UCLan medical school

This visit is part of the new school review to ensure 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 Central Lancashire (UCLan) medical school

Programmes MBBS

Date of visits

25 January 2016

03 May 2016 (OSCE observation)

08 June 2016

Key Findings

1 UCLan is developing a five year MBBS programme,

which is self-funded by student tuition fees. At

present, it is open to overseas students only. We had

previously recommended that the School defer its

opening by one year to September 2015, when the

first cohort of students commenced their studies.

2 As such, a comprehensive quality assurance cycle took

place during the 2015/16 academic year, with three

separate visits. We were impressed with how the

School had responded to our requirements and

recommendations, and noted significant progress in

many areas. In particular, the School was felt to

provide excellent pastoral and academic support to

students, as well as being highly responsive to student

feedback.

3 Other areas, however, continue to require work. In

UCLan medical school final visit report 2015-16

2

addition, some aspects of the programme require

further development, including the School’s

assessment system. We have set requirements for the

School to review and improve on these areas, and will

monitor progress over future visit cycles.

3

Updates on open requirements and recommendations

Open requirements Update Report

paragraph

1 In addition to generic UCLan

guidance, further programme

specific guidance will be required

to cover clinical placements,

scheduling of classes and

examinations where students’

cultural or religious expectations

may differ from expected practice

or rules, by 1 December 2014.

This requirement has been

met. The Equality and

Diversity (E&D) policy has

been updated to provide

specific guidance to students

about School practices.

29

2 The School must ensure that the

learning outcomes in the

curriculum align with those of the

contingency school, Liverpool, by

1 December 2014.

This requirement has been

met for Years 1 and 2, with

all learning outcomes of these

years now aligned with

Liverpool Medical School. The

School is now in the process

of aligning learning outcomes

for the later years of the

programme, which we will

review on future visit cycles.

99

3 The general practice teachers

need to be fully prepared for the

placements. This includes having

training to become familiar with

the curriculum, where their

placements sit within it, the

learning objectives students will

need to meet, how students will

be assessed, and evaluation and

quality management processes.

This must be done by 1 March

2015.

This requirement has been

met. All general practice

teachers have received the

required training, and noted

that they felt well prepared

for the first students.

34

4 Given the relatively small size of

the School and the committee

structures, the School must give

appropriate consideration to the

security of students’ personal

sensitive information. The School

must ensure the committee

The School is partially

meeting this requirement.

The School is mindful of

protecting confidentiality, and

the Structured Event

Reporting Form (SERF) now

includes a confidential tick

9; 44

4

structure excludes those formally

involved in student support and

progress decisions from making

formal fitness to practise

decisions.

box in order to protect

students’ personal sensitive

information. However, the

School recognises that

protecting the anonymity of

students in terms of giving

feedback remains a difficulty.

5 The UCLan MBBS curriculum

must be mapped in detail to the

Liverpool MBBS curriculum to

ensure no students are placed at

a disadvantage for assessments.

Were there to be any delays or

significant problems with the

MBBS, the UCLan students would

be required to take the Liverpool

assessments in order to complete

their studies.

This requirement has been

met for Years 1 and 2. The

curriculum for these years

has been mapped in detail to

Liverpool Medical School’s

curriculum. The School is now

in the process of undertaking

mapping for the later years of

the programme, which we

will review on future visit

cycles.

99

6 The School must include all

known risks in its risk register so

that the GMC can be satisfied

that they are being identified and

managed quickly and effectively.

The School is partially

meeting this requirement.

The risk register currently

holds high level planning

risks, but needs to include

more operational risks,

including all those associated

with the delivery of the

assessment system.

27

7 The School must have clear

methods to assess students’

professional knowledge and

behaviours both summatively and

formatively, with a clear

differentiation between academic

assessment of professionalism

from fitness to practice.

This requirement has now

been superseded by

requirement 2 below.

48; 130

8 The School needs to further

clarify its process on signing off

students’ workplace based

assessments and clinical

placements.

