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2014 Medical School Annual Return (MSAR)

The Quality Lead is the nominated person within each medical school who will be our point of contact for this MSAR with us. If necessary, 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.

We work with the Medical Schools Council (MSC) in a number of policy areas and so will share information such as student profile and progression from your responses with them to support our work.

We take our responsibilities under the Data Protection Act very seriously; any data you provide will be stored securely and confidentially. Please note that we are subject to the Freedom of Information Act 2000. If we receive a request, we may be required to disclose any information you provide to us unless a relevant exemption applies. We do not intend to publish the full MSAR returns from schools; however, we may publish selected information.

There have been a number of revisions made to the 2014 MSAR in order to make it as easy as possible to complete. These alterations are described below:

The total number of questions has reduced from 26 to 21. Whilst some have been removed or combined, there are also some new questions. We have highlighted the question numbers, theme and domains below.

Question 6 – Domain 2 – Independent reviews of student complaints

Question 11 - Domain 3 - Exit arrangements for students Questions 13 & 14 - Domain 5 - Prescribing Safety Assessment (PSA) and Medical

Schools Council Assessment Alliance

Question 21 – Additional question - Feedback on the Undergraduate Progression

Reports which are due to be published at the end of September 2014.

We have added three new fields to the MSAR Excel template ‘Section C 3 – SFtP’. These changes focus on professionalism and Student Fitness to Practice concerns. We appreciate that this data may not be accessible to all schools for this year’s return, and so are optional in 2014, but will be mandatory from 2015:

For any professionalism or SFtP concern, please provide the Entry Method of that student.

For any professionalism or SFtP concern, please provide the Location of Qualification Attainment of that student.

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If there is a professionalism or SFtP concern relating specifically to ‘Health’, please advise whether the concern relates to either ‘Adverse Physical Health’ or ‘Adverse mental Health’.

As in previous years, we request that you provide details of all low level professionalism concerns that have reached stages A – B of the process; and also all cases student fitness to practise cases reaching stages C – D of the process.

The deadline for this MSAR is 31st December 2014.

We want to make completing the MSAR as easy as possible, so if you need any help with completing this return, feel free to contact Nathan Brown or another member of the quality team on quality@gmc-uk.org or 020 7189 5221.

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MSAR 2014 – Section A

Domain 1 – Patient safety

Question 1: We have initiated a project with the MSC to review the guidance for Medical students: Professional values and fitness to practise. As part of this we will be asking you, at another time, to outline your processes for dealing with health and conduct related issues. We have therefore replaced the question related to professionalism, as recommended by the medical school Quality Leads, with a question on the systems your school has in place to monitor low level concerns. Do you have a process in place for monitoring low level conduct or health concerns?

☒ Yes

☐ No

If yes, please provide details of the processes you have in place, and if No, please provide details of the alternative measures you have in the box below:

KCL School of Medical Education has a system in place where we encourage staff to report students who are exhibiting “unprofessional behaviour” that may otherwise be overlooked. These low level concerns are logged and if a student has acquired three logged items they are required to attend for an interview with [information redacted]. Faculty (both academic and clinical) responsible for supervising students e.g. lecturers, firm heads, other staff or students can report an incident they have witnessed, especially where they feel a patient or student may be vulnerable.

We encourage students and staff to report student health concerns to members of the student support directorate; these often arise through the personal tutor and clinical adviser student support system which every student is a party to. For students at risk there are monthly student support meetings which enable monitoring of student progress. There is also a medical student health and wellbeing group with staff representatives from the College which is tasked with developing ways of monitoring and supporting students with mental health disorders.

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Question 2: Paragraph 35 of Tomorrow’s Doctors 2009 (TD09) stresses the significance of student clinical supervision with regard to patient safety. We would like to know about the nature of these issues, how you address them, subsequent evaluation or monitoring in place and current status. This information will enable us to cross-reference with information we hold about postgraduate training delivered in the same LEPs and highlight areas of potential concern.

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?

Please use the D1- Q2 sheet in the annex (Excel).

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Domain 2 - Quality assurance, review and evaluation

When responding to questions relating to good practice, please refer to the definition which can be found in the Quality Improvement Framework (QIF) on Page 27: ‘Good practice includes areas of strength, good ideas and innovation in medical education and training. Good practice should include exceptional examples which have potential for wider dissemination and development, or a new approach to dealing with a problem from which other partners might learn. The sharing of good practice has a vital role in driving improvement, particularly in challenging circumstances.’

Question 3: Paragraph 41 of TD09 states that medical schools will have systems to monitor the quality of teaching and facilities on placements. We use your responses to this question to build links between evidence gathered from undergraduate education with postgraduate training and education.

