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2015 Medical School Annual Return (MSAR)

Submission deadline 8 January 2016

The following table has been pre-populated with our latest records, please amend as required.

Name of Medical

School:

The University of Edinburgh

Name of

Dean/Head of School:

Name of Quality

Lead:

Name of Quality

Assurance Administrative contact:

Name of Senior Manager (signing off

quality and accuracy of MSAR

on behalf of school):

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 the quality and accuracy of the return. Please indicate who will be the primary point of contact for the MSAR above.

Data processing notice:

The GMC will handle any personal and sensitive personal data provided in the MSAR in line with the Data Protection Act (1998). Information provided to the GMC is subject to the Freedom of Information Act (2000).

The GMC will publish the following sections on our website by medical school and may share the information with other organisations including the Medical Schools Council and in response to Freedom of Information requests:

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Section A – Questions exploring the Tomorrow’s Doctors (2009) domains and

Promoting excellence themes

Section B - Quality Management

Information provided in Section C may be published on our website or shared with others, such as the Medical Schools Council and in response to Freedom of Information requests:

C1 - Student Profile

C2 - Student Progression

C3 – Student Fitness to Practise

C4 – Placement

Potentially identifiable information, such as name, job title or other protected characteristic, should only be provided if it is essential to your response.

Information will be anonymised or redacted before publication to protect privacy.

Data may be shared with data recipients, in accordance with the Data Protection Act. Data recipients may include the following non-exhaustive list: Medical Schools Council.

Information may be used for statistical and research purposes.

Medical Schools should submit information to the GMC in line with their established privacy agreements.

Changes to 2015 MSAR Template

The questions in Section A have been split into two sections; A1 and A2. Please ensure that all questions in Section A1 are answered. Questions in Section A2 only need to be answered if there have been any changes since the previous MSAR.

Guidance for Section C3 - Student Fitness to Practise

Please provide details of all low level professionalism concerns that have reached stages A and B of the process as well as all fitness to practise cases reaching stages C and D of the process.

Tomorrow’s Doctors (TD09) and Promoting excellence

The new standards ‘Promoting excellence’ bring together the standards for undergraduate training; ‘TD09 with postgraduate training’ and ‘The Trainee Doctor’. They were released in July 2015 and come into force in January 2016. This document references the relevant TD09 domain, and also includes the appropriate reference to the new standards ‘Promoting excellence’.

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The deadline for submission of this MSAR is 8 January 2016.

If you need any help with completing this return, feel free to contact Joseph Sadowski or another member of the team on quality@gmc-uk.org or 020 7189 5327.

MSAR 2015 – Section A

Section A1

Please answer all questions in this section

Patient Safety - TD09 domain 1 and Promoting excellence

theme 1

Question 1: In light of the recent publication, ‘First, do no harm: enhancing patient safety and teaching in undergraduate medical education’, the GMC are collecting data about how medical schools teach students about patient safety and equip them with the skills to contribute to safety improvement as doctors.

a) What is your approach to teaching the discipline of patient safety? (Please provide a brief – 2/3 paragraph – summary, highlighting any key innovations or particular areas of good practice.)

The teaching of Patient Safety and Continuous Quality Improvement sits within the Personal Professional Development theme and has a separate lead. The curriculum was developed using the ‘flipped classroom’ technique. Students are expected to prepare for whole year lectures and workshops in Years 1-3 by prior completion of relevant on-line IHI Open School resources

http://www.ihi.org/education/ihiopenschool/Pages/default.aspx

In Year 5 small groups attend the Scottish Simulation Centre and complete Significant Event Analyses following their visits. Some students also choose to do SSC2b or SSC4 in patient safety. There is an IHI patient safety chapter in Edinburgh maintained by interested students.

Other aspects of patient safety (infection control / prescribing) are covered in other areas of the course. (See summary tables 1 and 2 under (c); and eemec.med.ed.ac.uk/pages/patient-safety).

b) How do you ensure students understand why health-care professionals make errors? (see WHO patient safety curriculum guide Topic 5)

Prescribed IHI modules and whole year teaching in Years 2 and 3 cover this area. There is use made of appropriate clinical examples (e.g. the Elaine Bromiley case).

c) How does your curriculum cover the objectives and relevance of clinical risk management strategies in the workplace?

