Visit report on Exeter Medical School

This visit is part of the new schools quality assurance annual cycle.

Our visits check that organisations are complying with the standards and requirements as

set out in Promoting excellence: standards for medical education and training.

Summary

Education provider University of Exeter, Exeter Medical School

Programmes Bachelor of Medicine, Bachelor of Surgery (BMBS)

Dates of visit 12 June 2017 – Medical students years 1-4

4 July 2017 – Academic teachers and senior management

Key Findings

1 The team met with representatives of the University of

Exeter Medical School via videoconference as part of a

reduced visit cycle in 2016/17. This forms part of our

ongoing quality assurance of the school for its recognition

as an awarding body for a primary medical qualification,

which is anticipated for 2018. We conducted a student

survey and met with the school’s senior management team,

academic educators and students via videoconference.

2 The school took its first students in 2013 following the

disaggregation of Peninsula College of Medicine and

Dentistry (PCMD). It is currently in its fourth year of the

decoupling process with only year 5 students remaining.

3 The school continues to make good progress in

establishing the new programme and the disaggregation of

PCMD is being well managed. Both students and educators

continue to praise the facilities and the pastoral support

they are receiving. The school’s Aspire programme is well

received and there has been a positive change in culture

Exeter Medical School 2017

2

and dialogue around fitness to practise. SWARM profiles are

a positive step towards better managing the workload.

4 We identified a few areas for improvement, including the

process to be followed if an injury is suffered while on

placement, and the process for dealing with bullying and

undermining complaints on placements.

Update on open requirements and recommendations

Open requirements Update Status

1 The school must develop an

explicit strategy, with timeframes,

for patient and public

involvement in the development

and delivery of the programme.

They must ensure the views of

patients and the public contribute

to policies, processes and the

development of the curriculum.

The school has made considerable

steps towards embedding

meaningful patient public

involvement in medical education.

They held an event where there

was wide advertisement for

opportunities to get involved with

patient public involvement. The

school recruited to a working

steering group as a result of this.

It is clear that the School has set

up new arrangements however we

need to monitor what influence

they have. The School should

provide minutes from the meetings

with these various representatives.

Open

2 The school must make sure that

students and educators clearly

understand how professionalism

is assessed.

There have been developments in the assessment of professionalism and a longitudinal view is now taken across all years. Students understand the principle of on-the-spot judgements.

Closed

Open recommendations Update Status

1 The school should review its The school has effective Closed

3

communication of policies,

procedures and changes to make

sure there is a common

understanding between all

educators and students.

governance systems and processes

to manage the quality of

education. For example, the

Fitness to Practise process has

been effectively communicated to

students (see area working well 3).

From conversations we found a

common understanding of

professionalism judgements

between educators and students.

2 The school should clarify how

academic support is being

developed and specifically how

they intend to ensure education

and teaching capacity.

SWARM profiles for teachers have been created. These indicate if teachers are overworked and there is guidance for those that are. In terms of recruitment, there have been joint appointments with some junior doctors at NHS partners for the clinical skills and life sciences teaching. The School is looking to recruit to roles with a 50:50 split between their University role and their NHS role.

We still heard evidence of

significant differences between the

workloads of different types of

contracts. We would like to see

some evidence of actual changes

to workload based on the use of

SWARM before this is closed.

Open

3 We encourage the school’s review

of its teaching of basic sciences

to ensure improvement for

learners.

Changes to the curriculum will be introduced in September 2018-2019 for years 1, 3 and 5 and in 2020 for years 2 and 4. The anatomy team has made several changes following the results of the external review of the School’s teaching of basic sciences, surveys and student feedback. We would like to see in January how these changes are working

Open

4

before this is closed.

Areas that are working well

We note areas where we have found that not only our standards are met, but they are

well embedded in the organisation.

Number Theme Areas that are working well

1 Theme 1: Learning

environment and culture

(R1.19)

The facilities were praised by the students we met and they confirmed that the new Google site system is working well.