We would like to know:

a. The list of quality management visits you have undertaken in the 2013/14 academic year

b. Details of any concerns or areas of good practice identified during these visits. Please also provide us with the actions which you have taken to address concerns or promote good practice

Please use the D2- Q3 sheet in the annex (Excel format).

Question 4: A small number of newly qualified doctors may undertake their F1 training in overseas posts. If any of your graduated students are in this situation, we would like to know how you effectively quality manage these posts.

4. How do you ensure these doctors meet and are signed off as meeting the outcomes for the F1 year, in order to meet the requirements for full registration with the GMC?

KCL School of Medical Education have a small number of students who are currently undertaking their F1 year overseas. All F1 doctors overseas are required to complete the Foundation Programme e-portfolio; progress is monitored in liaison with Health Education South London (HESL).

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We strongly recommend students undertake their F1 training in the UK, applying through the Foundation Programme Application System (FPAS) in the normal way. Where students still decide to undertake F1 training overseas they must complete a F1 year overseas application during the Autumn prior to graduation. This application is first considered by the

[information redacted] and, if appropriate, prospective co-approval is sought from

[information redacted]. We utilise the supporting HESL Policy which principally determines how requests from students who decide to return to their home country for F1 training is facilitated. Completion of F1 is confirmed by the training provider using the Annual Review of Competence Progression (ARCP) Competency Certificate reconciled with the Certificate of Experience with coordinated approval by HESL. New entrants to the KCL MB BS programme from 2014-15 are advised that F1 overseas training will no longer be supported.

Question 5: We particularly want to hear of any instances of good practice. Please detail the relevant TD09 domain when giving examples. If you would like to be considered as a case study which is shared with others, please check the box at the end of the question.

5. Please tell us about any innovations you are piloting or potential areas of good practice in the box below.

Domain Example of Good Practice 4 “Medical School Admissions: Value Based Recruitment”. There is a clear

national focus on Value Based Recruitment approaches in the selection of health-care workers. KCL agrees that the future NHS workforce should be selected with the right academic and cognitive skills sets, and the right values that support effective team work whilst delivering excellent patient care. Therefore, when invited for interview, candidates are specifically asked questions using value-based questions and given value-based scenarios to consider.

4 “Medical School Admissions: Moving to Multiple Mini Interviews (MMI) format”. KCL School of Medical Education previously employed the traditional, structured interview methodology in the selection of students for the MBBS programme. Multiple Mini Interviews (MMI) have been introduced at many medical schools as they provide more information about candidates, better predict academic performance and are more reliable and valid than the traditional interview format. MMI interviews have already been introduced for the Graduate/ Professional Entry and Extended Medical Degree programmes. From 2015, the traditional interview method will be replaced by the MMI format for all applicants.

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Domain Example of Good Practice 5 MBBS Curriculum Map: In 2013-14 we implemented a curriculum review and

mapping process. This included developing an electronic, navigable programme overview, available to students and faculty listing for each year the intended learning outcomes and their relation to the King’s MBBS Competencies and GMC Tomorrow’s Doctors 2009 Outcomes. The ‘map’ is available on: https://virtualcampus.kcl.ac.uk/curriculummap/index.html

Access to the VC can be given on request

5 An OSCE website on the Virtual Campus has been created for students to aid their understanding and expectations regarding clinical examinations. https://virtualcampus.kcl.ac.uk/vc/medicine/assessment/osce/skillsmap/default.aspx

Access to the VC can be given on request

5 “Communicating across Language and Cultural Barriers” is a new interactive experiential workshop introduced to final year students in 2013-14, in which students learn to consult with patients who speak limited English or who require either ad hoc or professional interpreting services. This workshop is an addition to the existing cross-cultural communication components within the core curriculum.

5 “Action Learning Sets: a collaborative approach to work-based learning on the MBBS programme”. Action Learning Sets were piloted for volunteer 3rd year students in 2 hospitals. The evaluation of the pilot found high levels of student satisfaction. Through the Action Learning sets students developed key professional and lifelong learning skills. This work was presented at the

KCL Excellence in Teaching Conference.

5 The Patient Educator programme piloted in 2013-14 is a new inter-professional mental health learning session. This gave 3rd year students the opportunity to work with a mental health nursing student and an experienced service user. This patient-centred learning experience was well received and included elements of peer and self-reflection, feedback from the PE, and group discussion regarding recovery, teamwork, and learning that has taken place.