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A general introduction to clinical risk management is taught in 1st year patient safety lectures.

During the clinical years, students are introduced to relevant aspects of the Scottish Patient Safety Programme as part of their clinical teaching (e.g. the use of SBAR in clinical communication teaching, the use of the surgical pause during surgical teaching in the operating theatre). Students complete a Significant Event Analysis following their attendance at the Scottish Simulation Centre.

Table 1: Edinburgh MB ChB Patient Safety & Continuous Quality Improvement

Curriculum

Year Topics Suggested on-line

IHI open school resource

Year 1 Introduction to patient safety 1

PS 100: An introduction to patient safety PS 101: Fundamentals of patient safety

Year 2 Introduction to patient safety 2

PS 102: Human factors

& safety

Year 2 Opportunity for SSC2b project

Year 3 Introduction to patient safety 3

Clinical decision making

Quality Improvement

QI 101: Fundamentals of improvement

QI 102: The model for improvement QI 103: measuring for

improvement

Year 4 Opportunity for SSC 4 project

QI 201: Guide to the IHI Open School Practicum

Year 5 Scottish Simulation

Centre visit followed by Significant Event Analysis

PS 105: Communicating with patients after

adverse events

PS 106: Introduction to the culture of safety

Table 2: Aspects of patient safety taught elsewhere in the curriculum:

Year & theme Topics

Years 1 – 3 (Emergency care, clinical & resuscitation skills)

Infection control: Cleanliness Champions programme and essay

Must be completed by 3rd year.

Years 3-5

(Clinical pharmacology & therapeutics)

Whole year teaching on safe prescribing in Year 3, followed by ongoing learning in small groups through Years 3-5

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Quality Management – TD09 Domain 2 and Promoting

excellence theme 2

Question 2: We are interested in the nature of issues being raised as student complaints to the Office of the Independent Adjudicator (OIA) (England and Wales), the Scottish Public Services Ombudsman and the Visitorial scheme (Northern Ireland). Please provide details so that we can further understand the nature of appeals to student ombudsman services, and learning from these cases can be shared more widely to increase awareness among medical schools.

a) During 2014-15 were there any investigations into student complaints by

the OIA, the Scottish Public Services Ombudsman or Visitorial scheme in

Northern Ireland concluded in relation to your medical school?

[Information redacted]

b) What, if any, changes to policies or processes has your medical school implemented in response to investigations by the Office of the Independent Adjudicator, the Scottish Public Services Ombudsman or Visitorial scheme in Northern Ireland?

[Information redacted]

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Equality, diversity and opportunity – TD09 domain 3 and

Promoting excellence theme 2

Question 3: It is important for medical schools to meet the equality and diversity requirements set out within TD09 and their replacement, ‘Promoting excellence’. Examples of how this is captured include analysis of admissions and student profile, progression, academic appeals, and fitness to practise data.

a) When you have found evidence of differences (e.g. in admissions, student profile or those listed above) on the basis of gender, ethnicity, socio-economic status or other characteristics, what actions have you taken to understand or address this difference?

We have found no evidence of bias in gender balance in ration of applications to offers or admissions, however the ratio of male:female at all stages is approximately 45:55. Data on other characteristics is less robust, often because of lower numbers or incomplete information (e.g. race), but again does not show significant differences. However we are keen to improve our analyses of outcomes by protected characteristics as well as origin, age, markers of disadvantage, and will be working to improve this in 2016. We have recently made a senior academic appointment to oversee this analysis and reporting.

b) Is there a formal process for appeals made to schools about decisions on reasonable adjustments? If so please provide details on how appeals are handled

The Medical School in liaison with the Disability Service have drawn up a list of professionally appropriate reasonable adjustments. All students are seen by the Medical School student support service and Co-ordinator of adjustments to discuss and agree the reasonable adjustments suggested by the Disability Service. We work to an agreed list of reasonable adjustments (eemec.med.ed.ac.uk/pages/adjustments-policy-in-the-mbchb) and perhaps because of these measures have not had any appeals to consider. Unique individual circumstances are always taken into concern in interpreting these policies. Students are informed that if there are any difficulties or problems that they should contact Student Support at the Medical School and a joint meeting with the Co-ordinator of Adjustments and the Disability Service will be arranged. If there was still concern that policies were not being handled fairly and reasonably this would be reviewed by the Head of Undergraduate Medicine, and if not satisfactorily resolved would be dealt with as a student complaint.