2 Theme 1: Learning

environment and culture

(R1.22)

We commend recruitment to the Aspire programme, which promotes research, and in the past year has had over 100 students participating.

3 Theme 2: Educational

governance and leadership

(R2.18)

We heard about a positive change in culture and dialogue around fitness to practise. The message has been received amongst students that FtP should be perceived as a supportive and developmental process, rather than as a disciplinary one.

4 Theme 3: Supporting

learners (R3.2)

Students have good access to pastoral support. The hard work and dedication of the student welfare caseworker was recognised by the groups we spoke to.

5 Theme 4: Supporting

educators (R4.2)

The School has made good progress on creating more explicit workload models that are being used in promoting transparency and discussions around managing workloads.

6 Theme 5: Developing and

implementing curricula

and assessments (R5.6)

We support recent developments in the assessment of professionalism in taking a longitudinal view across all years.

5

Recommendations

We set recommendations where we have found areas for improvement related to our

standards. They highlight areas an organisation should address to improve, in line with

best practice.

Number Theme Recommendation

1 Theme 1: Learning

environment and culture

(R1.17)

Inter-professional learning as a principle is

there but more could be done to embed it.

There is a lot of learning and training from

other professions but not enough learning with

students from other professions. Please

provide an update on plans to embed this

principle.

2 Theme 3: Supporting

learners (R3.2)

The process for reporting injuries on placements should be clarified for students. While year 1 students reported being clear about the process, those in more senior years were less so. The School should ensure students in all years are clear about the process for reporting injuries on placements.

3 Theme 4: Supporting

educators (R4.3)

We heard that the assessment administration team and wellness support team have a demanding workload. We would welcome an update on any actions being taken to address this.

4 Theme 5: Developing and

implementing curricula

and assessments (R5.6)

We heard that positive on-the-spot judgements are perceived as not carrying equal weighting with negative judgements, and we would welcome an update on plans to address this perception.

Requirements

When the requirements that sit beneath each of our standards are not being met, we

outline where targeted action is needed and map to evidence we gathered during the

course of the visit. We will monitor each organisation’s response to these requirements

and will expect evidence that progress is being made.

6

Number Theme Recommendation

1 Theme 3: Supporting

learners (R3.3)

We found that methods in identifying concerns about bullying and undermining were inconsistent across different sites. We will be seeking clarification on how these concerns are identified and triangulated, how they are recorded and followed up and reassurance on the process for dealing with complaints on placements.

7

Findings

The findings below reflect evidence gathered in advance of and during our visit, mapped

to our standards.

Please note that not every requirement within Promoting excellence is addressed. We

report on ‘exceptions’, e.g. where things are working particularly well or where there is a

risk that standards may not be met.

Theme 1: Learning environment and culture

Standards

S1.1 The learning environment is safe for patients and supportive for learners and educators. The culture is caring, compassionate and provides a good standard of care and experience for patients, carers and families. S1.2 The learning environment and organisational culture value and support education and training so that learners are able to demonstrate what is expected in Good medical practice and to achieve the learning outcomes required by their curriculum.

Raising concerns (R1.1), Dealing with concerns (R1.2)

1. In the 2016 visit, most of the students we met confirmed that they knew how to raise concerns and generally students felt comfortable doing so, but we discovered some students were worried about being identified and protected against adverse consequences when raising concerns. We found some students were not aware of the systems in place for raising concerns about the quality of their education while on placements. After talking to students this year for the 2017 cycle, it is clear these issues have now been addressed.

2. The school has a raising concerns policy which is designed to be used by staff or students to report any serious concerns, whether related to patient safety or teaching. This policy clearly explains how learners and educators can confidentially raise concerns and encourages them to do so. There are several examples of concerns that were raised using the raising concerns policy during the academic year 2016-17.

