10 - Emerging Policy Themes from the Enhanced Annual Returns - Annex B
Question 4 - In the 2009/10 EAR some schools gave examples of projects that involve patients and the public, and others identified opportunities to work with partners to involve patients and the public. Some schools were experiencing challenges in this area. To assist us with sharing examples of practice please provide examples of patient and public involvement which have worked particularly well.
School
Cardiff
Swansea
HYMS
Example of Practice
Clinical Cases and demonstrations year 1
Family Case Study Year 2
Oncology Project Year 3
Lay member of Admissions Sub-Committee
Communication Skills simulated patients (general public)
Expert Patient Feedback in Community Based Learning
Expert Patient involvement in Integrated Clinical Method
We actively encourage feedback on student performance from patients and simulated patients during formal
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Leeds teaching session. We have found it difficult to develop formal mechanisms for patient feedback but are actively looking at ways to do this.
Feedback is sought from patients by tutors about students during clinical placements across the 5 years more prominently in phases 2/3. In Phase 2/3 communication master classes simulated patients provide direct student feedback on performance. We have two lead simulated patients who are involved in the design of and training for the summative OSCEs in years 1/2/4/5.
Two lay members of MBBS committee contribute to overall curriculum development and design. We are in the process of reviewing our external partnerships with a view to increasing public involvement in HYMS.
There is lay involvement on the Quality Committee and on HYMS Management Board.
Year 1
Introduction Week lecture: 'What do patients and carers want from TD?' Delivered by a patient
Term 1. Students working in pairs visit to interview volunteer patient at home. Feedback is provided to the Medical
School
Up to 4 Patients and carers work in the classroom setting with 16 students and 1 facilitator to discuss experience of illness. All feedback to each other, create records and contribute to the development of future sessions
Term 3. Campus to Clinic: 11 trained patient mentors read reflections of 250 students following home visits to patients. Students meet up in groups of 4 with patient mentor to assess progression
Year 2
Lecture from service user about living with Mental Health (MH) issues and addiction. Building their skills in MH history taking, the life story is told through prompts from the year group.
Year 3 and 4
Patient Voice Group – as per guidance
Year 5 final OSCE
'Patient Voice' produce scenarios and mark sheets taking part in OSCE; 3 results contribute to final assessment
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Sheffield
Patient Voice online feedback to Y3 students using PDA online assessment tools
Patient Voice network helps students in their Student Selected Components with research, writing and publishing.
Patients as Educators.
Belfast Core Curriculum:
Family Attachment Programme in yr 1: Students visit patients living in the community on four occasions (Doc 3).
Semester 1 yr 1: lecture is delivered by the parent of a patient who died as a result of medical error (Doc 4).
Throughout the curriculum patients from the Down's Syndrome Association and the Northern Ireland Council on
Disability deliver lectures.
Student Selected Components:
Many SSCs include direct patient contact and opportunities for patients to share their perspective; good examples include the SSC “Reproductive Technology” (Doc 5), in which students meet with an infertile couple, the SSC
‘Wholeness in Healing’ (Doc 6), where students are exposed to an alternative patient perspective through shadowing chaplains on their patient visits and also and the SSC ‘Working with Children with Disabilities’ (Doc 7), where young people share their experiences of living with cerebral palsy and spinal bifida.
General Points:
The Director of the Centre for Medical Education is a member of the Department of Health Social Services and
Public Safety Patient Safety Committee which has patient representatives and regularly requests information
About aspects of the undergraduate programme.
The Director of the Centre for Medical Education has had an initial meeting with representatives from the recently established Patient and Client Council to identify further opportunities to enhance patient involvement in the programme, for example inviting a patient representative to sit on the Undergraduate
Medical Education Committee and exploring the possibility of designing a Student Selected Component.
Simulated Patients – as per guidance.
Cambridge Review & Integration week programmes throughout the Clinical Course include a series of 'Patients Voice' lectures delivered by patients, now extended backwards into years one and two as part of SCHI.
Clinical Examinations: volunteer and trained patients.
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Leicester
5. The Clinical Communication Skills team is striving to involve service users in all aspects of curriculum design, planning and implementation. The steering committee meets annually for a daylong session and includes Hazel
Thornton ( Co-founder and Past-Chairman of the Consumers` Advisory Group for Clinical Trials), representing the patient's view.
Together with Papworth Hospital NHS Trust, the CCS team designed a teaching session on Communication,
Disability and Diversity. Expert patients identified by James Murphy (Disability Advisory Service Manager
Papworth Trust) along with students and the CCS team were involved in design and implementation. This session has been well evaluated. It provides each student with an opportunity to speak with an expert patient (and their carer if appropriate) with a severe speech and language difficulty, it also helps them to understand disability better and to explore their own assumptions about disability.
A student-selected component (SSC) on deaf awareness has been designed in collaboration with students with hearing difficulties, the Addenbrooke's audiology department and representatives from the Cambridge Deaf Club.
A student Paediatric Society takes part in the national "Teddy Bears Hospital" scheme - children from local primary schools visit the hospital to experience what it is like to be a patient using teddy bears as "simulated patients".
Students gain experience of working with children, especially in communication skills.
5. Patients work in partnership with medical educators to deliver teaching in Phase II with over 60 patients involved. Disabled patients have helped to plan, design and jointly deliver learning on patient-centred interprofessional communication. The interprofessional learning (IPL) offers the opportunity for students to pool their unique perspectives on professional communication and deepen their learning preparing them for practise.
The learning offers real interactions with users who are empowered to share their experiences of professional communication. The feedback process to students has been highly successful with patients rating student listening and communication skills. The power of receiving feedback from service users highlights to students their individual and team learning needs for effective communication. The learning cycle which combines experience, analysis and reflection is more powerful because it is completed with patients present at all stages and debate and discussion is integral. This is unusual as students typically present their learning from patients only to clinicians and colleagues. All patients report that the support they receive is adequate. The educational research which developed this learning is being published.
Nottingham Patients with particular conditions are involved in clinical and communication skills taught sessions on GEM.
These occur approximately once in every systems-based module. Students comment favourably regarding this
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UEA opportunity to hear about the impact of disease from the patients themselves and to examine patients with clear clinical signs in this first 18 months of the course.
GEM & BMedSci students also encounter patients in their early clinical experience visits in the first phase of the course.
GEM & BmedSci students visit patients and their families as part of the 'Community Follow Up' and ‘Shared
Family Study’
Patient representatives are involved in selection procedures for entry to the GEM course
Actors used in consultation skills.
Actors used in OSCEs.
Patients used in clinical structured teaching sessions in Primary and Secondary Care.
Patients used in OSCE assessments.
Birmingham We ran a pilot project in the Autumn at which we presented our curriculum (present and near future) to a group of about 12 patients (from across the UK) from the Patients’ Association. They were very enthusiastic about the consultation but found it hard to differentiate between aspects of education that could be addressed through
Medical Schools and those problems that relate more to the structure and function of the NHS. The overall feeling was that our academic curriculum/training is very good; their concerns related to communication skills in newlyqualified doctors and the ability of doctors (and the multi-disciplinary team) to view the whole patient pathway and needs of the patient both before and after hospital, rather than simply management aspects relating to an admission in secondary/tertiary care. They were particularly concerned with discharge planning, community care and rehabilitation. These points are being integrated into our new curriculum which is placing a greater emphasis on the patient pathway and further integration of primary care/community services with those in secondary and tertiary care.
As a result of its success, we plan to reconvene this group to discuss our admission process and criteria and also to explore involvement in our Fitness to Practise process.
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Keele
Warwick
A number of our partner Trusts have introduced additional teaching clinics, whereby patients who are known to the
Trust (through out-patient clinics or previous ward admissions) are recruited to attend teaching sessions, to be examined by students. Databases of patient details are kept for this purpose and many patients are invited to attend on a relatively frequent basis. This enables the patient to develop an understanding of the student requirements and hence inform the clinicians in charge of the strengths and areas for development of individual students and the process as a whole. The Trust which has advanced furthest in development of this system is City
Hospital Birmingham.
The Royal Orthopaedic Hospital, Birmingham has recently established a Simulated Patient Programme whereby volunteers are recruited play the role of patients, acting out various signs, symptoms and orthopaedic problems.
The volunteer group is diverse in nature, including retired teachers, hospital workers, members of the WRVS and students (unrelated to the MBChB programme). However, all parties are able to deliver feedback to both the students and the lead clinicians, on student performance and general strengths and weaknesses of the process.
The School has just restructured its committees and will have lay representation on its new Assessments,
Curriculum, Admissions and Student Professionalism and Welfare Committees.
Prior to the close involvement of patients in the clinical rotation part of the curriculum patients participate in the learning experiences of students by meeting with them in the community, under supervision and by attending the
University to talk about their experiences.
Some of the assessors for selection are patients. All assessors are trained in the criteria for both assessing the
UCAS statements and the competencies to be demonstrated during the selection centre process.
Patients are the core tool for the clinical component of both the intermediate and final professional examination, although they are not asked to contribute comments or a score based on their experience of the student.
The Steering Committee for the Curriculum Review has patients as members and a public meeting was held for input to curriculum development.
The Faculty Advisory Board and the Undergraduate Studies committee, which is the committee that reviews all aspects of the course, both include patients as members.
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Barts
Imperial
UCL
Simulated patients
Real patients /public
Clinical experience on wards, GP, and outpatient department clinics, poly-clinics and palliative care sessions
Involvement of lay members on admissions interviews.
Involvement of patients in the Year 1 Communication Skills Course
Simulated Patients for teaching and developing e-learning modules, history taking and feedback.
Year 6 Medicine and Surgery PACES and Year 3 OSCE Simulated Patients.
A local School's drama club has helped develop video clips to illustrate child psychiatric assessment. (Child
Psychiatry teaching, Year 5 Psychiatry module).
Lay member of North West Thames Foundation School Management Committee
Simulated patients in comm. skills teaching
Real patients in phase 1 PDS join groups to discuss experience of illness
Disability workshops run by disabled facilitators in phase 1
Gynaecology teaching assistants in yr 4.
We have a patient representative (nominated by the Patients' Association) on the External Governance Group of the Curriculum Review.
Cancer patient journey
Planned new patient pathways:
2011: cardiometabolic
2012: mother and baby and mental health
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Aberdeen
Dundee
Edinburgh
One of our students has just completed an extended student project in patient involvement in the new curriculum.
The recommendations are being considered in the implementation working groups.
Involving patents in giving feedback about their participation in undergraduate education is currently in early developmental stages
Feedback obtained from hospital patients who allowed first year students to take a history and examine the respiratory and cardiovascular systems in the new Year 1 course.
We have a bank of around 100 simulated patients - volunteers from the public who learn scripts to participate in history taking and communications skills teaching and assessment. They give feedback to students on the patient perspective.
We have around 100 volunteer patients with specific conditions who participate in history and examination teaching and assessment in related areas of the curriculum.
We had a patient representative on the Steering Group which developed our Personal and Professional
Development thread.
Simulated patient bank with these trained volunteers being involved in a wide range of teaching and assessment opportunities.
In final year GP placement we are piloting the use of the Consultation and Relational Empathy scale as a way of gathering reliable patient views of senior student’s consultation skills. This is appearing a worthwhile instrument but requires large number of patient returns.
A lay member of our Admissions Committee provides a very valuable external perspective on our evolving strategy. Principally, this has involved the introduction of an MMI in 2009. From the outset our simulated patients have been involved in scoring applicants and last year we introduced an interactive station involving an
SP/applicant encounter, also scored by an SP, which they felt ‘validated’ their involvement and proved a reliable station statistically.
