Lancaster Medical School report 2013-14

Lancaster medical school final visit
report 2013–14
Lancaster University medical school
This visit is part of the GMC's remit to ensure medical schools are complying with the
standards and outcomes as set out in Tomorrow’s Doctors 2009. For more
information on these standards please see: Tomorrow's Doctor's (2009)
R eview at a glance
About the School
Medical school
Lancaster medical school
University
Lancaster University
Dates of visit
11 June 2014 (Lancaster medical school)
10 July 2014 (Year 3 objective structured clinical
exam [OSCE])
16 July 2014 (Year 2 exam board)
23 July 2014 (Year 3 exam board)
Programme investigated
MB ChB
Area explored
Quality management strategy: quality
management of the programme, general practice
(GP) placements, hospital and community
placements; curriculum development and
mapping to Tomorrow’s Doctors 2009;
development and QA of assessment items,
delivery of assessments, blueprinting and
standard setting; University Hospitals of
Morecambe Bay NHS Foundation Trust
(UHMBNFT) reconfiguration; contingency
planning and decoupling; Cumbria Partnership
NHS Foundation Trust (CPNFT) clinical
placements and involvement.
Number of students
268 (2013 Medical School Annual Return
[MSAR])
Number of LEPs
2 acute hospitals, 2 mental health trusts and 34
general practices
Local Education and Training Health Education North West
Board
Last GMC visit
2013 QIF North West of England regional review
Significant Patient safety or
Educational concerns
identified
None
Has further regulatory
action been requested via
the Responses to Concerns
process
No
Executive sum m ary
Sum m ary of key findings
1
Lancaster University has delivered an MB ChB programme in partnership with
the University of Liverpool since 2006. Students enrolled in this programme
have followed the Liverpool curriculum and currently graduate with a Liverpool
primary medical qualification (PMQ). However, a process is underway to
decouple the medical schools. Lancaster is developing its own curriculum and
taking over responsibility for managing its own processes. The students
entering Years 1, 2 and 3 in September 2014 are registered as Lancaster
students; and, if the GMC agrees to add Lancaster to the list of bodies who can
award PMQs, these students would be awarded a Lancaster degree upon
successful completion of the programme.
2
We have been visiting Lancaster and Liverpool since 2011 and will continue the
rolling cycle of annual quality assurance visits to Lancaster medical school (the
School) following the first cohort of students through to graduation and their
first year of practice. The School has made much progress since our last visit in
November 2013 and we were pleased to find that many of the previous
requirements and recommendations that we had set for the School have now
been met. We also identified a number of additional areas of good practice.
3
There remain a number of challenges and risks for the School that have been
explored during recent quality assurance activities and will continue to be a
keen focus over the coming year. Not least, the uncertainty surrounding the
reconfiguration of healthcare services in the area, and the breadth of clinical
experience therefore available to students, along with the ongoing concerns
about the School’s main local education provider, University Hospitals of
Morecambe Bay NHS Foundation Trust (UHMBNFT). The School considers its
main risk to be the recruitment of a suitable successor to the current head of
school. It is vital that all of these risks are effectively managed and mitigated to
ensure the long term success of the School.
Good practice
Tom orrow ’s Good practice
Doctor
Report
paragraph
paragraph
1
43, 48; 51;
83, 101
The involvement of the Cumbria Partnership
NHS Foundation Trust (CPNFT) in the
development and delivery of the programme.
25, 30, 4344
2
49,54; 85;
89-90 and
115
The use of technology, including the eAssessment system and tablet computers to
enhance the development and delivery of
assessments, including standard setting,
quality assurance of assessment items,
feedback to students and reasonable
adjustments.
15, 56, 73,
76, 79
3
39; 49, 54;
43, 48
The extent of the School’s responsiveness to
student evaluation with examples of
improvements being made in response.
14, 19-20,
27-29
Requirements
Tom orrow ’s Requirements
Doctor
paragraph
Report
paragraph
1
28a
The School must ensure students are
provided with written guidance so they are
clear which clinical procedures they are able
to perform when on clinical placements.
1
2
44
The School must formulate detailed plans to
address the two long standing open
requirements concerning the appointment of
a successor to the Head of School and
ensuring the clinical experience of students is
not compromised by the reconfiguration of
healthcare services in the area.
32
Recommendations
Tom orrow ’s Recommendation
Doctor
Report
paragraph
paragraph
1
51
In developing the quality management of
general practice placements, the School
should check the current Care Quality
Commission (CQC) status of the practices,
and link to postgraduate quality management
systems for the postgraduate training
practices where possible.
22
2
51
The School should make the quality markers
for general practices mandatory
requirements; this includes completion of
equality and diversity training by the GPs.
23
3
41, 50
The formal responsibility for approval of new
general practice placements should be
reviewed to ensure there is an appropriate
governance structure and transparent
delegated authority.
26
4
43, 48
The role of patients in the quality
management of the programme should be
clearly defined.
31
5
44
The School should review and update the risk
template to reflect how the risk level or score
33
has changed over time.
6
100
The School should review the prescribing and
therapeutics workshops to enhance the
learning opportunities.
47
The Report
Domain 1: Patient safety
26. The safety of patients and their care must not be put at risk by students'
duties, access to patients and supervision on placements or by the performance,
health or conduct of any individual student.
27. To ensure the future safety and care of patients, students who do not meet the
outcomes set out in Tomorrow's Doctors or are otherwise not fit to practise must
not be allowed to graduate with a medical degree.
Acting within competence (TD28a)
1. The School is partially meeting this standard. The Year 3 students confirmed they
have been able to take blood while on placements in obstetrics and gynaecology and
general practice, under close supervision. Despite this, they were uncertain whether
or not they are permitted to undertake this procedure, and they had heard that
there is a list of procedures assigned according to year of study but they had not
seen this yet. The students said the medical educators at UHMBNFT will allow
students to do venepuncture with supervision, but that the School has not been
clear whether this was permissible. See requirement 1.
2. The Year 5 students said they have never been asked to complete a task that
was outside their competence.
Systems in place to minimise harm to anyone taking part in training (TD30)
3. The School is meeting this standard. We met with representatives of CPNFT,
which provides placements in acute mental health for Year 3 and 4 students and
community care services for Year 2 students as well as a ‘selective in advanced
medical practice’ (SAMP) for students in Year 5. We heard that an information leaflet
is provided in units to inform patients that medical students are present and what
their role is. It was explained that nursing staff select the patients with whom it is
appropriate for the students to meet and the patients give consent.
