University of Exeter Medical School

University of Exeter Medical School final report 2014 15 University of Exeter Medical School This visit is part of the GMC's remit to ensure medical schools are complying with the standards and outcomes as set out in Tomorrow s Doctors 2009. For more information on these standards please see: Tomorrow's Doctor's (2009) Review at a glance About the School Medical school University University of Exeter Medical School University of Exeter Date of visit 29 April 2015 Programme investigated Area explored BMBS Patient safety Resources Curriculum Assessment Equality and diversity Student support Quality management Number of students 259 Local education and training board Health Education South West 1

Last GMC visit 10 12 March 2014 Significant Patient safety or Educational concerns identified Has further regulatory action been requested via the Responses to Concerns process None No Executive summary Summary of key findings 1 In January 2012, the two founding members of the Peninsula College of Medicine and Dentistry (PCMD), the Universities of Exeter and Plymouth, outlined their plans to develop independent medical schools. University of Exeter Medical School () is one of the two schools formed following this decision. applied to the GMC for recognition as an awarding body for a primary medical qualification, and is undergoing the new school quality assurance (QA) process. The GMC first visited in March 2013 to assess the School s preparation for its first cohort, which enrolled in September 2013. As part of the GMC s ongoing QA activity, the School was also visited in March 2014. Reports from the first two cycles of visiting can be found on the GMC website. 2 As the School was judged to be making good progress in meeting the Tomorrow s Doctors (2009) standards during the first two cycles, it was agreed to adapt the approach to monitoring for the 2014-15 academic year. For this cycle of visiting, the GMC met with students in years one and two of the programme, and members of the senior management team via videoconference. Prior to the meeting, we reviewed the School s detailed Medical School Annual Return (MSAR) and carried out an online student survey. 38 students responded to our survey; 14 from year one (out of a cohort of 130) and 24 from year two (out of cohort of 129). 3 The videoconference was shorter than a standard visit, and the areas of exploration were more targeted. This final report is therefore shorter than those from previous years. For a full understanding of the School s progress, this report should be read alongside the previous reports. 2

4 Overall, the quality of medical education at was found to be high, and we concluded there was no need for a physical visit to the School in this academic year. The development of the school appears to be progressing well, with incremental change from the PCMD curriculum and processes. New buildings and facilities have been opened. Considering the sound structures that are in place, we were surprised that student feedback was not more positive. The student survey had a low number of responses, and may have been completed by students that were unhappy, but the feedback they gave was generally confirmed by the student representatives we met. It appeared that students were particularly dissatisfied with some specific policies (eg the attendance policy) and this may have coloured their overall responses in our survey. A full visit to the School will take place in 2016 as part of the regional visit of the South West. 5 Information about Peninsula College of Medicine and Dentistry (PCMD): PCMD will continue to deliver medical education to its existing cohorts of students. Student numbers of this joint institution will therefore decrease each year, during what is described as the 'teach through' period, until no PCMD students remain. Both University of Exeter Medical School () and Plymouth University Peninsula School of Medicine (PU PSM) have stressed their commitment to ensure that all students, both those of the new schools and of PCMD, receive a consistently high quality of medical education. 3

Good practice Tomorrow s Doctor paragraph Good practice Report paragraph 1 TD39, TD40 Sensitive and extensive quality management system that identifies and addresses issues. The level of detail with which the School completed their MSAR, providing evidence of issues being identified and remediated. 2 TD160, TD166 The University of Exeter s commitment to the medical school, demonstrated by the new buildings and facilities. Although the resources are newly opened, and are not yet in full use, students told us that the new study space was very good. We look forward to hearing more about the new infrastructure as students begin to use it more fully. 3 TD49 Continued responsiveness to our feedback on Admissions. We look forward to hearing the results of the move to a multiple mini interviews model. 11 39 15 Requirements Tomorrow s Doctor paragraph Requirements Report paragraph 1 TD86, TD87 Students must be given clear guidance as to the impact of individual professionalism judgements on progression. 2 TD28c, TD28e All students must be made aware of the raising concerns policy, including the process for raising concerns about other students. There must be a clear differentiation between whistleblowing and raising concerns. 10 7 4

