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
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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
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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
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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.
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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.
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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
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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.
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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
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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.
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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.
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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.
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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