We have an annual meeting with the Disability Service where reasonable adjustments are discussed.

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Design and delivery of the curriculum including assessment – TD09 domain 5 and Promoting excellence theme

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Question 4: We are working on options for a UK Medical Licensing Assessment (UKMLA) which will be consulted on during 2016. We would like to ensure we have comprehensive and up to date information on when medical schools hold all components of their final assessments so we can understand how a UKMLA could fit in.

Please tell us when you hold each component of your final assessments, including re-sits by completing the following table. If you permit more than one opportunity to re-sit without repeating a year please include details in the relevant row below.

Assessment

Term or equivalent

Year of study

(penultimate or final

year)

Maximum number

of re-sits (if

applicable)

Knowledge

This includes a two-paper Safety in Practice online

MCQ; and a Portfolio Viva on issues beyond acute

care

From 2016: February/March

(proposed : subject to validation)

Final Year 1

First knowledge re-sit

From 2016: June (proposed :

subject to validation)

Final Year

Second knowledge re- sit (if applicable)

n/a

Clinical

This includes the Clinical Practice Examination and

an assessment of the

Student Assistantship and

Elective

From 2016: Clinical Practice

Examination in February/March; Student Assistantship

and Elective in June

(proposed : subject to validation)

Final Year 1

First clinical re-sit

From 2016: Clinical

Practice Examination in June; Student Assistantship and Elective in June or in following academic year (proposed : subject to validation)

Final Year

Second clinical re-sit (if applicable)

n/a

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Question 5: We would like to gain a greater understanding about how GMC ethical guidance is taught in medical schools and how we can support this.

What is your approach to teaching students about the professional standards expected of them, including raising awareness of the GMC’s ethical guidance?

Formal Personal Professional Theme teaching contribution:

In the early years of the course, the PPD theme aims to teach on professional issues that are particularly relevant to younger medical students (e.g. effective lifelong learning, time management, self-care). In later years the focus becomes more clinical. Information about this is posted at: eemec.med.ed.ac.uk/curriculum/themes/personal-professional-development (linked from eemec.med.ed.ac.uk/curriculum)

Year 1 Talk in welcome week (with UG manager) to all new students regarding appropriate professional behaviour expected of medical students

PPD theme introductory lecture, which introduces concepts of professional standards including a brief introduction to Good Medical Practice (GMP)

GMC student engagement lecture follows on from this – arranged with GMC Scottish Affairs Officer

1st year students are encouraged to sign up for GMC student news

The Chair of the Fitness to Practise (FtP) Committee presents a lecture to 1st year.

In Health Ethics and Society (a Year 1 module) ethical frameworks are presented. eemec.med.ed.ac.uk/curriculum/modules/health-ethics-and-society

Year 2: PPD focuses on self-care with two whole year emotional resilience workshops. We plan to develop this further in future years.

Year 3 (= new Year 4 from 2016; PPD content will be unchanged): Introductory PPD session in Year 3 focuses on appropriate professional behaviour in the clinical years including self-care.

2nd semester: whole year session organised by PPD theme on subject of professionalism. Previously, talks were given by PPD theme and representative from MPS, focussing on themes in GMP. This year the 90-minute slot will be filled with a student engagement session offered by the GMC Scottish Affairs Officer, supported by the PPD theme.

