An Coiste FeabhaisAcadúil
The Committee on Academic Quality Improvement
The Academic Quality Assurance Programme 2002 – 2003
REVIEW OF
THE DEPARTMENT OF OTORHINOLARYNGOLOGY
Final Report
3rd September 2003
Department of Otorhinolaryngology: Review Group Report
This report arises from a visit by a review team to the Department of
Otorhinolaryngology on 11th- 12th 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.
The review team consisted of: Professor Brian Kavangh, 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, Trinity Centre, St. James’s Hospital, Dublin, Dr.
Geraldine Gaffney, Department of Obstetrics & Gynaecology, NUI, Galway; and Dr.
Iain Mac Labhrainn, (Centre for Excellence in Learning & Teaching) of the CFA
acting as rapporteur.
The report is structured to cover the following main topics :
1. Aims and Objectives
2. Organization and management
3. Programmes and Instruction
4. Scholarship and Research
5. The Wider Context
6. Summary and Concluding Remarks
7. Generic Issues
1.
Aims and Objectives
The Departmental aims as stated in the Self Assessment report are fairly generic in
nature. Although they were developed in 1987 and they do not appear to have been
updated since that time, they are appropriate with respect to the department’s role. In
regards teaching the aims appear to have been operationalised, but with regards
research they may not be realistic in the current context.
2. Organisation & Management
The Department provides an extensive clinical service as well as delivering
undergraduate and postgraduate teaching and training. There are three consultants and
a clinical tutor. No research strategy exists.
The relationship between the Department and the Department of Surgery is confused.
There is apparently no administrative or infrastructural support from the university
specifically for the department, and Western Health Board staff are being used,
unofficially, to deliver secretarial support.
There was a stated request to be considered as a separate entity from the Department
of Surgery.
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Department of Otorhinolaryngology: Review Group Report
3. Programmes & Instruction
3.1 General
There is a traditional approach to teaching in the Department of
Otorhinolaryngology, with the focus on 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 outside 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:
• teaching objectives are clear and relevant;
• provision of clinical tutor is an example of good practice that resolves tension
between clinical and academic and is a model that might suit other areas in
the curriculum;
• assessment methods are focussed on practical clinical skills, which is
appropriate for the subject;
• good sense of perspective regarding the requirements of undergraduate
teaching in ENT and the course is appropriately tailored to suit;
• student feedback identified the clinical tutor as being an excellent teacher;
• good library facilities
Weaknesses:
• non-relevance of timing of the lecture course to attachments;
• inappropriateness of space being used to deliver student teaching. The review
group regards the teaching conditions within the hospital as being archaic.
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Department of Otorhinolaryngology: Review Group Report
•
•
•
•
o This space is severely overcrowded and inadequate for the student
numbers currently being taught. This will be exacerbated with any
increase in student numbers.
o Clinical space is shared between teaching and clinical needs, causing
disruption of tutorials;
poor communication and management within department of surgery, which
possibly affects the use of space and resources;
the timing of attachments and examinations sometimes leads to impact on
attendance - students identified overall timetable as being chaotic;
over-reliance on patients for teaching as opposed to using other
approaches/resources e.g. clinical skills laboratory
tutorial groups are too large
Opportunities:
These should be properly reviewed on appointment of new staff.
•
•
•
The students specifically requested that there should be a short
exam/assessment at the end of the placement period.
Review timing and place of end of year examination in relation to final
degree;
Consider the use of outlying clinics as suitable for basic clinical experience
Threats:
• Lack of protected teaching time. The department had recommended,
preferably, an 8/3 split. If this is deemed appropriate, it requires to be formally
acted upon by the university.
• A new appointee needs a clear remit and job description regarding teaching. If
not, the program will founder.
4. Scholarship & Research
The Department has no specific research background, focus or strategy. This is
reflected in the absence of significant published research work, contribution to
textbooks, higher degrees, and research funding. The retired Head of Department was
quite explicit about the predominant teaching interest of himself and other lecturers,
and the students are clearly satisfied with the teaching course.
The replacement Head of Department will have significant research opportunities in
the hospital and University campus. The primacy in the sessional arrangements of the
new appointment, whether at Senior Lecturer or Professorial level, will be on
delivering on the established curriculum 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.
5. The Wider Context
The clinical workload of staff in the department is enormous and places pressure on
all other activities. A formal, contractual structure for time allocation will ease
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Department of Otorhinolaryngology: Review Group Report
management of the Department’s responsibilities and may facilitate other
developments.
6. Summary & Concluding Remarks
The Department presented clear and concise undergraduate aims, which the reviewers
felt were appropriate to an undergraduate course. The appointment of a clinical tutor
was felt to be beneficial to the department. Research activity within the department
has been minimal but the appointment of a successor to the retired Head of
Department could address this. Although part of the Department of Surgery, the
Department appears to function in isolation both from an administrative and academic
perspective. The review group have recommended that
1. The academic head of department should have Senior Lecturer status with
protected academic time.
2. The relationship with the Department of Surgery should be clarified. A
suggested approach would be that Otorhinolaryngology would function as a
sub-department of the Department of Surgery with its own administrative and
budgetary arrangements.
3. Formal or external assessment of the undergraduate course and examination
should be encouraged.
4. The timetable and scheduling of examinations, teaching and attachments in
Otorhinolaryngology and Ophthalmology need to be better coordinated.
7. Generic issues pertaining to Departments within the Department of Surgery
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.
2. Departmental Budgets
The system of linking departmental credit and budget to the curriculum-linked
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
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Department of Otorhinolaryngology: Review Group Report
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
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.
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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.
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 Otorhinolaryngology: 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 I. Mac Labhrainn (Rapporteur)
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(3rd September 2003)
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