3. The students we met informed us they are comfortable raising any concerns or issues they

may have and this was supported by the student survey results, though the low response rate makes this evidence weaker. Students reported that when they do raise concerns, they receive feedback on what action will be carried out as a result. They feel reassured that the appropriate action will be taken.

Seeking and responding to feedback (R1.5)

4. Students are presented with opportunities to submit feedback, including for every session

and lecture they have. The school then responds to feedback, including ‘you said, we did’

emails to outline what has been raised and what action the School has taken as a result.

8

Appropriate capacity for clinical supervision (R1.7), Appropriate level of clinical supervision

(R1.8)

5. Students informed us they receive good clinical supervision while on placement. The

medical staff are positive and supportive in supervising them.

Appropriate responsibilities for patient care (R1.9)

6. The importance of patient safety is emphasised to students and there are various sources

of information available online. In the second year, patient safety is regularly discussed in

professional practice groups. They are well informed about whom to contact regarding

patient safety and they are aware of how to convey any concerns they may have.

7. Students are able to go to their academic tutor for advice and feel comfortable discussing

any issues that may arise on a placement. For example a student raised an issue with the

Lead for Clinical Skills about malpractice and they then received an email acknowledging

the concern they raised and were assured it would be looked into.

Induction (R1.13)

8. Students indicated that prior to placements they receive adequate information and

documents on the location and profile of the placement. This information is available from

September throughout the year so students can plan in advance. This includes information

on what they will be doing on placement, what to expect and the people they will be

working with.

Inter-professional learning (R1.17)

9. Many of the academic teachers, addressing core parts of the curriculum, are from

professions allied to medicine and therefore students have an early introduction to inter-

professional teaching. Workshops are available with pharmacy students from Bath and

radiographers from Exeter. The students noted that the work with the radiographers

enhanced their understanding of x-rays and it was very useful to learn about the work from

their point of view.

10. The students are supposed to have two hours of workshops with the pharmacy students

over two weeks. There is a variation of engagement amongst the students and how much

a group gained from the exercise is inconsistent.

11. There is a view amongst students that this aspect of the work needs to be better

managed. Inter-professional learning as a principle is there but more could be done to

embed it. Inter-professional learning is encouraged in the clinical course: students spend

time with physical therapists; there is a midwife clinic week; some students have spent

time with podiatrists; there is a ‘working together for patients’ SSU. There is a lot of

learning and training from other professions but not enough learning with students from

other professions.

9

Recommendation 1: Inter-professional learning as a principle is there but more could be done

to embed it. There is a lot of learning and training from other professions but not enough learning

with students from other professions.

Adequate time and resources for assessment (R1.18)

12. Assessments are considered in more detail under theme 5 (R5.5, R5.6).

Resources and facilities (R1.19)

13. The facilities are viewed as excellent by the students, especially the library, and are

improving every year. The new Google site system is working well. More money is being

put into the facilities and this is noticeable. The school has recently ensured that there is

always access to study areas.

Area working well 1: The facilities were praised by the students we met

Accessible technology enhanced and simulation-based learning (R1.20)

14. Simulation training is valued by students. There is a society which conducts extra

simulation training and students can apply for this at the start of the year. The fourth and

fifth year involves a lot of simulation training, with birth simulation seen as particularly

useful.

Access to educational supervision (R1.21)

15. The professional practice group facilitator will soon be the student’s academic tutor. This is

intended to enable better oversight on the progress of students.

16. This change is being implemented following student feedback and there were

opportunities to comment on the draft documents for the new system. The aim of this is to

provide students with more of a relationship with staff rather than the existing system of

meeting three times a year. Professional practice groups will meet 10-12 times a year and

there will be 1:1 sessions with students. Students believe the new system will be more

effective due to the increase in contact time.

Support learners and educators to undertake activity that drives improvement in education

and training (R1.22)

17. The School has recruited to the Aspire programme which encourages students to get more

involved in research and carry out a research project outside the curriculum. In the past

year this programme has had over 100 students participating.

Area working well 2: We commend the recruitment to the Aspire programme.