4. CPNFT advised that students must complete one case for their logbook with a
patient who does not have capacity, and a foundation doctor supports the student in
doing this. At induction, students are informed of how to approach patients with
mental health problems including where to sit when meeting with a patient and
wearing an alarm. They are advised of the types of questions that some patients
may find distressing and what to do if this occurs. We heard that there is a protocol
in place for students to inform the nurse in charge if a patient discloses suicidal
thoughts or other information that suggests the patient is at risk. Students are also
informed what to do if they hear distressing information, such as reports of abuse or
symptoms of illness.
5. CPNFT confirmed they receive information about students from the School in
advance of the academic year. This includes student names, photos, special
circumstances, and any particular needs they must be aware of and accommodate.
Clinical supervision (TD31, 35)
6. The School is meeting these standards. The students we met from Year 3
confirmed they are supervised at all times on GP placements. They also told us there
are two community clinical teachers who they are able to contact. Students are
aware of a lead consultant at Furness General Hospital with a remit to work with
undergraduate medical students. Overall they feel well supervised.
7. CPNFT provides a half day induction for students at the beginning of their
placement (see also paragraph 4). We were informed by the Trust that students are
given clear instructions on how to end interviews if a patient becomes distressed,
and how to manage professional boundaries. Students are provided with an alarm to
carry when in clinical units. Home visits to patients are always undertaken with a
clinician from the Trust; never by a student alone.
UK Departments of Health guidance on accessing patients (TD32)
8. The School is meeting this standard. The Year 3 students had good awareness of
where to find further guidance and information. They told us that they are informed
about GMC guidelines at the beginning of the year and that they are signposted to
further policies and procedures, guidelines and local polices, with links available on
the Moodle system.
Identifying concerns about medical student conduct (TD28c)
9. The School is meeting this standard. CPNFT said its first point of contact for
concerns about students would be the Undergraduate Education Manager or the
Director of Medical Studies. We heard that potential concerns about students are
discussed, but they only knew of one occasion when a formal ‘concern’ form has
been completed. We heard that any concerns about performance or professionalism
are recorded in the students’ portfolios.
Fitness to practise (TD28d, 36, 37)
10. We believe the School is on track to meeting these standards. Over the past
year, Lancaster has taken over responsibility from Liverpool for running its fitness to
practise procedures. The first full fitness to practise panel was scheduled to run the
day following our visit in June 2014 and we will follow this up during future quality
assurance activities.
Raising concerns (TD28e)
11. The School is meeting this standard. We set a requirement for the School
following the November 2013 visit to ensure all students are aware of and able to
follow the process for raising patient safety concerns when on clinical placements.
The School and UHMBNFT have collaborated to produce two leaflets specifically for
students, one about raising patient safety concerns and whistleblowing and the
other about safeguarding. We viewed these leaflets shortly before the visit in June
2014. The students we met with were not yet familiar with these but were aware of
the appropriate ways to raise concerns. We heard from the School that it plans to
include these leaflets every year at induction. The School advised it has held further
discussions with students to make sure they know what to do if they have a
concern.
12. The Year 3 students were informed about whistleblowing at the beginning of the
year and said they are encouraged to raise concerns and given different routes by
which to do so. They told us about an example of a student raising a concern about
a problem they encountered at a care home, first discussing it with the teacher and
later with the Director of Community Studies. The Year 5 students clearly described
the process for raising a patient safety concern, which requires them to alert their
medical supervisor immediately, subsequently following up with the School
management if necessary. This requirement is now closed.
13. A significant event process is in place to deal with concerns arising in community
placements. We heard that a student had recently raised a concern, through a
community clinical teacher, about an incident. The teacher completed a significant
event incident form, this was sent to the Director of Community Studies who then
raised the concern with the practice involved. This was documented and reviewed by
the Learning and Teaching Committee and feedback was given to the student to
confirm action had been taken.
Domain 2: Quality assurance, review and evaluation
38. The quality of medical education programmes will be monitored, reviewed and
evaluated in a systematic way.
Quality management framework (TD39)
14. The School is meeting this standard. Following the November 2013 visit to the
School, we set a requirement to develop an overarching quality management
document, that sets out a clear framework or plan for how it organises quality
management and control including who is responsible for this. The document
‘Quality Management Framework for the MB ChB programme’ was provided in
advance of the visit. The document sets out clearly defined responsibilities and
reporting mechanisms, and the use of multiple sources of information. We note the
extent of student evaluation that is detailed in this document. This requirement is
now closed. See good practice 3.
Assessment of students (TD49, 54)
15. The School is meeting this standard. Since the last visit, we have received
monthly updates from the School about the development and quality control of
assessment items and papers. The School provided a demonstration of the Rogō
system that is used to create, quality control, and deliver online assessments. We
viewed the year 1 summative assessment paper 2. We viewed some example items,
including some ‘hotspot’ questions and could see that the quality control check is
recorded with the individual items in the system. A response to the quality control
check can also be recorded with the item. An audit trail in Rogō for the individual
assessment items records who completed the quality control check and when this
was done. See good practice 2.
16. A written assessment is mapped to learning objectives by question and each
learning objective often links to multiple questions. Once a written paper is
assembled it is made available to the external examiners to review online and submit
their reports. Internal quality control of the whole paper is also undertaken to make
sure there are no overlaps or over-assessment of particular modules.
17. The assessment team explained that the external examiners get a similar view of
the papers. There was initially an issue with the external examiners not being able to
view the hotspot images and this was worked around with PowerPoint slides being
provided to them. The issue has now been rectified.
18. An away day has been organised for September 2014 for assessment staff to
debrief and plan for the upcoming academic year. We heard the changes that have
been made to the OSCE for years 1 and 2 were based on learning from previous
quality activities. A further event is planned for the external examiners.
19. We heard about changes that have been made to assessments as a result of
student evaluation following the formative exams for Years 1, 2 and 3. For example,
although the exams are now completed electronically on Rogō, the students felt it
would be beneficial also to have a paper copy of the questions so they had the
option to read on the page instead of the screen. The Year 3 students told us the
onscreen assessment is not especially popular but they accept that electronic
assessments will become more common and were pleased that the School had
responded to their concerns by providing a paper copy.
20. The School also asked students to vote on whether they would prefer two
shorter papers, or one long paper for one of the examinations, with a narrow
majority favouring one long paper; therefore one long paper was set. See good
practice 3.
Clinical and vocational placements (TD51)
21. We are satisfied the School is meeting our standards in this area. Following the
last visit cycle, we set a requirement for the School to formalise and monitor the
quality management procedures for community placements, and to ensure the
outcomes of these are recorded and shared with the practices involved. We received
a report on the development of this system prior to our visit in June 2014, including
a summary of the visits that had been undertaken at this time and reports from the
individual practice visits. The system was presented at the School’s recent Learning
and Teaching Committee meeting. We note the good progress made in developing
the system. There is a visit schedule in place for the next three years, with flexibility
to allow practices to be reprioritised if necessary. 31 out of 34 practices have been
visited in the 12 months up to June 2014. The Director of Community Studies
currently undertakes the visits, but consideration is being given to training
Community Clinical Teachers to complete future visits.