This requirement has been

met. Students complete a

primary care placement form

for their GP placements, as

well as logbooks for

community placements, in

110

5

Year 1. For later placements,

students will be required to

complete logbooks that

specify particular skills.

9 It needs to be made clear to

students how the School uses the

module weightings within

modules in the MBBS assessment

policy handbook. If there is no

compensation on the weighted

parts of a module, the

percentages may confuse the

students.

This requirement has been

met. Students were clear

about how their assessments

are weighted, and

appropriate documentation

has been developed.

75

10 The School must be clear how

students move from student

support to sanction. It is not clear

what the thresholds are for

placing a student into the fitness

to practise process or how

decisions are made to enter them

into the fitness to practise

process.

The School is partially

meeting this standard. A

large volume of work to

improve guidance on the

thresholds has been

undertaken, but students

continue to be unsure about

the difference between

fitness to study and fitness to

practice.

77

11 The School must provide clear

information for students about

Educational Performance Measure

scores and other criteria used for

the UK foundation programme

rankings.

The School is partially

meeting this requirement.

The information in student

handbooks has been

updated, but we will explore

how assessments in the

various years of the MB BS

programme are weighted

during future visit cycles.

77

Open recommendations Update Report

paragraph

1 The School should review the

multiple sources, levels and

frequency of student evaluation.

The School should map where

students are asked to evaluate

the programme to ensure that

This recommendation has

been met. The School has

undertaken a detailed review

of its feedback methods, and

reduced the load as a result.

Despite a tail off towards the

end of the year, feedback

5

6

students are not fatigued by it. from students was high.

2 The School should develop a

rounding policy for its borderline

regression method calculations on

the multiple mini interview

stations to ensure a fair and

transparent process.

This requirement has been

met. A rounding policy for the

borderline regression method

calculations has been

developed and utilised.

55

3 The School should ensure that

the formative and summative

assessments are close enough in

format and scope, so that they do

not impact students’

preparedness for what is

expected of them.

The School has not yet met

this requirement. While

formative feedback was felt

to be useful, students

reported that the formative

and summative versions of an

assessment were not always

comparable in terms of

content or challenge.

77

4 Personal tutors and students

should be provided with guidance

that will support them in

understanding the School’s

fitness to practise procedures.

This recommendation has

been met. The School has

provided detailed guidance to

staff and students about

fitness to practise

procedures. In addition,

further training for staff

members is planned.

53

5 The School should be involved in

the University decisions regarding

reasonable adjustment and

fitness to practise to ensure

medical expertise and

understanding is included in the

decision making process.

This recommendation has

been met. The School is

actively involved in University

decisions regarding

reasonable adjustments. No

fitness to practise

proceedings have yet been

initiated for the School to

involve the University.

52

6 The School should recruit a Head

of Medical Education, to support

the Head of School of Medicine in

her numerous roles and

responsibilities.

This recommendation has

been met. A Professor of

Medical Education, who will

also undertake the role of

Lead for Assessment, has

now been appointed and is in

post.

10

7

Areas of good practice

We note good practice where we have found exceptional or innovative examples of work

or problem-solving related to our standards that should be shared with others and/or

developed further.

Theme Good practice Report

paragraph

1 Theme 2: Educational

governance and leadership

(R2.2)

The support from the Vice

Chancellor and University’s senior

team is clear and has a positive

impact on the development of the

School.

28

2 Theme 3: Supporting

learners (R3.2)

Students praised the academic and

pastoral support they receive from

the School; this was both informally

via the relationships they have with

staff and formally through the

provision of reasonable

adjustments. In particular, the

academic advisors were noted to be

an integral part of the support

system.

61-62

Areas that are working well

We note areas that are working well where we have found that not only our standards are

met, but they are well embedded in the organisation.

Theme Area working well Report

paragraph

1 Theme 1: Learning

environment and culture

(R1.5)

The School has shown itself to be highly responsive to student feedback. Students recognised that the School welcomes their evaluation, and takes action where possible.