10

Theme 2: Education governance and leadership

Quality management/control systems and processes (R2.1)

18. We continue to find that the school has effective governance systems and processes to

manage the quality of education. There have been regular meetings over the last 12

months, including education and quality groups, admissions selections and advisory groups,

assessment advisory groups and international recruitment steering groups.

Considering impact on learners of policies, systems, processes (R2.3)

19. The school has made considerable steps towards embedding meaningful patient and public involvement in medical education. They held an event where there was wide advertisement for opportunities to get involved with patient and public involvement. The School recruited to a working steering group as a result of this, with eight experienced members. There is now a much larger group of the public from which to draw. There is also a list of public involvement roles available from September 2017 onwards. We welcome the progress and will be checking this during the next visit.

Collecting, analysing and using data on quality, and equality and diversity (R2.5)

20. After each assessment (summative and formative), the School carry out detailed analysis. The student level factors that are routinely considered include gender, ethnicity, disability status, widening participation indicators, Home versus International fee status and mature student entry.

21. All assessment data is moderated after each assessment, and termly academic review

meetings are held to consider the validity of assessment data, mitigation, and remediation.

22. We heard that the assessment administration team have a demanding workload and would benefit from additional staffing. This is mentioned under theme 4 (R4.3).

Standards

S2.1 The educational governance system continuously improves the quality and outcomes of education and training by measuring performance against the standards, demonstrating accountability, and responding when standards are not being met. S2.2 The educational and clinical governance systems are integrated, allowing organisations to address concerns about patient safety, the standard of care, and the standard of education and training. S2.3 The educational governance system makes sure that education and training is fair and is based on principles of equality and diversity.

11

Systems and processes to monitor quality on placements (R2.6)

23. There has been a large increase in primary care placements. There was a Dean’s

commission and the School undertook a review which sets out the plans they are piloting

now.

24. The School are introducing a new range of teaching methods and have recruited new

teachers. Changes have been made to the infrastructure and research capabilities.

25. There appeared to be a lack of clarity about how concerns around bullying and

undermining are identified and triangulated across different sites. This is referred to under

theme 3 (R3.3).

Monitoring resources, including teaching time in job plans (R2.10)

26. The School seeks regular staff updates. They frequently check that staff are delivering

good quality placements.

27. Discussions with the senior management team indicate that they have listened to feedback

from teachers about the lack of progression opportunities. Career opportunities have since

improved for the current group of teachers. The School is working closely with the

University and has adopted their teaching models.

Sharing information of learners between organisations (R2.17), Requirements for

provisional/full registration with the GMC (R2.18)

28. The School have created a regulation that is mapped against the GMC’s guidance on

Fitness to Practise. This ensures that any student who is not fit to practise does not

graduate. There is no contention with the University over this issue because the Medical

School’s fitness to practice process prevails over the University disciplinary process when it

comes to judging whether medical students are in a position to successfully graduate.

29. The senior management at Exeter are implementing the GMC guidance on Fitness to

Practise. The School has successfully promoted a positive change in culture surrounding

Fitness to Practise. They emphasise that it is a supportive process rather than a disciplinary

one. This has led to an increase in disclosures from medical students.

30. The students informed us that there are a number of people they would feel comfortable

approaching should they need to raise a fitness to practise issue.

Area working well 3: The change in culture and dialogue around Fitness to Practise.

Recruitment, selection and appointment of learners and educators (R2.20)

31. There has been an increase in student numbers and the School believe it is the right time

to look at expanding, especially since the curriculum is being reviewed. There is a need for

more teachers to support the increase in student numbers. The School is making plans to

12

launch a graduate entry version of the existing programme, which would be four years in

duration.

32. The main resource will be the recruitment of more teachers. There have been joint

appointments with some junior doctors at NHS partners for the clinical skills and life

sciences teaching. They are looking to recruit to roles with a 50:50 split between their

University role and their NHS role. There have been 9 appointments in basic science

teaching with 30% research in the job.