The Chair of FtP presents a refresher lecture

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Year 4 (= new Year 5 from 2016: PPD content will be unchanged) In Year 4 optional workshops are offered entitled “Making professional

Judgements”. These are badged as early preparation for the impending Situational Judgement Test, and are very popular, but focus almost entirely on reviewing situations where there are issues of professionalism and ethical behaviour (mainly brought by the students themselves, some real and some

suggested as possibilities). GMP and relevant explanatory guidance are explored as the core texts of this session. Such is the demand, that additional workshops were offered to this year’s 5th year and the PPD theme plans to increase the number of workshops offered to the present 4th years.

A selection of the examples brought by the students to these workshops are then collected in an online document for use in student study groups. Further

commentary and links to relevant sections in GMP are added by the PPD theme.

Year 5 (= new Year 6 from 2016) Making Professional Judgement (MPJ) sessions are offered at the beginning of

Year 5 (see above).

In new Year 6 it is planned to offer an additional “Preparation for Practice” session in association with the MELPR theme during the clinical assistantship. This would build on issues raised in the MPJ sessions but allow more time, and smaller numbers in each group, to explore the issues further. It is hoped that GMC Scottish Affairs Officer may also be involved in this session.

Many other teachers contribute to the students’ professional development. E.g. a variety of aspects of appropriate professional and ethical behaviour are discussed in sessions during the Year 3 introductory week. In addition there is relevant teaching at modular level.

During their induction sessions, Personal Tutors and Clinical Tutor Associates are made aware of current GMC guidance on appropriate professional and ethical behaviour and they are encouraged to share this aspect of learning when meeting with their students so that informal conversations on professional behaviour can

be held on a 1:1 basis.

Management of teaching, learning and assessment – TD09 Domain 7 and Promoting excellence theme 2 & 5

Question 6: New standards, ‘Promoting excellence’, covering all stages of medical education and training will come into force on 1 January 2016. To help us to support medical schools it would be helpful to know about any changes you need to make or challenges you have identified in relation to implementing the new standards.

Please provide us with details of any changes planned, areas under review and any challenges you have identified in relation to implementing the new standards

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From August 2016 we are making significant changes to the final three (clinical attachment-based) years of our programme in response to a number of factors including different ways of working in hospitals, relative importance of topics in the curriculum, desirable alterations in student exposure to and involvement in medical practice, apprenticeship, readiness for earlier licence to practice – and to keep us closely aligned with GMC standards. The plans are outlined at eemec.med.ed.ac.uk/pages/curriculum-revision-2016.

These changes do not alter intended graduate outcomes or curriculum content, but position us better to provide top quality experience and education.

S1.2 – Ensuring an organisational culture that values and supports education and training in both the University and LEPs. In common with other schools we have encountered increasing challenges in both University and NHS environments from competing pressures to excel in research, and to sustain high quality clinical services, in a difficult economic environment. We have been endeavouring to create a more positive culture through:

an explicit statement from the Principal of the University that education is an unambiguous priority that all staff must address, coupled with a commitment to review teaching carefully as one of the criteria for promotion and in annual reviews

a revision of the MBChB (mentioned at the head of this Q) to reinvigorate educational thinking and module developments, being more explicit to students and staff about the expected teaching and learning activities

a drive to ensure that all clinical teachers have time in their job plans arising from the revised teaching and learning activities; aided by clear expectations from the medical school, and transparency of time in job plans through a new e-job planning system

more frequent meetings with our medical students council and a drive to ensure that student representatives are present routinely at education governance committees, and that we communicate changes better to them

the Clinical Educator Programme (sefce.net/cep). This was a joint initiative of the Medical School, the PG Deanery, and Lothian, Borders and Fife Health Boards, created to develop a community of practice amongst education faculty, raise the profile of teaching, reward good teaching and to train, motivate and encourage faculty. 2,000 staff are currently registered.

R2.3 – Taking account of stakeholder views. Within educational governance structures we take account of students, junior doctors, educators, and employers but it has been difficult to get consistent input from patients and the public. Local research suggests that many local patients are reluctant to be involved in medical education to this degree, or even to give specific feedback to the medical school. We are continuing to seek ways to strengthen this.

R2.5 – Equality and diversity analysis of outcomes. This has been difficult in the past but our ability to conduct such analyses is improving as university systems improve. We have appointed a senior academic to oversee this reporting in the future.