Members of the Edinburgh Simulated Patient Programme and the Edinburgh Patient Partnership to Support
Assessment and Teaching (EPPSAT) have long been successfully involved in structured teaching sessions in
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Glasgow communication, clinical skills, and module-based teaching such as rheumatology.
Members of the Edinburgh Simulated Patient Programme and the Edinburgh Patient Partnership to Support
Assessment and Teaching (EPPSAT) have long been successfully involved in virtually all clinical assessments, including OSCE exams and formative assessments.
The Edinburgh Simulated Patient (SP) Programme was established in 2000, and the Edinburgh Patient
Partnership to Support Assessment and Teaching (EPPSAT) in 2005. The SP programme is a joint initiative with
NHS Lothian, and EPPSAT is a joint initiative with the Royal College of Physicians of Edinburgh and the Royal
College of Surgeons of Edinburgh. Each programme employs a full time coordinator, and they provide simulated and “real” patients to support both undergraduate and postgraduate teaching, learning and assessment. Examples at undergraduate level include structured teaching sessions in communication skills, clinical skills and modulebased teaching such as rheumatology. Inclusion of patients in this way allows teaching to be planned well in advance to address specific topics, rather than the opportunistic style of clinical teaching which has been the norm.
The SP programme and EPPSAT support virtually all clinical assessments in the undergraduate curriculum, including OSCE exams, the Clinical Practice element of the final exams, and both summative and formative assessments during modules and attachments. Patients are routinely asked for feedback about the examination process, and in some assessments are involved in rating the student performance. Both programmes have developed progressively since they were initiated, and now support a growing range of undergraduate and postgraduate teaching and assessment activities.
OSCEs: simulated patients who are actors and lay volunteers.
OSCE training for staff and mock OSCEs for students: simulated patients who are actors and lay volunteers
Communication Skills teaching with simulated patients who are actors and lay volunteers.
Local councillors and community activists have been involved in the assessment of Community Diagnosis student group presentations – in terms of giving formative feedback as a part of the summative process.
Second year – students split into small groups to meet and talk to breast feeding mothers, and parents who have challenging family lives.
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St Andrews
Liverpool
We have developed a “patient tutor” program using volunteer patients who are prepared to come to one of four sites and allow students to take histories from them and examine them.
We are working with patient organisations such as Chest Heart and Stroke to develop teaching sessions which focus on the impact on the patient of disease
Students clerk in patient in every clinical year, therefore patient/public involvement throughout programme.
Quality Team and Board of Studies both include members of the public.
During the preparatory knowledge project we included patients and patient groups, especially in the disability rehabilitation workshops.
Pilot in final year of patient feedback to students when on a GP placement.
In second year students visit support centres in the community such as an AIDS support centre, also nursing homes. This project will be expanded in the next year
Manchester MMS: Our new strategic assurance committee has a nominated lay representative.
Community: Through clinical placements in the community (GP practices and community sign ups) and to a lesser extent in community small group teaching, students meet patients and lay people such as non-clinical practice staff. Other specific examples include work with simulated patients e.g., in community Early Experience (EE) teaching and contact with actors through attendance at a national theatre performance (Ice and fire: Asylum
Monologues).
Communications Teaching: There are currently three OSCEs for which Simulated Patients (SPs) contribute to the marking process: years 1 and 2; Year 3 formative. The SPs are asked to give a mark reflecting on whether the student appeared to be listening to the patient and whether concerns were responded to appropriately. The only variation to this is for the year 3 'Explanation and Planning' stations, where SPs are asked for a mark about the clarity of the explanation.
CMUHTr: Expert patients used during the Introduction to Clinical Learning Course Year 3 'Communication,
Disability and Diversity'.
LTHTr: Important contributions made by undergraduate administrative staff in terms of student support and various forms of advice and guidance. Simulated patients are also important in helping students with scenarios and
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Newcastle providing valuable feedback. A ‘Patients as Educators’ programme has been set up, run by both a dedicated Nurse
Educator who recruits and trains patients and a part time senior Skills Tutor who manages and develops the service. (Please also see DOCUMENTS 1a - 1e)
Use of patients as educators, simulated ward rounds, revision programmes. The patients as educators scheme at
LTHTr is dedicated to identifying suitable patients for skills unit and/or classroom based teaching. Patients are trained and briefed in the requirements of the role of patient as educator. Patients are used in communication skills teaching, physical examination skills, as a part of clinical team working scenario based teaching and for history taking practice. Patients are asked to evaluate sessions, with outcomes being used to inform the development of the scheme and the teaching sessions they are involved with. Patient as educator sessions are not used as part of any formal student assessments. Students can seek feedback from patients on their performance.
A Project Manager is in place to oversee the implementation of the 'Patient as Educators' at LTHTr. The patient consent and information leaflets are going ahead as these had to go through for Trust approval. Have developed posters and flyers, a complete training pack as well as certification and badges for patients once they have undergone their training. Two training days plus a virtual ward round have been delivered. The virtual ward round was based around revision for year 3 NME.
Patients are used in formal examination processes - OSCEs.
SRHTr: Neurology & HLB Expert Patient Teaching where patients are recruited through clinics and volunteer to be involved in regular teaching sessions with groups of students.
New educational pilot with neurology patients attending clinic for first time. Patients are contacted by Consultants prior to clinic and the process is explained to them. Patients are involved in teaching clinic with a group of 10-12 students. Patients & lay people (simulated patients, patients with communication disability) are involved in assessments and communication teaching sessions.
Lay members of public attend Open Day where medical students have a stand giving information about their medical education.
UHSM: In common with the other sectors we use expert patients in the "Communicating with patients with disabilities" communications session in ICL. Also use 4 expert patients who have been trained for this role. In the
M&M module two of the Consultants in orthopaedics and rheumatology use patients to teach students.
OSCE.
MOSLER (Multi-Objective Structured Long Examination Record)
Formative patient feedback form
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BSMS Joint Board has lay membership.
Patients involved in delivery of teaching and assessment.
Wide range of IRPs often including public engagement.
Discussions taking place for new domain in local Trust "Patient Voice Survey" to ask for feedback on students in the clinical environment.
KCL Global rating in OSCE assessments by simulated patients.
Clinical examination of most systems including skills sign off by gynaecology teaching assistants.
Development and delivery of SSCs such as sign language.
Role playing, teaching of communication skills with formative feedback to students.
St Georges Simulated patients are asked to mark each student for their ability in communication skills and rated for how they relate to and handle patients.
Bristol Patients in the Care of the Elderly, Primary Care and Paediatrics OSCE examinations are involved in the feedback to students at the end of the assessment.
During the Disability Week involves a variety of patients with different disabilities to explicitly teach on this aspect of the programme. Patients are also part of the Disability Station examined in the Final OSCE.
PMS Patient involvement in clinical assessment (ISCEs) at end of years 2 and 4.
Lay representation on medical school interviews (though not necessarily patients).
Fitness for Practise hearing could include lay community membership as set out in code pf practice.
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Oxford Two examples provided in additional documentation from Palliative Care and chronic conditions.
Obstetrics and gynaecology.
Southampton Simulated patients involved in teaching and assessment. The pool of simulated patients includes patients with learning disabilities.
Lay medical Selectors.
Expert patients in teaching sessions.
Curriculum review 1999.
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Question 21 - To assist us with sharing examples of practice please provide examples of good practice in the selection, support, training, and appraisal of teachers and trainers. We are particularly interested in examples of how teachers and trainers involved in educating students are selected and) appraised.
School
Cardiff
Example of Practice
Honorary Titles
All clinicians who teach our medical students apply for an honorary title appropriate to their involvement in the undergraduate course and reflects their level of responsibility. Before these are awarded an application form is submitted, with a CV and documentation of support from the Honorary Senior Lecturer in their hospital. All new teachers are encouraged to go on a ' teaching the teachers' course, if they have not done any equivalent course / training. This information is being collated on all our current teachers and will be requested from all future applicants. Appraisal of teaching is part of the clinician's annual review and peer review of academic teachers is encouraged.
Undergraduate Performance Programme:
This programme has been developed to support students with performance issues. Performance Case Managers were recruited and interviewed from our NHS colleagues from all over Wales. Training of Performance Managers took place in September 2010. There will be on-going training, review of the programme and appraisal will take place at the end of the academic year.
Swansea Our 57 Senior Clinical Tutors in hospital practice, primary care and public health, (referred to in our answer to
Domain 2 – Question 3) were selected and continue to be selected on the basis of an application from interested individuals together with scrutiny of their curriculum vitae. Support and training for our primary care based Senior
Clinical Tutors includes regular workshops (referred to in question X), practice visits and discussion of student feedback particularly with practices for which the feedback is less than universally positive. Support and training for hospital based Senior Clinical Tutors is planned intensively for February to July and less intensively on a regular basis thereafter. (relating to the delivery of year 3 teaching in 2011/2012) but, as mentioned in our answer to Domain 2 – Question 3, all existing Senior Clinical Tutors have extensive experience of teaching in classroom settings for the new Graduate Entry Medicine Programme and in the Cardiff 5-year course Clinical Placements.
Appraisal of teachers takes the form of peer reviews in which the colleagues being reviewed identifies before the teaching session with the reviewer any areas of concern. The teaching session is observed and feedback relating to these concerns and other aspects of the teaching discussed between the reviewee and reviewer. The content of this review is confidential to these two individuals but the fact that the review has taken place is reported to the
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HYMS
Leeds weekly Teaching Team meeting and documented. Anonymous free text student feedback of Learning Week lectures is reviewed each week and points (both positive and negative) drawn to the attention of individuals as appropriate. Student feedback is also collected on LOCS and Clinical Placements and again, fed back to the teachers concerned.
We have introduced a PGCert in Medical Education which has 28 local participants in 2009/10 with 40 enrolled for
2010. The PGCert comprises 3 modules, teaching and learning, assessment and professional development which are delivered by HYMS Faculty and designed to support local tutor development. We are also reviewing our faculty development which is at present based on structured training sessions and peer observation where tutors are paired and observe each others teaching sessions with feedback. We are planning to introduce a model of peer support whereby tutors are grouped and learning sessions take place which draw on tutor experience to assist the group in developing solutions to issues such as feedback, underperformance, unprofessional behaviour, clinical teaching etc which are particular to the tutor environment. This allows the tutors to be used as a resource and moves away from formal didactic teaching sessions. An example of this is the formative OSLER sessions in
Scarborough where tutors, patients and students actively participate in the feedback session to both the student undertaking the OSLER and the tutors assessing it. We are keen, as tutor experience and confidence develops, to utilise their growing expertise in supporting faculty development by defining their needs and resourcing ways of meeting these.
(i) All academic staff and Facilitators are recruited through advertising posts via appropriate channels followed by application, interview and selection. Clinical staff who support workplace learning are recruited through the
Medical Director for Undergraduate Education in each Trust.
(ii) All academic staff are appraised through an annual Staff Review and Development Scheme (SRDS) which involves 360 degree feedback and identification of staff development needs and opportunities. Clinical teaching staff are jointly appraised by their own Trust and by the University.
In the new curriculum we have major curriculum strands which spiral through the curriculum – Research,
Evaluation and Special studies (RESS), Innovation, Development, Enterprise, Leadership and Safety (IDEALS) and Campus to Clinic (CtoC). We have recruited Facilitators to support small group learning & teaching in each of these areas. All Facilitators have attended two half days of training and those new to teaching at the University have been allocated an experienced mentor to work with them in identifying their professional development needs and to provide opportunities for peer assessment of learning & teaching.
Similarly, in the new Medical Sciences theme (Introduction to Medical Sciences), newly appointed tutors who
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Sheffield support small group teaching have attended two half days of training. In addition, each new tutor has been paired with a member of staff experienced in delivery of themes to jointly deliver the small group teaching.
