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2014 Medical School Annual Return (MSAR)

The Quality Lead is the nominated person within each medical school who will be our point of contact for this MSAR with us. If necessary, please include additional details of anyone who should receive feedback and other communications regarding the MSAR. Senior Managers signing off on behalf of the Medical School are responsible for assuring thequality and accuracy of the return. We work with the Medical Schools Council (MSC) in a number of policy areas and so will share information such as student profile and progression from your responses with them to support our work.

We take our responsibilities under the Data Protection Act very seriously; any data you provide will be stored securely and confidentially. Please note that we are subject to the Freedom of Information Act 2000. If we receive a request, we may be required to disclose any information you provide to us unless a relevant exemption applies. We do not intend to publish the full MSAR returns from schools; however, we may publish selected information.

There have been a number of revisions made to the 2014 MSAR in order to make it as easy as possible to complete. These alterations are described below:

The total number of questions has reduced from 26 to 20. Whilst some have been removed or combined, there are also some new questions. We have highlighted the question numbers, theme and domains below.

Question 5 – Domain 2 – Independent reviews of student complaints

Question 10- Domain 3 -Exit arrangements for students

Questions12&13 - Domain 5 - Prescribing Safety Assessment (PSA) and

Medical Schools Council Assessment Alliance

Question 20–Additional question - Feedback on the Undergraduate

Progression Reports which are due to be published at the end of September 2014.

We have added three new fields to the MSAR Excel template ‘Section C 3 – SFtP’. These changes focus on professionalism and Student Fitness to Practice concerns.We appreciate that this data may not be accessible to all schools for this year’s return, and so are optional in 2014, but will be mandatory from 2015:

For any professionalism or SFtP concern, please provide the Entry Method of that student.

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For any professionalism or SFtP concern, please provide the Location of Qualification Attainment of that student.

If there is a professionalism or SFtP concern relating specifically to ‘Health’, please advise whether the concern relates to either ‘Adverse Physical Health’ or ‘Adverse mental Health’.

As in previous years, we request that you provide details of all low level professionalism concerns that have reached stages A – B of the process; and also all cases student fitness to practise cases reaching stages C – D of the process.

The deadline for this MSAR is 31st December 2014.

We want to make completing the MSAR as easy as possible, so if you need any help with completing this return, feel free to contact Nathan Brown or another member of the quality team on quality@gmc-uk.org or 020 7189 5221.

MSAR 2014 – Section A

Domain 1 – Patient safety

Question 1: We have initiated a project with the MSC to review the guidance for Medical students: Professional values and fitness to practise. As part of this we will be asking you, at another time, to outline your processes for dealing with health and conduct related issues. We have therefore replaced the question related to professionalism, as recommended by the medical school Quality Leads, with a question on the systems your school has in place to monitor low level concerns.

1. Do you have a process in place for monitoring low level conduct or health concerns?

☒Yes

☐No

If yes, please provide details of the processes you have in place, and if No, please provide details of the alternative measures you have in the box below:

The Professionalism Concerns Group (PCG) is responsible for the monitoring of and improvement of the professionalism of any student whose unprofessional behaviour is giving cause for concern. The primary role of the Professionalism Concerns Group is to help unprofessional students improve their professionalism. The group has external and lay representation.

Students are referred to the Professionalism Support Group by the PCG. This group provides structured remediation and educational programmes.

Question 2:Paragraph 35 of Tomorrow’s Doctors 2009 (TD09) stresses the significance of student clinical supervision with regard to patient safety. We would like to know about the nature of these issues, how you address them, subsequent evaluation or monitoring in place and current status. This information will enable us to cross-reference with information we hold about postgraduate training delivered in the same LEPs and highlight areas of potential concern.

2. 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?

Please use the D1- Q2sheet in the annex (Excel).

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Domain 2 - Quality assurance, review and evaluation

When responding to questions relating to good practice, please refer to the definition which can be found in the Quality Improvement Framework (QIF)on Page 27: ‘Good practice includes areas of strength, good ideas and innovation in medical education and training. Good practice should include exceptional examples which have potential for wider dissemination and development, or a new approach to dealing with a problem from which other partners might learn. The sharing of good practice has a vital role in driving improvement, particularly in challenging circumstances.’

Question 3: Paragraph 41 of TD09 states that medical schools will have systems to monitor the quality of teaching and facilities on placements.We use your responses to thisquestion to build links between evidence gathered from undergraduate education with postgraduate training and education.

3. We would like to know:

a. The list of quality management visits you have undertaken in the 2013/14 academic year

b. Details of any concerns or areas of good practice identified during these visits. Please also provide us with the actions which you have taken to address concerns or promote good practice

Please use the D2- Q3 sheet in the annex (Excel format).