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R3.13 – Feedback to students on their performance Our challenge here is with feedback from patients, families and carers (see R2.3 above). Patients and simulated patients contribute to the marks and feedback in OSCE stations but do not formally contribute in clinical learning or formative assessments. Informal feedback may occur.

R5.2 – Developing the curriculum Again the notable challenge is achieving meaningful lay/ patient involvement in these processes (see 2.3).

R5.3 – Longitudinal following patients through care pathways. We believe we fully satisfy this standard but have been thinking about it. We foster this in longer attachments, and in case reports requiring consideration of the whole pathway. We have considered but not so far implemented formal longitudinal attachments, holding back because of the logistical complexities. SSC projects often offer detailed opportunities to do this.

Question 7: A small number of newly qualified doctors may complete an overseas GMC approved programme for provisionally registered doctors or the recognised F1 training year overseas. If this applies to your graduated students, we would like to know how you effectively quality manage these posts.

If none of your graduates go on to train overseas as described, please tick the box stating ‘No graduates continuing their training overseas’.

☒ No graduates continuing their training overseas a) How do you ensure that overseas training provides suitable curriculum coverage and that doctors in training receive an appropriate level of clinical and educational supervision?

b) How do these doctors record their progression?

c) How do you ensure that doctors meet all of the required outcomes for the F1 year and are signed off in order to meet the requirements for full registration with the GMC?

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Section A2 The questions in Section A2 need only be answered if there have been changes since the MSAR you submitted in December 2014

Equality and diversity and opportunity – TD09 domain 3

and Promoting excellence theme 2

Question 8: It is important for medical schools to meet the equality and diversity requirements set out within TD09 and Promoting excellence. Examples of how this is captured include analysis of admissions and student profile, progression, academic appeals, and fitness to practise data.

[Information redacted]

a) Briefly tell us if you have made any changes, in the academic year 2014/15, to the way you use evidence to monitor how you are meeting the equality and diversity requirements.

[Information redacted]

b) Do you have any examples of challenges you have had or actions you have taken to ensure fairness and equality in medical education and training (since your last submission).

[Information redacted]

c) Please include details of any changes you have made to the way students can access advice on reasonable adjustments and support in making sure agreed adjustments are implemented – including on placement.

d) Please provide us with details of any changes you have made since the last MSAR in relation to how the curriculum addresses providing

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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?

There have been no changes to the curriculum since last year. We are currently in the process of developing an Open Educational Resource on LGBT health which will be available to students during 2016-17.

Student Selection – TD09 domain 4 and Promoting excellence

theme 2 Question 9: 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.

You will find the flowcharts you submitted for the 2014 MSAR in the Excel template tab ‘Annex A – Q9’.

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

☐ Our student selection processes have changed

☒ No change to our selection processes

Design and delivery of the curriculum including assessment – TD09 domain 5 and Promoting excellence

Question 10: Please raise any issues you would like us to consider around the outcomes for graduates and practical procedures currently in TD09. Your input will make sure that medical school perspectives and knowledge are reflected and logged when we scope the case to review the outcomes.

Have any issues emerged since last year’s MSAR which suggest the GMC might consider revising the Outcomes for graduates and the associated list of practical procedures in which graduates must be competent?

Please describe the issues and the implications for the Outcomes for graduates and the list of practical procedures.

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Generally our views are similar to those raised in last year’s MSAR. General Comments on the Learning Outcomes The layout of the learning outcomes in Tomorrow’s Doctors (GMC 2009) is helpful in planning, developing and auditing a curriculum, and for blueprinting

assessment. The number of major outcome domains (16) is perhaps more than ideal, especially within the Doctor as a Professional. Nonetheless review by our

lead faculty suggests that the detailed learning outcomes (106) address the key

competences that must be achieved by graduation.

In our curriculum review (2015) we have identified and added 3 additional learning outcomes that do not appear to have been addressed in Tomorrow’s Doctors (GMC 2009):

Describe the development, assessment and regulation of new drugs

Demonstrate critical awareness of rapid developments in eHealth

Demonstrate critical reasoning in situations of ethical and legal uncertainty

to inform clinical decisions.

