2015 Medical School Annual Report - Published Items
ACTION PLAN (This action plan will be published on the GMC website)
a) Have you identified, in the last academic year, any issues with clinical supervision (supervision by clinicians during clinical placements) within your Local Education Providers (LEPs) and if so what steps are you taking to resolve them?
b) Please provide details of any concerns or areas of good practice identified during these monitoring visits. Please include also provide us with the actions which you have taken to address concerns or promote good practice.
c) Please tell us about any innovations you are piloting or potential areas of good practice.
School
ABD
Item number
ABD1214-06
New item?
No
ABD
QA4677
No
ABD
QA4581
Local education provider Site
NHS Grampian
Aberdeen
Royal
Infirmary
ODS/NSS Code
(if available)
Please list the years of
students affected
Year 4 Clinical
Placements in
Cardiology
Item type
Concern
Theme
Visit - Requirement
No
Visit - Requirement
ABD
Yes
NHS Grampian
Aberdeen
Royal
Infirmary
Year 4 Clinical
Concern
Placements in
Haematology/Oncology/
Genetics/Plastic
Surgery/Palliative
Medicine
ABD
Yes
NHS Grampian
Aberdeen
Royal
Infirmary
Year 4 & 5 Clinical
Placements in General
Surgery and Emergency
Medicine
ABD
Yes
NHS Grampian
Year 4 & 5 Clinical
Good practice
Placements in Obstetrics
and Gynaecology
ABD
Yes
NHS Grampian, NHS
Highland, NHS Western
Isles, Shetland, Orkney
Aberdeen
Royal
Infirmary &
Aberdeen
Maternity
Hospital
Inverness,
Aberdeen
All years
ABD
Yes
NHS Grampian
Aberdeen
ABD
Yes
NHS Highland
Wick
Description of item
Whilst there has been negative feedback from
students across several years of the programme
from this specialty over remains concerning, it
appears that changes have recently been made to
improve the student experience. Please provide an
update on this item in the next MSAR, where we
would hope to see further improvements.
Date item was
identified
(DD/MM/YY)
29/08/2014
What further actions are planned?
Individual induction and close liaison with the new Educational lead for
the clinical placements in this year of the programme. Regular review of
SCEFS with report to NHSG medical and dental educational governance
committee and Tutelage. Year 4 curriculum major review
2012/13 QIF Aberdeen Medical School Check.
The School must formalise the assessment of
professionalism. At present professionalism is
reviewed during Mini-Clinical Evaluation Exercise
and Objective Structured Clinical Examinations.
Clinical teachers and academic staff advised they
would be aware of any professionalism issues and
would escalate to the School, however there needs
to be a robust formal documented process
introduced to meet the standards of Tomorrows
Doctors 2009.
2012/13 QIF Aberdeen Medical School Check
A range of actions have been undertaken to formalise the assessment of professionalism in response to the GMC Quality Visit and the Assessment
Professionalism domain is rolling out across the OSCE assessments throughout the whole curriculum this year. Assessing
Audit.
professionalism and raising concerns has been included in our new training the trainers activity this year (RoT workshops). A new
We have undertaken a mapping exercise on the teaching and assessment of professionalism across the programme
curriculum lead for professionalism was appointed this year.
A new domain has been piloted in the Year 1 formative OSCE assessing student professionalism. This will then be included in every OSCE question
across the curriculum where the student interacts with a patient, member of public or professional colleague.
We developed and piloted TABS as introduction to 360 feedback for students undertaking their student assistantship in final year in paediatrics and
some medical blocks. This records the staff perceptions of the student’s professional attitudes and assessment of their team worker skills and is in
addition to the end of block assessment. It is our aim to extend the pilot in the next academic year to other clinical blocks and to encourage use of this
feedback by the educational supervisor. Ultimately we plan to role this out widely across the student assistantship programme so that each student will
have at least one TAB assessment across the year.
Professionalism continues to be assessed in all workplace based assessments in Year 5.
We aim to have professionalism and reporting concerns workshops as a regular part of our annual trainers away day programmes to promote the
assessment of this domain and further encourage reporting of issues to the School (Workshops planned for the Year 1 – 3 away day and Year 4 / 5 away
day in 2015). This will be a core part of training for our Recognised and Approved Trainers development in assessment going forwards.