Question 4: We particularly want to hear of any instances of good practice. Please detail the relevant TD09 domain when giving examples. If you would like to be considered as a case study which is shared with others, please check the box at the end of the question.

4. Please tell us about any innovations you are piloting or potential areas of good practice in the box below.

Domain Examples of Good Practice

Patient Safety

Enhanced liaison between the Medical School and University Hospitals NHS Trust concerning education for patient safety.The medical school now sits within the newly formed group, Education to Improve Patient Safety (EIPS) within UHL. This has ensured several developments namely:

Access for medical students from September 2014 to the UHL free phone line 3636 for the reporting of patient safety concerns. The anonymous phone line is continuously open and recordings are read every 24 hours. This mechanism will be analysed over the next coming academic year to assess medical

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Domain Examples of Good Practice

student uptake. Agreement between the Trust and the medical school

concerning a framework for medical students writing in patient records endorsed with an agreed paper on content.

On-going developments to engage medical students within UHL on Quality Improvement projects- several units and wards have hosted medical students on these project in August 2014.

A conference on patient safety in which pedagogic research projects were shared.

Burton Hospitals NHS Foundation Trust The medical students receive feedback from standardised patients who discuss the impact of their communication and relate this to patient safety. The facilitator discusses team working, leadership and escalation of care and offers points for further reflection.

Peterborough & Stamford Hospitals NHS Foundation Trust All placements receive a student induction book from MDE. In addition different departments and specialist nurses circulate newsletters and information sheets. The BaSIS document is a good overview of patient safety for doctors in training. We signpost the students to the documents on the intranet.

Within specialties students are encouraged to attend mortality/morbidity case review meetings as a valuable learning opportunity. On the wards they will have the opportunity to interact with Ward-based Pharmacists and junior doctors to develop good prescribing habits.

United Lincolnshire Hospital NHS Trust Staff are made aware that undergraduate blocks are in progress and students are identified by their university ID cards. Students are allocated Educational Supervisors and mentors who provide a high degree of clinical supervision.

The staff in clinics have been made fully aware that we have medical students and the limitations of what the medical students can do. The nurses also ensure that they keep an eye on the students to ensure that patient safety is not compromised. Staff are aware they should contact the supervising consultant or the students’ module lead if they have any concerns. A copy of the guidelines on patient and personal safety that are in the students’ handbook will be placed on the undergraduate area of the hospital Intranet under Guidelines. This is available to all staff in the Trust.

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Domain Examples of Good Practice

Quality The Medical School have developed a Tomorrow’s Doctors’ Quality Assurance Register, which documents key systems and process in place, to support the achievement of TD standards. Kettering General Hospital NHS Trust Regular feedback is received from LMS and is reviewed by [information redacted]. Information is discussed with the trusts [information redacted], and module specific feedback is sent to each module lead.

Burton Hospitals NHS Foundation Trust Burton Medical Student Teaching Working Group: Group established to centralise the co-ordination of undergraduate teaching within the trust. Please see the enclosed minutes from the last meeting

Leicestershire Partnership NHS Trust Regular review meeting during each block between leads and educators. Leads and educators also, communicate regularly with service managers and ward managers to ensure parity of experiences and quality assurance.

We organised a one-day educational conference with a specific focus on quality assurance of medical education at LPT in December 2013. The emphasis was on undergraduate medical education and general principles of medical teaching. The conference was attended by over 80 clinicians and was endorsed by [information redacted]. It was also well-supported by [information redacted].

The outcome of the conference was a report that has been incorporated into the current Medical Education Strategy. This report was circulated to all delegates.

Following the success of the focus group of 2013, we are considering carrying out further focus group activities to address any further quality assurance issues. A brief quality document is currently in draft form for mental health.

Equality Kettering General Hospital NHS Trust Every member of staff requires re-certification 3 yearly. As such the trust employs an Equality & Diversity Lead and provides on line, work-book and class room delivered courses. Staff completion records are held centrally and reported monthly to Line Managers and overall compliance reviewed at Trust Board.

Curriculum Developments in teaching in response to student, tutor or national influences. Kettering General Hospital NHS Trust Open Forum meeting held once every two weeks. This is to ensure medical students have an opportunity to discuss any progress or difficulties they may be facing and to offer support.

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Domain Examples of Good Practice

E-Newsletter has been published directed at Medical Students and junior doctors to facilitate more integration and involvement around the process of learning.

Burton Hospitals NHS Foundation Trust A high fidelity ward simulation has been developed and implemented following overwhelming requests for this modality of teaching. Currently this is in place for the cardiorespiratory and GI blocks who are given the opportunity to manage relevant acutely ill patients in a realistic setting. We are starting simulation training for the O&G medical students.