All members of staff involved in learning & teaching are invited to participate in both the School and wider
University CPD programme.
All academic staff within the Medical School are expected to be involved in teaching medical undergraduates.
The School has instituted an annual survey of teaching which provides detail as regards all teaching that is undertaken by academic staff and allows the School to plan for optimal use of its resources.
All academic staff are required to be Personal Academic Tutors for medical students and, as part of their induction, receive a detailed briefing on the nature of the undergraduate course. Further training is available to all staff, both academic and within the NHS, through the Academic Unit of Medical Education's Gateway Programme which goes into considerable detail about medical education.
As can be seen from the answer to Question 19 all teachers, both within the academic staff and the NHS are now subject to annual appraisal.
Belfast The main role of staff appointed to the Centre for Medical Education is delivery of the undergraduate programme.
At the time of appointment staff are expected to be in possession of or completing a qualification in education. In accordance with university requirements all staff in the Centre undergo an annual appraisal, their contribution to teaching and their training requirements are discussed as part of the appraisal process. Clinically qualified staff in the centre participate in a joint NHS/University appraisal with representatives from the university and hospital trust present.
Following the establishment of the Sub Deanery structure in each hospital trust education specialty leads have been appointed for each discipline. While the appointment process varied between trusts (some trusts advertised and held interviews others invited consultants to take up appointments) appointees were selected for their interest and commitment to medical education.
The Belfast Trust has agreed to fund 20 Senior Registrars who make a substantial contribution to teaching to complete the Postgraduate Certificate in Clinical Education. The Supplement for Undergraduate Medical and
Dental Education (SUMDE) is being used for this purpose. Other Trusts have indicated that they plan to do the same in the future.
Cambridge The Clinical School has appointed an Academic Lead for staff development.
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There are now three parallel accredited staff development programmes to support teachers and trainers:
1. Clinical Supervisors Programme: a one-year, rolling programme of mandatory regular sessions for Clinical
Supervisors (junior doctors, FY2 and above). There is an annual half-day course and an appraisal/feedback process.
2. GP Teacher Programme: this is closely aligned with the Clinical Supervisor programme and a number of the sessions are shared; additional sessions have a specific focus on the training needs of GP Tutors.
3. General Teaching Programme: introduced in 2010, this programme is open to all staff. It is aimed at more experienced teachers, possibly who have previously completed one of the other two programmes. It is a blendedlearning programme with face-to-face as well as online and reflective components. The programme incorporates peer review and completion requires the participants to provide a reflective critique of their learning and their own teaching.
Each programme is aligned to the UKPSF frameworks and participants who complete them are eligible to apply for recognition by the Higher Education Academy (HEA). The first two programmes are accredited to Associate level and the third to Fellowship level with the HEA.
The training programme for tutors in Clinical and Communication Skills offers a university certificate.
There are no formal, universal mechanisms for selecting teachers and trainers- the preclinical departments and clinical specialties each have a specialty lead teacher who ensures that sufficient staff are available and responds to feedback from students either to identify the best or to discuss problems where they are found. Staff with formal teaching roles, such as associate deans, clinical supervisors and clinical sub-deans have clearly defined appraisals of their teaching, for others it forms part of their general appraisal and is not thought to be very satisfactory. This area requires further work.
Leicester Not stated
Nottingham Since 2007, all staff recruited who will have a role in teaching medical students on GEM are assessed at interview for their ability to deliver a brief teaching task.
All new lecturers are expected to complete a minimum of 30 credits of the PGCHE. Teaching staff are appraised by a number of different methods, including student feedback in the form of SET and SEM and through the
University’s activity/performance review process.
Medical consultant appraisal - a template for evidence has been agreed with HR in our largest partner NHS Trust
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UEA
(Joint academic appraisal and NHS consultant appraisal) as part of collecting evidence for revalidation.
All new lecturing staff must undertake the MA in Higher Education Practice and completion of the PGCert is compulsory to enable them to pass their probationary period.
Birmingham The new Heads of Teaching Academies are responsible for selecting and appraising Senior Academy Tutors (who will meet with their small groups [up to 6] students each week for 2-4 hours to assess clinical progress and professional development. These Tutors will be appraised annually, including peer observation and student feedback. In addition, Senior Academy Teachers (appointed by the Head of Academy) will be responsible for delivery of curriculum content within the Trust and will appraise Academy Teachers on subject-specific content delivery through feedback and peer observation. As part of the Professional Patient programme, we are exploring this as a process for standardised peer observation of clinical teachers at all levels.
We also undertake training/refresher programmes for all clinical examiners involved in OSCEs (primary, secondary and tertiary care) in order to ensure standard approaches to examining and reduce variation in examiner expectation and hence severity of marking.
Keele
Warwick
All new non-clinical, academic appointees enrol on a programme of Learning and Teaching in Higher Education that leads to accreditation as a Fellow of the Higher Education Academy. The School of Medicine runs a number of postgraduate modules in Medical Education which clinical appointees are encouraged to take as part of their professional development, as well as other academic staff with an interest in Medical Education research, with a view to acquiring a certificate, diploma or masters in Medical Education. Some staff are on programmes leading to a doctorate in Medical Education. i) Selection
All teaching staff are appointed to specified jobs via a competitive process. Those appointed are those with the skills and experience that best match the job description and person specification for the relevant post. Selection panels are constituted in accordance with best practice and the University Human Resources policies. All members of Appointment Panels are regularly trained in best recruitment practice. ii) Appraisal
All staff with substantive contracts of two or more sessions are appraised annually. The School recommends that
Staff with contracts of less than two sessions are appraised annually but this is not obligatory.
All potential University employees are invited to interview based on review of an application which has been submitted by an applicant informed by an accurate job description and a person specification for the role. On initially joining the University they are placed on probation with a mentor to support them in their new role. Annual review then takes place and education, together with research and administration, are the three key areas explored.
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Barts
Imperial
UCL
This process is true too for the clinical academics who are appointed by the university. Annual review in these instances is held jointly with someone from the Trust and someone from the University with appropriate seniority.
Appointments made solely by any one Trust will be overseen by the relevant Trust and the medical school is not consulted on the job description or person specification in respect of any educational commitment they may be expected to undertake. See also response to question 19.
Teacher Coaching Programme for Clinicians and Non-Clinical Lecturers
This is a faculty development process to create a group of trained clinical and non-clinical academics to deliver a teacher coaching programme within the Schools, Institutes and partner NHS Trust. This activity has been coordinated by the Centre for Medical Education. The first cohort started in September 2010 and comprises colleagues from within Barts and The London SMD and our partner NHS Trusts. The pilot scheme has recruited very experienced teachers and this group will be able to move directly into a roll-out phase once they are completed i.e. to deliver teacher coaching to colleagues within our purview.
The Teacher Coaching training programme can be run each year and specifically targets colleagues based in the wider Trust-based environs. In this way, using our model, we will be able to enhance teaching activities and support teachers across all our partner NHS institutions and within QMUL. The process will create an everwidening pool of ‘teaching champions’, to further ensure we are able to support teachers, high quality teaching and give exceptional educational experiences to both undergraduates and trainees.
With regards to recruitment, we have found that open advertisements disseminated throughout the Faculty and our associated Trusts have identified some outstanding individuals for leadership roles on the course. As well as doctors recruited by the Trusts to teach, we also encourage the participation of professions allied to medicine, such as nurses physiotherapists and psychologists, along with junior doctors have all made very valuable contributions to teaching.
The table in Q15 of the 2009-10 EAR shows how teachers are appraised. See DR01.
The professional development spine uses small group teachers to run sessions with students weekly in years 1 and 2, and monthly in years 3 and 4. All tutors apply to become teachers: outlining their existing strengths as a teacher and their previous development as a teacher. They are also invited to ‘sit in’ in a PDS session to see if the style of teaching matches their abilities. All those selected from the application process are interviewed. The
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Aberdeen successful tutors under go an intensive training package. In the final session of this they are introduced to their buddy who is an existing teacher who acts as their informal mentor for the first year. All tutors are encouraged to attend further course specific and generic teacher raining during that first year. During their first year of teaching they also arrange an appraisal whereby a senior academic sits in on their teaching and then afterwards the teacher does a self assessment exercise and the two meet for a developmental conversation about the observed session and their teaching in general. All PDS tutors attend compulsory training 2-3 times per year and have a further appraisal every two years.
This is a labour intensive activity but it has helped with both tutor retention and the quality of student feedback on their PDS tutors.
Selection
There is no real selection process for the majority of NHS teachers and teaching is mostly delivered as a specialty responsibility, with the assignment of teaching duties dependent on internal management of resource within the unit. The University of Aberdeen is represented on consultant appointment committees of both NHS Grampian and
NHS Highland and a briefing document setting out NHS teaching responsibilities has recently been prepared for
UoA committee reps and approved by both the School Executive and NHS Grampian TUTELAGE (see para 3 above).
We do have control over University selection procedures and teaching experience or skills are important criteria for academic appointment. The creation of a Division of Education as part of management re-structuring within the
School of Medicine and Dentistry in 2008 resulted in the selection of staff with a proven educational track record to specialise in education. Divisional staff have responsibility for the academic leadership of the MBChB programme.
Support and Training
This year we have linked in with NHS Education Scotland (NES) to offer training sessions in Medical Education topics for FY1 and FY2s e.g. Adult Learning Theories and Developing Your Teaching Competencies. This gives the opportunity for academic staff to describe the MBChB curriculum and highlight opportunities for FYs to get involved in more formal tutorials (e.g. Communication Skills, Personal and Professional Development, etc.).
Other examples of support/training
Support where face-to-face training is difficult to organise is supplemented by other means e.g. Online Toolbox for
Teaching (GP teaching on Community Course), Facilitators Guides (Professional Practice Block, First Aid teaching, Understanding Error in Health Care).The development of videos of OSCE station in Phase III for examiner training was very successful and well received and we would hope to extend this across the curriculum,
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Dundee
Edinburgh although it does require investment of time and resource.
New staff, where possible are mentored e.g. Buddying system in Community Course, SimMan teaching for final year in the Clinical Skills Centre.
Our newly appointed Lecturer in Medical Education makes links across the different strands of teaching within the
MBChB, links with NES and the University's own Centre for Learning & Teaching. There is an important national initiative on staff development led by NES to which we are fully committed - this is currently identifying the core competences of a teacher across the undergraduate/post-graduate interface and subsequently appropriate training opportunities will be identified or developed across Scotland. The development of a database to list all staff development is also being considered by this project.
Appraisal
As described in para 19 above, all academic staff are subject to appraisal within the university structure, with joint appraisal of clinical academics. Teaching is an essential part of that process. The NHS consultant appraisal process includes educational roles and we believe that most NHS consultants who teach our students participate in this process. We have, however, no way of verifying this.
A local example has been the recruitment of teaching leads. These NHS posts have been funded via ACT monies.
Typically they provide 1-3 PAs of time per individual. Most post holders are Consultant grade staff but we also have Allied Health Professionals (e.g. Pharmacist, Nutritionist) in such posts. Their role is to provide discipline leadership e.g. in Medicine, Surgery, O&G, Child Health to engage and support other colleagues in teaching delivery and to contribute to curriculum development in their specialist areas. Several have major roles within the curriculum e.g. block / system convenors. They are recruited via competitive interview and are supported via a
'teaching leads group' which meets regularly to discuss ideas and developments and share examples of good practice, joint University / NHS appraisal and funding to undertake additional teaching related qualifications e.g. certificate / diploma / masters in Medical Education.