Assessing professionalism will be included regularly in training the
trainers programme of activity going forwards. Once professionalism
domain in place across all appropriate OSCE questions (over this
academic year) students will receive a report on their average
professionalism score after each summative OSCE (this already is in
place for communication). Should there be concerns in this area
students will be able to track their progress across the curriculum.
Professionalism lead will report regularly through the Curriculum
Steering Group on progress and new developments, linking with the
lead for the Professional Practice Blocks of time which run across the
whole curriculum (individual sessions in Year 1, several days across the
middle years, four weeks in final year).
Negative feedback from students on Student Course Evaluation
Forms.
The Haematology/Oncology/Genetics/Plastic Surgery/Palliative Medicine/Endocrinology & Diabetes block underwent a redesign in 2014 however this
Redesign of Block 2014. Educational Reviews carried out by the Medical Education Team in Oncology and Diabetes and Endocrinology
has not had what we consider to be sufficient success in changing negative student feedback. There have been areas of improvement and the feedback during 2015. Year 4 curriculum review beginning January 2016 will take careful account of blocks where there are / have been
is improving overall however it is not yet satisfactory. An educational review was carried out in March and September 2015 in Oncology and Diabetes
sustained difficulties such as these
and Endocrinology respectively where members of the medical education team engaged with the consultants, trainees and management to discuss
education within the departments. Challenges still exist in some aspects of the block and we are working with the education leads in this area, however
recruitment of senior staff is difficult in one of the specialities. Clinical Teaching Fellows have been redirected to support in this area in the interim. Work
is continuing to examine and support the areas receiving negative feedback.
Close liaison with clinical placement lead - awaiting new appointment
for overall block lead following a retirement. Our Year lead is covering
this temporarily. Recruitment of new consultant staff in oncology is
ongoing but this is recognised as a difficult area to recruit to. Nurse
educator teams are closely monitoring the student experience on a
week by week basis
Continued input to quality visits from the UG sector and close
monitoring of the student learning experience through SCEF, SSLC and
nurse educator system. Close engagement with clinical placement leads
through the year lead teams, Tutelage meetings, Year annual reviews
and RoT workshops.
Quality framework will be reviewed annually. It is anticipated
that the Scottish joint QM visiting programme will be up and
running in the next academic year.
Following our GMC check we have developed an over-arching Quality Handbook (version 2 April 2014) to be the reference point for all information
about QA and QE for all the teaching programmes within the Division of Medical and Dental Education (DMDE). Version one is released and in use.
Following the successful pilot of joint visits with the Postgraduate deanery to clinical areas we put a proposal to NHS Education for Scotland and the
Scottish Deans Medical Education Group for a system of joint visiting across Scotland. This would ensure consistency, give an additional perspective on
educational performance, allow sharing of resources for visiting and minimise the workload for clinical services. A short life working group is now
working to develop the strategy and documentation for this.
In addition we recognise that there are student placements which do not fit neatly into the post graduate training programmes and that the schedule of
visiting will only allow visits every 4 / 5 years which would not allow the early pick up of developing issues. Therefore our strategy includes actively
gathering data about the quality of clinical placements in a number of other ways in an ongoing basis. In addition to the national RAG reports, the
mechanisms for this include:
• at least 2 yearly visits to remote and rural locations
• visits to all clinical areas at least every month by the Nurse Educator Group
• facilitated student debrief after each clinical placement in year one
• student evaluation forms after every block and Staff Student Liaison Committee meetings every term
• visits to GP practices – before the practice can take any student attachments (visit checks against the criteria agreed by the Scottish GP Trainers group,
and then whenever there are any changes (e.g. change in staff, taking additional student). An annual return is completed by each practice.
• Visits to new clinical areas, areas hosting student assistantships
• Focus group debrief with all students at the end of each block of student assistantship
• We are developing a programme of meetings with our now Recognised and Approved Trainers
List the actions taken since previous MSAR (2015 update)
Redesign of Cardiology Block 2014. Educational Review carried out by the Medical Education Team in 2015. NHS Grampian has
appointed a new Clinical Lead for Cardiology. A new university cardiology lead has been identified and will be appointed subject to a
job plan review. Year 4 review planned to examine current teaching blocks.
