 and 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.
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Department of Opthalmology: Review Group Report
2.
Departmental Budgets
The system of linking Departmental credit and budget to the curriculumlinked student FTE is inappropriate for rewarding Departments that are
unable to achieve representation in the final medical examination. It may
discriminate against such Departments, and provide unfair advantage to
Departments whose curriculum is in part taught by ‘non-credited’
Departments.
3.
Curriculum Review Committee
The structure of the curriculum review committee is small and does not
represent many Departments (e.g. anaesthesia, radiology) that are not
featured as distinct elements in the traditional curriculum. This is
inappropriate, and reflects (apart from medical informatics) a binding of
undergraduate teaching to a traditional medical degree construct (Bachelor of
Medicine, Bachelor of Surgery, etc).
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 and
facilities for teaching need to be developed along modern lines. There are
particular opportunities for all Departments involved in this review process
and this theme should be driven through cross-Departmental strategy within
the Faculty and curriculum review group.
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
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.
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Department of Opthalmology: Review Group Report
10. Stipend for Clinical Lecturers - potential for creative development
An approach to financial issues, suggested by Dr Flynn (Anaesthesia), 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.
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Department of Opthalmology: Review Group Report
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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(16th June 2003)
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