An Coiste FeabhaisAcadúil
The Committee on Academic Quality Improvement
The Academic Quality Assurance Programme 2002 – 2003
REVIEW OF
DEPARTMENT OF PAEDIATRICS
Final Report
2 May 2003
Department of Paediatrics: Review Report
This report arises from a visit by a review team to the Department of Paediatrics on 5-6 March 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 Hilary Hoey, Department of Paediatrics, University of Dublin,
Trinity College, National Children’s Hospital, Tallaght, Dublin (Chairperson); Dr John McIntyre,
Academic Division of Child Health, Derbyshire Children’s Hospital, Derby (University of
Nottingham, UK); Professor John Morrison, Department of Obstetrics and Gynaecology, NUI,
Galway; and Dr Philip Dine, Department of French, NUI, Galway, acting as rapporteur.
The report is structured to cover the following main topics:
1.
2.
3.
4.
5.
6.
7.
1.
Aims and Objectives
Structure and Organization
Programmes and Instruction
Scholarship and Research
Community Service
The Wider Context
Summary and Concluding Remarks
Aims and Objectives
The aims and objectives for this Department relate to delivering high quality teaching and contributing
through research to the scientific basis of paediatrics. These are acknowledged as encapsulating
succinctly appropriate aspirations for an academic paediatric department and being potentially
achievable.
2.
Structure and Organization
The Department of Paediatrics is a small department within the Medical Faculty of NUIG with a
Professor, Clinical Lecturer, Tutor/Lecturer (temporary contractual post), Technician (full-time) and
Secretarial/Administrative assistant (50% support). It is obvious from the review that this small group
of staff function well together, and decision-making within the Department runs smoothly. Much of
the Department’s efforts are directed at the undergraduate programme. The Department facilities
within the Clinical Science Institute consist of two rooms. One of these is the Professor’s office; while
the other office is shared by the secretary, technician, and clinical tutor. An additional room will be
required with the forthcoming appointment to the new post of Senior Lecturer. Of the two other
hospital-based Consultant Paediatricians at University College Hospital Galway, one does not
participate in the academic department or its teaching programme.
In relation to the structure and organisation from a personnel point of view, the Review Committee
made some recommendations. The full-time technician post is a historical post, which has apparently
been in place for many years. It was felt that this technician post was not necessary within the
Department and hence not a worthwhile use of resources. In view of the fact that it is a very small
department, with other needs for resources, it was felt that this matter should be investigated and the
funding be redeployed within the Department of Paediatrics.
In relation to teaching staff, it was the view of the committee that the Tutor/Lecturer post serves a most
useful role within the Department, and the student feedback was most positive. It was appreciated that
this is a temporary contractual post which functions from October to May, and is remunerated by the
University. There is no clear definition of the future for this post. It was felt by the Review
Committee that this post should be retained, even after the appointment of the new Senior
Lecturer/Consultant in Paediatrics. All holders of this post should be advised with respect to the future
development of their careers.
It was apparent to the Review Committee that much of the teaching within Paediatrics takes place on
the basis of goodwill. It appears that considerable input to the Undergraduate course from Community
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Department of Paediatrics: Review Report
Paediatrics is made by a person who is not part of the official Department. The committee questioned
whether or not this goodwill would continue after the retirement of the current post-holder in
Community Paediatrics. Similarly, significant responsibility and commitment in terms of teaching falls
to the only Clinical Lecturer in Paediatrics at UCHG. It was also felt that much of this participation is
based on goodwill.
The Department currently has a 50% secretarial input, i.e. during mornings only. While this situation
currently appears satisfactory, on questioning, it was the view of the Committee that it is difficult to
maintain an academic department, with an ongoing undergraduate programme, without secretarial
assistance and an open office in the afternoon. It was certainly felt that if further development within
the Department took place, that full-time secretarial assistance would need to be considered.
From the point of view of structure and organization, it was the view of the Review Committee that
much of the available academic time is concentrated on the undergraduate programme. In addition, the
significant clinical workload of the Head of Department restricts the time spent on the organization and
management of the Department. While it is a small department, it was felt that a reduction in these
loads would result in greater utilisation of the available time for the other aims and objectives of the
Department. We recommend that the University discuss the urgent need for an increase in Consultant
Paediatric staff with the Western Health Board. Teaching facilities are good except that Master of
Medical Science (M Med Sci) candidates have no designated room and expressed concerns relating to
computer access. We recommend that a room with computer access be allocated to postgraduate
students.
3.