Leicestershire Partnership NHS Trust Expanded the range of service users utilised for IPE events as a result of student feedback. As a team, we have also created an innovative medical education app regarding ADHD to further supplement our teaching on this topic. As incoming students from 2016 will all have iPads given to them via the University, we felt that this would be an ideal way to carry out student directed learning as per University and national guidelines.

United Lincolnshire Hospital NHS Trust This Trust employs Clinical Teaching Fellows (CTFs) to assist with the delivery of medical education. We currently have 2 at Pilgrim Hospital and 3 at Lincoln County. All our CTFs are sponsored through a Master’s Degree in Medical Education at the University of Nottingham. They provide a valuable service to our students as they are based in the education centres and able to provide both pastoral and educational support. The also organise clinical skills teaching for students on any block or module who wish to hone their skills.

Our Clinical Fellows are currently working on the following projects as part of their Masters’ degree in Medical Education:

Implementing a new style of teaching and learning where PBL is

used and there are Case Based Discussions of real life clinical

cases.

One of our Clinical Fellows [information redacted] has

launched the PREPARE4FY1 youtube channel with high quality

clinical examination videos. Not only does it push our students

to excel (both the students on placement as well as other

students that follow) it is also a way of highlighting good

practise here in Lincolnshire.

Support and Development

Kettering General Hospital NHS Trust Simulation training workshops were arranged with HEEM attended by consultants and clinical skills staff and resuscitation team. Work is in

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Domain Examples of Good Practice

progress with medical school for staff development and training. Locally work is in progress to identify and implement training courses.

Burton Hospitals NHS Foundation Trust The development and implementation of a ‘Learning to Teach’ course aimed at FY1 doctors who regularly teach the medical students. This is a series of six 1 hour lectures covering Learning Styles, Small Group Teaching, How to Teach a Practical Skill, Assessment and How to Give Feedback. The sessions have been quite positively received and they have been shown to enhance the ability of the Foundation Doctor to teach medical students. We are hoping that the University of Leicester will support us in issuing a certificate for the Foundation Doctor as evidence that they have had an introduction to formal training in teaching.

The simulation trainers have a rolling programme of educational objectives to contribute to high quality service delivery.

United Lincolnshire Hospital NHS Trust The Trust is committed to providing the opportunity for those involved in medical education to complete training to improve and enhance their teaching ability.

The Trust held the last in a series of 4 ‘Teach the Teacher’ courses in January 2014 aimed at all doctors who have educational roles. Under the auspices of the LETC a half-day conference is planned for 1 December 2014 to discuss providing high quality education in Lincolnshire and sharing good practice. All medical staff who teach students are encouraged to enrol and complete the University of Nottingham’s on-line teaching, learning and assessment training for medical educators.

If you would like your school to be considered as a case study, please check the following box: ☐

Question 5:To supplement our information on students’ perspectives,we would find it helpful to understand the issues being considered through independent review of student complaints by the Office of the Independent Adjudicator (England and Wales), the Scottish Public Services Ombudsman or the Visitorial scheme (Northern Ireland). This will help us and the MSC to develop our relationship with the independent adjudicator bodies.

4. During 2013-14 was your medical school subject to investigations into student complaints by the OIA, the Scottish Public Services Ombudsman or Visitorial scheme in Northern Ireland?

☐ Yes

☐ No

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If yes, please provide details of the issues related without identifying the individuals involved in the box below:

[Information redacted]

Domain 3 - Equality, diversity and opportunity

Question 6:It is important for medical schools to meet the equality and diversity requirements set out within Domain 3 ofTD09. Examples of how this is captured include analysis of admissions and student profile, progression, academic appeals, and fitness to practise data.

6a. Please briefly tell us how in the academic year 2013/14 you used evidence to monitor how you are meeting the equality and diversity requirements set out in Domain 3 of TD09.

The strategy for analysis of equality and diversity by gender, ethnicity disability and other characteristics is being planned. This is being overseen by [information redacted] who will use a range of appropriate statistical methods and hypotheses to establish that equality and diversity requirements are being satisfied. This includes a proper consideration of how students are admitted using UK demographics as the reference to analyse the application and admission process.

This will be used to determine how closely student profile meets ideal requirements. With this initial profile as baseline student performance and progression can be

analysed and statistical inference providing objective support.

Academic appeals and fitness to practice data will be expected to produce lower numbers from which to return statistics from. The appropriate statistical methods will be employed on these data sets.

A written report will be produced to accompany and explain statistical evidence.

6b. Please tell us the biggest challenges you face in promoting fairness and equality in medical education and training.