13

Theme 3: Supporting learners

Good medical practice and ethical concerns (R3.1)

33. The school’s curriculum and culture ensures students are aware of the importance of achieving and maintaining a high standard of professionalism throughout their careers. Students attend professional practice groups which help them develop the personal and professional skills that are essential for their future career as a doctor. They are consistently reminded of their responsibilities as a medical student, such as how to behave on social media.

Access to resources to support their health and wellbeing, educational and pastoral support (R3.2)

34. The students were very complimentary of the pastoral support at the School. There are various well-being services and within the School there is a student welfare caseworker who is easily contactable. Pastoral tutors and sub-deans also make themselves available for support. As explained under theme 1 (R1.21), the professional practice group facilitator will soon be the student’s academic tutor and this will provide the student with more contact time.

35. If a student suffers an injury on placement, there are recognised procedures to follow.

These procedures are highlighted in the Medical School handbook. Students are educated

on this topic during their induction to the medical school. However, the students

themselves appeared uncertain over the procedures to follow if they suffer an injury, such

as a needlestick. The student survey indicates that 20 out of the 83 respondents do not

know what to do if a needlestick injury occurs, with 9 of those 20 in year 3. It would be

beneficial if the students were regularly reminded about this topic.

Area working well 4: Good reviews for student welfare caseworker and general pastoral support Recommendation 2: The process for reporting injuries on placements should be reinforced for

students. We suggest the School provides refresher guidance for the later years.

Undermining and bullying (R3.3)

36. Discussions with third and fourth year students indicated that there are a few of

consultants on placement who are known to treat students in a derogatory manner that

makes them feel uncomfortable. Attempts have been made to address their behaviour,

with the consultants in question being sent on training. However this does not appear to be

solving the issue as the perception was that the behaviour of these consultants has not

improved.

Standard

S3.1 Learners receive educational and pastoral support to be able to demonstrate what is expected in Good medical practice and achieve the learning outcomes required by their curriculum.

14

37. All the students we spoke to are aware of how to report concerns about bullying and

undermining. They stated that if they ever did feel the need to raise concerns over bullying

or undermining they were confident the school would attempt to address these issues.

Senior management stressed that concerns raised by students are taken seriously and

acted upon. Each locality maintains a log of any concerns raised on placement. There are

regular meetings between the sub-deans at localities.

38. Senior management informed us that on GP placements, there have been low level

concerns. There is one practice that has had complaints by both Foundation trainees and

medical students. The School has taken measures, including removing the GP in question

from supervising students and Foundation trainees.

39. We found a lack of clarity about how concerns around bullying and undermining are

identified and triangulated. Methods for dealing with bullying and undermining appeared to

be inconsistent across different sites.

Requirement 1: further clarification on how these concerns are identified and triangulated, how

they are recorded and followed up and reassurance on the process for dealing with complaints on

placements.

Timely and accurate information about curriculum, assessment and clinical placements (R3.7)

40. We discovered students are generally receiving timely and accurate information about their curriculum, assessments and clinical placements. Prior to placements students receive adequate information and documents on the location and profile of the placement. This information is available from September throughout the year so students can plan in advance. This includes information on what they will be doing on placement, what to expect and the people they will be working with. They also appreciate the advice provided by the School on potential research they can engage in prior to the start of the placement to ensure they are fully prepared.

41. Students are provided with clear learning objectives at the beginning of every lecture and

there is a full clinical skills guide available online.

Support while studying outside of medical school (R3.9)

42. We have seen an incident response plan document from the School. This sets out the arrangements for dealing with emergency situations which may arise when students from the School undertake elective periods of study at other institutions, both in the UK and abroad. The School will provide appropriate support to students if they get into difficulties or are involved in emergency incidents which have the potential to significantly impact on their welfare.