6 A learning support set was developed for students identified as being at risk of failing MB BS on entering their final year. This was called the “Karabiner Group” in an attempt to prevent stigma. 40 students were identified and invited. The project was initially undertaken and reviewed to see if it was acceptable to students and identify the characteristics of those at risk. The outcomes of the invitees were also documented. Further work is being considered this year for future at risk final year students. This work was

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Domain Example of Good Practice

presented at the KCL Excellence in Teaching Conference.

6 We instituted an Additional Study Programme for students required to repeat either their 3rd or 4th year that ran in parallel with their course. This incorporated aspects of Educational Theory and Performing Medicine in novel ways not reported elsewhere in the literature. The course was well evaluated by students and faculty and was presented at the KCL Excellence in

Teaching Conference.

6 Students identified as at risk of failing during their first clinical year were invited to attend an interview with two senior members of staff to work with them on assessing their motivation and identifying areas for enhanced support. 30 students were interviewed and we received excellent informal feedback from the students.

6 In 2013-14 we started “drop in sessions” for students to come and talk to a senior staff member about any issues they were worried about, these could be curriculum-related, helping resolve internal dilemmas relating to the course or pastoral matters. These are held every two weeks and have continued into the current academic year.

6 A Medical Student Mental Health & Wellbeing Support Group has been set up this past year with student, School and Central University representatives and has proved very successful and valuable for the students.

8 The “Lecture Capture” project resulted from a successful College Teaching Fund bid in 2012-13. All lectures in the large Greenwood Lecture theatre were recorded, mostly covering MBBS Years 1 and 2. An audit of lecture capture usage led to the publication of guidelines for use by KCL. The project was so successful that it is being rolled out across all KCL Schools.

If you would like your school to be considered as a case study, please check the following box: ☒

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Question 6: To supplement our information on students’ perspectives, we would find it helpful to understand the issues being considered through independent review of student complaints by the Office of the Independent Adjudicator (England and Wales), the Scottish Public Services Ombudsman or the Visitorial scheme (Northern Ireland). This will help us and the MSC to develop our relationship with the independent adjudicator bodies.

6. During 2013-14 was your medical school subject to investigations into student complaints by the OIA, the Scottish Public Services Ombudsman or Visitorial scheme in Northern Ireland?

☒ Yes

☐ No

If yes, please provide details of the issues related without identifying the individuals involved in the box below:

[Information redacted]

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Domain 3 - Equality, diversity and opportunity

Question 7: It is important for medical schools to meet the equality and diversity requirements set out within Domain 3 of TD09. Examples of how this is captured include analysis of admissions and student profile, progression, academic appeals, and fitness to practise data.

7a. Please briefly tell us how in the academic year 2013/14 you used evidence to monitor how you are meeting the equality and diversity requirements set out in Domain 3 of TD09.

King’s College London School of Medical Education recognises that widened participation can have a very positive impact on future delivery of healthcare. Therefore, we welcome students from the UK and across the globe with a wide range of qualifications and abilities, and widened participation programmes have been created which facilitate long-term, targeted support to those with the ability to succeed at King’s.

K+ is a flagship King’s two-year programme which aims to equip post-16 year old students, from under-represented groups, with the knowledge, confidence and skills to transition successfully to the academic rigours of university life.

The EMDP course is the UK’s flagship widening access to medicine programme. The programme runs for six years rather than the usual five, allowing the first two phases to be studied at a slower pace and with greater support for the first three years. EMDP students follow the same medical curriculum as all other medical students and undergo the same rigorous assessment.

King’s also recognises that mature applicants to Medicine (i.e. those who are already degree holders in a wide range of subjects) and those who have enjoyed time in industry, bring a wealth of knowledge, experience, and values to the profession. For these students we have a 4 year fast track programme (GPEP).

KCL has an Equality Objectives Action Plan for the period 2012-16 that it is rigorously following (please find attached below), in addition Equality and Diversity Action Plans are formulated annually (please find most recent attached below) according to KCL Equality and Diversity policy. In 2013-14 the College Education Committee presented a project involving the monitoring of committee membership with a gender breakdown of College senior academic committees. The Faculty of Life Sciences and Medicine has been granted Athena SWAN awards by the Equality Challenge Unit.

We provide annual training to all new and existing interviewers on the Equality and Diversity requirements of the College. Admissions staff will also randomly sit on interviews to ensure that correct and appropriate questioning is being used.

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7b. Please tell us the biggest challenges you face in promoting fairness and equality in medical education and training.

Brief details of challenges

Race Equality Charter Mark

The Race Equality Charter Mark (REM) is being launched by the Equality Challenge Unit (ECU) at King’s, alongside 30 other institutions taking part in a trial.

The REM aims to help address the continuing under-representation of Black and Minority Ethnic (BME) staff in higher education and to inspire a strategic approach to making cultural and systemic changes that will make a real difference to minority ethnic staff and students at King’s.

