REPORT OF THE INSPECTORS

REPORT OF THE GDC INSPECTORS ON THE UNIVERSITY OF LIVERPOOL FOUR-YEAR GRADUATE ENTRY BDS PROGRAMME DELIVERED BY CUMBRIA AND LANCASHIRE MEDICAL AND DENTAL CONSORTIUM AT THE UNIVERSITY OF CENTRAL LANCASHIRE 7 th and 8 th March, 2 nd and 9 th June 2011 REPORT OF THE INSPECTORS PROFESSOR P S WRIGHT * MR P A COOK * PROFESSOR E W ODELL MR D J TOPPIN PROFESSOR D HERBERT MS L HARRISON * & ** Each inspector attended the programme inspection on 7 th and 8 th March Inspectors marked with * also attended the final examination on 2 nd June and the Examiners Board Meeting on 9 th June ** GDC member of staff

Overview This report describes the General Dental Council (GDC) inspections of the University of Liverpool (Liverpool) four-year Bachelor in Dental Surgery (BDS) programme delivered by the Cumbria and Lancashire Medical and Dental Consortium (Consortium) at the University of Central Lancashire (UCLan). We were impressed with the dedication, motivation, enthusiasm and attitude of the consortium partners, the staff and the students. The programme successfully utilizes a number of Dental Educational Centres and we are confident that there is effective standardization of both the delivery and assessment of the curriculum. The assessment scheme comprehensively measures students progress against each of the learning outcomes and there are extremely robust and reliable assessment mechanisms in place. In so far as the different models of delivery used by the two universities allow, there is parity between the experience gained by students at Liverpool University and UCLan. We feel that an external examiner ought to observe the clinical assessment of students across Dental Educational Centres in future as this is the sole method by which students clinical treatment of patients is measured. It is our view that this qualification delivered by UCLan is sufficient for the purposes of GDC registration as a dentist. Introduction 1. As part of its duty to protect patients and promote high standards, the General Dental Council (GDC) monitors the education of student dentists and dental care professionals (DCPs) at institutions whose qualifications are approved by the GDC. The aim is to ensure that these institutions provide high-quality learning opportunities and experiences and that students who obtain a dental qualification are safe to practise. 2. This inspection was the fifth in a series being undertaken by the GDC during the years leading up to the graduation of the first cohort in 2011. 3. This report sets out the findings of a two day programme inspection at the University of Central Lancashire (UCLan), followed by an observation of the final OSCE examination and the Examiners Board Meeting. The inspections used the assessment principles and guidelines set out in The First Five Years Third Edition (Interim) 2008 (TFFY) as a benchmark. The report is based on the findings of the inspections and the supporting documents prepared by the School. 4. The inspections took place on 7 and 8 March and 2 and 9 June 2011. During the inspections, we met with staff from both UCLan and Liverpool University involved with the management and delivery of the BDS programme. We also met with clinical supervisors, tutors, specialty leads, consultants and students on the BDS programme. We would like to thank everyone for their assistance and courtesy during the inspection process. 1

5. The report will be considered by the Education Committee of the GDC. The Consortium partners will be given the opportunity to correct any factual errors and then submit observations on the content of the report. Programme Content and Delivery 6. This is a four-year Liverpool University Graduate Entry Programme (GEP) BDS that is delivered by the Consortium at UCLan. The first cohort of students commenced in September 2007 and they graduated in June 2011. There are 32 students per cohort and all 32 of the first cohort were entered for their final examination. 7. The delivery and assessment of the Liverpool GEP BDS curriculum has been very carefully mapped against the Learning Outcomes of The First Five Years. Whilst the assessment framework is identical at both Universities, the delivery of the curriculum varies greatly. In the absence of a dental hospital, the Consortium and UCLan have developed an innovative model of clinical training for students. The PCTs and Acute Trusts within the Consortium provide the clinical placements and the patients for the programme. 8. First year UCLan students are initially based in the UCLan School of Dentistry. The educational facilities within this modern School are excellent and include a range of dental clinical skills areas, non-clinical teaching rooms and a Human Anatomy resource room. 9. Students develop their clinical skills in one of four Dental Education Centres (DECs) that are located in Accrington, Blackpool, Morecambe and Carlisle. Eight students are placed in each DEC and they are generally allocated one of their two preference locations. Students are based in their DECs from the latter part of year one until the end of the programme. 10. The DECs each have their own on-site UCLan-employed clinical teaching staff and hospital-based secondary care consultants and specialists who deliver the curriculum for years 2, 3 and 4 in association with the UCLan dental school. 11. Each DEC is co-located within a primary dental care centre, through which the majority of patients are triaged. Students access a high number and range of primary care patients and screening of patients by the clinical teachers ensures they are allocated patients with increasingly complex treatment plans. The level of primary care activity is very high and students benefit from an excellent level of clinical support and supervision from the clinical teachers in each of the DECs. 12. The videoconferencing facilities at UCLan dental school and the four DECs are excellent and these ensure there is a regular and visible point of contact between the students and the staff. Lectures and tutorials are delivered from UCLan and they are relayed to the DECs via the hub at UCLan. The students quickly adapt to, and feel comfortable with this form of communication. 2