22. A master spreadsheet captures key information about the 34 active practices,
with student evaluation, significant events and practice visits clearly shown.
Attendance at the Training in Practice course is recorded, although this is not yet
mandatory. It would be helpful to see that in the future this system checks the
current CQC status of the practice, and that it will permit liaison with postgraduate
GP training quality systems. See recommendation 1.
23. The Director of Community Studies informed us that they have worked with
Leeds medical school and Liverpool medical school to share good practice and to
develop quality markers for community placements. One further area of
development planned for the coming year is longitudinal analysis of student
evaluation of placements. Not all of the quality markers are currently mandatory
requirements for the practices; for example, completion of equality and diversity
training by the GPs is not. This should be reviewed. See recommendation 2.
24. A significant event process (see paragraphs 12 & 13) is in place to deal with
concerns arising in community placements. We heard that a student had recently
raised a concern, through a community clinical teacher, about an incident. The
teacher completed a significant event incident form, which was sent to the Director
of Community Studies who then raised the concern with the practice involved. This
was documented and reviewed by the Learning and Teaching Committee and
feedback was given to the student to confirm action had been taken.
25. We also discussed the quality management systems in place with CPNFT. We
heard the Trust has a very good relationship with the School, with key contacts
enabling concerns to be shared and resolved. The Trust receives evaluation on its
placements and has developed the student questionnaires to improve the extent of
the evaluation to identify areas for improvement. For example, ‘Did you get
information on arrival?’ has been expanded to ask whether it was the right
information and if there was anything further that the students needed. See good
practice 1.
Agreements with providers (TD41, 50)
26. The School is meeting these standards. However, we recommend the School
reviews the process for approving general practices. The Director of Community
Studies completes a new practice proforma and decides whether or not to approve a
new practice to teach students. The contract agreements make the requirements of
practices clear; nonetheless, the formal line of responsibility for approval does not
seem to be clearly defined at present and should be reviewed to ensure there is an
appropriate governance structure and transparent delegated authority. See
recommendation 3.
Student, Patient and Employer Involvement in Quality (TD43, 48)
Students
27. The School is meeting this standard. Online surveys capture students’ evaluation
of placements. The School reviews the data in order to identify any immediate
concerns. The information is collated and feeds into the quality management visits
and is shared with the relevant local education provider. The online student survey
system allows student evaluation to be easily collated. The completion of surveys is
not compulsory at present, but students are reminded of their professional
responsibility to do this. We heard that completion rates in Years 1 and 2 are high,
at around 80-90%, although this reduces in the later years.
28. The School told us about how student evaluation can lead to developments, for
example, positive student evaluation of dermatology clinic experience during a GP
placement led to the incorporation of this area into the Year 3 logbook for the
coming academic year.
29. The Year 3 students told us the school is receptive to their evaluation and
responds. A recent example was provided of an extension being given for an
assignment as it clashed with revision time. See good practice 3.
30. CPNFT informed us it completes an end of year report to evaluate delivery of the
curriculum and identify opportunities and areas for improvement. The report
includes information about induction, student evaluation of teaching, timetabling,
and the sign off of clinical experiences in student logbooks to assess how easily
students are able to complete the required cases. We heard that student evaluation
is generally positive. See good practice 1.
Patients
31. The School is partially meeting the standards for involvement of patients in
quality. We heard that patient satisfaction surveys are required in year 5 for GP
placements and also that there are plans to increase expert patient involvement in
community teaching. We have previously reported on the introduction of real patient
problem based learning (PBL) cases in year 3 of the curriculum. However, although
patient groups are represented at the School’s Board of Studies, the role of patients
in the quality management of the programme does not appear to have been clearly
defined. See recommendation 4.
Identifying and managing risks and concerns (TD44)
32. The School is not meeting our standards for identifying and managing risks and
concerns. While the key risks facing the School over the coming years have been
identified and recorded, the management and mitigation of these risks could be
more effective. We recognise that some of the risks arise from external factors; the
School does need to formulate more detailed plans to ensure these risks are
mitigated and, if necessary, contingency plans are in place. In particular, there
remain two open requirements that we set for the School following visits in 2012.
These relate to appointing a successor for the Head of School (see also paragraph
86); and ensuring the clinical experience of students is not compromised by the
reconfiguration of healthcare services in the area. Addressing these requirements is
crucial to ensuring the long term success of the medical school. See requirement 2.
33. The Faculty of Health and Medicine requires the School to review the risk register
twice per year. The School’s template, which is provided to the GMC, does not show
how the risk level or score has been adjusted over time and it would be helpful to
capture changes in this way. See recommendation 5.
34. Reconfiguration of healthcare services in the area has been under consideration
for some time and we heard that this is now moving forward, with the strategic
outline case submitted at the end of June 2014 and the business case due to be
completed by the end of August 2014. The Head of School advised the risk register
will be reviewed in light of this.
35. UHMBFT is the only acute trust currently providing core placements for Lancaster
students.
36. The day prior to the visit, it was announced that the Chair of UHMBFT had
resigned. The CQC visit report was published shortly after this. An interim Chair of
UHMBFT has been appointed. The media reported that the Medical Director of the
Trust had also announced his resignation; however, his appointment last year was
for a fixed term and the resignation will not take effect for another year. The Trust
plans to recruit a new medical director who will work alongside the current Medical
Director until this time. Nonetheless the CQC report is critical of the leadership and
notes a sense of disconnect between the front line staff and the executive board.
37. UHMBFT is under enhanced monitoring by the GMC, with ongoing concerns
about postgraduate medical education at Furness General Hospital, especially in
emergency medicine, obstetrics and gynaecology and paediatrics. There is also a
public inquiry into the deaths of mothers and babies at the hospital, as well as an
ongoing criminal investigation in relation to the same.
38. The CQC report was published on 26 June 2014 and subsequently the Trust has
been placed in special measures. The School informed us it does not have concerns
about its undergraduate placements at Furness General Hospital and the students
we met did not inform us of any patient safety concerns. Nonetheless, we are
concerned about the potential impact this report could have on organisational
stability in view of the reconfiguration agenda and will continue to monitor this
closely over the coming year.
Domain 3: Equality, diversity and opportunity
56. Undergraduate medical education must be fair and based on principles of
equality.
Local education provider commitment to equality and diversity (TD69)
39. The School is partially meeting our standards in this area. CPNFT informed us
that equality and diversity training is mandatory within the Trust and a separate
course is also completed for those with an educational role that is monitored by the
Medical Education Facilitator. See also paragraph 23 and recommendation 2;
regarding the quality management of general practices.