Feedback on performance, development and progress (R3.13)

43. Students receive feedback in a timely manner, normally three weeks after completing assessments. They encounter a mixture of applied medical knowledge tests (AMKs) (four times a year) and competency-based assessments. Students then receive a final grade and

15

general overview for specialties. Their competencies are online in a portfolio database and can access feedback via this route.

44. Students are engaged in peer feedback, a principle that is valued. It enables students to

gain an understanding of how others interpret their behaviours and the manner in which

they come across, rather than the sole perspective of just their PBL tutor.

Support for learners in difficulties (R3.14)

45. The University of Exeter provides support services which are advertised to the students within their handbook. It has been agreed by the two Universities that, exceptionally, those students who drop back for academic or personal reasons by interrupting this year, will be allowed to join the final PCMD cohort in Torbay.

Progression and meeting requirements (R3.15)

46. Any competencies that require a ‘pass’ have to be completed and redone until passed.

Students cannot progress until these are completed.

16

Theme 4: Supporting Educators Standards

S4.1 Educators are selected, inducted, trained and appraised to reflect their education and training responsibilities. S4.2 Educators receive the support, resources and time to meet their education and training responsibilities.

Induction, training, appraisal for educators (R4.1)

47. We heard that academic educators are generally being appropriately supported by the

School. The system for academic tutors is currently being developed as described under

theme 1 (R1.21).

48. There are two key appraisal systems in operation in the medical school; the University of

Exeter’s Performance Development Review (PDR) and the NHS appraisal and revalidation

systems in place for primary and secondary care clinicians.

Time in job plans (R4.2)

49. The School has worked hard to establish collaborative, trusting relationships with their specialty leads and providers. This enables clinical teaching to occur regularly and where cancellations occur, the school looks to rescheduling these sessions.

50. The School created SWARM profiles for academics and this forms part of their professional development review. These indicate if teachers are overworked and there is guidance for those that are. If teachers are 10% over their allocated workload, measures are being introduced to address this.

51. The School are currently in negotiation with the trusts to make sure there is whole time equivalent time allocated in job plans. A good system is in place which has been built on the original agreements with PCMD.

52. For those with a research aspect of their work, it’s quite difficult to balance time when there is a large teaching workload. Teaching and research are not being weighted evenly and research is seen as more valuable.

Area working well 5: The School has made good progress on creating more explicit workload models that are being used in supporting academic staff and managing workloads.

Resources for educators (R4.3)

53. The assessment administration team is responsible for ensuring there are no errors in assessment. Academic teachers noted that there is a lot of pressure on the team and they have a demanding workload.

54. There have been a couple of changes in wellness support at the School. The academic teachers commented that it would be beneficial to have more support in this area. They

17

believe more staff would help the issue. Despite this, the student welfare caseworker that the School has in post at the moment is excellent.

55. The School are looking at improving facilities for small group teaching and the physical space available to cope with the expansion of student numbers.

56. There are professionalism panels, which capture low level concerns and can be compared to the student’s record overall. Attendance registers feed into the professionalism panels.

Recommendation 3: Make changes to appropriately support the assessment administration and wellness support teams in delivering the important work they undertake.

18

Theme 5: Developing and implementing curricula and assessments

GMC outcomes for graduates (R5.1)

57. The School provides core themes for its medical students, which they need to cover to achieve the learning outcomes of the curriculum.

Informing curricula development (R5.2)

58. The School has been continuously improving aspects of the taught programme, assessment and student support. This involves changes to the professional practice groups, expansion of the remediation team, augmented anatomy teaching resources and a shift towards General and Community practice-community care weeks in year 3. In the future, the curriculum review will include an academic programme review which aims to create and clearly map a conceptually sequenced, multi-layered, longitudinal student journey.

59. Changes to the curriculum will be introduced in September 2018-2019 for Years 1, 3 and 5

and in 2020 for years 2 and 4. This gives the opportunity to integrate all years into the curriculum and improve the student learning journey. The GMC will check the curriculum review in the next cycle.