13. During their third year, the students commence a range of secondary care placements, alongside their clinical training in their DEC. The teaching of specialist subjects and the secondary care experience gained by the students is good. 14. Students gain most of their experience of secondary care dentistry within hospitals local to their particular DEC. Students spend two sessions of 3 4 hours per week in specialist clinics in both the third and fourth years. In respect of Oral Medicine, all the students spend sessions at Liverpool Dental Hospital. 15. There is relatively little opportunity for students to follow the treatment of those patients they have, themselves, referred to specialist clinics. However, there is evidence that during their timetabled sessions on specialist clinics, some students have been able to follow the treatment of their own referred patients. Students we spoke to were enthusiastic about their secondary care training. 16. In addition to continuing their clinical training in their DEC and attending hospital placements, final year students also treat patients in one of four Enhanced Training Practices (ETPs). The ETPs are general dental practices which are located close to each of the four DECs. At the time of our inspection, two of the ETPs were temporary but we understand that permanent arrangements will have been made by next year. 17. Students work with much less direct supervision and instruction at the ETPs. They are able to work with their own designated dental nurse and they can also gain experience of working in an environment where there is a dental therapist available. They get a broader, general experience that is more akin to working in general practice and those we spoke to were very positive about this. 18. There is always at least one ETP tutor available to oversee and assist the student where necessary. Typically a tutor will directly observe and supervise surgical interventions, and otherwise be available for the students should they need them. The tutors have regular discussions with the students both before and after seeing the patients. 19. Students complete their own paperwork and organisation in an attempt to mirror the practice environment. The students see patients who are on the same waiting list as those seen by the dentists in the practice, and unlike in the DEC, the student will be able to recall the patients, for routine follow-up care. Standardisation of Programme Delivery 20. The separation of the students in the DECs, Secondary Care Placements and ETPs for the duration of their clinical activity requires extremely careful management, in order to ensure students receive a standardised and consistent level of patient exposure, supervision and assessment. We feel the development of cross-dec networks for clinical tutors DEC operational group (DOG) - regular monitoring of the placements by UCLan staff and the use of a clinical supervisors handbook has been key in achieving this. 21. It was clear that the teaching of primary care dentistry across the DECs has been standardised. The students also gain a similar level and amount of clinical 3

experience, irrespective of where they are based. Whilst there are permanent clinical teachers in each DEC, sessional clinical supervisors have been introduced in order to provide an additional perspective. Regular meetings and liaison between the permanent clinical teachers from each of the DECs helps to ensure a uniform approach. 22. We felt that there was a consistent experience for students in terms of specialty teaching and secondary care placements. Lead clinical tutors for the specialties rotate across the DECs and each DEC benefits from the input of a Senior Dental Officer who is a specialist in paediatric dentistry and/or special care dentistry. Students receive an identical experience in respect of Oral Medicine, as all attend sessions with the same consultant at Liverpool Dental Hospital. The specialist teachers had a good understanding of their role and objectives, gained through regular contact with each other and UCLan staff. In addition, the case-mix in each of the DECs and secondary care placements is carefully monitored centrally at the School. 23. Regular visits to the ETPs by a senior member of the UCLan teaching staff and meetings with students, ETP tutors and DEC senior clinical teachers ensure equivalence across the practices. We envisage that ETP tutors will develop further their understanding of the assessment process through increased contact with the DECs for future cohorts. In- Course Assessment 24. Students are monitored on their clinical skills through longitudinal clinical assessment by the full time and sessional clinical tutors within their DEC and ETP. For each clinical activity, students are marked on both specific clinical skills, (ie, the type of procedure such as fillings, crowns, dentures) and generic clinical skills, (such as professionalism, communication etc). The assessments are termed Integrated Clinical Assessments. 25. There is a robust marking scheme for the assessment of clinical activity with clear descriptors of what is expected as the year specific standard. This clear and thorough marking guide reduces the risk of inconsistent marking. Clinical tutors undertake calibration exercises at other DECs, including the double marking of students assessments and peer reviews. 26. Whilst on the specialist clinics, students are expected to reflect and discuss their observations, although they are not formally graded. Students must complete a reflective document on a treatment session of a patient four times every month and they are graded on their self-analysis. We considered this to be a very good method of developing self-aware, reflective practitioners. 27. As mentioned above, UCLan has ensured DEC based clinical teachers, hospital based specialists and ETP tutors attend regular meetings, and this has helped to achieve consistency in the assessment of students. 28. The marks for every assessment are held centrally and rigorous monitoring of the data ensures any areas in which a student needs to improve are very quickly and easily identified. 4