For most of our teaching activities e.g. bedside teaching, all members of a university or clinical department are expected to contribute, though the distribution of work depends on the line manager. In some units all staff share teaching equally but in others, those who are keen deliver the majority of the teaching.
All new consultants attend an induction day and hear about the opportunities to contribute to the MBChB programme and are encouraged to contact the Director of Undergraduate Learning and Teaching or the Centre for
Medical Education to get involved or find out more details. This usually contributes a steady trickle of eager teachers and potential leaders of education.
When there is a specific need for teachers who do not belong to one department e.g. for communication skills
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Liverpool teaching then the Director/s of Medical Education for the NHS hospitals assist us in distributing calls for support, reminding staff of their obligation to contribute.
Teachers and trainers are often self-selected. This has the advantage that those who are keen and interested step forward and are usually creative and enthusiastic advocates.
When there is no heir apparent to senior positions the Director of Undergraduate Learning and Teaching works with our 3 Heads of Schools to identify an appropriate person. This has the advantage of finding someone who can add the new responsibility to their current workload and also of having the work well recognised by the Head of
School.
Increasingly however we have put out a call, along with a role description, for those interested in undertaking posts of responsibility within the programme. This has attracted variable responses but has certainly encouraged some who might not have otherwise come to attention.
For information on appraisal please see question 19 above.
Selection.
All members of University staff are placed under an obligation to participate in teaching. Contribution is encouraged and the process is managed through training and evaluation followed by appraisal. All University staff are required to complete a Certificate of Professional Studies within their first three years in post. All clinical staff involved in teaching in the trusts are expected to attain at least level 1 competency, but many will be involved in teaching medical students before this is finally certificated.
Appraisal
All teaching is subject to student feedback which is collected on-line, or as written questionnaires. Each member of staff receives the results of their student feedback, which they may include in their portfolio if they so choose. In the clinical environment, the clinical sub-deans are also told if they have staff who need support, encouragement or reward. All clinical staff and all University staff are subject to annual appraisal, and for those with significant teaching responsibilities, this will be included. Clinical academics with joint contracts are subject to joint appraisal according to Follett principles. All University staff are also required to undertake a peer review of their teaching every two years.
Manchester As a School we have our own staff development officer who organises staff development specifically related to the needs of the School and increasingly targeted to the needs of our tutors both academic and NHS. In addition to numerous workshops we run 2 annual conferences for the teaching staff both academic and NHS. One of these conferences is specifically targeted at the GPs and attendance is part of their teaching contract.
The University is focussing on peer review of teaching. We as a School are considering how to take this forward as adding another member of staff to small group teaching can alter the group dynamics. We have an evidenced
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Newcastle based evaluation of PBL in Years 1 and 2. We have made managerial decisions based on the results of this evaluation and on free text feedback from students. This evaluation is founded on the work of Dolmans and Ginns
(Dolmans, D.H. & Ginns, P. (2005) A short questionnaire to evaluate the effectiveness of tutors in PBL: validity and reliability. Medical Teacher 27(6) 534-538)).
For academic positions in MMS we select using job specifications that require qualifications and experience in education. We are at present not in a position to select NHS teachers although we do encourage motivated and enthusiastic clinical teachers to undertake further qualifications in education and trained in MMS under our 'intern programme' (please see Doc 17). We anticipate that the SPA time which Trusts use for undergraduate education will be increasingly focused with fewer clinical teachers due to the financial restraint we see occurring in our partner NHS Trusts.
LTHTr: A process for educational appraisal for staff in lead education roles is currently in development at LTHTR.
An education development programme for new consultants will be launched in April 2011. The Trust is seeking accreditation for this to be at a Masters level. This course will help engage consultants in the educational business of the organisation and will help support selection processes associated with identifying and approving consultants to act as educators and teachers.
A portion of SIFT at LTHTr is dedicated to supporting educational staff in taking post graduate certificates in clinical and or medical education. This helps the department in developing these staff who have a significant teaching role or are wanting to develop this.
UHSM: Our postgraduate department runs "Train the Trainers Courses" for all educational supervisors and our
Associate Hospital Dean for Community runs training courses for GP educators including a newly established
"Feedback Course" for lead tutors at UHSM, South Sector and South Education Zone. Information in Appraisal can be found in response No. 19 above.
The School has now introduced a formal and competitive process for selecting individuals for Course Director and
Sub-Dean roles. The process includes a formal interview with a panel which will contain both University and Trust personnel. The University where appropriate remunerates Trust personnel either by way of honoraria or sessional payment to ensure staff have protected time in which to carry out their duties. Individuals applying for such roles will normally have been involved in teaching, learning and assessment over a period of time and are ready and willing to progress. The Board works closely with its Trust partners who in turn have a number of key appointments locally to plan, co-ordinate and deliver the curriculum in their own Trust and the Base Unit. Teaching duties are outlined in job plans, and allocated sessional payments. A scientifically based, on-line teaching
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BSMS evaluation tool has been developed in partnership with one local trust, international collaboration and Deanery support, for use by clinical teachers. Phase I teachers are drawn from University staff, who undertake a compulsory course in teaching as part of their probation. The University has commenced a peer review scheme that all teachers must participate in.
Year 5 Sub-Dean Appraisals take place very 18 months.
Regular Teaching Introductory Course aimed at Specialist Groups now take place for GPs, Anatomy
Demonstrators, Foundation and Specialist Trainee Doctors.
Students are trained to be Admissions Interviewers
A large cohort of ex-BSMS graduates in local Trusts have wanted to get involved in teaching and they have been recruited and a teaching programme developed.
OSCE training continues using a successful DVD training tool supplemented by group discussion.
Not Stated KCL
St Georges 1. All new members of staff are recruited through the formal, centralised recruitment process, managed and monitored by Human Resources. Every new and replacement post has an up to date job description and person specification. SGUL’s Recruitment and Selection Policy states that all recruiting managers must attend the
Recruitment & Selection Training Workshop.
SGUL introduced an e-recruitment system in 2008 which is used by all recruiting managers to administer the recruitment process. This has resulted in a reduction in time taken to recruit.
All new academic staff are expected to undertake the Post Graduate Certificate in Healthcare and Biomedical
Bristol
Education (unless they already posses a similar qualification).
2) All members of SGUL staff have an annual Personal Review or joint appraisal (in the case of clinical academic staff).
Selection of individuals to teach and lead in the programme is managed on the basis of a process which is competitive and seeks to determine the best individual for the post. The recent appointment of a new Academy
Dean – a key role involved in educational leadership and pastoral care in an academy - is an example of how this works in practise. Following the receipt of notification that the current Academy Dean was stepping down, a notification of the vacancy and the job specification was circulated to all the acute trust consultants and all the principals in primary care in the linked primary care trust. Those who applied were already involved at the
“coalface” in their teaching roles and following short-listing, were interviewed. The interview was undertaken by the
Faculty Dean, the Chief Executive of the host trust, the programme director and one of his deputies, a senior representative of the primary care trust as well as an external person from a neighbouring University. In the course
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PMS of the interview, issues discussed included: finance management, handling challenges with students including illness and behaviour. In this way, the appointment process investigated all the necessary components of the job, ensuring that the appointee was competent, and also that all the parties to the role were in agreement with the appointment.
This was a high level appointment and roles with less responsibility would be less complex. Unit leads are usually appointed from the pool of staff already involved in the undergraduate programme, and are likely to be a lead for one of the elements of the particular Unit. Leadership will rotate around the contributing elements, and an element lead will usually be an academic, with this role generally being rotated through the individual academic speciality area, to ensure fresh thinking and approaches.
Appraisal has been addressed in Q. 19 and for space reasons is not dealt with here further. i) Selection & Training:
The school has a large number of teachers and trainers. Academic clinical leads exist for several disciplines including pharmacology and pathology. These are specialty clinicians or academics and the positions were appointed via competitive interview. In each clinical area per locality, there are specialty representatives who form the link between the college and its curriculum and frontline teachers.
Each locality also has regular training days where key educational theories, curricular and assessment matters and student support issues are presented and discussed with providers. There are also specific sessions for providers of SSUs, academic tutorship and benchmarking for assessments.
Assessment and role training is mandatory for providers (e.g. year 3-5 assessments, academic tutoring) and this is provided predominantly by the core locality clinicians or SSU leads etc. A small number of specialty leads will also provide updates, but they are carefully chosen based on their experience and engagement with the curriculum. ii) Appraisal:
NHS staff generally undergo appraisal of their teaching roles via the NHS appraisal systems. However, the school now undertakes regular QA of provider assessments in both primary and secondary care. This peer appraisal of teaching is also feedback to providers. This is discussed in more detail in Q35 domain 6 later.
Core clinical staff, however, undergo separate appraisal of their medical school activities. These are performed by line managers, including the associate deans, sub deans and the directors of undergraduate medical studies and
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Oxford clinical learning. Core teaching staff from the University similarly have appraisal via the school's line management systems.
TRAINING
Seminars and workshops for all those who teach in the Collegiate University are arranged within a four part framework, tailored to the needs of individuals at different stages in their academic careers. For graduate students and others with little experience of teaching:
1. Preparation for Learning and Teaching at Oxford (PLTO)
2. Developing Learning and Teaching (DLT)
For academic and research staff, including NHS staff, especially those expanding their teaching responsibilities:
3. Developing Academic Practice (DAP)
4. Postgraduate Diploma in Learning and Teaching in Higher Education (PGDipLATHE)
DAP is for all academics, including those new to Oxford and those new to teaching, but also catering for the more experienced who wish to take a practice-based learning approach to their continuing professional development.
For those who wish it, there is an opportunity to gain HEA Fellow status by pursuing the Planning, Review, and
Integration (PRI) strand of DAP. In addition to the general programme, specialist seminars for teachers in clinical medicine are available. Examples of these include: Approaches to Lecturing in Medicine; Lecturing Performance in
Medicine; Teaching in the Clinic and at the Bedside; Developing Students’ Learning in Medicine; Evaluating
Teaching in Medicine; Assessing Students’ Learning in Medicine; Examining in Objective Structured Clinical
Examinations; Introduction to Small Group Teaching in Medicine; Teaching practices in clinical medicine;
Assessment practices in clinical medicine.
The PGDipLATHE is a year-long course for more experienced teachers who wish to reflect on and develop their skills in curriculum design and development, as well as a range of other aspects of teaching. Successful completion confers HEA Fellow status as well as an Oxford Postgraduate Diploma qualification.
Southampton Staff development (SD) activities are well attended by both School and NHS teachers. Courses run by our Medical
Education Development Unit are heavily subscribed and it has been necessary to repeat several courses during the year – e.g. a one-day course entitled ‘Teaching in A Clinical Setting’ recruited 80 clinicians on first advert. Our four-day education course entitled ‘Teaching Tomorrow’s Doctors’ (TTD) proved particularly popular and ran on three occasions during 09/10. The most recent TTD course scored 5/5 on all evaluation criteria.
Embedding staff development in the curriculum has also been very successful. For example, in 09-10 we have run innovative courses in support of third and fourth year developments and courses for mini-CEX and OSCE examiners. During the year SD has also focussed on a number of clinical areas of the curriculum including psychiatry, paediatrics and ophthalmology - as well as continuing to support areas such as PMC teaching and the
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BM4 and BM6 programmes. Early years’ staff development included successful courses on small group tutorials, on-line assessment and working with learning outcomes.
A number of funding streams have recently helped expand our staff development provision. Funding from the
Strategic Health Authority has enabled us to develop an online eStaff Development resource with new modules on
OSCE and MiniCEX examining and on lecturing. TQEF Funding from the MHLS Faculty supports a number of initiatives within the School that incorporate staff development activities. These include the new third year tutorials, the Assistantship developments and dissemination of findings from research into the Demise of the Firm.