Domain 5: Design and delivery of the curriculum, including assessment
81. The curriculum must be designed, delivered and assessed to ensure that
graduates demonstrate all the 'outcomes for graduates' specified in Tomorrow's
Doctors.
Student selected components (TD94-99)
40. The School is meeting this standard. We viewed a sample of the Year 2 student
selected module reports, and noted the quality of work produced by the students,
including a good range of contemporary topics and primary research as well as
literature review. The external examiners at the Year 2 exam board also commented
on the overall high standard of the work. See also paragraphs 57 & 58 for
information about marking and feedback.
Curriculum design and structure (TD83, 101)
41. The School is meeting this standard and has continued to develop its curriculum.
This year it has delivered a revised Year 1 as well as some further developments and
minor changes for Years 2, 3 and 5. The revised curriculum for Years 2 and 3 has
been planned and will be delivered in the 2014/15 academic year. Changes to Year 5
include a new lead for the patient safety programme and a management and
leadership week, which included the involvement of the Chief Executive of Health
Education England. Changes to Year 4 are expected to be implemented in 2015/16.
42. Student involvement in the curriculum review has included focus groups for each
year group. In addition, all student evaluations have been used to feed into the
reviews for each year.
43. Changes have been made to the Year 3 women and child health block including
additional involvement of CPNFT, with some community based paediatrics, as well as
obstetrics and gynaecology. There are further potential opportunities for clinical
placements with the introduction of a community based eating disorders service.
44. CPNFT told us of its involvement in a full review of the mental health aspects of
the programme, which is currently nearing completion. Previously, it was felt that
cover across the five years was patchy, and the revisions will introduce spiral
elements to the curriculum. The Trust is not part of the core curriculum group but is
included in a sub-group specifically looking at mental health. See good practice 1.
45. Another area that is being evaluated is the inclusion of some longitudinal cases in
order that students can see a full patient journey. During four to five months in
general practice, students will follow approximately four patients long term. There
are no current plans to implement this further until it can be shown to enhance the
learning experience.
Balance of learning opportunities (TD100)
46. The School is meeting the standards for ensuring a balance of learning
opportunities. Extra-curricular debates have been introduced to support student
learning about ethics and law. We heard that students were asked to suggest ethical
issues they were concerned about. One such debate was held on discharge against
medical advice.
47. The Year 3 students told us their sexual health teaching is very good, but the
prescribing and therapeutics workshops are less helpful and would be improved by
greater structure. For example, they felt the inclusion of foundation doctors in
learning how to complete prescriptions would be beneficial. See recommendation 6.
Clinical Placements and Experience (TD84)
48. We remain concerned about the breadth of experience the students gain from
their clinical placements and will continue to monitor this in light of the potential
impact of reconfiguration. The Year 3 students expressed concerns about the
learning opportunities in a number of specialities.
49. The Year 3 students told us the paediatric units at both Royal Lancaster Infirmary
and Furness General Hospital are small and the cases seen during the seven week
attachment are limited in both range and volume. Complex cases presenting at
Furness General Hospital tend to be transferred to Royal Lancaster Infirmary. The
students told us they have problems completing the required cases in their
logbooks; and on some occasions had to complete a theoretical case based
discussion with a consultant as they had not seen a relevant case.
50. The Year 3 students reported that they had some concerns about the breadth of
their clinical experience to date but the Year 5 students were more positive and
reported feeling well prepared to begin the foundation programme. However, they
said there is limited exposure to cardiology, neurology and renal medicine and would
welcome additional opportunities in these specialties and are aware that the School
continues to explore possibilities with other local education providers. During the
next cycle of visits we will focus our quality assurance activity to enable a conclusion
to be drawn as to whether or not there is sufficient breadth of clinical experience.
51. CPNFT told us of possible opportunities to extend student experience in some of
the specialist community services such as end of life/palliative care and neurology.
There are ongoing changes to the high level leadership and strategic planning for
the Trust; however, they do not consider there to be any risks to education
opportunities for students. Likewise, CPNFT is not aware of any risks posed by the
reconfiguration of acute services to its own services and therefore the placements it
provides the School. The Year 3 students told us they were aware of reorganisation
within the Trust but had not been directly affected by it. Nonetheless, CPNFT has
kept them informed of changes and has seemed to manage it smoothly. The
students were positive about their placements with CPNFT.
52. The School has made some progress in agreeing further placements with
Blackpool Teaching Hospitals NHS Trust, with further SAMPs to be offered in
cardiothoracic surgery for Year 5 in 2014/15, following positive student evaluation
this year; and also some placements included during the Year 3 women and child
health block.
Mandatory clinical placements (TD106)
53. As described in paragraph 34 it is expected that acute care services will be
reconfigured, with details to be set out in a business case in August 2014. The
School maintains there is no problem with the range of experience delivered to its
students at present. We must establish clearly whether we agree that this is the
case, and we will continue to monitor developments closely to ensure each student
receives sufficient experience including in all of the mandatory specialties.
54. We heard that of the current Year 5 cohort, seven of the 54 students were
planning to complete their foundation training at UHMBNFT, based at Royal
Lancaster Infirmary rather than Furness General Hospital, with 63% staying in the
North West region for foundation training (44% in North Western and 19% in
Mersey). The School has set up a formal study by a postgraduate student to look at
the reasons behind the choice of where to complete the foundation programme with
Year 5 students and foundation doctors. The Year 3 and 5 students we met told us
they would probably not choose to complete foundation training at UHMBNFT, and,
although the reasons for this varied, we were told by several that they wish to have
a broader range of experience, or particular specialist experience in another local
education provider. The Year 5 students told us they would not be against returning
to UHMBNFT for core or specialist training.
55. The School thinks the options for foundation training in the area have improved
this year as the track has changed to allow the doctors to complete both years at
either the Royal Lancaster Infirmary or Furness General Hospital rather than rotating
as in previous years. The Head of School sits on a working group at UHMBNFT to
look at increasing the number of foundation doctors training in the Trust.
Feedback to students on their performance (TD85)
56. The School is meeting this standard. We previously set a recommendation for the
School to give students more detailed feedback on the formative OSCE and this has
been enabled via the use of tablet computers and the development of detailed
feedback sheet for each station. Year 3 students told us this has been the best year
so far in terms of feedback on assessments, in particular the very detailed feedback
provided on the formative OSCE. All students who fail the formative OSCE receive
individual feedback in person from a clinical skills assessor. Rogō provides individual
feedback sheets to students on their written exams, with scores on topics rather
than individual questions. This recommendation is now closed. See good practice 2.