Programmes and Instruction
Introduction
This section focuses on the teaching element of the Department with particular emphasis on the
undergraduate medical student programme. From the wide range of sources we sampled there was a
consistent finding of excellence. The Review Committee highly commend the Department on
establishing and maintaining their undergraduate teaching programme.
Sources
Information was gathered from the Self-Assessment Report (including Extern Examiners’ Reports), the
members of the Department, current undergraduate students, undergraduates who had completed the
course, and students attached to the Department through the M Med Sci course.
What is the Department trying to do?
Students spend seven weeks doing a paediatric attachment. The curriculum design ensures students
have a very clear set of learning objectives for their knowledge base, clinical skills and attitudes during
this period. The objectives are comprehensive, relevant, coherent and balanced. Their formulation
takes account of the current best practice for encouraging the development of future doctors of high
standards. They are transparent to the students, who recognise their relevance for their future career as
doctors. The Department should be commended on the tangible links established between the learning
objectives and the assessment process. An environment exists in which desirable learning behaviour
can flourish.
How is the Department doing it?
The programme is delivered through a formal lecture series, small-group tutorial teaching, close
personal interaction with teachers (often on a 1 to 1 basis), and self-directed learning. The teaching
methods encourage the development of core competencies, being particularly strong for achieving
relevant clinical skills, communication skills and information retrieval. The students were generally
complimentary about all aspects of their attachment. However, they suggested that a more structured
programme of tutorials rotating through the different teachers and clinical topics would improve their
learning experience. There were examples of innovative approaches driving desirable learning
outcomes such as self-directed learning.
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Department of Paediatrics: Review Report
The assessment procedures are very wide-ranging. These comprehensively assess the knowledge,
skills and attitudes set out in the objectives. Their breadth ensures the risk of mistakes is minimised.
The standards for the major grades are defined and transparent to students. There is every reason to
think they are accurately discriminating between different levels of knowledge, skills and attitudes.
There is a postgraduate teaching programme for junior doctors to which members of the Department
contribute. Furthermore, students on the M Med Sci course can also be placed in the Department. The
personal supervision of these students by the very limited senior staff complement, often on a weekly
basis is extremely time-intensive. The input was clearly valued by the students. The visible benefits to
the Department, e.g. through publications, appears minimal.
How does the Department know it works?
The feedback mechanism allows students to inform the course development. Feedback comes from a
structured feedback form with space for additional comments and through the close daily contact of
students and teachers. From the quantitative data provided students rate the course as good or
excellent in key areas. Qualitative comments were also available. These were usually positive and in
addition contained constructive ideas for improvement, suggesting the process was taken seriously.
There was evidence these ideas were being incorporated as an ongoing process.
The extern examiners’ reports confirm the positive student perceptions. The assessment process is
confirmed as being rigorous and the training programme excellent. The standards achieved by
students are comparable to, and in some areas, such as clinical skills, exceed those of other institutions.
How does the Department change to improve?
The efforts of the academic staff in keeping the undergraduate course up to date and of such high
standards cannot be overstated. Their work is highly commendable. It has been achieved in the face of
serious resource shortages.
Best practice in medical education is evolving quickly. Future issues that may be considered are likely
to include: optimising the impact of delivered lectures and tutorials; formal documentation during the
attachment of student progression, especially when areas of weakness are evident; streamlining
assessments. There is embedded in the culture of the Department a mechanism to ensure continuing
adjustments of the course. This is important in ensuring the course retains its excellence.
4.
Scholarship and Research
There have been only modest achievements in research during the past 5 years with 6 papers published
in refereed journals. As stated in the self-assessment report, the research output has declined during
the past five years. This is to be expected given that there is only one permanent academic post in the
Department of Paediatrics. Previously basic scientific research had been performed in collaboration
with the Departments of Physics and Biochemistry. We believe that there is potential for the
development of substantial research in the Department of Paediatrics in collaboration with departments
within the Faculty, and with other faculties, and also nationally and internationally.
We recommend that the Head of Department be allowed protected time to develop a research strategy,
and that he should be supported by a new Senior Lecturer post (in addition to the already agreed Senior
Lecturer post) in order to establish and develop research in child health. If it is not possible to obtain a
Senior Lecturer post in the short term, one of the new Consultant posts should have dedicated research
sessions.
We were very impressed with the enthusiasm and offer of support from Dr Maura Hiney from the
Office of the Dean of Research and also by the support and enthusiasm shown by the Medical
Librarian, Mr Tim Collins and Ms Mary O’Riordan in Computer Services.
5.