29. Summative knowledge-based assessments at the end of each year are preceded by formative assessments. The assessments are each formally standard set to an appropriate level for the year group and blue-printed to the learning outcomes. The process by which questions are developed and validated is extremely robust. The assessments test knowledge the students have learnt through Problem Based Learning (PBL) and take a variety of forms including: Extended Matching Items (EMIs), Single Best Answer (SBA), Short Answer, Critical Reasoning short answer, and in-course essays. UCLan and Liverpool students sit exactly the same summative assessments in different locations but at the same time. 30. In addition, the clinical activity (the ICAs) undertaken by both UCLan and Liverpool students is assessed by a Clinical Assessment Panel (CAP). There are two formative CAPs during the year and one summative CAP at the end of the year. This panel is made up of teaching leads from both UCLan and Liverpool and an external examiner observes the discussions. The Panel will review data relating to the clinical activity of each student. The data provides extensive information on numbers of procedures and grades attained, and thus a thorough overview of the students ability and competency in each of the learning outcomes. The panellists review numbers of procedures and grades attained. Students must pass their CAP review (clinical learning outcomes) and the summative assessments (academic learning outcomes) in order to progress to the next year. The CAP and summative assessments identify whether set targets for each academic year have been reached. 31. We were pleased to note that UCLan has adopted the University of Liverpool Fitness to Practise procedure and we are confident that it would be robustly applied if need be. Final Examination 32. The final examination comprises the final CAP review, knowledge-based papers and an OSCE examination. Students who do not pass the CAP review are not eligible to sit the knowledge based questions or the OSCE. Both examination elements have to be passed independently in order to graduate. 33. As the continuous assessment of clinical work forms the clinical element of the BDS final examination, we were a little surprised that there was no external examiner involvement in this, other than their attendance at the CAP review where raw data only is available. 34. The CAP determined that all 32 of the UCLan students had successfully met their clinical targets during their final year and they were thus suitable for entry to the final examinations. 35. The final knowledge-based examination comprised two 3 hour papers, each split into two 1.5 hour sessions, each session containing 60 EMIs. Students undertook the examination online with each question on a slide appearing for 1.5 minutes. There was an excellent spread of questions across the main subject areas of Restorative, Oral Disease and Oral Medicine. 5

36. On this occasion, the UCLan students undertook their OSCE examinations at UCLan Dental School the day after Liverpool students had taken the same OSCE examination in Liverpool Dental Hospital. We did not feel that a perceived risk of question leakage rendered the examination unreliable because it was a competency rather than knowledge based assessment. In any case students had been given a blue-print of the examination showing the range of areas the OSCE would cover. In future all students will take both summative and formative OSCEs together in Liverpool. 37. Prior to the examination both examiners and students received a clear briefing and we understand the external examiners reviewed the layout of the stations. The OSCE examination consisted of 20 stations, 16 of which were active and 4 were rest stations. There were 3 actor stations. The examination was very well organised and it ran to time. There was a sufficient level of supplementary staff available to direct students and there were clear instructions to candidates, examiners and actors. There was very good consistency across the stations. We felt the OSCE covered a wide range of topics and the questioning was pitched at the correct level. The actor stations were particularly effective at assessing the students knowledge and patient management skills. 38. We felt the final examination as a whole was valid and reliable and we were most impressed by the fair and transparent approach to standard-setting. 39. The external examiners role was to quality assure the examination processes and to confirm they were fit for purpose. They were therefore required to review the questions and papers in advance of the examination and ensure the correct administrative and marking processes had been followed. The external examiners observed the OSCEs and were content that they had been conducted with impartiality and consistency. Exam Board Meeting 40. A pre Exam Board meeting takes place to analyse the results and to re-assess whether the pass mark has been correctly set. Lead clinical and administrative staff from UCLan and Liverpool attend this meeting. A robust and valid mechanism was used to determine the final pass mark and an extremely detailed and clear report was produced on the findings of the meeting. The External Examiner did not attend but was sent a copy of the report prior to the Examiners final Board Meeting. It was explained to us that the role of the External Examiner was to validate the findings of the pre- Exam Board. 41. The marks obtained by all Liverpool and UCLan students who sat the GEP BDS final examinations were confirmed at the Exam Board Meeting and an external examiner approved the final marks. Recommendations to UCLan 42. In future, the External Examiner should observe clinical assessments undertaken by students across clinical placements. This would provide a further level of quality 6

assurance of this important element of the assessment framework (ref : paragraph 33) Recommendation to the GDC 43. To grant sufficiency to the Liverpool GEP BDS delivered by UCLan. 7