Brief details of challenges

The biggest challenge is in increasing awareness of genuine fairness and equality amongst students and their constituent groups. In some natural groupings, a predominantly masculine ethos persists. This ethos can be associated with an implicit and sometimes explicit resistance to recognising and accepting that other groups deserve equality of opportunity in pursuing a medical career.

In particular there is evidence of some negative attitudes to women being treated as equals which leads to restriction of educational and training opportunity. This needs to be appropriately, and where necessary, robustly challenged.

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Question 7:This Guidanceon Supporting medical students with mental health conditionswas published in July 2013. We would like to measure its impact and yougave us feedback that case studies would be the most effective way of sharing the learning and experiences of different medical schools. We will build these into an anonymised set of case studies for your reference.

7. Please provide a brief case study outlining the management and support of a student with a mental health condition. Please highlight any changes in the management of students as a consequence of implementation of the GMC guidance: managing students with mental health conditions. If you do not have a suitable case study, please tick the box below:

[Information redacted]

☐No case study available

Question 8:Three areas were highlighted by our review of health and disability in medical education and training, and we want to build a picture of current arrangements for each and identify practice to share among all schools. We are particularly interested to hear about instances where there is an identifiable individual who students can contact for advice.

8. You only need to complete this question if you have made changes since the 2013 MSAR.

If so, please let us know how your students can access the following and give brief details of what they consist of.Please include links to relevant information if helpful.

If no changes have been made, please leave blank.

a. Careers advice in relation to those with disabilities

Students who may require reasonable adjustments during postgraduate medical training and/or individual and tailored career advice are identified through occupational health assessment, through the personal tutor system or medical school student support unit at any point during the MB ChB course and can be referred to the named lead for student support/career development. Students are also able to contact this individual for advice and support directly.

b. Occupational health services

Students can access Occupational Health in a number of ways:

- They can self-refer, either at the beginning of the course when they meet the OH nurses during induction, or at any other time later in the course

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- They can be referred by their GP - They can be referred by a clinician within the Medical School should it be

deemed necessary for either medical reasons or in the case of conduct concern; in order to ascertain whether they require any reasonable adjustments on the course, or, in some cases, to assess whether they are medically fit to continue on the course or to be a doctor.

Students are encouraged to be proactive in looking after their health and to access

help via their GP or Occupational Health as soon as they perceive that there is a

problem.

[Information redacted]

c. Advice on reasonable adjustments and support in making sure they are implemented once agreed, including when on placements.

Students with disabilities are supported centrally by the University of Leicester AccessAbility Centre, part of the Student Support Service.

Students are introduced to the AccessAbility Centre during Induction week at the start of the course. The AccessAbility Centre advises the Department of adjustments required and students are advised to seek advice from [information redacted]. Contact details for [information redacted] are available in the course handbook. The principles for the support of students with disabilities are described in a podcast available via the VLE. Written guidance on how students should request Alternative Examination Arrangements is available via the VLE. A database recording adjustments made is maintained, and cases are reviewed as required and no less frequently than annually.

Adjustments to placements made for reasons of disability are made on a case-by-case basis by consultation with the Phase 2 Lead.

Question 9: Following our work on health and disability in medical education and training during 2012-14, we are continuing to monitor practice on reasonable adjustments to share good practice and identify any areas of difficulty across medical schools.

9. Please tell us about adjustments relating to the 2013/14 academic year only:

a. Any new reasonable adjustments you made which you had not made before.

b. Any requests for reasonable adjustments that you turned down and why.

c. Any cases where a student was withdrawn from the course on the grounds that they would be unable to meet the outcomes required for graduation due to disability.

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Criteria Brief details of new reasonable adjustment

a. n/a

b. [Information redacted]

c. n/a

Question 10:We are aware that a small number of students are unable to continue their studies due to health, academic or conduct reasons. We wish to better understand and share practice on the exit arrangements and awards that are in place for such students.

10. Please briefly describe the exit arrangements and awards you have in place for students who are unable to continue to study medicine. We are particularly interested in arrangements and awards for students who make it as far as:

a. Year 3 b. Year 4 c. Year 5 (if applicable) d. Year 6 (if applicable)

Year Exit arrangements and awards

a. Year 3 If the student passes the Phase I examinations – the Preliminary Professional Examination – which take place at the end of the Semester 1 in Year 3, they are entitled to the award of a Bachelor of Medical Science (BMedSci), an unclassified degree, in the event that they are unable to continue their studies beyond that point and if they wish to accept it.

b. Year 4 If a student fails the Year 4 examinations – the Intermediate Professional Examination – or are otherwise unable to continue their studies, they are entitled to the award of the BMedSci, if they wish to accept it.

c. Year 5 (if applicable) If a student fails the Year 5 examinations – the Final Professional Examination – or are otherwise unable to continue their studies, they are entitled to the award of the BMedSci, if they wish to accept it.

d. Year 6 (if applicable)

n/a

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Domain 4 - Student selection

Question 11: Each year we ask you to check and update the flow charts showing, at a high level, the admissions processes you use at your school.