Identification of strengths and weaknesses (TD111)
57. The School is meeting this standard. A new assessment mark sheet has been
introduced for the student selected modules. This includes an overall percentage
mark that is based on the university’s marking system. The assessment lead told us
that so far, the evidence suggests the new mark sheet is clearer and fairer. Prior to
the Year 2 and Year 3 exam boards we viewed a sample of SSM reports and results,
including the convenor and second marker feedback sheets. We noted a difference
in the quality and consistency of the feedback, with the new mark sheet and
descriptors appearing to provide greater clarity in marking and reduced variability in
feedback.
58. Although assessor feedback provided with the new mark sheet was generally
good, it was not of a consistent standard and there were some examples of very
brief, general feedback, which was also highlighted by the external examiners. The
exam board acknowledged the inconsistency and outlined plans to improve this. The
final Liverpool student selected modules have now been delivered, so going forward
all student selected modules will be Lancaster’s own. Consequently, the consistency
might improve as the assessors become more familiar with the mark sheet and
further training is provided.
Fitness for purpose of assessments (TD86)
59. The School is partially meeting this standard and we note the significant progress
and improvement made since the 2012/13 visit cycle, when we set a requirement for
the School to provide regular monitoring and reporting of its progress in this area.
We have closely monitored the development of assessment items and papers, and
were pleased to find that all the milestones and plans were met.
60. We heard that the current assessment lead is working on the psychometrics of
the assessments; in particular, she is looking at improvements to individual
questions where necessary.
61. This year, the School has delivered electronic assessments through Rogō for
Years 1 and 2. The development and delivery of the Year 3 papers has been shared
with Liverpool, with each school producing a written paper.
62. We heard of contingency plans in place to manage risks of delivering electronic
assessments. The School notifies University’s information security department of the
dates and times of exams so it can avoid restarting the systems during this time. A
member of the team checks in advance that all the computers to be used for
assessment have had updates run.
63. The Cronbach’s Alpha 1 reliability scores for the assessments for both year 2 and
year 3 were below 0.7 in five of the seven assessments. The School’s information
states that a score in the range 0.7-0.9 is good. We will continue to monitor
progress in assessment development, including reliability, over the next cycle of
quality assurance activities.
Assessment of Tomorrow's Doctors outcomes including practical procedures (TD112)
64. The School is partially meeting this standard. We raised a requirement following
the November 2013 visit for the School to ensure the contingency plans for the
decoupling from Liverpool University medical school continue to be feasible; and we
required that the Lancaster curriculum be mapped to the new Liverpool curriculum
to ensure no students are placed at a disadvantage for assessments. Both Schools
have signed the variation of the consortium agreement. Liverpool is preparing to roll
out a new curriculum and Lancaster confirmed it has received an overview of the
timetable for the five years of the programme, but is awaiting the learning
outcomes.
65. Lancaster has documented all changes to its curriculum and has mapped it
against Tomorrow’s Doctors 2009. Lancaster advised it is awaiting Liverpool to do
the same and it will then be able to map the curriculum to the new Liverpool
curriculum. The Director of Medical Studies is confident any gaps would be identified
and remediated if necessary so that students would not be disadvantaged if they
had to undertake Liverpool assessments. We will continue to monitor developments
over the next cycle of visits.
66. We set a requirement for the School following the 2012/13 visit cycle to ‘provide
an assessment blueprint that shows in detail how the assessments used map against
the individual objectives rather than higher level themes. This should show sampling
strategy and define how validity will be demonstrated and how a reliable result will
be arrived at’. Blueprints for written assessments have been provided as well as a
clinical skills map for Years 1-5.
Design and delivery of assessments (TD113)
67. The School is meeting our standards in this area. This year, the School had
planned to run its own Year 3 OSCE for the first time, using a combination of
existing Liverpool stations and some new stations it had developed itself. However,
Liverpool made changes to the Year 3 OSCE following a review in the months
preceding the assessment. Lancaster were informed of this late in the planning cycle
and after consideration it concluded that it had to run the new Liverpool OSCE in its
1
Cronbach’s Alpha is the most commonly measured aspect of reliability of a test, checking for internal
consistency. The closer to 1.0, the more reliable the assessment.
entirety, to ensure equivalence as current Year 3 students have dual registration and
will receive a Liverpool degree upon graduation. We were very concerned that, only
four weeks before the OSCE, Lancaster had not yet received full details of the new
OSCE and could not assure us that the assessment would be fit for purpose.
68. The students felt anxious about the changes. We fed back our concerns to the
School on the day, and subsequently held a conference call with the Heads of School
for Lancaster and Liverpool, to discuss the work needed to ensure that the Year 3
OSCE would be fit for purpose. We requested and received additional documents
and assurances from both Schools that the information and paperwork required to
deliver the OSCE had been completed and shared. We attended and observed the
OSCE and the exam board at Lancaster. Despite the late changes, the OSCE was
well organised and well run by Lancaster and there did not appear to be an impact
on the day. Nonetheless, the Cronbach’s alpha reliability score for the OSCE was
only 0.53. From next year, Lancaster will be running its own Year 3 OSCE rather
than using Liverpool’s so such a situation with late changes should not reoccur.
69. Some of the OSCE stations we observed could be improved; in particular, we felt
the ‘headache’ station could include an element of probable diagnosis following the
consultation with the patient. The School’s report on the OSCE showed that similar
feedback was given by one of the examiners as there was no assessment of global
diagnosis in the mark scheme for this station.
70. We also heard from the Year 3 students about a switch to a Liverpool Year 3
written paper, including unexpected assessment item format types (extended
matching items). We were informed this would also include some content which the
students had previously been informed would not be included (Individuals, Groups,
and Society). Following our visit the School confirmed it had provided the students
with a copy of the formative exam items that were taken by the Liverpool students.
71. We heard an example of a perceived inconsistency from the formative Year 3
OSCE, in which one student reported having been marked down in one station for
re-sheathing a needle, but another student received the opposite feedback for the
same station, and was marked down for failing to do so. At the Year 3 OSCE we
observed the examiners behaving appropriately and keeping to their brief. The
simulated patients used were of a high standard and were consistent in following the
instructions.
Guidance about assessments (TD87)
72. The School is meeting this standard with students being provided with
comprehensive information about each element of their assessments, which we
viewed prior to the Year 2 and Year 3 exam boards. As a result of the School having
to run the Liverpool OSCE for Year 3, and the need to ensure equivalence with
Liverpool, these students were provided with prior information about the stations
that would be appearing. We consider that having this prior knowledge may result in
students focussing on one skill to the detriment of the development of others and
could significantly reduce the value of sampling across skills in OSCEs. The external
examiner also commented on the negative impacts of providing station information
ahead of the assessment, and the School confirmed at the exam board that there
are no plans to provide such information for any future OSCEs.