Recommendations Tomorrow s Doctor paragraph Recommendation Report paragraph 1 No recommendations were identified in this cycle. The Report Domain 1: Patient safety 26. The safety of patients and their care must not be put at risk by students' duties, access to patients and supervision on placements or by the performance, health or conduct of any individual student. 27. To ensure the future safety and care of patients, students who do not meet the outcomes set out in Tomorrow's Doctors or are otherwise not fit to practise must not be allowed to graduate with a medical degree. Acting within competence (TD28a) 6 All of the students that responded to our survey said that they are properly instructed and supervised when carrying out procedures. As the students are currently only in years one and two, this is an important area that we will be checking next year, when students are on longer clinical placements. Identifying and addressing patient safety concerns (28b), Identifying concerns about medical student conduct (TD28c, TD28e) 7 When we visited in 2013 14 we noted that had introduced a raising concerns policy, but that students seemed unaware of it. We expressed concern that staff and students were using the term whistle blowing to describe the process of raising a concern. 8 Although 63% of the students who responded to our survey agreed that they would know how to raise a concern about patient safety, the students we met with on the visit this year did not have a full understanding of the concerns process, particularly if these concerns are about other students. They were not clear as to the route they should use, were unsure as to how such concerns would be handled and felt reluctant to report concerns about another student. 5

Some students were aware of a document that they thought might provide guidance on raising concerns, but referred to this as the whistleblowing policy. 9 It is important that students are clear, as individuals who will soon be doctors, about the importance of raising concerns (including those about their peers), and how any concerns are managed. This is therefore an area for further development. Fitness to practise (TD28d, 36, 37) 10 Students understand the importance of professionalism, support the School s stance on it, and are aware of the different ways in which they are assessed on it. Despite the School s efforts, it wasn t always clear to students we met how a final judgement of professionalism is derived and how individual professionalism judgements contribute to the overall assessment framework. This was identified as an area for development in last year s report. It remains an area for development. Domain 2: Quality assurance, review and evaluation 38. The quality of medical education programmes will be monitored, reviewed and evaluated in a systematic way. Quality management framework (TD39, TD40) 11 has a detailed quality management framework and systems, which we explored in detail in 2013-14. There is a sensitive and extensive quality management system that helps identify and address issues. Identifying and managing risks and concerns (TD44): Actions (TD53), Feedback to students (TD53), Resolution (TD53). 12 All of the students we met were representatives and members of the student staff liaison committee (SSLC). They gave examples of change made in response to student feedback both ad hoc and arising from formal surveys (eg the module and course evaluation). The online student survey we conducted had a low number of respondents. Of the 38 students who responded, 42% said that the school responds effectively to their evaluation of the curriculum, and only 29% that the school responds effectively to their evaluation of facilities, with responses from year two students being less positive than those in their first year. 6

13 We asked the students we met about the survey results, and we heard that staff had spent time in lectures explaining the changes that had been made in response to student feedback, and that emails had been sent to all students. The student representatives suggested that students on the SSLC were more aware of the school s actions than the wider student body. Agreements with providers (TD41, 50) 14 has Service Level Agreements (SLAs) with all local education providers (LEPs). The management team explained that hospital and community sub deans meet with specialty leads for every placement, to discuss quality data including student feedback. The School s MSAR provided strong evidence that issues that arise at LEPs are identified, acted on and monitored, to ensure that quality is maintained. Admissions (TD49) 15 Following our report for 2013 14, the school has reviewed their processes for creating interview scores. The plan is to introduce a multiple mini interview process for entry in 2016. We look forward to hearing more about the school s admissions processes. Educational resources and capacity (TD49, 52), Teaching (TD51) 16 Formal mechanisms are in place to quality manage resources (the annual student experience review) and curriculum delivery (module and course evaluation). We heard examples from students and staff of how the information gathered through these processes has been used to make improvements. Domain 3: Equality, diversity and opportunity 56. Undergraduate medical education must be fair and based on principles of equality. 17 We have looked in depth at the processes for ensuring equality and diversity in previous years. University of Exeter Medical School has gained a silver Athena Swan award. This is a significant achievement and recognises the school s work to ensure equality of opportunity for women in education and research. We will continue to explore the school s processes as the school grows and as changes are made. 7

Domain 4: Student Selection 71. Processes for student selection will be open, objective and fair. 18 We have looked in depth at the processes for student selection in previous years. The school has made some small improvements since our last visit (see para. 16). We will continue to explore the school s processes as further changes are made. Domain 5: Design and delivery of the curriculum, including assessment 81. The curriculum must be designed, delivered and assessed to ensure that graduates demonstrate all the 'outcomes for graduates' specified in Tomorrow's Doctors. Curriculum plan (TD82), Curriculum design and structure (TD83, 101), Balance of learning opportunities (TD100), Student selected components (TD94-99), Integration of basic and clinical science (TD101) 19 The curriculum is based on that taught by PCMD, in line with the GMC standards. We have explored the School s plans in previous years. No substantive changes have yet been made. Students we surveyed made a number of positive comments about the course structure, particularly the clinical relevancy of material taught and the opportunities for early and sustained patient contact. Other students gave positive feedback about problem based learning, small group learning and the student selected units. Inter-professional learning (TD102) 20 We asked students in our survey about opportunities to learn with and from other professionals. 84% of students that responded said that they had had the opportunity to do so, and most students said that they had had several learning opportunities with other healthcare professional students. 21 We are pleased that students are getting opportunities to learn with, and from, other healthcare professionals. This is an area of growing importance, and we will continue to look for evidence of good practice as the school develops. 8