Community Service
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Department of Paediatrics: Review Report
The Review Group felt that this aspect of the Self-Assessment report tended rather to underplay the
valuable contribution made by the Department both to the University and the broader community.
Members of the Department have been involved both in delivering undergraduate courses to students
of other departments within the Faculty of Medicine, such as student midwives, as well as participating
actively in the Faculty-wide postgraduate programme leading to the award of the degree of M Med Sci.
It has also welcomed significant numbers of exchange students as part of the University’s commitment
to the European Union’s Erasmus/Socrates scheme. In addition, the Head of Department has made
substantial contributions to the management of the University as Dean of the Faculty (1994-1997) and
to national education for paediatrics and medicine in general. This sustained involvement in a variety
of national bodies includes particularly the Faculty of Paediatrics and the Postgraduate Medical and
Dental Board (Chair). The Head of Department has also greatly contributed to health services
development with his roles on Comhairle na nOspideal, the Medical Manpower Forum, and, currently,
the National Taskforce for Medical Staffing. The Review Committee felt that all of these contributions
were likely to have benefited the Hospital and the University in ways that, although by their nature not
straightforwardly measurable, were nevertheless real and should be recognised accordingly. The
Department has also played a leading role in a variety of fund-raising initiatives, including significant
collaboration with bodies such as Enable Ireland, and in key targeted projects such as the re-equipment
of the Neonatal Intensive Care Unit. All of these activities were felt by the Reviewers to have served
to reinforce the Department’s widely acknowledged provision to the broader community of excellent
clinical services, both inpatient and outpatient.
5.
The Wider Context
The Review Committee noted that the Faculty of Medicine is currently projecting significant increases
in undergraduate recruitment. The Reviewers felt that, to be properly manageable, such an increase
would depend upon the maintenance of the current very high standards set for all entrants, including
particularly non-EU students. It was felt that basic issues such as competence in the English language
and effective cultural adaptation should remain particularly high priorities in a department such as
Paediatrics, where child protection issues were of central importance. An increase in student numbers,
and particularly in overseas students where English was not their first language, would necessitate an
increase in teaching staff. This is essential in Paediatrics where students must be divided into small
groups for bedside clinical teaching. The extra income generated by increased recruitment would need
to be fed back to the Faculty and its constituent departments in the form of extra resources (staffing,
space, and others).
6.
Summary and Concluding Remarks
The principal conclusions of the Review Committee are as follows. The members of the academic
department work well and effectively together. The undergraduate programme is highly
commendable: the Department is to be congratulated on achieving and maintaining a high-quality
programme. The Department has also made important contributions to the local community. Research
activity is low. The Review Committee also noted that the anticipated increase in student numbers
may benefit the University, but could threaten the high quality of teaching unless proper attention is
given to the allocation of adequate resources to the Department. The Review Committee made the
following strategic recommendations, all of which have significant resource implications, in order to
enable the Department both to build on existing strengths and to remedy identified weaknesses:
•
•
•
•
The Department has achieved excellent results in undergraduate paediatric education in the
face of serious staff shortages; maintaining these high standards, and dealing with planned
increases in student numbers, will only be possible with an associated increase in teaching
staff.
In addition to the planned appointment of a Senior Lecturer, one additional Senior Lecturer
post should be created.
It is also highly desirable that the clinical tutor/lecturer post be retained.
Research should be encouraged through the following measures: the development of a
research strategy; the appointment of a Senior Lecturer with active research interests; the
appointment of additional consultant staff to deliver more of the clinical service requirements;
and by taking full advantage of the research support services available through the University.
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•
•
•
•
•
Protected time should also be made available to the Head of Department, through reductions
in both his clinical and undergraduate workloads, to allow him to develop and implement the
Department’s research strategy.
Input to the undergraduate course from the Community Paediatrician is valuable and the
University needs to recognise this through striving to retain goodwill and in future
appointments.
The future development of the Department will require full -time administrative support.
The full-time technician post should be redeployed.
The future Senior Lecturer will require appropriate office space.
In short, the Department is currently understaffed and its undergraduate programme thus depends on a
considerable amount of goodwill on the part of non-academic staff. There is an urgent need for the
appointment of consultants to share the clinical workload, and all new appointments should have
designated teaching and/or research sessions.
Professor Hilary Hoey (Chair)
Dr John McIntyre
Professor John Morrison
Dr Philip Dine (Rapporteur)
(2 May 2003)
Comments on the Methodology of the Review Process
The Review Committee was very satisfied with the procedures, documentation, and organization of the
self-assessment and review processes.
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