Assessment criteria and marking guidance (TD115)
73. The School is meeting this standard. At the Year 3 OSCE we observed an
appropriately informative briefing for the examiners prior to the assessment. The
assessment lead advised that all assessors have completed training to support
marking the OSCEs with tablet computers. The examiners we met with on the day
were positive about the use of the tablets and we observed how detailed individual
feedback and notes were recorded for each individual student at each station.
Although there were no issues with the tablets on the day, risks associated with use
of technology have been well managed. This includes having paper mark sheets
available as back up, chargers for the tablets at each station as well as spare tablet
computers and a central charge station. See good practice 2.
74. This year the School introduced a professional practice, values and ethics (PPVE)
case analysis for Year 3. Students are required to identify and write about an ethical
dilemma witnessed on a clinical placement and apply ethical theories to this. We
viewed a sample of the work along with the mark sheets and feedback. Each case
was marked by a pair of assessors – one academic and one clinician. There was a
variation in the scores awarded by the first and second markers, with the final mark
being an average of the two, unless there was a difference of 10 marks or more, in
which case the assessors would meet to discuss each section. The external
examiners also noted this variation and the School advised that feedback has been
provided to all of the assessors and some examples of good quality feedback have
been produced to support their training. The descriptors are being reviewed with the
aim of bringing them in line with the quality of the students selected module mark
sheets.
Standard setting (TD89)
75. The School is meeting this standard. As we have previously heard, the School
uses Modified Angoff to standard set the written exams. Borderline regression is
used to standard set the Year 1 and 2 OSCEs and for the majority of Year 3 OSCE
stations this year. For 2013/14, responsibility for the Year 3 assessments was shared
with Liverpool and so the common elements (the OSCE and one of the written
papers) were jointly standard set. An external examiner, who is also an external for
Liverpool, considered that there was equivalence between the two schools.
76. A webpage is available for students to provide evaluation of the assessments.
Statistics from Rogō support the standard setting meetings. Individual questions are
discussed and student evaluation is also considered. We observed during both exam
boards the good extent to which the analysis of the results and the evaluation was
deliberated. The exam board discussed and agreed decisions to remove particular
questions and in one case changed the standard setting method for an OSCE station
that did not perform as expected. See good practice 2.
External examiners (TD116)
77. The School is meeting this standard and has appointed all of the external
examiners it currently requires. External examiners attend all of the exam boards.
We heard that a one day meeting with all external examiners was held in January
2014, which the School considered useful and allowed discussion of the curriculum.
At the Year 2 and Year 3 exam boards, we observed that the external examiners
were appropriately involved in the process, and the insightful feedback they
provided was clearly valued by the School. The School welcomed the advice offered
by the external examiners about how it might change its processes in future.
QAA Code of Practice (TD119)
78. The School is meeting this standard. We previously set a requirement for the
School to provide anonymised documentation at the Year 5 final exam board, as,
when we observed the exam board during the 2012/13 visit cycle, documentation
provided to the members of the exam board displayed student names. The School
has assured us that all summary documentation provided at the meeting is now fully
anonymised and so individual students cannot be identified. We observed that all
documentation at the Year 2 and Year 3 exam boards was anonymised. This
requirement is now closed.
Reasonable adjustments (TD90)
79. The School is meeting this standard. We heard that Rogō allows changes to be
made for individual students as required, for example, the font size, type and colour
can all be adapted to meet individual students’ needs. The system retains the
changes so that each time a student undertakes an assessment the appearance is
automatically changed for them. See good practice 2.
Domain 6: Support and development of students, teachers and local
faculty
122. Students must receive both academic and general guidance and support,
including when they are not progressing well or otherwise causing concern.
Everyone teaching or supporting students must themselves be supported, trained
and appraised.
Guidance about the curriculum (TD123)
80. The School is meeting the standard for providing guidance on the curriculum.
The curriculum lead explained that each cohort receives a lecture about the
upcoming curriculum, which includes an opportunity for questions and answers as
well as a ‘You said, we did’ briefing. All of the changes are detailed at the lecture as
well as on Moodle. The student parliament continues, with two meetings per year.
The students confirmed the student parliaments are well run and that changes are
implemented as a result.
81. CPNFT provides a half-day induction on the first day of each placement. The
students are oriented to the unit and introduced to key staff. They also talk about
risk management and safety for themselves and patients. Students receive a
timetable to attend particular aspects of the service and the mid-point review with
the medical education facilitator provides an opportunity to change the timetable if
needed. Feedback sessions are also held with the students at the end of the
placements.
Academic and pastoral support (TD124)
82. The School is meeting this standard. We heard of improvements to pastoral
support for students completing placements at Furness General Hospital. There is
now a flat provided, so that if a student is feeling unwell or for other reasons is
unable to travel, they can stay at the flat if needed. The students were clear whom
in the School or local education provider they can contact for support when required.
83. As on previous visits, the students we met told us they like the School and feel
the small size is beneficial in many ways. In particular, they feel they get more
contact time with senior staff at the School as well as clinicians, and they know
individual students well. They also know the other year cohorts and are able to help
each other. Overall the students would recommend studying at the School and those
in Year 5 had no doubt students in the earlier years of the programme would be
getting a good experience based on their evaluation and the changes implemented
by the School.
Training the trainers (TD148)
84. The School is meeting this standard. CPNFT representatives informed us that
most of those involved in undergraduate teaching are also trainers for foundation
and other doctors in training. They told us they are kept up to date with changes to
the curriculum, meet with the Head of School once a year and also receive regular
emails from School. Attendance at the Training in Practices and Education day
events for general practices is now tracked via the quality assurance master
spreadsheet.
Domain 7: Management of teaching, learning and assessment
150. Education must be planned and managed using processes which show who is
responsible for each process or stage.
Management plan (TD151)
85. The School is currently meeting this standard. Professor Neil Johnson has been
appointed as the new faculty dean and took up post officially from 1 August 2014.
Professor Johnson is currently Pro-Dean of Education at the Warwick Medical School
and a General Practitioner. There have been no other significant changes to the
staffing and leadership at the School.
86. The School continues to search for a replacement for the Head of School, who
plans to retire in the coming years. There is an open requirement for the School to
ensure that there is clarity and action around succession planning to ensure the
future expert leadership and management of education strategy, development and
delivery required to establish an independent medical school. We will continue to
monitor this closely and recognise that the School perceives this as its major risk.
See paragraph 32 and requirement 2.
Teacher involvement in curriculum management (TD152)
87. The School is partially meeting this standard. We previously reported on the
dissociation of Furness General Hospital from Royal Lancaster Infirmary and the
School, and recommended consideration be given to the use of alternative means of
inclusion such as using video conference facilities to maintain relationships across
sites and with the School. We heard that video conferencing was discussed and
trialled but did not receive positive feedback, probably as the School’s system did
not have good compatibility with the NHS system. The CQC report published on 26
June makes reference to the ‘cultural disparity between the hospital sites’ and found
that ‘staff felt that they were not always listened to and that Trust’s Executive Team
needed to be more visible’. We will follow this up during the next cycle of quality
assurance visits.