7

2 Theme 2: Educational

governance and leadership

The development of West

Cumberland Medical Education

Centre looks to have the potential to

32

8

(R2.6) provide multiple opportunities for

the School, students and the local

healthcare economy.

3 Theme 2: Educational

governance and leadership

(R2.6)

The engagement with and support

of placement providers looks to be

working well. In addition, the

collection and analysis of

intelligence on placement settings is

impressive.

33; 36

4 Theme 2: Educational

governance and leadership

(R2.8)

The School continues to effectively

build and expand on their external

stakeholder relationships.

37

5 Theme 3: Supporting

learners (R3.1)

E&D has been effectively embedded

into the curriculum, with clear

policies and processes.

59

6 Theme 4: Supporting

educators (R4.1)

Training for staff looks to be

comprehensive, readily available,

and includes staff development

initiatives such as peer observation.

85-87

Requirements

We set requirements where we have found that our standards are not being met. Each

requirement is targeted, and outlines which part of the standard is not being met, mapped

to evidence we gathered during the course of the visit. We will monitor each

organisation’s response to requirements and will expect evidence that progress is being

made.

Theme Requirements Report

paragraph

1 Theme 2: Educational

governance and leadership

(R2.16)

The School must review the

guidance provided to students and

educators about the professionalism

and reporting system in order to

improve understanding of the

purposes of the process.

46-47

2 Theme 2: Educational

governance and leadership

(R2.16); Theme 5:

Developing and

The School must develop a clear

mechanism to assess student

professionalism that is separate

48; 130

9

implementing curricula and

assessments (R5.6)

from fitness to practise.

3 Theme 5: Developing and

implementing curricula and

assessments (R5.5)

The School must review its

curriculum and assessment content

and attached guidance in order to

improve student preparedness for

summative assessment and

programme progression.

115

4 Theme 5: Developing and

implementing curricula and

assessments (R5.6; R5.8)

The School must ensure that it has

adequate numbers of experienced

and trained assessment staff to:

ensure the quality of item or

station writing.

ensure the quality of resit

assessments.

create detailed mark schemes

that promote consistency of

marking for short answer

questions and essay

questions.

develop and administer

standard setting procedures

that are appropriate for the

context of each summative

assessment.

prepare and interpret

psychometric analyses for

each summative assessment

event, and use this to quality

manage item/station banks.

improve the School’s ability

to write, mark and standard

set assessments.

118

Recommendations

We set recommendations where we have found areas for improvement related to our

standards. Our recommendations explain what an organisation should address to improve

in these areas, in line with best practice.

10

Theme Recommendations Report

paragraph

1 Theme 3: Supporting

learners (R3.7)

The School should review the

information available to students

about various aspects of the

programme and ensure that student

understanding improves.

78

2 Theme 5: Developing and

implementing curricula and

assessments (R5.3)

The School should take steps to

standardise the duration and depth

of detail of class based lectures. In

addition, the School should ensure

that students receive lecture slides

within a specified, standardised time

frame.

106

3 Theme 5: Developing and

implementing curricula and

assessments (R5.4)

The School should take steps to

improve the standardisation of

students’ experience of primary care

placements, by making expectations

and learning outcomes explicit to

both students and educators.

109

4 Theme 5: Developing and

implementing curricula and

assessments (R5.6)

The School should review its policy

for releasing OSCE station titles 24

hours in advance to ensure students

allocated to earlier circuits are not

disadvantaged compared to

students on later circuits. In

particular, it must ensure that

students are aware that the policy is

planned to be changed for the

clinical years of the programme.

125-126

5 Theme 5: Developing and

implementing curricula and

assessments (R5.6)

The School should ensure that all

equipment and simulated patients

are standardised for each OSCE

station to avoid unnecessary

concerns from students.

127

6 Theme 5: Developing and

implementing curricula and

assessments (R5.6)

The School should review the

marking sheets provided to OSCE

examiners. This will avoid the risk of

error due to transcription of marks

from paper to an online system.

128

11

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’, such as where things are working particularly well or

where there is a risk that standards may not be met.