£200,000 funding was also awarded by the HEA NTFS Project Strand to research and develop the transition from classroom learning to clinical settings. This will contribute to and incorporate elements of staff development over the next two years.
Question 33 - In the 2009/10 EAR some schools reported challenges in involving employers in curriculum planning and management. To assist us with sharing examples of practice please provide examples of employer involvement in the School’s structures for managing teaching, learning and assessment. Please also report any challenges that the School is experiencing with employer involvement.
School
Cardiff
Example of Practice
The School structure incorporates the opportunity for employers to be involved in curriculum planning and management. There are employer representatives on the Undergraduate programme Board of Studies and the
School has had employer / NHS representatives on several working groups e.g. Attitude and Conduct Review
Group and placement evaluation group. In developing some new modules (geriatrics and neurology 09/10 and acute care module 10/11) there were extensive discussions with colleagues who would be involved in the delivery of this training in hospitals throughout Wales -In 09/10 we have had two meetings of clinical skills tutors throughout
Wales and also set up a prescribing and therapeutics forum for Wales with representation from academic and NHS staff, including several pharmacists.
The School works closely with the Postgraduate Deanery in the FY1 Monitoring Group and Foundation School
Board.
The School of Medicine and Cardiff University has Partnership Boards with Cardiff and Vale UHB, Bro Morganwg
(Swansea) UHB. Aneurin Bevin(Gwent) UHB and North Wales Clinical School Board and UHB at senior Executive
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Swansea
HYMS
Leeds level. Undergraduate teaching review meetings are held annually with the relevant Health Boards and General
Practitioners. We consider that the School has positive working relationships with the NHS in Wales and senior staff, such as the Deans have close working relationships with key staff in the Welsh Assembly Government and
BMA Wales.
There was an 'all Wales' Curriculum Conference held on 17 September 2010 which allowed all partners to be updated on the current programme and future programme developments and participate in formulating ideas for the future. There were >150 delegates. This was the first of a series of 'All Wales' conferences which will be held regularly over the next three years.
Abertawe Bro Morgannwg University (ABMU) Health Board is the NHS organisation with which we have closest contact in that both in classroom teaching and teaching in clinical settings, staff employed by the Health Board and general practitioners in the ABMU Health Board area carry out much of the teaching. One route for constructive dialogue with the Health Board has been achieved through the submission of a Service Specification (modelled in that of a school of medicine elsewhere) to its Quality and Safety Committee and thence to the Board itself. This advocates the establishment of a joint Undergraduate Board to work in parallel with an already established
Postgraduate Board for the joint governance of undergraduate teaching.
In a separate but related exercise, the existing quality assurance mechanisms for the undergraduate programme are being modified into a system virtually identical to that already existing for the monitoring of quality of postgraduate training. This work is being carried out in conjunction with colleague based at the Postgraduate
Deanery. It builds on the fact that the locations and people involved in undergraduate teaching are, by and large, the same as those for postgraduate training. This ‘harmonisation’ extends to other features of the programmes such as work-place based assessments.
The School has a devolved structure with each main clinical site having at least one Senior Director of Clinical
Studies (SDOC)in hospital and Primary Care. The SDOCs are Trust employees and are actively involved in both
Phase2 and Phase 3 curriculum design and delivery. They are responsible for the delivery of the Year 4 and 5 clinical examinations and recruit patients, subject to the blueprint. The School is moving toward a new streamlined management structure with a School Board with representation from each of the clinical sites. Furthermore as stated in response to 3 above there are annual monitoring visits to the Trusts at which discussion takes place about teaching and assessment and this is fed back to the BoS. We have good working relationships with the local employers and see this as one of the strengths of the school. The only challenge we face is the increasing service demands on senior clinical time.
We have no challenges to report in this area of employer involvement. Engagement is good, with coverage at a series of levels
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Sheffield
Belfast
Individual Participation – across Trusts, Primary Care and Deaneries with contribution to our curriculum review, planning, implementation and management
At Programme Committee level (and individual year level course management teams), where the local Foundation
School Director sits on the year 5 management team, and at MBChB Programme Committee, where our Associate
Postgraduate Dean is a member
Fitness to Practice – both employer and Deanery are represented in the membership of our Health & Conduct committee, and are part of its development and planning
Via NHS liaison and SIFT visits – where School, employers and SHA meet to look at clinical placement evaluation, planning and quality – in both primary and secondary care
Curriculum Review process – additional to individual participation, we have been very well supported with a key stakeholder group (Employer medical education leads) and in visits and discussions with local Trusts and GP consortia
School/Foundation School liaison – which deals with ToI, special circumstances, shadowing and ensuring close alignment. Foundation School representatives provide talks and information about UKFPO application processes, and contribute significantly to the MBChB’s careers strand
Deanery/Foundation School Board – executive/strategic overview between employers, Deaneries, SHA and
Schools – covers the entire Yorkshire & Humber Deanery area and 3 medical schools (Leeds, HYMS, Sheffield)
The employers, the Trusts who are also involved in teaching the students, have representation on the management committees at every level. The Associate Directors of Teaching (one in each Trust) disseminate information to their tutors and receive information, suggestions and data to pass onto the Medical School. Their expertise is used in management and planning at the highest levels (Curriculum Management Committee and Curriculum Assessment
Group).
Working with the local Post Graduate Deanery, the three medical schools in Yorkshire and The Humber are collaborating in the development of the Student Assistantship, Prescribing and Patient Safety.
The establishment of the Sub Deanery structure
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Cambridge (See Q3.) Employer involvement occurs through the regional hospital Trust scheme, the Clinical Sub-dean appointments and the regular QA visits by the Clinical Dean and her team.
The main challenges facing us are the impending cuts in SIFT funding to the Cambridge University Teaching
Hospitals NHS Trust (Addenbrookes) and West Suffolk Hospital (base for the CGC) as part of the MPET review.
This is a major concern and could have significant effects on the provision of teaching, particularly in relationship to tertiary care, academic medicine and translational research. Our regional hospitals are projected to break even or have a slight gain in SIFT funding.
Other issues related to employer involvement include the teaching and learning difficulties brought about by the implementation of the EWTD and full-shift working. The impact of the loss of traditional firm structures has been great on teaching at all levels. We are exploring ways of maximising clinical supervision, continuity and teaching by alternative methods.
The clinical pressures on the CUH Trust remain very high and once again we have had to undertake lengthy negotiation to secure suitable clinical space to host examinations in 2011 (despite the sizeable SIFT budget allocated to clinical examinations).
Leicester The current version of Phase 2 of our medical curriculum was constructed in partnership with our NHS colleagues, and is intended to reflect the priorities of the clinical service environment. The vast majority of our 'Education Leads' are NHS consultants, and they are linked into NHS management structures through a high level appointment at
Trust senior management level, as well as to the management structures of the medical school. All of our management processes for the curriculum and for assessment have a majority of colleagues from the NHS, both locally and our DGH partners. At both the strategic and detailed levels our curriculum design and delivery is fully informed by NHS service needs. We work closely with the local Foundation School, and several key players in the
Medical School Structures are also significant figures in Foundation training, providing immediate mechanisms for feedback from Foundation training to the undergraduate course.
Nottingham Formal documents have been agreed through local SIFT planning for SIFT-funded contributions to management of the curriculum
We will be evaluating the effectiveness of establishing these structures in future years.
See supplementary document 11_SectB_clinical_supervision.doc
UEA This is managed through the Academic Clinical Partnership (ACP) and Trust representation is drawn from among
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the ACP as appropriate for all major committees: eg. Curriculum Development and Delivery (CDD), Assessment
Group, Clinical Methods Team, Professionalism Committee. In addition there is Trust representation on the
Admissions Team and many consultants are involved in interviewing applicants. OSCE assessments are staffed by clinicians and academics.
Trusts involved in the Academic Clinical Partnership are:
Norfolk and Norwich University Hospitals NHS Foundation Trust
James Paget University Hospitals NHS Foundation Trust
Queen Elizabeth Hospital King's Lynn NHS Trust
Ipswich Hospital NHS Trust
Norfolk and Waveney Mental Health NHS Foundation Trust
NHS Norfolk Primary Care Trust
NHS Great Yarmouth and Waveney Primary Care Trust
Norfolk Community Health and Care NHS Trust.
Birmingham As mentioned in question1, as a result of the development of our Trust Teaching Academies, we now have much greater strategic input from our Teaching Trusts with regard to curriculum content, design and delivery, with colleagues in the individual Trusts sharing responsibility with a College colleague for specific aspects of the curriculum (including integration into the first two years of the programme). Colleagues in specific areas (eg
Pathology) have developed teaching packages that can be shared and delivered across Trusts to ensure equity of experience and quality of teaching for our students.
We have also been running a successful Liaison Committee with the West Midland Deanery which ensures engagement and input from the Postgraduate Dean and Associate Dean on a range of issues. We hope to include a wider range of colleagues from the Deanery on F2P panels in future years.
Keele The School has appointed Hospital Deans at our main hospital Trusts who are consultants employed by these
Trusts and have enhanced our liaison with local employers. The Deans sit on the Partnership boards that exist between the School and each Trust. These structures have ensured that employers are involved with the School's planning and delivery of teaching, placements and assessment.
Warwick We consider that, in general, engagement from our NHS partners is good. Any meeting which we would like clinicians to attend is timetabled with a long lead in time to allow them to make necessary arrangements that fit in with Trust policies and practices.
WMS has a Management Group for the clinical element of the programme that encourages all leads for rotations to attend; all clinical leads for rotations are encouraged to provide input to the University annual review of courses.
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Barts
Imperial
UCL
Aberdeen
The marking of written assessments in the clinical years is conducted by clinicians.
Our new University/NHS strategic liaison committee is designed to enhance contributions and buy in from our NHS partners.
Plan to run a series of road shows around the Trusts on the curriculum review timed to meet the needs of clinicians.
A consistent challenge is determining how our wish for clinician involvement at many different levels filters down to individual clinicians.
There is active representation and participation in the Curriculum Working Group from clinical and non-clinical academic colleagues from within QMUL and our clinical tutors within the partner NHS institutions.
Accordingly, all stakeholders play a significant part in shaping the respective themes within the curriculum via the committee membership, not least the Medical Education Committee, Medical Assessment Committee and the
Medical Education Quality and Enhancement Committee.
Employers are involved in the Curriculum Development Group, the Directors of Clinical Studies Committee, the
Strategic Education Committee, the NWTFS Management Committee, Deanery Foundation Board, and are involved in regular meetings between DoE and London PG Dean.
We are developing good working relationships with all our partner NHS sites who employ 60-70% of our graduates.
The final year team have worked closely with the director of the local Foundation Programme in developing the new final year programme incorporating Assistantships. Through these initiatives we are increasingly focussing areas that will increase immediate preparedness for practice without compromising longer term educational goals.
However it is not possible to consult with all employers as our graduates take up posts throughout the UK (and further a field). There is rational method for doing this however the Quality Assurance Unit is considering a
"preparedness for practice" survey in collaboration with the Foundation School.
As described in Domain 2, Q3, we have good representation from our NHS partners on the committees that either run or monitor the curriculum. Although not strictly speaking employers, we also have good links with NES through the local PG Deanery, which is represented on our School Teaching and Learning Committee. We also meet twice a year with the PG Deanery to document and review previous year's graduates who have not successfully completed FY1. We recognise that employers are under increasing pressure to deliver service and the combination of EWTD and reducing numbers of trainees has had a significant impact on several specialties this year. The NHS
Grampian TUTELAGE group, chaired by a senior NHS manager, has been invaluable in troubleshooting difficulties
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Dundee
Edinburgh in teaching delivery. As a direct result of these discussions, NHS directorates have been asked to formulate teaching plans to ensure that their responsibilities are explicit.