Clinical Placements and Experience (TD84), Early patient contact (TD103), Mandatory clinical placements (TD106) 22 The curriculum includes significant early patient contact, which is appreciated by students. The first cohort will undertake concentrated clinical experience from September 2015. The School plans to continue with the PCMD placement structure for at least the first year, making incremental changes from September 2016. Pilots are planned to test placements allow students longer on base wards, for better immersion, but keeping the same content. Fitness for purpose of assessments (TD86), Guidance about assessments (TD87) 23 In our report for 2013 14, we identified areas for development, for example we noted that students were confused about the attendance policy and professionalism judgements. Since then the School has put considerable work into making sure that students understand the policy. However, we heard (from our survey and from the student representatives we met) that there remains considerable confusion with the application of the policy. 24 In the small survey that we ran we received 37 negative comments about assessments. These comments focussed on the attendance policy and the professionalism policy, which are linked and form part of the formal assessment system. 25 We heard from students that they believed there had been cases where administrative errors (eg a lecturer failing to take an attendance register or last minute timetable changes) had caused students to receive negative professionalism judgements. Students also felt that the requirement to give apologies in advance for both mandatory and recommended sessions was burdensome, and we heard that the spot check system for recommended sessions has led to some students deciding to not send apologies in the hope that a register will not be taken, even if their attendance at recommended sessions is above 70%. 26 Students commented positively on the seriousness with which the School regards professionalism, several students said that they had no clear guidance as to what behaviour will result in a negative professionalism judgement, and that they believed professionalism to be judged subjectively. Students were unable to explain to us the significance of failure to comply with the attendance policy, or of receiving a negative professionalism judgement, within the overall assessment framework. 9

27 We commend the school for its clear commitment to professionalism. In our survey, 98% of students agreed that learning about professionalism is an important part of the course, and there have been changes (School management staff told us that they have changed the rules to allow students with a doubtful professionalism module to progress to the next year, with additional monitoring and support). However, we continue to have concerns about the application of professionalism judgements, the impact of negative judgements on a student s progression and how the policy is understood by the students. Domain 6: Support and development of students, teachers and local faculty 122. Students must receive both academic and general guidance and support, including when they are not progressing well or otherwise causing concern. Everyone teaching or supporting students must themselves be supported, trained and appraised. Guidance about the curriculum (TD123) 28 Although students we surveyed and met with were generally positive about the course as a whole and the guidance they received about it, there appeared to be some particular issues with timetable information. In our small survey of 38 students, there were 22 negative comments about aspects of administration and organisation, with more than half of these related to timetable issues. Students reported longstanding issues with timetable clashes, and frequent last minute changes. Students we met confirmed that there had been real problems with timetable changes, and that, for some students, problems seemed to persist. 29 There also seemed to be some confusion amongst the students we spoke to, about which documents are available on the Exeter learning environment, and which are on the intranet. 30 We were not able to explore this issue fully in this cycle but will do so in 2015-16. Academic and pastoral support (TD124), Support networks (TD131) 31 In previous years we investigated the arrangements for student support and found them to be strong. The medical school now has a one stop shop for all 10

student enquiries, based at College House. This is also the base for other courses run from the medical school. 32 In our survey of 38 students, 74% agreed that academic support is accessible when needed while 5% disagreed. 66% agreed that they have access to the general welfare support that they need while 18% disagreed (5% strongly). It was not clear from the responses why these students felt that they did not have the support they needed, although the students we met suggested that the support from academic tutors and College House was variable. 33 Student representatives we met said that they perceived support at the school to be generally good, and were clear that there are multiple clear avenues of support. Mentors and staff based at locality offices were mentioned as particularly helpful. Students we met agreed that advice from College House could be contradictory, and suggested that as the facility was relatively new, staff may have been initially confused about the rules that applied for particular teaching programmes. 34 We will be exploring student support over the next cycle of visits. Reasonable adjustments (TD132) Careers advice (TD125), Strategy and resources (TD134) 35 In previous years we have been impressed with the provision for careers advice. We were therefore surprised that in our survey only 42% of students agreed that the school/university careers service provides opportunities to explore different medical careers. Although the students are early in their course, it is important that careers advice and planning begins early in medical education. We will explore this further in future years. Student health (TD126), Help and support (TD139) 36 School senior management said that they were not aware of any issues with support for students experiencing health issues. In response to increasing demands for support and the recognition that there is a need for a resilient workforce the school is looking at ways to improve student self reliance and resilience. 37 Students we met said that the School reminds them frequently that health issues should be reported for support. Several people were named as good sources of support, including the student welfare office and the director of 11