60. The School has taken on board feedback from students for the upcoming changes, along with contributions from all the academic teachers. For example they are moving the research module for year 4 back into year 3 as a result of student feedback. Also each GP practice currently only has students for a small part of the year however this will progress to a longer time frame each year.

Undergraduate curricula design (R5.3)

61. The School uses a variety of teaching and learning methods, including professional

practice groups, clinical skills sessions, lectures, problem based learning and special study units.

62. Students feel there is a good range of biomedical sciences, psychology, sociology,

anthropology and public health. There is a broad spectrum of subjects being taught,

however the students did comment that perhaps it would be beneficial if there were less

lectures and more time put aside for workshops, particularly in psychology.

63. The anatomy team has made several changes following the results of the surveys, the external review of the School’s teaching of basic sciences and student feedback. These include developments in animal organ dissection, plastinations and 3D software systems. The pharmacology curriculum has an extensive curriculum devoted to clinical pharmacology and therapeutics. This is mapped to reflect the British Pharmacological Society’s

Standard

S5.1 Medical school curricula and assessments are developed and implemented so that medical students are able to achieve the learning outcomes required by graduates.

S5.2 Postgraduate curricula and assessments are implemented so that doctors in training are able to demonstrate what is expected in Good medical practice and to achieve the learning outcomes required by their curriculum.

19

undergraduate curriculum and increasingly the Prescribing Safety Assessment’s blueprinting matrix and scenario styles.

Undergraduate clinical placements (R5.4)

64. In 2017-18, UEMS will have its first year 5 students. This will be the first time the School has students going out on electives. There is minimal change to the clinical timetable and clinical exposure when compared to the year 5 curriculum for PCMD. All students will undertake five, 6 week blocks in different clinical areas (immediate care, medicine, surgery, community/GP and specialties).

65. There were some concerns raised regarding placement capacity. Paediatric placements for

example appear to contain a large number of students at one time, along with Emergency Medicine. We heard mixed feedback about oncology placements. Although some medical students had a good experience in oncology, we heard that oncology at Truro was felt to have insufficient capacity.

66. There had been concerns about placement capacity in Cardiology, Histopathology and Surgery. However, there has been a recruitment drive so staffing at the hospital is far better. Evening placements and ward rounds, alongside the existing day time placements, have been implemented to try and improve the issues raised surrounding placement capacity.

67. The short length of placements are seen by some students as a negative aspect as they

effectively only get the equivalent of three full days each week. We heard that specialties which are linked to each other can be separated too much and it was a suggestion that it might be better to incorporate related specialties as a single block rather than jumping from one specialty to a completely different specialty.

68. Rheumatology and dermatology were named by students as very useful placements and

even though the placements are only one week long, the learning is very structured in that week.

69. As noted in the 2016 report, there is a lack of ethnic diversity amongst the patient

population in the region. Students are given both urban and rural placements to try and cover a diverse range of patients. The community placements contribute to this.

Assessing GMC outcomes for students (R5.5)

70. The Applied Medical Knowledge (AMK) test is an online longitudinal assessment that is delivered four times a year to test the growth of student’s medical knowledge.

71. Students encounter competency based assessments along with the AMKs. They receive a

final grade and general overview for specialties. Their competencies are online in a

portfolio database. Any competencies that require a ‘pass’ have to be completed and are

re-done until passed.

72. Senior management informed us that one of the advantages of the AMK is that they can

see the longitudinal progression of the student. Therefore they can identify any anomalies,

such as student’s marks suddenly jumping up. Cheating within this system is not currently

a problem but the School are ensuring they keep an eye on it. There does not appear to be

any particular groups gaining an advantage in the AMKs.

20

73. The School has a BMBS Assessment Handbook for 2016-17. It identifies the key roles and

responsibilities of committees and groups, academic and administrative staff and students.

The handbook sets out the criteria for successful completion of each of the BMBS

assessment themes, progression and awarding criteria.