11. You will find the flowcharts you submitted for the 2013/2014 academic year in the Excel annex – D4 – Q11.

Please let us know of any changes to your process for student selection to any of your programmes by updating the excel worksheet and ticking the box below indicating if changes have been made.

☒Our student selection processes have changed

☐No change

Please update the D4- Q11sheet in the annex (Excel).

Domain 5 - Design and delivery of curriculum including assessment

Question 12: In order to develop a comprehensive and authoritative picture of implementation of and support for the Prescribing Safety Assessment (PSA) we would like information from each school to complement information available through GMC membership of the PSA Stakeholder Group.

12. a) Does your medical school require that its final year medical students take the Prescribing Safety Assessment (PSA)?

☒ Yes

☐ No

12. b) If so, is the PSA used formatively or is success required in order to graduate?

☒ Used formatively

☐ Success required to graduate

12. c) Please summarise the school’s position and intentions with regard to the PSA.

To continue with the expectation that final year students take the PSA at or around the time of the final examination in march. We have no plans currently to make it a summative assessment.

Question 13: The MSC Assessment Alliance is researching the equivalence of standards in finals through a project that involves medical schools using questions (‘Common Content’) from its item bank.

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To enable us to develop a comprehensive and authoritative picture of support for the MSCAA Common Content project we would like information from each school to complement information available through MSCAA.

13. Is your medical school using Common Content in finals as part of the MSC Assessment Alliance project on equivalence? Please summarise the school’s position and intentions with regard to Common Content

☒ Yes

☐ No

If yes, please provide details of the issues related without identifying the individuals involved in the box below:

Yes we will be using the common content as part of finals in March 2015.

We introduced a single-best answer exam across all year groups in 2014. Last year’s final year group also had a pilot SBA exam component as part of their IPE (penultimate year examination) so the structure was not new to them.

We are currently working hard to create a database of high quality questions. For the IPE and final exams, each question goes through an editing group before it is used in the examinations. Last year we also used some questions from the MSC Assessment Alliance database to compare their performance data with our own questions.

We are intending to continue using common content questions. If the number of common content questions increases in future years, we may need to increase the overall number of SBA questions used in the IPE and finals examinations or use some of the common content questions in the IPE examination (which is deemed to be finals standard for the content covered).

Question 14:Paragraph 81 of TD09 states that the curriculum must be designed, delivered and assessed to ensure that graduates demonstrate all the ‘outcomes for graduates’. In order to mitigate the risks of schools not meeting the standards in TD09, we gather early indications of any changes which you have or plan to make. We use this to assure our standards are met and to provide you with additional support if necessary.

14. Please use the box below to inform us of any changes that you have made within the school regarding processes, curricula and assessment systems to comply with TD09 or address issues raised by postgraduate bodies or employers since the previous MSAR.

Changes made Driver(s) for changes

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Changes made Driver(s) for changes There were no curricular changes made in 2013-14 specifically to comply with TD09 or address issues raised by post-graduate bodies or employers.

Any changes made in the curriculum in 2013-14 were part of routine / continual curriculum review and development.

If you have any documentation relating to the changes you have stated above, please comment/attach the information in the box below:

Domain 7 - Management of teaching, learning and assessment

Question 15:Only complete if you have responded positively to Q. 14

Your response to this question will help us to understand how schools assess, monitor and mitigate risks associated with new curricula and curricular change. We hope to share effective practice in this area.

15. We would like to know if you have risk assessment strategies for the introduction/implementation of new curricula and curricular change. It will be helpful if some practical examples are included in your response.

This is not a curricular change.

The changes to standard setting bring us in line with internationally agreed methods so risk assessment not necessary prior to implementing changes.

Single best answer assessment risk assessment carried out prior to implementation and managed by:

Pilot SBA exam for IPE 2013 with psychometric data reviewed

Exam questions used from national MSC-AA bank with historical psychometric data for comparison with locally generated questions. Short answer question paper (used historically with good reliability) used alongside SBA examination. Good acceptance of SBA examination from student feedback (from IPE and FPE years)

An extensive examiner training programme was developed and run to ensure that all examiners were familiar with the new marking strategy. The vast majority of this was completed as face-to-face training with a small minority of doctors completing an online training package if they could not get to one of the 20 dates for face-to-face training.