NHS Tayside staff sit on UMEC the Curriculum Management Team, Student Support, Phase committees and short life curriculum / assessment working groups.
NHS ACT funded staff provide the clear communication links and their key role is to engage with all elements of curriculum planning and management. Assessment has proved an issue but collaborative working has produced a working plan which it is hoped will be successful for both partners.
The NHS Director of Medical Education ensures that teaching is on the agenda at meetings from Health Board to departmental level.
Our principal local employer is Lothian Health, together with the Fife and Borders Health Boards. Methods of engagement with the School’s structures for managing teaching, learning and assessment include:
1. The Head of College, Professor Sir John Savill, is a member of Lothian Health Board and engages the Board with teaching issues at that level
2. Bi-monthly formal meetings between the Director of UG Teaching CMVM (Prof Allan Cumming), the PG Dean for
SE Scotland (Prof Bill Reid), and the Director of Medical Education for Lothian Health (Prof Paul Padfield).
Professor Padfield as DME is the main employer representative in the strategic planning of undergraduate education.
3. The Regional ACT Group for SE Scotland. It considers applications for funding of educational developments and is a key forum for joint discussion of UG education issues. All the local employing Boards are represented by senior staff on this group.
4. The annual University/NHS liaison meeting. This evening meeting, with dinner, is hosted by the University and attended by senior staff of each local Board, including DMEs, ADMEs, Clinical SubDeans, the PG Dean, and the
Medical Director of NHS Lothian. A series of presentations inform delegates about teaching developments and form a focus for active discussion and debate.
5. Senior clinical staff of Lothian Health hold key positions in curriculum management and sit on all University teaching committees. They help to disseminate information, canvas opinion within the NHS locally and feed it back to the University.
Inevitably teaching is not at the top of the priority list for NHS Lothian or our other partner Boards. Nevertheless they take their responsibilities under the ACT agreements seriously, and have moved to create proper educational
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Glasgow governance structures. This makes liaison and engagement with teaching issues much more straightforward than in years gone by.
Employers (local NHS Hospital Consultants, General Practitioners and NHS Education for Scotland staff) are represented on the various Medical School Committees, including: Hospital Sub Deans Committee; Medical
Education Committee; Admissions Committee; Evaluation Working Group; various Year Deputy/Directors meetings
(which include NHS staff); OSCE Planning Group, Clinical Skills and Acute Care Curriculum Group; Preparation for
Practice group; and Boards of Examiners meetings. Furthermore, there is an NES/University Liaison Group meeting and various planned and ad hoc meetings with the Directors of Medical Education. Employers were/are also involved in Curriculum Review meetings, both past and current.
A Service Level Agreement has been signed with Greater Glasgow and Clyde Health Board; negotiations with the other Health Boards are underway. The challenge will be to make this work and, in addition, matching the undergraduate and postgraduate curricula.
St Andrews St Andrews does not directly generate graduates who enter the FY1 programme so this makes direct interaction with employers more difficult than for other medical schools. Nonetheless we do strive to involve our local NHS employer in our School structures. With respect to the delivery of medical education to our students our main partner institution is NHS Fife. This clinical input is funded by Additional Cost of Teaching (ACT) funding which is monitored and distributed by NHS Education Scotland (NES). This allows a national response to requirements and guidelines such as those detailed in Tomorrow’s Doctors 2009. There are regional and national ACT meetings where local education providers and all 5 medical schools in Scotland meet and engage in discussions and strategic planning. A Regional Group, involving NHS Fife / NHS Tayside / Dundee and St Andrews Medical Schools is in place which provides opportunities for joint planning and sharing of resources (staff and facilities). Implementation of
Tomorrow’s Doctors 2009 is on the agenda at these meetings.
More specifically joint St Andrews / Fife liaison committees deal with planning, development and quality assurance of NHS Fife teaching input into the St Andrews curriculum. These committees maintains an overview of the strands of NHS teaching input to ensure a wide range of learning opportunities are exploited across all sectors of healthcare delivery and that these teaching activities are appropriately supported through Medical ACT funding.
Implementation of Tomorrow’s Doctors 2009 is now on the agenda at these meetings
BSMS All year 5 regional centre sub-deans are members of the School's Curriculum Management Board and the Director of Medical Education of BSUH has been invited to joint the School's Academic Board. We have joint staff appointments (honorary contracts) with BSUH and our mental health provider, Sussex Partnership NHS Trust. Any reduction in SIFT funding will reduce our capacity to make creative and beneficial joint appointments of this kind.
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KCL
St Georges Clinical Sub-Deans of all major teaching Trusts are invited to the MBBS committee which oversees course design, delivery and management of the curriculum. Therefore there is contribution of the LEP to the process, together with providing a vehicle for dissemination of requirements and developments. There are also termly meetings with the
Sub-Deans for feedback of Trust activities and developments. The Clinical Sub-Deans and lead teachers from
Trusts are closely involved in detailed planning and monitoring of clinical teaching of nearly all specialties, which meet at regular intervals. The involvement of teachers in the local education providers has led to good uptake of many new initiatives in the new 2007 SGUL MBBS curriculum, such as work-based assessment. It has also led to improved monitoring of quality of teaching delivery in clinical placements, including responses to issues raised in student feedback.
Bristol
We have found employers increasingly keen to be involved in curriculum planning and management, particularly in the final year of the programme. King’s Health Partners has been developed involving the College and three of our major Trusts and each clinical area will have an identified educational lead covering all aspects of undergraduate and postgraduate education. This is already beginning to stimulate and coordinate involvement in undergraduate education.
For clarity, “employers” are understood to mean both NHS trusts and Deaneries, the latter being the first point of contact for our students in terms of allocation for F1 posts. In this section, we can report both good examples and some challenges.
An example of good practice in managing teaching and learning has been the way in which we have worked with our local Severn deanery in the development and management of the changes to the Year 5 curriculum (full details of these changes are provided in Q36). The project group responsible for re-designing the Year 5 curriculum had a representative from one of the acute Trusts, two representatives from the Deanery, an administrator and a clinical member, This meant that the implications and the practicalities of the changes have included their perspectives.
The Foundation School Head in the Severn Deanery has also allocated a named individual to work specifically with the School to provide accurate and timely advice on careers to our students from Year 2 onwards, with spiralled input from then till Year 5 to assist students in making choices about their careers.
The challenges faced by the School in this area are mainly around patient involvement, use of teaching space and identifying venues for OSCE examinations. We have been trying to develop our patient involvement to meet with this standard required by the GMC. This has been very difficult so far. This is frustrating as trusts have a requirement to be involved in undergraduate education, but they are not held to account on these less definable areas and as a consequence, there are no levers for change. Therefore, it is considered that direct pressure and reminders from the GMC to the Medical directors and the Chief Executives would be of assistance.
In some trusts, there has been some considerable threat to teaching space, leading to high level discussions with the Trust’s executive. We have worked hard to try to facilitate resolutions in these situations and have included
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PMS personnel from the Strategic Health Authority to resolve this process.
The Year 3 and Year 5 Clinical OSCE exams are currently held in outpatient clinic space as these facilities are the most suitable for bringing patients into, and offer a multitude of rooms with privacy and space. However, despite the large amount of money which the host trusts receive for relinquishing this space for two days a year, the trusts have lodged concerns about this arrangement on the grounds that waiting list targets are being affected. We have investigated the possibility of hiring a suite of hotel rooms and using the SIFT income to pay for this. The trusts refused to agree to that, despite it being cheaper, but we still find that access to clinic space is constantly under threat and requiring constant re-negotiation.
Overall it is fair to say the school has excellent and enduring commitment from NHS providers. The main challenges are inevitably related to ever increasing pressure on providers to deliver NHS service commitments, and the effect this has on undergraduate and postgraduate training roles.
There are, of course occasions, when this has impacted on teaching but thankfully this still remains a small, but manageable amount that the school can deal with. One particular challenge is the timely submission of written assessment marked by providers. This sometimes delays the standard setting and release of results to students within the student selected component.
Busy providers also have occasionally cancelled clinical skill sessions at short-notice due to clinical commitments.
Again, this is a very small minority and the sessions are usually rebooked but clearly these pressures are unlikely to diminish.
Oxford Our main channel is the Board of the local Foundation School. The Director of Clinical Studies sits on this board and invites feedback from the members of the board, who represent the NHS trusts who employ the students.
The school reviews all documentation submitted from the employing Trusts prior to recommending students for full registration with the GMC. It is of note that, although there is a section on the form for comments on F1 performance, very few educational supervisors or Foundation Programme Training Directors take up this opportunity--as all F1's must submit this paperwork, this would be a simple way of getting feedback, if more comments could be encouraged
We were also asked about graduate involvement in curriculum planning. We have F1 and F2 representatives on our
Clinical Education Committee, who participate in curriculum planning and review.
Southampton It is not clear what you mean by "employer" involvement. Many of our course leads are also NHS Employers. Our
BM Programmes Management Committee has the Foundation School Director as a member as well as the Director of Medical Education for Southampton University Hospitals NHS Trust (SUHT) and they both represent an employer's perspective. The School has Associate Clinical Sub Deans in place in the Trusts providing placements
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to Southampton students and these are all representatives of employers who have an input into the teaching experience and curriculum development.
Question 33 - Please identify any innovations the School is piloting or potential good practice that it would like to report, particularly successes or effective actions taken in implementing Tomorrow’s Doctors 2009 to potentially share with other schools.
School
Cardiff
HYMS
Leeds
Example of Practice
1. Undergraduate Performance Programme
Developed to ensure students are supported in a robust manner. The framework has been developed to monitor and manage students who present with performance issues. The process fits in with current student support mechanisms such as personal tutors and academic appraisers. The process will be evaluated on an ongoing basis.
2. 'All Wales' clinical skills forum has held two meetings in the last year. This has been a forum for all the clinical skills tutors who work in hospitals throughout Wales to meet, share good practice and discuss changes for the future. The development of the clinical skills portfolio arose from this forum and will be implemented for 2011.
3. The 'acute care module' which was started in the summer of 2010 for final year students addressed some of the issues related to assessment and care of the acute patient. It has taught the students the principles of assessment of sick patients and given them experience of managing these situations using simulator scenarios. Initial evaluation has been positive but we will continue to monitor it to ensure the initial enthusiasm continues.
4. Appraisal scheme for all students - see earlier comments.
5. Development of a core drug formulary for students to know, personal copies of ' Good prescribing guide' and copies of BNF supplied in years 2 and 5.
We believe the mapping exercise demonstrated that the HYMS curriculum is well aligned to TD2009. The process of undertaking this raised the profile of TD and engaged academic and clinical staff in the School and lead to a very constructive and ongoing dialogue about maintaining and reviewing the curriculum.
The new Leeds MBChB is delivering a 5 year strand around Innovation, Development, Enterprise, Leadership and
Safety (IDEALS). This develops and prepares students as providers, team workers and leaders of healthcare.
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Using blended methods and a spiral philosophy, the strand develops understanding of ‘self’ and ‘structure’, and builds skills in self-regulation, professional and team development. There is a strong focus on management, NHS organisation and healthcare structure. This is underpinned by a 5 year patient safety curriculum and the principles of human error, situational awareness, managing and learning from error and systems thinking using case studies and clinical incidents.