74. The School has plans to introduce electronic assessments to move in line with F1

assessments, which have also become electronic. We will check how the electronic

assessments are working when we visit in 2017/18.

Fair, reliable and valid assessments (R5.6)

75. Students understand the principle of the on-the-spot judgements. Senior management

claim that two-thirds of on-the-spot judgements are positive and one third are negative.

The negatives do not go on record officially until they are remediated.

76. However, students feel the system is not weighted fairly. A negative on-the-spot

judgement leads to a face-to-face discussion and the students are of the understanding

that three would result in going to the board. The consequence of this can lead to being

prevented from progressing to the next academic year.

77. Negative judgements result in action being taken and positive judgements result in little

action being taken (generally a congratulatory email). Several of the students expressed a

desire for positive judgements to be recorded on their portfolios.

78. There is an aggregation matrix available to academic teachers for on-the-spot judgements to explain how they work. The academic teachers say that most of the on-the-spot judgements they give out are positive ones. This varies from the student’s perception.

79. The academic teachers are aware of students’ concerns that positive on-the-spot judgements carry less weight than negatives and they are working on ways to raise the profile of the positives. They, like the students, want to work towards more acknowledgement of positives.

80. The teachers emphasised that negative judgements are usually well thought out before being issued to students. Any inconsistencies with issuing on-the-spot judgements can be picked up at the panels, where they are moderated.

81. The School takes a longitudinal view to the assessment of professionalism, similar to how AMKs are evaluated, so the School can check how each student has developed across the years.

Recommendation 4: Address the weighting of on-the-spot judgements

Area working well 6: The recent developments in the assessment of professionalism in taking a

longitudinal view across all years

21

Team leader Dr Lindsey Pope

Visitors Mr Daron Aslanyan, Dr John Jones, Dr Jean McKendree and

Mr Geoff Wykurz

GMC staff Emily Saldanha (Education Quality Assurance Manager) and William

Henderson (Education Quality Analyst)

Evidence

base

UEMS Raising Concerns policy

Raising Concerns examples

BMBS and Pharmacy IPL activity on hypertension

UEMS Promoting Inter-professional Learning

UEMS Update on Radiology and Histopathology Placements

EQSG minutes

JARB minutes

Admissions Selection and Advisory Group minutes

Assessment Advisory Group Meeting minutes

UEMS Health & Conduct Committee minutes

BMBS International Recruitment Steering Group minutes

Public Involvement poster

List of Public Involvement roles

UEMS Public Involvement

UEMS Differential Attainment in Assessment

UEMS SWARM Information

UEMS Workload Planning Policy Document 2017/2018

UEMS Update on Changes to Professionalism Assessment

Lectures to BMBS Students on fitness to practice

22

UEMS Update on Recruitment, Selection and Appointment of Learners

UEMS Electives Emergency Incident Response Plan

UEMS Update on Arrangements for PCMD students not graduating in

2016-2017

UEMS Update on Time in Trainer Job plans

Overview of Main Changes to the BMBS Curriculum

Developments in Anatomy and Basic Science Teaching

Student Assistantships in year 5 – UEMS Plan

BMBS Assessment Handbook

UEMS Student Survey

23

Mr Henderson

Education and Standards Directorate

General Medical Council

Regents Place

350 Euston Road

London

NW1 3JN 28 September 2017

Dear Mr Henderson

University of Exeter Medical School - Response to Visit Report 2017

Thank you for sending the Visit Report to the University of Exeter Medical School

and for the constructive dialogue during our videoconference in June.

The School is pleased with the positive outcome of, and are delighted that the visiting

team felt able to commend our good practice across a range of areas. The School notes the requirements and recommendations contained within the report, and

looks forward to sharing our success in addressing these, in advance of the next visit. Once again, the School would like to thank the visit team for their helpful and constructive

feedback, which we continue to draw upon to enhance the student experience and quality of

education at University of Exeter Medical School. Yours sincerely

Professor Jean McEwan Vice Dean Education