As a university that is firmly committed to equality of opportunity, King’s is reviewing how we go about our day-to-day business to ensure that we attract and retain the best talent. Supported by a self-assessment team comprising staff and students from across the university, King’s will be working to improve the representation, progression and success of minority ethnic staff and students.

Dealing with unconscious bias. KCL has run a number of workshops to help staff recognise and counteract any unconscious bias

Disclosure: There is a cohort of students who do not disclose additional needs around assessment for fear of being different or standing out. Lack of disclosure may make the assessment unnecessarily difficulty and the students’ result may be lower than if they had arranged the necessary adjustment.

Inclusive practice: individual adjustments are costly but essential in some assessment cases for a few students. Establishing inclusive educational measures to benefit all students can result in improved learning and teaching practice. For example, more flexible methods of assessment which explore different foci of strengths required for graduation/provisional registration and which removes the distinction between disabled and non-disabled students.

Student understanding of reasonable adjustments.

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Question 8: Guidance on Supporting medical students with mental health conditions was published in July 2013. We would like to measure its impact and you gave us feedback that case studies would be the most effective way of sharing the learning and experiences of different medical schools. We will build these into an anonymised set of case studies for your reference.

8. Please provide a brief case study outlining the management and support of a student with a mental health condition. Please highlight any changes in the management of students as a consequence of implementation of the GMC guidance: managing students with mental health conditions. If you do not have a suitable case study, please tick the box below:

[Information redacted]

☐ No case study available

Question 9: Three areas were highlighted by our review of health and disability in medical education and training, and we want to build a picture of current arrangements for each and identify practice to share among all schools. We are particularly interested to hear about instances where there is an identifiable individual who students can contact for advice.

9. You only need to complete this question if you have made changes since the 2013 MSAR.

If so, please let us know how your students can access the following and give brief details of what they consist of. Please include links to relevant information if helpful.

If no changes have been made, please leave blank.

a. Careers advice in relation to those with disabilities

Careers advice and support in relation to those with disabilities consists of the following strands:

1. One: one support

Medical students at all stages are able to access one: one support with careers consultants from the University’s Careers Service. Support includes help with a range of

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career-related issues, including exploring different specialty options, reflecting on career preferences, career decision making, building a medical CV, and making applications to different opportunities.

2. Curriculum sessions

The Medical School also works with the Careers Service to deliver a programme of lectures and workshops throughout the programme, including:

a) Induction sessions for Phase 1 students b) Career sessions included in the Professional Symposia that are timetabled in each

year c) A timetabled Careers Day for Phase 4 students including a range of career relevant

themes covered by different external speakers, and optional careers relevant workshops (e.g. considering an academic medical career; training flexibly; options to take time out of training or work abroad)

d) A programme of support for final year students to help them to apply for foundation and academic foundation posts

e) Specialty focussed careers Student Selected Components (SSCs) in Phase 5 which are experiential and reflective.

3. Information & career planning resources

Where appropriate, students are signposted to existing resources online (e.g. www.medicalcareers.nhs.uk). In addition the Careers Service has produced a number of bespoke resources developed for King’s students, and students can access the support of the Careers Service information team to locate relevant resources online. The Careers Service also has a number of licences for the specialty preference inventory Sci59.

The School and the Careers Service also support the work of numerous student-led societies which run events and other activities relating to particular specialties or medical themes (e.g. medical leadership; the Medical Students Association).

We provide one medical degree which results in a single tiered provisional GMC registration for medical applicants with or without long term conditions and disabilities. Medical students with disabilities and long term conditions have the same career aspirations as those without. Providing separate career advice may place an unnecessary divide when we need to promote cohesion; all graduates have career advice needs.

b. Occupational health services

Detail as 2013.

c. Advice on reasonable adjustments and support in making sure they are implemented once agreed, including when on placements.

Detail as 2013. Please note new role title [information redacted]

Question 10: Following our work on health and disability in medical education and training during 2012-14, we are continuing to monitor practice on reasonable

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adjustments to share good practice and identify any areas of difficulty across medical schools.

10. Please tell us about adjustments relating to the 2013/14 academic year only:

a. Any new reasonable adjustments you made which you had not made before.

b. Any requests for reasonable adjustments that you turned down and why.

c. Any cases where a student was withdrawn from the course on the grounds that they would be unable to meet the outcomes required for graduation due to disability.

Criteria Brief details of new reasonable adjustment

a. [Information redacted]

b. [Information redacted]

c. N/A

Question 11: We are aware that a small number of students are unable to continue their studies due to health, academic or conduct reasons. We wish to better understand and share practice on the exit arrangements and awards that are in place for such students.