student support. The students we met said that the policies were all good, and that as representatives they knew about the university services on offer. The representatives also said that there had been some problems with students getting support in practice, for example long waiting lists for university counselling services, and confusion from academic tutors and other staff about procedures for sickness absence certification. Domain 7: Management of teaching, learning and assessment 150. Education must be planned and managed using processes which show who is responsible for each process or stage. 38 We have looked in depth at the processes for managing teaching, learning and assessment in previous years. We will continue to explore the school s processes as the school grows and as changes are made. Domain 8: Educational resources and capacity 159. The educational facilities and infrastructure must be appropriate to deliver the curriculum. Learning resources and facilities (TD160), Clinical skills facilities (TD166) 39 The University of Exeter has opened the planned new buildings and facilities for the medical school, including new learning space in South Cloisters, a new combined support facility in College House, and new teaching and research facilities on hospital sites. Although the resources are newly opened, and are not yet in full use, students we met were enthusiastic about them, particularly as we had heard from students of some difficulties with study space. 40 Medical school management staff explained that the University of Exeter did very well in the Research Excellence Framework exercise, and that this will benefit the medical school in additional funding. 41 Considerable work has taken place to establish IT systems for the new school, while continuing to manage the PCMD systems. We asked school management staff whether there have been any issues with IT systems, and were told that there had been some problems with the provision at the Knowledge Spa at Truro, but that these have been addressed. We also heard from students that that they have had no issues with access to IT or to clinical skills facilities. 12

42 The medical school has four undergraduate programmes: BMBS, Sports & Exercise Medical Sciences, Medical Sciences and Medical Imaging. The medical imaging programme will be moving to the St Luke s campus in September 2016. The medical sciences cohort will increase to 180 in 2016 (from 27 in 2014). 43 We look forward to hearing more about the new infrastructure as student numbers expand and as students begin to use it more fully. Agreements with providers (TD165) 44 Medical school management staff told us that trusts are feeling the impact of the changes to service increment for teaching payments. The school commission specific teaching so are able to monitor what is delivered, and work with providers to find ways to decrease cost without impacting quality. Staffing (TD162) 45 The University is currently reviewing its professional services through a transformation programme and it is looking to reshape how professional services operate to better improve ways of working and support professional development across the University. The outcome of this transformation will enable the University to improve surpluses for investment by 25m by planned efficiencies and increased revenue from new activities. A voluntary severance scheme has been in place as part of the programme and a professional homing exercise is now being undertaken. These will have an impact on the Medical School and risks are being mitigated through College, Service and University level risk management plans. Domain 9: Outcomes 168. The outcomes for graduates of undergraduate medical education in the UK are set out in Tomorrow s Doctors. All medical students will demonstrate these outcomes before graduating from medical school. 169. The medical schools must track the impact of the outcomes for graduates and the standards for delivery as set out in Tomorrow s Doctors against the knowledge, skills and behaviour of students and graduates. 13

Appendix 1: Visit team Dates of visit Wednesday 29 April 2015 Team Leader Visitor Visitor Visitor Visitor GMC Staff Professor Roger Barton Mr Geoff Wykurz Dr Jaimie Henry Dr Jean McKendree Dr Lindsey Pope Elspeth Buchanan Louise Devlin Robin Benstead 14

Appendix 2: Document register Document number Document name Description Source Doc 001 MSAR 2014 Spreadsheets Annual submission to the GMC Doc 002 MSAR 2014 Section A Annual submission to the GMC Doc 003 MSAR Additional documentation Annual submission to the GMC Doc 004 BMBS Attendance Policy 2014 15 BMBS Attendance Policy Doc 005 Changes to BMBS Admissions Process Note of changes to BMBS Admissions Process Doc 006 Exemplar SLA with Royal Cornwall Hospitals NHS Trust Exemplar SLA with Royal Cornwall Hospitals NHS Trust Doc 007 Flexible Combined Honours Student Handbook 2014 15 Flexible Combined Honours Student Handbook 2014-15 Doc 008 Instructions for Interviewers Instructions for Interviewers Doc 009 Interview scoresheet Interview scoresheet Doc 010 Interviewer comments sheet Interviewer comments sheet Doc 011 NSS Action plan 2014 NSS Action plan 2014 Doc 012 On-The-Spot-Feedback form On-The-Spot-Feedback form Doc 013 Panel chair comments sheet Panel chair comments sheet 15