The School must formalise its quality management
in a framework. At present the School makes a
specific visit to each site every two years, excluding
Aberdeen Royal Infirmary where co-location has
resulted in a less formalised approach. There are
plans to begin visiting Aberdeen in 2013 and the
new Quality Manager post will support this
process. The undergraduate Director of Medical
Education at Aberdeen Royal Infirmary visits
specialties as part of his quality control processes.
Developing and implementing Concerns regarding student feedback from the
curricula and assessments
Haematology/Oncology/Genetics/Plastic
Surgery/Palliative Medicine/Endocrinology &
Diabetes Block
Visit - Requirement Learning environment and
culture
How was the item identified?
Negative feedback from students on Student Course Evaluation
Forms.
Previous return update: 2014 MSAR
or
Additional information requested by GMC (visit items ONLY)
The Cardiology/Cardiovascular Surgery/Respiratory/Clinical Pharmacology/Vascular Surgery/AMIA block underwent a redesign in 2014/15, and although
this initially appeared to be improving the situation, the trend has not been sustained to produce a satisfactory sustained situation. Some aspects
appear have improved more than others but the situation is not constant, although variable student response rates may also impact on the analysis of
trends. The feedback from this Year of the programme contrast with the feedback from Year 2,3 and 5 of the curriculum where there is excellent
feedback for attachments to cardiology. An educational review of this attachment was carried out in June 2015 where members of the medical
education team from the University and the NHS educational governance leads engaged with the Cardiologists to discuss education within the
department. This once again appears to have had only limited success and further discussion with the Cardiology education team is scheduled. The
University is embarking this month (January 2016) on a major review of the Year 4 MBChB curriculum, led by the Deputy Head of Division. In addition
to working with the Cardiology team to improve the student experience at this stage of the curriculum, this curriculum review will include careful
consideration of the issues raised by students in this complex 5 week block.
Concerns raised by GMC Enhanced Monitoring of
General Surgery and Emergency Medicine at
Aberdeen Royal Infirmary
During 2015
Deanery visits and Health Improvement Scotland (HIS) reports.
There was concern that poor postgraduate trainee satisfaction and increased adverse media coverage might impact on undergraduate students and
their teaching within General Surgery and Emergency Medicine. A selection of medical students on placements within these departments were invited
to attend an interview during the Deanery/GMC visits and were questioned on their teaching. The reports indicate that the students were satisfied with
their clinical placements and teaching had not been impacted upon. General Surgery and Emergency Medicine have seen a significant improvement
since the initial visits and the University of Aberdeen is confident that teaching has not been affected however they will monitor the situation going
forward.
Learning environment and
culture
High level of student satisfaction
ongoing
Student Course Evaluation Forms
Obstetrics and Gynaecology consistently report high levels of satisfaction of both year 4 and year 5 students. This is evident from the RAG results and
has been consistent over many years.
Good practice
Supporting educators
Recognised and Approved Trainers workshops: we 01/12/2015
have developed a new regular programme of
workshops for our Recognised and Approved
trainers. It is planned that these will run three
times per year in three different sites. The
programme will include education and curriculum
updates, professional development opportunity
and time for sharing good practice / learning about
approaches to challenges from our trainers
network. We hope that this will support our
trainers and help establish a community of
practice. The first workshop was held in Aberdeen
at the beginning of December 2015 and received
positively. The next workshop will be held in
Inverness in the spring
Planned through MBChB programme leads in collaboration with
Directors of Medical Education in LEPs. Evaluation from
participants
All years
Good practice
Learning environment and
culture
development of team specific educational groups
across 2015
within services e.g. paediatrics, general surgery,
anaesthesia where those with educational
responsibility / interest meet regularly to consider
all educational issues (UG / PG and also training the
trainers and frequently general supporting CPD
within the unit)
a combination of ongoing regular contact with teams, visits and
recent RoT workshop (see item above)
Year 5
Concern
Supporting learners
Levels of consultant staffing at Caithness General
summer 2015
Hospital has been a matter of concern to NHS
Highland for the last two years. University of
Aberdeen has been closely monitoring the student
experience in both medical and surgical placements
at Caithness General, maintained contact with the
team in the hospital and also with the
postgraduate education team. Student feedback
through staff student liaison committees, SCEF
results and informal feedback had been more than
satisfactory and for academic year 14/15 and we
judged that there was sufficient support to
maintain the student placements. Over the
summer of 2015, staffing became more critical and
Foundation and GPST training places were
withdrawn. We also withdrew student placements
which had been scheduled for August 2015 and
have continued to monitor the situation. The
students were relocated to Inverness where there
was sufficient capacity and no concerns about
changes in placement have been reported. It is our
intention to restore placements in late February of
2016 when a stable staffing arrangement will be in
place. When students return, we will closely
monitor their progress through the block and if
necessary, will relocate them to Inverness if there
are concerns.