We have based our own detailed learning outcomes on those of Tomorrow’s Doctors. Our intention is to include all the latter but in editing them we may have added some additional elements.

The learning outcomes in Tomorrow’s Doctors are not defined in terms of the complexity of contexts or limits of responsibility. The statements apply equally to Consultants, Trainees and graduating students: some refinement to describe more specifically the scope including the contexts of practice and whether with direct/indirect supervision would help. This comment also applies to the list of practical procedures in Appendix 1.

The scope of the learning outcomes or competences could be defined in relation to specified core content. We have embarked on defining prioritised lists of Core Content in 8 domains including: key scientific concepts, situations/contexts, presentations, conditions/diseases, drugs, investigations, other treatment modalities, and practical procedures. This is proving very popular with students in guiding their use of time.

Biomedical Science Learning Outcomes These are very compressed considering how much is contained in each short statement. This was one of the triggers to develop Core Content. We have expanded the learning outcomes with lists of scientific concepts and areas of required knowledge.

Practical Procedures Workplace assessment is the best way to test these skills. Asking 250 students to complete workplace assessments of all 32 would be overwhelming, and some are more important and difficult than others.

The guidance could be clearer about the level of supervision or success expected for a graduating student in each skill, as described above under learning outcomes.

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There are also difficulties giving students adequate workplace experience of some

of the 32 skills on the Appendix 1 of Tomorrow’s Doctors to develop competence. The reasons range from low exposure rates e.g. for suturing; limited opportunity because nursing staff usually perform the procedure e.g. wound dressings, skin, ear, nose and throat swabs and female catheterization; and safety issues which require one or two trained staff to be closely involved with every procedure every time e.g. blood transfusion, administering IM, IV, or SC drugs, use of local anaesthetics and use of infusion devices.

To develop success in IV cannulation 80% of the time junior doctors must undertake the skill approximately 79 times (de Oliveira Filho, 2002). We have therefore been keen to focus students’ practical learning and summative assessment on the key skills that they will be responsible for as an FY1. Results from a questionnaire to 237 clinical skills experts in Scotland on the relevant importance of the 32 skills allowed us to prioritise five 'big skills' that students must achieve and demonstrate competence in, through workplace assessment, prior to graduation. These five are venepuncture, IV cannulation, oxygen therapy, BM and urinalysis. Students also have a formative on-line logbook containing all 32 skills where they can log attempts, follow cumulative sum charts and store workplace assessments

Perhaps some of the 32 practical skills could be subdivided to allow a clearer description of the expected competences. For example Therapeutic Procedure 17: Establishing peripheral intravenous access and setting up an infusion; infusion devices, includes the essential core skill of intravenous cannulation along with setting up an infusion device, a competence many would consider postgraduate because of the array of device types.

Performing an arterial blood gas is not one of the 32 procedures listed by the GMC and was quoted by a number of respondents in our questionnaire as a skill that they felt was important for junior doctors to be competent at.

☐ No issues to raise

Question 11: Medical schools provided information in last year’s MSAR on how issues related to the care of dying people were covered in their programmes. Please provide an update if there have been any changes this year.

We have recently published an update to last year’s, ‘One chance to get it right report: Improving people’s experience of care in the last few days and hours of life’ setting out progress since last year: [One chance to get it right: one year on report].

Since the last return in 2014, have there been any changes in the way end of life care is taught at your school?

Please provide any examples of good practice that you would like to share with other schools.

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☒ No changes Question 12: Please tell us about any changes in the way your medical school handles the Prescribing Safety Assessment (PSA) since last year’s MSAR submission.

☒ No changes to report a) Does your medical school require that its final year medical students take the PSA?

☐ Yes

☒ No b) If so, is the PSA used formatively or summatively?

☐ Used formatively

☐ Used summatively c) Please summarise the School’s position and intentions with regard to the

PSA.

We make a very strong recommendation to students that they should take the PSA but it is not compulsory. Over 99% did so. Prescribing is also tested in our current summative assessments and during some attachments.