11. Please briefly describe the exit arrangements and awards you have in place for students who are unable to continue to study medicine. We are particularly interested in arrangements and awards for students who make it as far as:

a. Year 3 b. Year 4 c. Year 5 (if applicable) d. Year 6 (if applicable)

Year Exit arrangements and awards

a. Year 3 BSc (Ordinary) Medical Science

b. Year 4 BSc (Hons) Medical Science

c. Year 5 (if applicable) BSc (Hons) Medical Science

d. Year 6 (if applicable) N/A

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Domain 4 - Student selection

Question 12: 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.

12. You will find the flowcharts you submitted for the 2013/2014 academic year in the Excel annex – D4 – Q12.

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

☒ Our student selection processes have changed

☐ No change

Please update the D4- Q12 sheet in the annex (Excel).

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Domain 5 - Design and delivery of curriculum including assessment

Question 13: In order to develop a comprehensive and authoritative picture of implementation of and support for the Prescribing Safety Assessment (PSA) we would like information from each school to complement information available through GMC membership of the PSA Stakeholder Group.

13. a) Does your medical school require that its final year medical students take the Prescribing Safety Assessment (PSA)?

☒ Yes

☐ No

13. b) If so, is the PSA used formatively or is success required in order to graduate?

☒ Used formatively

☐ Success required to graduate

13. c) Please summarise the school’s position and intentions with regard to the PSA.

The School supports the PSA and some of the School’s faculty are involved in the PSA as Examination Board Members, Standard Setting Group Members and Item Writers. The School encourages its students to sit the PSA as a formative assessment.

The School currently has no particular plans to incorporate the PSA into the Examination Regulations. We currently test prescribing knowledge in our written papers, and prescribing skills in our OSCE, and have done for a number of years.

Question 14: The MSC Assessment Alliance is researching the equivalence of standards in finals through a project that involves medical schools using questions (‘Common Content’) from its item bank.

To enable us to develop a comprehensive and authoritative picture of support for the MSCAA Common Content project we would like information from each school to complement information available through MSCAA.

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14. Is your medical school using Common Content in finals as part of the MSC Assessment Alliance project on equivalence? Please summarise the school’s position and intentions with regard to Common Content

☒ Yes

☐ No

If yes, please provide details of the issues related without identifying the individuals involved in the box below:

This will be the 4th consecutive year that KCL has participated in this project. We agree with the principles behind assessing all medical students on the same items. We have had problems with the quality of some of the items submitted for inclusion into our papers. In addition, the writing style has needed adjusting to integrate into our papers. With appropriately different standard setting methodology approved for each institution and different curricula at each institution the comparisons between institutions may be flawed as these are performed on the basis of binary action.

Question 15: Paragraph 81 of TD09 states that the curriculum must be designed, delivered and assessed to ensure that every graduate demonstrates all the ‘outcomes for graduates’. In order to mitigate the risks of schools not meeting the standards in TD09, we gather early indications of any changes which you have or plan to make. We use this to assure our standards are met and to provide you with additional support if necessary.

15. Please use the box below to inform us of any changes that you have made within the school regarding processes, curricula and assessment systems to comply with TD09 or address issues raised by postgraduate bodies or employers since the previous MSAR.

Changes made Driver(s) for changes

Curriculum Mapping Project. The curriculum map has clarified the intended learning outcomes for our students and teachers and clearly shows where curriculum items are taught and assessed. This will be further developed over the coming year and then be maintained.

In particular we wanted to respond to the demands of the students, teachers and the GMC in ensuring the curriculum was clearly visible for all stakeholders and students had clarity over where curriculum items were to be assessed. In addition, we wished to review the current curriculum with the intention of developing a new KCL curriculum and so therefore wished to clearly

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Changes made Driver(s) for changes document where the KCL and TD09 learning outcomes were currently intended to be taught and assessed.

Written assessment items for the clinical years’ summative examinations have started to be co-located into a KCL section of the Medical School Council database. This work has also included moving to SBA question-format alone.

We recognised the need for a more robust system and wished primarily to obtain a secure depository for all our assessment items. We also wanted to utilise the meta-data for our assessment items more fully e.g. each item is assigned a TD09 outcome, science domain or clinical skill and specialty data; this will allow us to blueprint our assessments more easily. In addition we will be able to track performance of items used and target items that need reviewing on the basis of poor performance. By auditing the bank it will allow us to better identify any gaps we might have in any assessment area and then we will be able to address the deficiencies in the bank in a targeted manner.