88. The School informed us that an anaesthetist based at Furness General Hospital
has been appointed as the deputy lead for Year 5. The School also delivered an
education day at both Furness General Hospital and Royal Lancaster Infirmary this
year.
89. CPNFT said it has a good relationship with the School and participate in student
selection and admission, PBL, as well as assessments including the LOCAS (Liverpool
Objective Clinical Assessment System) and OSCEs. We heard the Furness General
Hospital is keen to continue to build a strong partnership with the School.
Agreements with local education providers about curriculum delivery (TD157)
90. The School is meeting this standard. CPNFT told us that like many other local
education providers, job planning for consultants’ educational roles is imperfect and
historically reliant upon good will. It is currently in the process of drawing up
educational agreements with all undergraduate and postgraduate trainers. This will
form part of the appraisal and job planning process. There is a separate educational
appraisal completed for those with educational roles in the Trust.
Domain 8: Educational resources and capacity
159. The educational facilities and infrastructure must be appropriate to deliver the
curriculum.
Clinical skills facilities (TD166)
91. The School is partially meeting this standard and there have been positive
developments with plans agreed for new clinical skills laboratories and an improved
location for the OSCEs. During 2014/15 a temporary improved location for the
OSCEs will be provided at Royal Lancaster Infirmary, with a new purpose built facility
on site at the hospital expected to be completed in time for the 2016/17
assessments.
92. This is a very positive development, as the current OSCE location at Queen
Victoria Hospital is not fit for purpose. The venue is small and there is noise pollution
between the stations, for example, there was a mental health station curtained off
on the corridor that received some ambient noise.
Appendix 1:
Visit team
Dates of visits
11 June 2014 (Lancaster medical school)
10 July 2014 (Year 3 OSCE)
16 July 2014 (Year 2 exam board)
23 July 2014 (Year 3 exam board)
Team Leader
Professor Paul O’Neill
Visitor
Dr Steve Ball
Visitor
Mrs Sue Hobbs
Visitor
Dr Matt Kirkman
Visitor
Dr Will Owen
GMC Staff
Trish Steele, Jennifer Barron and Emily Saldanha
Appendix 2: Document register
Document
number
Document
name
Description
Publication
date and
version
Source
Dec 13 doc
1
Monthly
assessment
update
December
2013
Update on
progress in
developing,
quality
assuring and
delivering
assessments
December
2013
Lancaster Medical
School
Feb 14 doc
1
Monthly
assessment
update
February
2014
As above
February
2014
Lancaster Medical
School
Mar 14 doc
1
Monthly
assessment
update March
As above
March 2014
Lancaster Medical
School
2014
Apr 14 doc 1 Monthly
assessment
update April
2014
As above
April 2014
Lancaster Medical
School
May 14 doc
1
Monthly
assessment
update May
2014
As above
May 2014
Lancaster Medical
School
May 14 doc
1a
Safeguarding
leaflet
Guidance for
students on
their
responsibilities
and reporting
procedures for
safeguarding
issues
May 2014
Lancaster Medical
School/ UHMBNFT
May 14 doc
1b
Patient Safety Guidance for
leaflet
students on
procedures for
raising
concerns
about patient
safety and
whistleblowing
May 2014
Lancaster Medical
School/ UHMBNFT
May 14 doc
2
Current risk
register
School’s risk
register
May 2014
Lancaster Medical
School
May 14 doc
3
Minutes of
decoupling
meeting - 6
February
2014
Minutes of
meeting with
Liverpool
medical school
May 2014
Lancaster Medical
School
May 14 doc
4a
GP placement
Quality
Assurance
Policy
Quality
assurance for
community
and primary
care
placements at
Lancaster
Version 3.0
Lancaster Medical
School
May 2014
Medical School
May 14 doc
4b
GP placement Update report
Quality
Assurance
update for
2013-14
May 2014
Lancaster Medical
School
May 14 doc
4c
GP placement Quality
Assurance
master
spreadsheet
May 2014
Lancaster Medical
School
May 14 doc
4d
GP placement Reports from
QA visit
individual QA
reports
visits to
general
practices
May 2014
Lancaster Medical
School
May 14 doc
5a
Quality
Management
Framework
Quality
Management
Framework for
the MB ChB
programme
May 2014
Lancaster Medical
School
May 14 doc
5b
QM
Framework
Appendix 1
-
May 2014
Lancaster Medical
School
May 14 doc
5c
QM
Framework
Appendix 2
-
May 2014
Lancaster Medical
School
May 14 doc
6
Summary of
the
placements
provided by
Cumbria
Partnership
NHS
Foundation
Trust
-
May 2014
Lancaster Medical
School
June 14 doc
1a-b
Emails from
UHMBNFT to
2 x Emails
regarding
changes to
11 June 2014
Lancaster Medical
School
the School
leadership at
the local
education
provider
June 14 doc
2
Learning
objectives for
Year 1
formative
paper one
Example of the 11 June 2014
learning
objectives
sampled by a
specific paper
Lancaster Medical
School
June 14 doc
3
Minutes of
the
decoupling
meeting 2
June 2014
Minutes from
the sixth joint
decoupling
meeting
between
Liverpool and
Lancaster
medical
schools
2 June 2014
Lancaster Medical
School
June 14 doc
4
Year 1-5
clinical skills
map
Mapping of
clinical skills
against TD09
outcomes
showing when
assessed
May 2014
Lancaster Medical
School
June 14 doc
5
Year 3
Assessment
Including
presentation
slides, copies
of emails and
information
relating to the
individuals,
groups and
societies
element of the
Liverpool
formative
exams
June 2014
Lancaster Medical
School
Outline of
information
provided to
June 2014
Liverpool Medical
School
Summary of
information
sent to
students
June 14 doc
6
Responses to
queries
the GMC
following
conference call
on 15 June
2014
June 14 doc
7
Year 3
general
examiner
briefing
Slides from the Summer
Year 3 OSCE
2014
examiner
briefing
Liverpool Medical
School
June 14 doc
8
Changes to
the format of
the Year 3
OSCE
Details and
June 2014
background of
the changes to
the 2014 OSCE
Liverpool Medical
School
June 14 doc
9
Email to
students
Copy of email
to students
outlining
changes to the
OSCE
June 2014
Liverpool Medical
School
June 14 doc
10
Genetics
station
Documentation June 2014
about the
genetics
station
including old
and new
weightings,
mark sheets
and
instructions to
illustrate the
changes to the
OSCE
Liverpool Medical
School
June 14 doc
11
Psychosis
station
Documentation June 2014
about the
psychosis
station
including old
and new
weightings,
mark sheets
and
Liverpool Medical
School
instructions to
illustrate the
changes to the
OSCE
June 14 doc
12
Comment
sheets
Sample of
examiner
comment
sheets from
other
summative
OSCEs 2014
May/June
2014
Liverpool Medical
School
June 14 doc
13
Student
briefing video
Video viewed
by students
before the
OSCE
Summer
2014
Liverpool Medical
School
June 14 doc
14
Year 3 14
complete preOSCE
information
PowerPoint
presentation
provided to
students
ahead of the
summative
OSCE
Summer
2014
Liverpool Medical
School
June 14 doc