We are continuing to develop a framework for defining how students will demonstrate a number of key practical outcomes, including prescribing, and specific skills listed in Tomorrow’s Doctors. For prescribing we forsee expecting:

Evidence of participation in online testing of calculation skills (eDrugCalc)

Evidence of participation in practical prescribing for patients through our Pre-Prescribing programme with a certain minimum number of prescriptions written and approved

A pass in the PSA

If any of these is deficient we will expect extra evidence. For example if the PSA had not been taken or had not been passed, we are likely to have much higher expectations from Pre-Prescribing, or make other specific requirements.

Comparable approaches will be taken to other skills; adequate evidence will be required and we are defining the principles for each.

Pre-prescribing continues to expand across final year clinical attachments with 96% of students now reporting having the opportunity to pre-prescribe. A revised and standardised induction has been rolled out to all units using pre- prescribing and this appears to be working well. Audit of errors and risk continues with no significant issues recorded since the introduction of the new induction session.

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Support and development of students, teachers and the local faculty – TD09 domain 6 and Promoting excellence theme

3 Question 13: Medical students should have access to career advice and opportunities to explore different careers in medicine.

We would like to know if there been any changes to how your school attempts to increase students’ attraction to specialties with particular recruitment challenges including general practice.

Please provide any examples of good practice that you would like to share with other schools

We have given careful consideration to how much we are able to influence career decisions. We are aware that a lower than average proportion of Edinburgh graduates go into general practice; 29% versus 34% (range from all schools 16- 43%). However Edinburgh produces slightly more than its share of trainees in medical specialties, paediatrics, anaesthesia, and psychiatry – a list that includes several other shortage specialties.

We note a poor correlation between career destination and student exposure to, and ratings of, those specialties. For example Emergency Medicine has a long attachment compared to the size of its specialty workforce, is very highly rated by students, but is an uncommon career destination.

Primary Care is central to the UK’s healthcare, and we regard good exposure to it as extremely important. Edinburgh had the first academic department of General Practice in the UK, and students are exposed to it in Years 1, 2, 4 and 5 of the current curriculum, including 7 weeks full time. These are very positively rated by students. Our August 2016 revisions will extend this to 8 weeks, and bring the first full-time exposure forward into new Year 4, the first clinical attachment- based year, to be revisited in final year.

Our Medical Students Council collates a list of student-run societies at eemec.med.ed.ac.uk/pages/medical-societies

We will continue to monitor this position and respond carefully to questions raised.

Section B – Quality Management

Please answer all of the questions in this section.

To answer the questions below, please use the ‘Section B – Quality Management’ tab in the accompanying Excel spreadsheet

Question 14: We would like to know about any issues relating to student clinical supervision and patient safety. How do you address these issues, and what subsequent evaluation or monitoring is in place and current status.

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This information will be cross-referenced with information we hold about postgraduate training delivered in the same LEPs to highlight areas of potential concern.

a) 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?

Medical schools should have systems to monitor the quality of teaching and facilities on placements. Your responses to this question will be cross-referenced to evidence gathered from postgraduate training and education.

As always, some attachments disappoint, and this comes back to us in spontaneous comments and verbally in meetings or conversation as well as in our annual questionnaires to students (each attachment is surveyed twice annually). We review these with DMEs and module leads. Often these are areas in which postgraduate trainees also report difficulties, and we are coordinating our responses increasingly closely with postgraduate colleagues. During 2016 we plan to pilot joint UG-PG visits to units/ specialties.

b) Please provide details of any concerns or areas of good practice identified during monitoring visits. Please include actions you have taken to address concerns or promote good practice.

We recognise excellent performance in survey reports and other student feedback and nominations in a number of prizes. Mostly these are won by dedicated teachers using conventional methods with enthusiasm, teaching in a wide variety of styles including eccentric ones, but from whom students pick up enthusiasm, and most importantly, students recognise eagerness that the students should learn.

We would like to hear about any instances of good practice. Please detail the relevant TD09 domain or Promoting excellence theme in your examples.

c) Please tell us about any innovations you are piloting or potential areas of good practice.