The entire curriculum is supported by an innovative technology-enhanced learning strategy, partnered between the
School of Medicine and a number of commercial partners. Key components focus on a virtual healthcare community, progress file that builds towards the format used by the Foundation Programme and MBChB ‘Mobile’.
This mobile learning solution sees students in year 4 and 5 of the programme issued with an i-phone, a range of dedicated ‘apps’ and links the electronic progress file. Apps allow workplace based assessment, and a range of mobile content including clinical handbooks, BNF, NHS evidence that link near-patient clinical experience with learning, assessment and feedback. This is wirelessly linked with the progress file, allowing data to flow in both directions, reviewed by, and the strengthening the relationship between the student, clinical supervisors and university tutors.
Belfast Final year students completed a one week Patient Safety and Clinical Skills Course during Semester One. This course was designed to allow students an opportunity to revise and refine the clinical skills required by the F1 doctor. (Doc 16).
An apprenticeship is being piloted for final year students during the current academic year, following an evaluation of the pilot the programme will be implemented during the 2011-2012 academic year (Doc 2).
A one week course which focuses on teaching about radiology has been introduced into the fourth year teaching programme, feedback from students and external assessors suggests that this course has been very successful
(Doc 17).
Cambridge The School of Biology has initiated a collaboration with the Karolinska Institute to evaluate the "Virtual Patient" teaching model in an attempt to offer additional clinical context to the MVST students.
With the introduction of the new curriculum in 2005, the Clinical School developed a core clinical problems list that is available to students on the VLE as a foundation to assist their self-directed and reflective clinical learning. This is currently undergoing revision as part of the mapping process against TD 2009, alongside which more imaginative ways of encouraging students to develop a portfolio are under consideration.
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Stage 2 of the Clinical Course is undergoing significant revision. The Review & Integration weeks have previously never matched the clinical learning modules for more than a fifth of the students (due to rotations). By using elearning methodologies for teaching Pathology, we are developing "personalised R & I weeks" in which students will learn material relevant to their most recent clinical placement. They will have fewer formal lectures and additional supported e-learning activities - we hope to provide each student with their individual learning opportunities in part of the taught course. This exciting attempt to overcome the issues of clinical rotations will be introduced in June
2011.
Leicester None
Nottingham The main risk to implementation is staff capacity both in University and partner NHS organisations.
NHS organisations do not allocate the same priority to dealing with requirements for UG education as they will to issues related to frontline clinical service delivery.
The anticipated reduction in SIFT payment will probably have a detrimental impact on delivery which is most likely to impact on people not managing to complete training and not completing returns for QA. It is difficult to see how this can be avoided.
Changes in service configuration are already being proposed, driven by financial considerations, with a very short timeframe. The needs of UG medical education in planning are not typically on the NHS agendas, despite trying to flag these. There is a risk of holes appearing in capacity. While there is engagement with providers, direct engagement with commissioners is a very difficult area here.
The planned move to deliver more clinical delivery in the community suggests that more education should take place in a community setting. It is extremely difficult to recruit and sustain GP capacity to do this locally. Again, reduction in SIFT linked to delivery is not helping. There is competition with GP capacity to deliver PG training.
UEA From 2011/12 the School has revised its Final year, to better fit the GMC's new guidance. Currently, the final year consists of two 14 week placements in Mental Health, and Emergency Care, followed by a 5 week shadowing period. From 2011-12, this is to be changed to a three week Year 5 induction (including an ALERT course, ILS course, advanced consultation skills and core lectures across mental health and emergency care). Students will then undertake three 9 week modules in Mental Health, Emergency Care, and two 4.5 week student assistantships in medicine and surgery.
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In 2009-10 the School piloted student locums. This was a very successful pilot and a small number of students have now undertaken locums this academic year (2010/11). Locums are selected on a competitive basis from the top 2 quartiles of the Year 5 to work closely with an F1/F2 where hospital teams are short-staffed. An evaluation of the pilot project was undertaken in 2010 by our Director of Clinical Skills. This indicated that this was extremely good experience for our senior students and found to be very helpful to our NHS colleagues, both medical and nursing teams involved.
In 2009/10 the School formally reviewed our admissions policy, analysing predictors of success on our course. This analysis reviewed 3 years data from 4 cohorts of students (2003-2006 entry). This analysis revealed that whilst high (>390, ie AAB + B at AS) A-level tariff scores were not associated with improved performance compared to those with tariffs of 350-390, tariffs below 300 (3 Bs at A-level) were associated with increased risk of course failure.
This has led to a review of our admissions criteria, and a decision that all graduates and those coming via Access courses to medicine must have obtained 3 Bs at A-level for those entering from 2011/12. (See also Q10).
Birmingham Welcome Week - In response to the University’s request to ensure that students have an academic as well as a social induction to their programme we designed activities which involved students accessing our VLE prior to coming to Birmingham: undertaking some reflective work on learning; viewing ”Talking Heads” of key staff welcoming them and reading three abstracts of papers and answering and generating questions on them. Four mornings in the first week were then spent in team building; appraising the full papers; making a group presentation; meeting key staff; understanding the programme and the welfare system with input from current students. Staff have noticed that the small groups have functioned better this year and that students started with a clearer idea of what is required for success.
Automated lecture recording – a new system to automate the recording of a lecture has been introduced. This offers lecturers and guest speakers the ability to schedule the recording of all their teaching; it automatically captures and synchronises the audio commentary with the electronic presentation, with additional video input optional. The recordings are made available to students within minutes of the lecture as a series of streamed and podcast formats through the virtual learning environment, WebCT. This has considerable and proven benefit to student revision and recapping on lecture notes, in addition to assisting those students who have been unable to attend the lecture. This approach has now been adopted by several modules in Years 1 and 2, as well as being used by the Surgery
Society for invited lecturers.
Interactive lectures using voting pads – During this current academic year, all Year 1 MBChB students have been provided with their own 'clickers' (Personal Response System). This follows widespread approval of this form of
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Keele lecture-based voting system over the previous year from both staff and students when they were available for loan on a lecture-by-lecture basis. This removes the considerable delays from repeatedly handing out and collecting in the units, and will give further confidence to teaching staff to begin including this technology in lectures. Staff who have previously used the system have been very impressed by how easy it is to set up and deliver in a normal lecture. They have used it to include small knowledge tests during their lectures, or to gather opinions on sensitive or provocative matters. The instant results can then stimulate further discussion or inform the lecturer of common misunderstandings which can be revisited during the same lecture.
Hospital –based Pathology Tutorials - This academic year a series of 8 small group tutorials in Pathology is being provided to students in the 3rd year. These tutorials will be provided delivered by hospital histopathology clinicians during the students’ hospital placements. They are based on a series of case studies. The students are expected to work their way through the cases prior to their attendance at the tutorials. The tutorials are designed to bridge the gap between academic and clinical learning and to ensure students have a good appreciation of the clinical relevance of their pathology studies. These tutorials build upon a series of tutorials in infection which use a similar format and were instituted a number of years ago.
1. Higher Consultation Skills in Module 4.
In each of the five units in Module 4, students attend a 1 week Higher Consultation Skills block. These blocks include classroom based activities and placements in general practice. The focus is on enabling students to develop their consultation skills and the five main areas covered are : a. Making a diagnosis and focussed information gathering b. Biases and cognitive error in medical practice c. Information management d. Effective management e. Maximising adherence.
2. GeCoS (Generic Consultation Skills) tool.
This has been developed to form the basis for the teaching and assessment of consultation skills throughout the course. It provides students with very specific feedback as well as specific strategies for improving their performance. An electronic version has been developed which ensures rapid delivery of feedback.
3. Module 2 SSC.
Module 2 students are placed with third sector providers for 8 half days throughout the year. They then produce a poster and report about the third sector organisation. These non-clinical placements provide students with a
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Warwick
Barts valuable insight into the range and variety of agencies operating in the health and social care field in the local area and have enhanced the School's relationship with its local community.
4. Learning Technology.
The School has appointed a Lecturer in Learning Technology who has developed specific technologies to enhance the implementation of Tomorrow's Doctors 2009. These include electronic MSF, eGeCOS(see above), a searchable curriculum map for students to use in their final year to help them address unmet learning needs and an innovative electronic sign up system.
The selection centre process allows the assessment of competencies determined to be consistent with effective medical practitioners. Data collected will allow us to explore personality profiles and what the process is selecting for.
Global Health issues:
Currently students have 3 days International Health Lectures in Year 4. Individual lectures covering topics related to global health are given in years 2, 4 and 5. The local environment of East London is multi-cultural and multinational with a disease pattern to match, so global health teaching helps our students to understand both the reasons for increased population movement and the social, economic and cultural factors underlying patients' ill health at home as well as abroad. Current initiatives are to extend provision in this area especially with respect to the development of links with partner institutions in India and collaborators in Africa, China and Central America. A number of our students have formed a group to advance these aims and have been working in local and national networks and projects. Application for funding has been made to Queen Mary to plan and implement this programme of curricular expansion and development in Global Health for the MBBS programmes that would draw on a wide range of existing skills and expertise.
Practical Prescribing:
- Practical Therapeutics for Year 3 Medical Students course – teaching is in six 4-hour sessions per annum which comprise small group sessions with tutors to take students through common and practical prescribing scenarios that they are likely to encounter in routine practice. Students are rotated through 6 stations each with 2 prescribing scenarios. The tutor (either a clinician or a pharmacist) spends half an hour working through the 2 prescribing scenarios in detail. Students are given a prescribing portfolio to fill in prescriptions as they go along as well as a handbook with scenarios and model answers to take away. PBL/Prescribing for Year 3 student in cardiovascular medicine are covered in this weekly 2 hour teaching session (every week for 4 weeks) with linked prescribing practice that speaks to the topics covered. For example, if the PBL is concerned with acute coronary syndrome the students are taught to write prescriptions relating to the drugs used in that setting such as aspirin, clopidogrel,
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oxygen, ACE-Inhibitor, Beta-blocker… This has the purpose of not only exposing junior students to prescribing on drug charts but also helps to reinforce the PBL and the feedback has been very complimentary.
- Practical Prescribing course for Year 5 students is an initiative that is a component of the Year 5 teaching in therapeutics with a particular remit to improve prescribing skills and drug chart writing. The students are taught by pharmacists at all the different hospitals they rotate to for 2 hours each week. At the end of each term there is a 3 hour assessment in Pharmacology and Therapeutics.
Moving and handling technique:
Moving and handling techniques have been introduced in Years 2 and 5 in 2010-11 in order that all Barts and the
London graduates in medicine are competent in this skill. We have ensured the appropriate resources and curricular time have been made available in order that graduates are competent in the skills of moving and handling by 2011.
Assessment:
- Question bank of quality-assured questions that are linked to the electronic curriculum map [COMPAS].
- Longitudinal Progress Testing across Years 2-5 of the MBBS with the development of an in-house version in collaboration with Peninsula College of Medicine & Dentistry.
On-line information
- Membership of IVMEDS that provides quality-assured electronic simulated patients
Faculty Development
- A range of faculty development workshops for clinical and non-clinical colleagues, both in-house, by the members of the Centre for Medical Education, and in collaboration with the local Deanery
Medical Education: practice and excellence:
- An intercalated BSc in Medical Education where the majority of the students have attended and presented their research projects in the form of either verbal or poster presentations.
Imperial Lay members on interview panels, e-learning, e-portfolio, Teaching Skills course
UCL None
Aberdeen The integration of science and medicine together in a systems based course is working well and Year 1 and 2 students are very enthusiastic about the early clinical experience. Collaborative links are being established between
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scientists and clinicians which will increase the level of integrated teaching as the course settles down. The ACT funded expansion of our Clinical Skills staffing has allowed a comprehensive programme of consistent teaching on history and examination for each system. Involvement of nursing staff in negotiating opportunities for ward visits for junior students has also been very successful. A custom VLE (My MBChB) constructed by our in-house MediCAL team has also proved very successful and gives each student a personal timetable with learning resources e.g. podcasts, weblinks, PowerPoint files etc. all linked to each teaching event.