OSCE stations have been assigned TD09 learning outcomes. OSCE circuits have been blueprinted to demonstrate broad coverage of TD09 learning outcomes contain within an assessment.

Recognition for the need to demonstrate compliance with GMC TD09. A desire to track assessment of learning outcomes longitudinally.

We have introduced more formative OSCE examinations for students in a number of years where there were deficiencies.

This was in response to improving the clarity of assessments, student requests and GMC advice.

If you have any documentation relating to the changes you have stated above, please comment/attach the information in the box below:

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Domain 7 - Management of teaching, learning and assessment Question 16: Only complete if you have responded positively to Q. 15

Your response to this question will help us to understand how schools assess, monitor and mitigate risks associated with new curricula and curricular change. We hope to share effective practice in this area.

16. We would like to know if you have risk assessment strategies for the introduction/implementation of new curricula and curricular change. It will be helpful if some practical examples are included in your response.

The School of Medical Education follows King’s College London’s processes for making modifications to the MBBS Curriculum. We are currently re-writing the MBBS Curriculum. Subject to formal approval and with the agreement and support of HESL and our partner local education providers, we intend to introduce the new Curriculum from 2016. Just as the process for developing the new Curriculum is subject to project management with regular risk assessment overseen by a Project Board, the implementation will use a similar approach. We will be seeking approval in February 2015 for the new Curriculum.

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Domain 6 - Support and development of students, teachers and the local faculty

Question 17: Paragraph 125 of TD09 states that students will have access to career advice and opportunities to explore different careers in medicine. We would like to know how you inform students of career opportunities across specialties, especially those with particular recruitment challenges. It would be helpful if practical examples can be provided with evidence such as evaluation of initiatives. Your response may enable us to develop further work in this area and share practice across schools.

17. How are students made aware of career opportunities across the full range of specialties including those with particular recruitment challenges?

The Careers Service delivers informative sessions from the first year of the course onwards with the aim of making students aware of the breadth of specialties available. Later sessions introduce the issues relating to workforce planning and competition ratios and how these can have an impact on specialty choice and access.

One of the student societies run an annual careers fair for students, supported by the Careers Service, which aims to include exhibitors from a wide range of specialty choices. Students are also signposted to larger national careers events such as the annual BMJ Carers Fair held in London and the careers conferences run by the London Shared Services Unit (working on behalf of Health Education North Central and East London, Health Education North West London and Health Education South London). In addition to learning within usual clinical environments, where students are exposed to many different specialties, we are privileged to be able to provide access to more specialist areas of practice in home Trusts. In the 4th year there is a timetabled Careers Day which includes opportunities to find out about specialities which are less visible to medical students. All 4th year students are asked to reflect on their career plans and write about how they might use their elective experiences to further develop those plans within their assessed Elective Portfolio submission. Students are supported in the 4th and final years to use a SSC to investigate pre-identified areas of career interest, but are also encouraged to explore and research a wide range of possible career options and to challenge any pre-existing specialty choice ideas through their research and taster career sessions. Feedback on the career SSC programme has been very positive since it started in 2011, with students reporting that they feel much more confident about how to navigate medical career decisions in the future.

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Domain 9 – Outcomes

Question 18: Please raise any issues you would like us to consider around the outcomes and practical procedures currently in TD09. Your input is essential to ensure that medical school perspectives and knowledge are reflected and to demonstrate an open and inclusive approach to the review.

18. Does the medical school have any concerns about, or suggestions for amendments to, the GMC’s outcomes for graduates (TD09, paragraphs 7-23) or practical procedures (TD09, Appendix 1)?

Please set out these concerns and suggestions and explain the background to them, giving any evidence available

Overarching structure:

In developing the curriculum map we wanted to demonstrate how the KCL curriculum was future-facing and evolved into the GMC domains faced later in life, potentially as a consultant or GP. However this task was incredibly difficult as all the GMC documents for different stages in a medical career are illustrated differently. It is very difficult to align TD09 structure (outcomes and domains), Foundation Programme Curriculum structure and the GMC domains from Good Medical Practice. This illustration demonstrates this and our attempt at best fit.

Clinical Skills:

The majority of occurrences encountered by doctors in the NHS can be simulated for students or easily practiced with appropriate supervision in a clinical environment. However, with developments in technology and concerns about data protection, it is becoming increasingly difficult for students to access electronic notes and treatment records and therefore learn and practice how to keep good records in an up-to-date manner, navigate investigations for ordering and results-viewing, view radiology images and practice writing electronic prescriptions. Many NHS Trusts are increasingly unwilling to let students perform these tasks in the real clinical environment.