Doc 014 Policy (BMBS) Fitness to Practise 2014-15 Policy (BMBS) Fitness to Practise 2014-15 Doc 015 Recognition of trainers questions Exeter Recognition of trainers questions - Exeter Doc 016 Report on MACE 2013-14 Report on MACE 2013-14 Doc 017 Report on QMQ 2013-14 Report on QMQ 2013-14 Doc 018 Supplementary report on the qualitative QMQ data for PCMD year 2 Supplementary report on the qualitative QMQ data for PCMD year 2 Doc 019 Terms of Reference Health and Conduct committee Terms of Reference Health and Conduct commitee Doc 020 Year 1 Review Year 1 Review Doc 021 Years 1 4 MACE and QMQ scores Years 1 4 MACE and QMQ scores 16

Appendix 3: Abbreviations BMBS E&D Bachelor of Medicine, Bachelor of Surgery Equality and diversity F1 foundation year 1 GEH GMC GP IPL LEP MACE MB ChB NHS NSS OSCE PMQ QIF QAA SIFT SLA SPA George Eliot Hospital NHS Trust General Medical Council General practice/practitioner inter-professional learning local education provider Module and Course Evaluation Bachelor of Medicine and Surgery National Health Service National Student Survey objective structured clinical examination* Primary medical qualification Quality Improvement Framework Quality Assurance Agency service increment for teaching service level agreement supporting professional activities University of Exeter Medical School

Louise Devlin Education Quality Analyst Visits and Monitoring Team Education and Standards Directorate General Medical Council Regents Place 350 Euston Road London NW1 3JN 21 st October 2015 University of Exeter Medical School - Response to GMC Final Visit Report 2014-15 Thank you for sending the Final Visit Report (2014-15) to the University of Exeter Medical School (). The Medical School is pleased with the positive outcome of the 2014-15 visit cycle, and we are delighted that the visiting team felt able to commend our good practice across a range of areas. The School notes the requirements contained within the report and outlines its plans to address these below. In 2014-15 the Medical School was also pleased to welcome Medical Imaging (Diagnostic Radiography) to it s portfolio of undergraduate programmes, thus greatly enhancing the opportunities for inter-professional learning and helping to establish St Luke s as the University s healthcare campus. The Medical School is excited to have now delivered two full academic years and to see its students commencing clinical placements in both Exeter and Truro. After the success of introducing Term Leads for Years 1 and 2, we have introduced a front-ofhouse aspect to the academic days, allowing closer liaison with students about their experience of the academic and clinical programmes. Requirements Domain 1, TD 86 and 87 - Students must be given clear guidance as to the impact of individual professionalism judgements on progression. The School looks forward to sharing in greater detail with the visit team, innovations within its professionalism theme, including an evolution in the role of the professionalism judgement. The School is now in the process of transitioning the professionalism theme from a summative assessment theme that informs progression, to a predominantly formative theme that highlights fitness to practise concerns.

The new approach to professionalism will provide greater clarity as to the purpose and impact of professionalism judgements; enhance equity for those students impeded by mitigating circumstances; and enhance the School s ability to undertake longitudinal monitoring of student professionalism. In implementing these changes we also retain the hugely beneficial formative aspect of multiple opportunities to feedback on students professional behaviour. We believe that this will be a more straightforward process for students, staff and stakeholders to understand. Domain 2, TD 28c and 28e All students must be made aware of the raising concerns policy, including the process for raising concerns about other students. There must be a clear differentiation between whistleblowing and raising concerns. In preparation for the 2015-16 academic year, the School made revisions to its Raising Concerns Policy, ensuring that a clear distinction now exists between raising a concern and the practice of whistleblowing. Increased awareness of the Policy has been achieved through a combination of improved visibility for the Policy and the reporting mechanisms therein, within handbooks and on the student intranet; inclusion within induction lectures delivered to all years and across all localities; and, email circulation to all students. Professional Practice Groups have, and will continue to play a key curricular role in facilitating student discussion about difficult clinical experiences, which can, on occasion, include genuine concerns about colleagues, staff or organisations. Once again, the School would like to thank the visit team for their helpful and constructive feedback, which we will use to enhance the student experience and quality of education at University of Exeter Medical School. Yours sincerely Professor Jean McEwan Vice Dean Education