15
Year 3 Global
descriptors
for OSCE
performance
descriptors for
standards
expected of a
third year
medical
student
Summer
2014
Liverpool Medical
School
July 14 doc
1
Examiner
brief Year 3
summative
2014
Presentation
slides from
OSCE
examiner
briefing
July 2014
Lancaster Medical
School
July 14 doc
2
OSCE map
3rd year
Summative
map 1314
FINAL
July 2014
Lancaster Medical
School
July 14 doc
3
OSCE info for
students
y3s 14
complete pre-
July 2014
Lancaster Medical
School
OSCE
information
Lancaster
version
July 14 doc
4
Global
descriptors
year 3 Global
Descriptors for
OSCE
performance
July 2014
Lancaster Medical
School
July 14 doc
5
Examiner info
Year 2 exam
board
paperwork
July 2014
Lancaster Medical
School
July 14 doc
6
Student
briefing
Student brief
Year 3
Summative
OSCE
July 2014
July 2014
Lancaster Medical
School
a) Agenda
b) Results for
board
c) Year 2
standard
setting report
2013-14
d) Year 2
summative
exams 201314 feedback
for students
e) Year 2
summative
OSCE report
f) Year 2 exam
board report
paper 3 2014
g)Year 2
summative
exams
reliability
a) Agenda
b) Results for
board
c) Year 3
standard
setting report
July 2014
Lancaster Medical
School
July 2014
Lancaster Medical
School
July 14 doc
7a-g
July 14 doc
8a-h
Year 3 exam
board
paperwork
2013-14
d) PPVE Case
Analysis
Coursework
Summative
Exam Board
2014
e) Reliability
statistics
f) Year 3
Summative
OSCE Report
2014
g) Year 3
Summative
Exams:
Student
Feedback
h) Year 3
Summative
Exams:
Reliability
Appendix 3: Abbreviations
CPNFT
Cumbria Partnership NHS Foundation Trust
CQC
Care Quality Commission
GMC
General Medical Council
GP
General practice/practitioner
LEP
local education provider
LOCAS
Liverpool Objective Clinical Assessment System
MB ChB
Bachelor of Medicine and Surgery
MSAR
Medical school annual return
NHS
National Health Service
OSCE
objective structured clinical examination*
PMQ
Primary medical qualification
PPVE
professional practice, values and ethics
QIF
Quality Improvement Framework
QAA
Quality Assurance Agency
SAMP
selective in advanced medical practice
UHMBNFT
University Hospitals of Morecambe Bay NHS Foundation Trust
*See glossary (in appendix 4) for definition.
Appendix 4: Glossary
OSCE
A type of examination to test clinical skill performance and
competence in skills such as communication, clinical examination,
medical procedures or prescription, exercise prescription, joint
mobilisation or manipulation techniques, radiographic positioning,
radiographic image evaluation and interpretation of results.
Rogō
University of Nottingham e-Assessment system that is used to
create, quality control, and deliver online assessments.
Moodle
Virtual learning environment. A tool used by staff to add resources
for students to access online to enhance teaching and learning
efforts.
Lancaster Medical School
Response to GMC final visit report 2013-4
We were pleased to receive this report and to note that the visiting team have considered we have
made much progress since their visit in November 2013 and that they have identified a number of
additional areas of good practice.
Response to requirements
•
The School must ensure students are provided with written guidance so they are clear which
clinical procedures they are able to perform when on clinical placements.
We had already recognised that this was an area of ambiguity for students as well as for the
clinical teachers and had been working on a document to make this clearer. This document
is now complete, has been through the committees of the Medical School and is already
incorporated into the appropriate year log books for all students from the beginning of this
academic year. The information is also on the Trust Intranet and has been disseminated to
all GP practices who take our students.
The document is appended to this response.
•
The School must formulate detailed plans to address the two long standing open
requirements concerning the appointment of a successor to the Head of School and ensuring
the clinical experience of students is not compromised by the reconfiguration of healthcare
services in the area.
The post of replacement Head of the Medical School is about to be re-advertised
We understand that there are two areas of concern regarding our clinical placements
a) that our students have expressed concerns about whether or not they are exposed to a
sufficient breadth of clinical experience (paras 48-50)
b) concerns around the local Acute Trust as identified by CQC and the GMC (paras 36-38)
Furthermore we recognise that these two areas of concern could potentially be worsened by
the Trust’s plans for reconfiguration of their clinical services.
However we also consider that reconfiguration as proposed by UHMB Trust may well offer
significant opportunities for providing a curriculum that is reflective of future models of
healthcare delivery rather than old models.
As regards the first area of concern, we are confident that our students do receive sound
clinical experience. This confidence is based on the evidence that we have now graduated
four cohorts who have gone on to fill Foundation posts across the country and the anecdotal
reports we receive from both our graduates and their employing Trusts is that they are well
prepared for their role as Foundation doctors. In addition, the feedback we have from HENW
is that, while the numbers are small, our students have a lower incidence of ‘doctors in
difficulty’ than average
As regards the second area, we are confident our students receive a good educational
experience at the Trust as evidenced by the feedback we monitor from their placements and
by their performance in the exams which they sit jointly with Liverpool students and in
which they perform comparably.
Nonetheless, we recognise the importance of mitigating the concerns raised by the visiting
team and are currently working on
•
•
•
•
developing plans with other local Acute Trusts for our students to undertake specialised
placements
working with UHMBFT, and other Trusts involved with them in the plans for new patterns of
service delivery in Cumbria and North Lancashire, so that as they develop, our students will
be able to experience these new models of care provision
maintaining a very close working relationship with the local health economy so that the
clinical placements are not affected by changes in service provision and that changes in
service provision are reflected in the curriculum
monitoring the situation through our regular meetings of the Curriculum Co-ordination
Group, student feedback and the School Learning and Teaching Committee. Should there be
any evidence from our monitoring, or from any other quality monitoring processes, that our
students are being affected by the situation in the Trust, the we will develop, as a matter of
urgency, contingency arrangements to deal with this.

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