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Domain 6 - Support and development of students, teachers and the local faculty

Question 16: Paragraph 125 of TD09 states that students will have access to career advice and opportunities to explore different careers in medicine. We would like to know how you inform students of career opportunities across specialties, especially those with particular recruitment challenges. It would be helpful if practical examples can be provided with evidence such as evaluation of initiatives. Your response may enable us to develop further work in this area and share practice across schools.

16. How are students made aware of career opportunities across the full range of specialties including those with particular recruitment challenges?

Career Management and Guidance is a Personal & Professional Development vertical theme strand delivered through all years of the MB ChB course in partnership with a University Career Development Medicine-specific project manager and with advice and support from the East Midlands LETB Career Development team. Students receive lectures, web-based resources and complete-career related tasks from year 1 onwards; initially focusing on career diversity in medicine, career planning skills through workshops and small group activities linked to leadership & management and later, opportunities to experience a range of “taster” specialties during SSC s and guidance on recruitment processes and application to the UK Foundation programme. Leicester Medical School has informed students of opportunities in specialties with recruitment challenges as follows: A “career development” SSC in 4th year offers a choice of 3-week opportunities for students to experience a wide ranges of medical specialties in more depth with support and mentoring from a consultant in that specialty. Choices include small specialties, which students may not have experienced during their core placements and “difficult to recruit” specialties. The undergraduate psychiatry education team support an annual East Midlands psychiatry Summer School open to Undergraduates and Foundation doctors. The Psychiatry Education leads offer a regular programme of psychiatry-related film screenings for students at a local independent arts centre followed by a discussion group led by a psychiatrist to stimulate interest in the specialty. General practitioners act as role models, educators and mentors throughout the MB ChB course. Students are exposed to general practice from week 1, through the “Living with Long Tem Conditions” programme. Students have early contact with GP educators through communication skills development. Feedback from the general practice –based 7-week clinical methods course is consistently positive. Students state that the course has positively influenced their career choice towards general practice. Student led career societies and an annual Careers Fair are used to promote a wide range of specialities through invited speaker presentations.

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Domain 9 – Outcomes

Question 17:Please raise any issues you would like us to consideraround the outcomes and practical procedures currently in TD09. Your input is essential to ensure

that medical school perspectives and knowledge are reflected and to demonstrate an open and inclusive approach to the review.

17. Does the medical school have any concerns about, or suggestions for amendments to, the GMC’s outcomes for graduates (TD09, paragraphs 7-23) or practical procedures (TD09, Appendix 1)?

Please set out these concerns and suggestions and explain the background to them, giving any evidence available.

Question 18: In the outcomes for graduates in TD09 we require that they are able to provide appropriate healthcare and understand health inequalities (paragraphs 10d, 11b, 13a, 14a and 20d). Information from medical schools about current arrangements will help us to review the outcomes for graduates in TD09.

18. How does the curriculum address providing appropriate healthcare and understanding health inequalities, particularly relating to people from lower socioeconomic backgrounds, lesbian gay bisexual or transgender people, and people with learning disabilities?

Socioeconomic background

What does the curriculum say?

Special Study Module: Project LIGHT (Leicester Initiative Good Health Team)

This learning is offered in Phase I and Phase II as a special study module

Intended Learning Outcomes Demonstrate an awareness of homelessness and

the statutory and non-statutory responses Demonstrate the appropriate level of clinical

competence relating to minor illness and injury relevant to the homeless sector

Describe the presentation and management of chronic health conditions

Describe common mental health problems experienced by homeless people

Demonstrate knowledge and appreciation of the drug and alcohol problems within this population for both acute and chronic presentations

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Describe common approaches to manage substance abuse

Demonstrate abilities and competence in basic life support

Develop awareness and appropriate response skills for working in difficult and challenging situations

Explain relevant ethical and legal principles for working within LIGHT and working with homeless people

Evaluate effective health promotion interventions

Evaluate your limitations including personal anxieties of clinical uncertainty for working with challenging populations.

How is this assessed? The summative assessment consists of two parts; i) a reflective essay concerning the student experience of learning about and working with homeless people in a range of placements, and ii) OSCE examination testing their knowledge and skills in assessing the needs of homeless people, using simulators (4 stations).

Please give examples of any challenges

Students ask for more placements within the homeless sector. These are important for their learning but the number of students who can access these placements bodes against increasing capacity above cohorts of n=25, at the moment. The students particularly enjoy time spent with young offenders in the prisons, who have been homeless and also, working with those being supported back to independent living within a city voluntary sector provider.