GOOD PRACTICE – 1. Peer Assisted Learning now a core part of the curriculum in the penultimate year, supported by lectures and online materials on teaching, learning and assessment throughout the programme.

2. Students in their first year of hospital-based learning experiences have small group sessions to orientate them to the beside and ward environment, supported by online video and materials.

3. A co-ordinated staff development programme across South East Scotland, in line with the NES managed system for Scotland, aimed at a well developed faculty and recognition and approval by GMC of ’named trainers’. The staff development programme and processes are supported by comprehensive information on the VLE (EEMeC) with links to the Scottish Trainers Framework and

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with scaffolding within the appraisal website (SOAR) for demonstration of the evidence of competence (eemec.med.ed.ac.uk/pages/recognition-of-teachers).

Two main medical education courses provide comprehensive training across the 7 domains of the Framework for the Professional Development of Postgraduate Medical Supervisors (Academy of Medical Educators 2010):

the Clinical Educator Programme which has 2,000 clinical teachers enrolled on its classes and

the Edinburgh Summer School in Clinical Education, a week-long comprehensive course.

4. An early warning system to flag up students at risk of failing Year 1, Semester 1 exams; and from 2016 Final Year also, in order to offer an individual meeting with their Personal Tutor and then a senior student led group session to consider strategies for effective study, a good work-life balance and sources of support.

PILOTS and INNOVATIONS

5. Ward based experience for volunteer Y2 students working for several shifts alongside nursing staff to learn how to care for patients and how wards operate. In 2016 we are mainstreaming this programme for all students for a two-week block in new Year 4.

6. A small simulated inter-professional prescribing masterclass for 3 non-medical prescribing students, 2 Y4 medical students and 2 pharmacists was piloted using three common prescribing scenarios and 2 simulated patients. The medical students, non-medical prescribing students and pharmacists worked together to formulate and implement evidence-based prescriptions. The Readiness for Inter- professional Learning Score (RIPLS) and a self-efficacy score were administered to the students and the Trust in Physician Score to the simulated patients. Overall, the RIPLS and self-efficacy scores increased. Pharmacists showed the highest rating in the Trust in Physician score. Post masterclass group discussions suggested that the intervention was viewed as a positive educational experience. We are seeking funding to extend this pilot. [Paterson, R. et al., 2015. Inter-professional prescribing

masterclass for medical students and non-medical prescribing students (nurses and pharmacists): a pilot study. Scottish Medical Journal. Available at: http://scm.sagepub.com/content/early/2015/09/22/0036933015606583.abstract ]

7. In response to strong student feedback we have dropped the summative assessment of workplace based clinical skills; they had proved unreliable, and standardising the marking for each module was possibly unattainable. Instead we have focused on encouraging students to seek narrative feedback on clinical tasks while on attachment, as with supervised learning events.

Students have a batch of feedback postcards that can be completed by student or tutor immediately after the event, discussed during and at the end of an attachment with tutors, and then returned to the medical school for scanning into a student's own portfolio. Completion of the postcards was made compulsory to emphasise their importance to staff and to ensure opportunities for students to check their own progress before the end of year clinical exams.

We have not yet fully evaluated the system but there are clearly some issues to

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address with both students (shy to ask) and teachers (not yet fully acquainted with what they are replacing, or what they will feel when they are shown what they have written). We also made the mistake of assuming the students knew that trainee doctors are required to complete a portfolio and undertake supervised learning events. They tend to regard SLE-type ‘compulsory feedback’ as nannyish.

Section C

Please complete the information required in Section C – excel spreadsheet

Section C1 – Student Profile

Section C2 – Student Progression

Section C3 – Student Fitness to Practise

Section C4 - Placement

Thank you for completing the questions for the 2015 MSAR. The deadline for this return is the 8 January 2016; please ensure you have completed each of the following:

☒ Section A (Word) – MSAR qualitative questions

☒ Section B – Quality Management (Excel)

☒ 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, or have any suggestions, feel free to contact Joseph Sadowski or another member of the quality team on quality@gmc-uk.org or 020 7189

5327.