Ongoing liaison and monitoring of the staffing levels in the
placement through our Director of Teaching in Highland, the
Director of Medical Education in Highland and our regular
communication with the Postgraduate team.
We continue our programme of visits as detailed in last years MSAR (at least 2 yearly visits to geographically remote locations, nurse
Development of a new summary reporting form for the next academic
educator team visits to all clinical areas in our two main campuses at least every month, facilitated student debrief after each clinical
year for completion following visits by the DME and Quality manager
placement in year one, visits to GP teaching practices before they start taking students and after any change in the GP learning
team.
resource or student numbers with Annual Returns completed by each practice). In addition at our large campus at Foresterhill
(including Aberdeen Royal Infirmary) our Director of Medical Education (undergraduate) and Quality Manager are now following a
programme of visits to all areas and specialities. In the last 18 months there have been visits to anaesthesia, oncology, cardiology,
paediatrics, Dr Grays hospital, Endocrinology & Diabetes, Infectious Diseases, Neurosurgery, Trauma & Orthopaedics. Student
evaluation forms, which are completed after every clinical attachment, are examined before visits to identify good practice and
challenges that merit exploration. Issues are also identified from communication with both the year lead teams and nurse educator
teams. Further background information is identified from the regular Staff Student Liaison Committee and Tutelage meetings.
Reporting from these visits will both to the University and also through the Medical and Dental Education Governance Group who can
escalate concerns directly to the Board if necessary. As detailed in the 2013/14 MSAR we have promoted and piloted joint PG / UG
visiting across Scotland. The short life working group chaired by NES, with representation from all Scottish Medical Schools, the
postgraduate deanery and the education providers is now established and working towards implementing the first version of the
Scotland wide system later in 2016. A pool of representatives from the Universities, to be members of visit teams, are currently being
recruited and the short life working group is considering the question template for students. We recognise that this programme of
visiting will only allow for visits every 5 years and the more frequent links with placement areas detailed above will remain. A further
initiative, begun this year in collaboration with NES and the Scottish Deans group, is the development of the National Quality Panel - at
this meeting the RAG reports from all placements in Scotland were reviewed together with the purpose of identifying patterns across
institutions and across specialities, ensuring appropriate actions being taken where problems were identified as well as learning from
good practice across teams. The very few specialty concerns identified were fed to the relevant postgraduate lead.
University representation on subsequent quality visits (so PG, UG and GMC representation at these). Continued close monitoring of
student feedback through SCEF and staff student liaison committee meetings. We are aware that there have been significant
improvements in the culture and circumstances in both specialties. At our recent RoT workshop (new initiative) we had a presentation
and discussion from the general surgical RoT team on their new joined up approach (across UG / PG sector) for education. The
approach was greeted positively by their peers and viewed as good practice to be learned from by other specialities. We continue to
engage closely with both areas and this is an item on both Tutelage meetings and also the new NHSG medical and dental education
governance committee.
NHSG and UOA medical Education team to visit Obstetrics and Gynaecology to investigate further the reasons behind the high levels of
satisfaction and to promote any areas of good practice to other specialties.
Concerns ONLY Deadline for
resolution
(DD/MM/YY)
Concerns ONLY - Status
Person responsible
Engagement with
deanery, LETB or
other organisations
including healthcare
regulators (if any)
Supporting documents
Quality Handbook