Please give examples of any initiatives

This work is a partnership between the medical school and a city voluntary sector provider which has led to student volunteering to help homeless people within an initiative called project LIGHT (Leicester Initiative Good Health Team). Students were encouraged to establish this project because they linked with students doing student clinics in Canada. Students run project LIGHT as a charity.

This learning was presented this year at ASME by [information redacted] who took part in 2010 and who went onto publish a paper on the work (see below). The participation in this module prepares them for this work:

[Information redacted]

http://informahealthcare.com/doi/abs/10.3109/13561820.2014.

944258

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Socioeconomic background

What does the curriculum say?

Health in the Community: Interprofessional Learning

Intended Learning Outcomes (competencies)

Following your learning, the competences you should be

able to demonstrate are:

Knowledge

Analyse how health inequalities relate to the different inner city populations in Leicester

Analyse service provision and the quality of local

models of partnership working aimed at

addressing inequalities in health and social care

Analyse the central role of the patient/service

user and carers within interprofessional team

working

Describe the range and roles of professionals

working to meet the health and social care needs

of individuals and the local population

Apply your theoretical knowledge, from science

and social sciences, to the patient/service user

context.

Skills

Complete a holistic patient/service user or user centred assessment/history

Demonstrate effective communication and team

working throughout and within the student team

Analyse, debate and discuss your experiences to

produce group outcomes.

Attitudes

Demonstrate professionalism and interprofessionalism

Engage positively in the process of collaborative

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practice with the wide range of agencies you will

meet.

Medical students engage in experiential practice-based learning which directly relates to prior classroom-based learning on health inequalities, delivered by the health psychologists. In this module they work with patients being cared for in their homes who live in the most disadvantaged areas of the city. The students meet and analyse a case chosen because of the complexity of comorbidities often including biopsychosocial issues. The learning is completed interprofessionally which adds to the value as student together consider the interprofessional solutions to address patient need.

How is this assessed? Students complete a written reflective essay on their patient which is marked as a ‘Formative’ assessment. The work is included within the student portfolio of professional practice and is part of their longitudinal theme of learning relating to team working and interprofessional practice. In addition questions from this learning appear in the end of phase I professionalism examination.

Please give examples of any challenges

The timing in the course has been revised and this has not always been to the agreement of the students. Moving the course has also caused many problems for the interprofessional arrangements we have established making access for some student difficult.

Please give examples of any initiatives

The results of pedagogic research into this course have resulted in many publications over the years but this is a recent output:

[Information redacted]

Socioeconomic background

What does the curriculum say?

HaDSoc Unit Learning Outcomes include: Describe the relationship between health and variables

including social class, ethnicity and gender in Britain today.

Describe and evaluate some explanations for health inequalities.

Describe and evaluate evidence on inequities in access to healthcare.

How is this assessed? This material is introduced in a lecture and then further explored in a small group teaching session. This material is

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included in formative and summative exam papers.

Please give examples of any challenges

Some students have problematic perceptions of people from lower socio-economic groups – particularly in relation to their likely intelligence level. In addition, some students find assessing the likely explanations for socio-economic health inequalities difficult – focusing solely on financial ability to use healthcare services rather than appreciating how socio-economic disadvantage may cause health problems in the first place.

Please give examples of any initiatives

We are extremely lucky to have a guest lecture each year from [information redacted] a leading expert in providing health services for homeless people. [Information redacted] talk is always extremely well-received by the students.

LGBT

What does the curriculum say?

HP&HD Unit Learning outcomes: LGBT health

Explain how experiences of discrimination can lead to poorer health for LGBT patients

Define and give examples of heterosexism Give examples of how stereotypes about LGBT

patients can affect their healthcare Describe the specific health needs that are

prevalent in the LGBT community

Explain the ethical and legal requirement of doctors in providing good care for LGBT patients

How is this assessed? In summative exams, against the above learning outcomes

Please give examples of any challenges

Student attitudes – some see it as a non-issue which is a barrier to engaging with reflection on issues; others hold strong personal/religious beliefs that make this a challenge. The main message for this second group is around giving good care to all regardless of personal beliefs

Please give examples of any initiatives

Lecture from diversity trainer

Learning disabilities

What does the curriculum say?

HP&HD Learning outcomes: Disability (LD is not a specific focus but included in two small group sessions, also

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touched upon in lecture on communicating with children.)

Identify definitions of disability and their implications

Describe barriers for people with disabilities in accessing healthcare

Give examples of good practice in communicating well with patients in situations where there may be barriers

How is this assessed? LD issues not specifically assessed although may come up in summative exams

Please give examples of any challenges

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Please give examples of any initiatives

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Question 19:Paragraph 14J of TD09, whichcovers the doctor as a practitionerand includes outcome requirements on the diagnosis and management of clinical presentations, requires that students must:

Contribute to the care of patients and their families at the end of life, including management of symptoms, practical issues of law and certification, and effective communication and team working.