To improve the feeling of preparedness to practice this is becoming a topic that needs to be addressed nationally. From discussions at international conferences the “gap” between

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what can be achieved as a student, and what is expected of the newly qualified doctor is something that other nations are struggling with too, for many of the same reasons.

Practical Skills:

Arterial blood sampling is a core F1 skill that is currently not present within TD09.

NG tube insertion is a core F1 skill that is currently not present within TD09. As this is closely associated with a “never event” it is an important patient safety topic that we currently teach.

The following items are current TD09 practical skills that can be difficult for medical students to partake in, depending on the Trust in which they are taught or depending on national trends: blood cultures (may require specific local training and certification which may not be available to students); blood transfusion; pregnancy testing; making up drugs for parenteral administration.

GMC documents:

Outcome 3:20(A) - Know about and keep to the GMC’s ethical guidance and standards including Good Medical Practice, the ‘Duties of a doctor registered with the GMC’ and supplementary ethical guidance which describe what is expected of all doctors registered with the GMC.’

These resources could be improved with more case examples and opportunities for interactive learning

Question 19: In the outcomes for graduates in TD09 we require that they are able to provide appropriate healthcare and understand health inequalities (paragraphs 10d, 11b, 13a, 14a and 20d). Information from medical schools about current arrangements will help us to review the outcomes for graduates in TD09.

19. How does the curriculum address providing 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?

Socioeconomic background

LGBT Learning disabilities

What does the curriculum say?

Items in all years – see below for details

Items in all years – see below for details

Items in all years – see below for details

How is this assessed? SBAs, presentations, essays, OSCEs

SBAs, OSCEs SBAs, OSCEs, GP visit sign-ups, symposia sign-ups

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Please give examples of any challenges

time Low student perceived priority

time

Please give examples of any initiatives

See below See below See below

Providing appropriate healthcare and understanding health inequalities

The KCL School of Medical Education Curriculum on Understanding Health Inequalities has components delivered within all preclinical and clinical years.

Prejudice is explored in the 2nd year with the Justice, Resources and Diversity lecture and break-out groups. Students undertake a task assessing acceptable and unacceptable practices which indirectly helps them to address their own prejudices. Health Inequalities Learning Outcomes include:

The student will be able to describe, using clinical examples:

· the impact of health and illness on individuals, families and diverse

communities

· patient pathways through the health care system, with particular focus

on barriers to accessing healthcare

The student will demonstrate an understanding of:

· their own values and attitudes and be aware of and respect those of

others

· a patient-centred approach

Investigating interventions addressing inequalities:

History-taking: The main objective of the course is to learn how to take a sexual health history in a non-judgemental manner (including offering an HIV test) from patients from all socioeconomic backgrounds, sexual orientations or preferences and those with learning disabilities. The impact of these factors on the acquisition of STIs including HIV is also highlighted. STI and HIV testing is offered to all patients who attend clinics and students have an opportunity to observe, discuss issues with clinicians and practice sexual history taking. A Student Clinical Ethics Committee has discussed the ethical and legal issues in the following cases relevant to these themes:

Suspected domestic abuse in antenatal setting where the pregnant woman did not speak English

Patient (a healthcare worker) at high risk of HIV refuses testing because of concerns re confidentiality

A homosexual man presents to fracture clinic, potentially as a result of abuse - role of doctor to make further enquiries

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Should we provide a bed for man who is homeless with self-reported suicidal ideation?

Appropriateness of doctor as gatekeeper for treatment A family's request not to inform their grandmother, who does not speak English, that

she has a terminal diagnosis.

Socio-economic background

Curriculum: There are multiple curriculum areas, particularly in community teaching with opportunities to investigate interventions addressing inequalities. Clinical learning also takes place in many Trusts that are sited in deprived inner-city areas as well as others in more affluent urban and rural environments. Therefore students are exposed to patients from many different socio-economical backgrounds.

Challenges: Limited time and follow through in practical application

Initiative: Phase 4 students required to consider impact on pregnancy of social determinants of health

Assessment: The OSCE scenarios include patients and simulated patients from a wide variety of backgrounds. Communication and professionalism are assessed within these.

Sexual history taking including lesbian gay bisexual or transgender people

The learning opportunities within our curriculum include GP visits and seminars with specific focus on access to healthcare – students learn about the impact of current service provision on individuals and diverse communities, and in the seminar they are supported in applying critical thinking skills to issues faced by vulnerable patient groups

Challenges: LGBT issues were seen as low priority in a survey of students’ interests for the access to healthcare symposium –the reasons for this will be explored in this year’s survey.

Initiative: Access to healthcare symposium – speakers included [information redacted], on lesbian and gay health and access issues.