Dundee None
Edinburgh 1.A pilot is taking place of 'pre-prescribing' in a systematised way to give students practice at prescribing while protecting patients from risk. This pilot is being undertaken after negotiation with and briefings of relevant pharmacists, nurses and doctors and a range of tools and mechanisms have been put into place. The pilot will be audited and if effective and safe, we plan to expand it into the student assistantships and then into other Year 5 attachments.
2. An electronic wide-ranging curriculum mapping exercise is taking place. All course learning outcomes are in a database and are being reviewed by both course organisers and programme theme heads to ensure each course outcome carries appropriate tags to link them to the Programme Outcomes or GMC 'outcomes for graduates'. This will stimulate and inform curriculum review to ensure we address all the detailed outcomes in Tomorrow Doctors
2009. In the coming years other tags will be added to permit a variety of search and sorting strategies by students and staff. Resources will be linked to course learning outcomes and there are plans to use the same tags for assessment questions thus cross-referencing intended learning with delivered assessment.
3.Not exactly an innovation in practice, however, research is currently being undertaken with employers, new graduates and students into how to better prepare our students for acute care and clinical procedures prior to graduation. This will inform our curriculum development.
4.Edinburgh has a lot of eLearning resources but particularly within Pharmacology and Therapeutics and students undertake an online formative assessment in calculations for prescribing, twice per year.
5.De-identified peer feedback on group working in PBL and SSCs in Years 1 and 2 helps students develop skills in critiquing behaviour against criteria and in delivering written feedback in a constructive manner. Staff review the commentaries before they are published and also give feedback on each student including the feedback they have given if necessary.
6.Concerns about professionalism are tracked electronically throughout the programme with an emphasis on early intervention, enquiry and support for the student concerned if at all possible. Professional behaviour within the programme is formally assessed on a variety of occasions throughout. Through this assessment and at any other time, a member of staff may raise a concern about a student's Personal and Professional Development or professionalism. This is logged electronically and the information is routinely sent out to the student concerned, the
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Director of Studies who has a pastoral role, and the Year Director. The process ensures that the student meets with the Director of Studies to discuss the incident. The Year Director will review the confidential records to see if this is a recurring concern and will refer the student as required the Professional Development Committee in cases of complex needs, the Board of Examiners, or the Fitness to Practise Committee.
7.Members of the University, the Deanery and the local NHS are collaborating to create the South East Faculty of
Clinical Educators a forum for sharing professional development within education and to develop a community of scholarly practice.
We have introduced a Medic Family Scheme and created a supportive network of peer 'families' into the school.
Year 3 students 'adopt' students joining the medical school in first year. The third year 'parents' introduce new students to the life of the medical school. The student association sponsors Medic Family social events too.
Critical appraisal
Critical appraisal is taught through collaboration with researchers in South Africa. The students appraise a major piece of research from the research team, one of whom visits Glasgow regularly and thus introduces the research in person. After self-directed study and a supporting plenary the students pose questions to the research team by video-conferencing before submitting their appraisals for assessment.
Cont/
Recognition and Management of the Sick Patient
All fourth year students now spend 2 days on a course on ‘Recognition and Management of the Sick Patient’. This course runs in purpose built facilities with up-to-date model patients. Students are taught management of the airway, cannulation of vessels, management of hypovolaemia, and cardiac arrest. They are then able to practice techniques under supervision. Student evaluation of this teaching has been excellent.
On day two of the programme they run through six scenarios in the simulator on clinical issues, for example: asthma, unconscious patient, chest pain, where they are assessed on leadership/ influencing stills/ delegation/ clinical decision making/ communication skills, and SBAR and patient safety.
Volunteer patients
Two years ago we introduced volunteer (lay) people into our simulated (actor) patient programme. The lay people complement the work of the actors in the teaching and assessment of communication skills and specifically history taking.
VPs help us to offer high quality communication and clinical skills teaching and assessment and have been shown
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to provide consistent and accurate simulations of real encounters with patients. VPs work with us to help students develop their skills. Many of the encounters are recorded so that students may look back on their performance and skills as they progress to become doctors. Working with VPs means that patients' confidentiality is not breached. In controlled conditions VPs give their own impressions of a student's performance to help their development.
Teaching Podcasts
Students and staff have been awarded national funding to develop clinical skills teaching podcasts. A number of these are now developed and available to medical students. The preliminary evaluation has encouraged the development of further podcasts which can be made available for all medical, dental and nursing students.
St Andrews 1) Galen is the School of Medicines curriculum management system which is constantly evolving to improve the student experience and facilitate the management of all aspects of the curriculum. The School has invested heavily in developing this system which aims to integrate the educational, administrative and practical aspects of managing the BSc Hons in Medicine. Both staff and students have a personalised timetable that links directly to targeted teaching resources. Staff use Galen to display their learning objectives, recommended reading and provide electronic resources for every learning event. This information is available prior to the start of each module providing students with a clearly visible curriculum which is mapped directly to the governing body the GMCs ‘Tomorrow’s
Doctors’ learning outcomes and to the Scottish Doctors document. A similar map exists for blueprinting exam papers as Staff are required to link their proposed assessment questions to their learning objectives within Galen, this facilitates constructive alignment of learning and assessment.
2) To encourage students to adopt the General Medical Council’s guidance “Medical Students: Professional behaviour and fitness to practise” we developed a yellow card system. This system allows the teaching staff to apply consistent, gentle pressure, discouraging undesirable behaviour and promoting professionalism without disrupting the current teaching session. Following the well recognized football warning system, a yellow card was developed. Printed on the yellow card were 11 numbered points relating to professional attitudes and behaviour.
The cards are issued without discussion to avoid disruption to teaching. Any student receiving a card should reflect on why it had been issued. Any student receiving a card was free to email the issuer to arrange a time to discuss the matter further. Yellow cards would be recorded together with the reason for issue. 3 or more cards in a semester would be called for interview to discuss their professional attitudes and behaviour
3) We are aware that the introduction of integrated curricula can result in an overall reduction in teaching time for the basic medical sciences and in particular the opportunity for student dissection in anatomy. We are also aware that concern has been expressed by clinicians that the anatomical knowledge of current trainees is inadequate
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BSMS
(Waterston and Stewart, 2005; McHanwell et al, 2007; Turney, 2007). During the development of our systemsbased curriculum it was decided that student dissection of the entire body should be maintained and supported by clinical anatomy lectures. This approach has been fully supported by the School through the appointment of appropriately trained and experienced staff and provision of a modern facility in the new medical school building.
Our aim is to continue to ensure our students have a practical understanding of 3D structure of the human body and its application to clinical examination and procedures based on anatomical knowledge that is appropriate for doctors of the 21st century.
4) Over the past year we have sought to increase integration of the course not only with other elements of the medical course but also with students studying different aspects of health care. In association with the University of
Dundee and the NHS, we have appointed a lecturer to perform a study of number and types of health students currently educated in NHS Fife and to look at the possibilities for inter – professional teaching and learning in Fife.
We have already begun IPE having developed with our colleagues in NHS Fife an “Introduction to the ward” module
This programme consists of four stand alone modules, focusing on patient admission, planning and implementing care, discharge planning and the ward round. Students participate in a range of shared learning activities in a ward area with other undergraduate students also on clinical attachments from Nursing, Allied Health and Social Work professions. This inter-professional collaboration enables students to practise their clinical skills together and also gain an appreciation of the roles of other health professionals. Core clinical university staff now not only teach in a university simulated setting, but also take this to the next stage by going with the students to their clinical placements to teach on patients in a clinical setting.
Our electronic learning resources are excellent. Our online learning package "Clinical and Professional Studies
Online" now contains over 600 clinical cases with immediate feedback.
The Mobile Medical Education Initiative continues with all students in years 3-5 given PDAs with SD cards containing a suite of reference material such as BNF and Oxford Handbooks that has been very useful in addressing learning at the point of need.
In collaboration with MSC, we have successfully piloted the national Prescribing Test and will pilot the Situational
Judgement Test in Spring 2010
BSMS continues to be strong in delivering teaching using Allied Health Professionals, with specific appointments in diabetes , pharmacy and rehabilitation.
KCL None
St Georges We have successfully introduced a 2 week Introduction to Clinical Practice session which takes place ahead of Tyear. It provides students with the basic skills and knowledge required beyond their Clinical Skills sessions in
Clinical Sciences and also as a refresher. Early indication is that this is particularly useful for Clinical Transfer
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Bristol students.
The introduction of the five stranded assessment strategy seems to be going well with and in the development and introduction of the Longitudinal Professional Assessment. A particular innovation in this area is the successful introduction of the Work Based Assessments and Progress Testing.
Implementation of a new Question Writing Workshop for academics and clinicians involved in teaching and assessment has helped us increase the number of question writers we have available at any one time.
One of the major ways in which we have changed the programme in response to TD2009 has been to completely restructure and reorder the Year 5 to reflect the outcomes of TD2009 (doctor as scholar/scientist, practitioner and professional). The GMC will be aware from our previous inspection that we have run an extensive programme to assist students in “preparing for professional practice”. This programme ran over three weeks, but has now been extended to 12 weeks. The programme now incorporates the elements of the learning outcomes which are embedded in tutorials, increasing the PPP time to include an element of peer assisted learning for all students*, a clinical apprenticeship for two weeks and a new 2 week attachment in primary care for Year 5, with the emphasis on learning outcomes which are appropriate to general professional practice, rather than being focussed on Primary
Care as in Year 4. (*: the peer assisted learning which was highlighted by the GMC in our inspection report and in other documentation subsequently, was excellent but was not accessible to all. We have rectified this by taking the principles of that programme and incorporated them into the PPP block.
A further development we have undertaken is in the area of the GMC required Clinical and Practical skills which have now been incorporated into a skills logbook which will ultimately span all the skills that are required by the
GMC. This was introduced as a pilot in the academic year 2009-2010 in Year 5 only. This pilot highlighted some unforeseen problems and as result the pilot will continue in Year 5 only in 2010/2011. This will allow us to fully resolve these issues before roll out to other years. We ran a dedicated session to achieve this in 2010 which was well attended by representatives from the Academies and teaching units. During this session we worked through each skill required and allocated each one in a systematic and considered way to an individual teaching unit. As such, it is expected that there will be a greater degree of commitment and awareness of the skills required, with some already being incorporated to a certain extent in to the curriculum for this academic year. It is thought that we have allowed adequate lead in time for them to be fully embedded within the curriculum.
In terms of successes, the year 5 changes have yet to be evaluated but this will happen in part within the next few weeks for the first half of the year and then at the end of April for the second half. We are fortunate to have a PhD student who will be assisting with this as part of her thesis to allow us to undertake a rigorous evaluation of the entire process. This in turn will allow us to plan effectively for any further changes and we may need to make.
B48

Overall, we are pleased with the changes and how they have been implemented and received by the students so
Oxford None
Southampton The last year has resulted in unprecedented cuts to funding to HEI and the NHS. This has resulted in the University restructuring and cutting large numbers of management and administrative staff. The NHS seems more and more focused on service delivery and it is only through the determination and professionalism of our NHS colleagues that high quality clinical teaching continues to be delivered. The focus has been on maintaining quality rather than enhancements. However we have continued to develop e learning and e assignment systems as well as educational research initiatives. We have continued to deliver training and staff development to our teachers.
B49