The care of dying people is an important issue, and it is key that students are prepared effectively. We would like to knowhow you have reflected on and made changes as a result of the Leadership alliance on the Care of Dying People report.

19. How does your school teach students how to best handle the issue of the care of dying people?

Phase 1

HP&HD unit includes learning outcomes related to this issue (this should be seen as just an introduction to the issues, and is covered in lecture material):

• Describe diversity in patterns of dying

• Describe the 5 stage grief model of adjusting to the idea of dying

• Explain the potential positive and negative implications of denial, in coming to terms with a diagnosis of terminal illness

• Describe ‘symptoms’ that are often experienced following bereavement

• Identify the risk factors for chronic grief following bereavement

• Describe the aims of palliative care

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• Explain why it is important to tell patients when there is bad news

• Explain the implications for patients if bad news is not delivered well

• Describe ‘blocking behaviours’ in breaking bad news

Describe each step in the ‘SPIKES’ model of breaking bad news, with examples of good practice for each step

Phase 2

Palliative medicine makes up a significant component of the cancer care block and includes 2 full days of teaching at LOROS, the local hospice.

Breaking bad news and symptom control are addressed on the first day.

The second day focuses on EOLC and the role of the FY1 in providing this. The students are asked to identify what skills, knowledge, attitudes and beliefs they perceive impact on whether they would feel equipped to fulfil this role.

The main components of teaching include;

A BBC DVD following the journey for a patient with advanced cancer that elects to die at home. Discussion regarding the challenges of this and the impact on the patient, their family and health care professionals follows the DVD.

An interactive seminar on how to recognise that a patient may be dying, the importance of communicating this with the family and the patient and the benefits of anticipatory prescribing.

The principles of using both the Amber care bundle and an end of life pathway such as the LCP are shared. Subsequent discussion focuses on the benefits and potential downfalls of such an approach for to patient care.

A further session is based on the GMC guidelines regarding withholding and withdrawing treatment, including IV fluids and DNA-CPR. The role of MCA, ADRTs, LPAs and advanced care planning in general are also covered. Discussion regarding ethical challenges such as euthanasia, assisted dying and the doctrine of double effect are encouraged.

In facilitated small group sessions the students explore the experiences of recently bereaved carers, regarding their husband/wives cancer journey, how the diagnosis was shared, their perceived involvement in choice of treatment, advanced care planning and their experience of EOLC. Subsequent discussion is used to draw out the importance of treating patients with dignity and respect during all stages of their illness, including end of life.

Death certification is covered elsewhere in the course, but is often revisited during the small group clinical teaching which takes place at the hospice on an additional morning.

Throughout the palliative medicine teaching the students are encouraged to reflect upon the impact of doctors’ actions on patients, including the challenge of maintaining realistic hope. Communication is emphasized as key in providing high

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quality care and effective team working. In keeping with one of the key messages inLeadership alliance on the Care of Dying People report, emphasis is placed on considering each patient as an individual and tailoring their care accordingly.

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Additional question

Question 20:In autumn 2014 we will be publishing reports around Medical School Progression Data and we have asked you to update us through the MSAR on how you have used this new information to improve your understanding of and make improvements to the quality of training. We would like to work with schools on case studies to be published in spring 2015.

20. Please provide information on how you have used the new reportsto understand or improve the quality of training or highlight any other points of interest in relation to the data.

Leicester Medical School intends to introduce a new curriculum in September 2016.

This provides us with an opportunity to review the full pattern of clinical training from Year 1 through to graduation. The progression data, together with many other sources of information will be included in the planning process. We have chosen to look at clinical training as a whole. A detailed programme will be submitted to our University in the summer of 2015 and will be shared with our GMC representatives. We will liaise with the GMC over the next few months to seek comments and feedback (and have already discussed the process).

At this stage we do not have a strategy linked only to progression data.

If you would like your school to be considered as a case study for our 2015

publication, please check the following box:☐

Thank you for completing the questions for the 2014/15 MSAR. The deadline for this return is the 31st December 2014; please ensure you have completed each of the following:

☐Section A (Word) – MSAR qualitative questions.

☐Annex to Section A (Excel) – Templates for D1-Q2, D2-Q3 and D4-Q11.

☐Section B (Excel) – Quality Visits/QIF visits requirements (if applicable).

☐Section C (Excel) – Worksheets.

We want to make completing the MSAR as easy as possible, so if you need any help with completing this return, feel free to contact Nathan Brown or another member of the quality team on quality@gmc-uk.org or 020 7189 5221.