Initiative: 4th year Genitourinary Medicine 3-day course with interactive lectures. This includes sessions where the positive impact of reducing HIV stigma is taught, the impact of not doing so on epidemiology and patient morbidity and the principles of equality and diversity are highlighted. Cases include the following: HIV case histories, the role of

[information redacted], Sexual history-taking (practical practice session), Diagnosis and management of opportunistic infections, HIV epidemiology, Ethics, Sexual Health case histories and management of HIV infection. Students are then asked to attend for a male and a female GUM clinic as a minimum. Students are assessed on whether or not they exhibit a non-judgemental attitude to sexual history taking, including offering an HIV test and discussing HIV in all the OSCE stations examined by Sexual Health. Failure to exhibit non-judgemental attitudes will result in failing the station and a poor global rating which is a flag for the medical school to address this issue for this student.

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Learning Disabilities

Learning opportunities include a curriculum item in the 2nd year regarding deaf and blind patients. There are other aspects of the course where learning disabilities are met such as within the Child Health, Development and Ageing rotation and Neurology, Ophthalmology and Psychiatry rotation.

Initiatives: Access to healthcare symposium – speakers have included [information

redacted], on health inequalities and access issues for patients with learning disabilities.

Question 20: Paragraph 14J of TD09, which covers the doctor as a practitioner and includes outcome requirements on the diagnosis and management of clinical presentations, requires that students must:

Contribute to the care of patients and their families at the end of life, including management of symptoms, practical issues of law and certification, and effective communication and team working.

The care of dying people is an important issue, and it is key that students are prepared effectively. We would like to know how you have reflected on and made changes as a result of the Leadership alliance on the Care of Dying People report.

20. How does your school teach students how to best handle the issue of the care of dying people?

Year 2: Ethics and law seminar – includes a session on the ethical issues involved in euthanasia and physician assisted suicide. Year 3: Loss and Grief Seminar- exploration of the different cultural and religious attitudes to grief and mourning, discussion of the latest sociological and psychological models of the grieving process. Year 4: Seminar on therapeutics of symptom control at the end of life, including pain, followed by a clinical teaching session on this topic, where students have the opportunity to take a symptom history from a patient, present their findings and receive feedback. Symposium on End of Life Care looking at diagnosing death, planning to facilitate patient preference as to place of death, medical management of symptoms and pre bereavement assessment of families and an outline of bereavement care. Year 5: Community focussed Palliative Care Symposium, discussion of professional responsibilities and the change from student to doctor with a focus on decision making at

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end of life, small group work with vignettes on controlled drug prescribing, oncological emergencies in the community, ethics of decision making, end of life care. Hospice visit for all students with goldfish bowl exercise to explore the thoughts and experiences of users of hospice facilities. SSC options:

Clinical SSC following patients in the hospital and out into the community and hospice

Essay based, Management of pain in advanced cancer

Essay based, Ethics of withdrawing or withholding nutrition and hydration at the end of life

With both of the essay based SSCs, students are encouraged to spend time with the team and meet with patients who have experience of the issues to be explored in the essays.

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Additional question

Question 21: In autumn 2014 we will be publishing reports around Medical School Progression Data and we have asked you to update us through the MSAR on how you have used this new information to improve your understanding of and make improvements to the quality of training. We would like to work with schools on case studies to be published in spring 2015.

21. Please provide information on how you have used the new reports to understand or improve the quality of training or highlight any other

points of interest in relation to the data.

The data presented in the reports is of interest and the School of Medical Education has begun to consider it together with data from other surveys. Unfortunately there were some errors in the report and we have brought these to the attention of the GMC.

As a School of Medical Education, we have been reviewing other outcome data such as the Severn Deanery’s survey on perception of preparedness for practice. This has informed developments in the final year programme particularly around prescribing skills. We are still discussing how we can meaningfully use the progression data. Our historical data lies within the University of London data, so currently we have a limited data-set that might inform our understanding of the quality of training or any other highlights for our school. The utility of the information will for us develop over time and in future may help triangulate other data sources. This is a positive initiative.

If you would like your school to be considered as a case study for our 2015

publication, please check the following box: ☒

Thank you for completing the questions for the 2014/15 MSAR. The deadline for this return is the 31st December 2014; please ensure you have completed each of the following:

☐ Section A (Word) – MSAR qualitative questions.

☐ Annex to Section A (Excel) – Templates for D1-Q2, D2-Q3 and D4-Q12.

☐ Section B (Excel) – Quality Visits/QIF visits requirements (if applicable).

☐ 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, feel free to contact Nathan Brown or another member of the quality team on quality@gmc-uk.org or 020 7189 5221.