Theme 1: Learning environment and culture

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); Educational and clinical governance (R1.6)

1 The School appears to have a clear process for raising concerns. We heard in our

Equality and Diversity (E&D) meeting that the Structured Event Reporting Form

(SERF) is used to raise concerns about students and staff that occur at the School

and on placement; students are asked to complete a SERF in addition to following

local processes while on placement. The School encourages the use of the SERFs as a

method of developing a culture of raising concerns in professional practice.

2 Positive SERFs can also be given for exceptional performance. At the time of visiting

in June, 28 had been awarded. The School feels that this encourages information

sharing.

3 We were concerned to hear that the students we spoke to did not seem clear on how

to raise a patient safety concern on placement. Some said that they would raise a

SERF, while others told us that there is a dedicated email address and contact

telephone number for concerns. All students did, however, appear able to raise any

concerns or issues they have about placements directly with School staff. We will

review this area on future visit cycles.

Supporting duty of candour (R1.4)

4 We heard from curriculum staff that students will be taught about the duty of

candour in Year 2. As such, the students we spoke to were not aware of the concept,

but had looked at GMC guidance. In addition, professionalism has been integrated

into teaching from the beginning of Year 1, with Interprofessional Learning (IPL)

sessions being patient centred to focus on developing professionalism.

12

Seeking and responding to feedback (R1.5)

5 We previously set a recommendation for the School to review its methods for

collecting student feedback. We heard from the senior management team that the

School has completed a mapping exercise and changed its processes to reduce the

likelihood of feedback fatigue. The central UCLan policies that the School had planned

to adopt would have duplicated the School’s text feedback forms, and have been

removed as a result. See open recommendation 1.

6 The School uses a text survey system to collect feedback. Students answer two

questions and provide a RAG rating for each teaching block and at the mid-point of

placements; this allows the School to respond quickly to immediate concerns. The

School also collects feedback through a suggestions box that is considered each week

at the Rapid Response Medicine group (RRM), a placement evaluation questionnaire,

and a module feedback questionnaire at the end of the year. The School is currently

waiting for the final results of this questionnaire, which we will follow up on future

visit cycles. The Head of School told us that student engagement with the feedback

system has been decreasing as the year has progressed, but after talking to the

students the completion rate has recovered. We were told that the end of year survey

was mandatory.

7 We were impressed with the School’s responsiveness to student feedback. All

students we spoke to commented that they felt able to raise any concerns, and that

the School took action where they could. Students were also aware how they could

feed back about their placement experiences. We heard of many examples where the

School collected and responded to feedback, such as the amendments to the Year 2

timetable and provision of funding for travel expenses. The School takes care to

publish the minutes of the Staff-Student Liaison meetings and ‘You Said, We Did’

updates on the intranet so as to show that they welcome and act on student

evaluation. The GPs and staff from Bridgewater Community Healthcare NHS

Foundation Trust (Bridgewater) we spoke to also felt that the School took

suggestions and feedback very well. See areas that are working well 1.

8 We voiced our concerns that as the number of students increased, it will become

harder to provide the same level of response as at present. While the School

recognises this, we heard from staff responsible for quality management that

feedback can be easily separated into the programme’s three ‘themes’ (Integrated

Science and Clinical Medicine [ISCM], Evidence Informed Practice of Medicine

[EIPOM] and Medical Skills and Quality Care [MSQC]), and do not envisage the

increased level of feedback presenting insurmountable problems.

9 In addition, we expressed concerns about the confidentiality and timeliness of

feedback on placements. The Head of Phase 2 recognised that due to the small

number of students, it will be difficult to protect confidentiality. While aggregation of

data is possible, the School is keen to act on negative feedback as early as possible to

13

improve the students’ experience. We will follow this up with the School during

subsequent visits. See open requirement 4.

Appropriate capacity for clinical supervision (R1.7)

10 The School has undertaken a large amount of work to ensure that staffing levels are

adequate. In June, we heard from the senior management team that multiple staff

have been recruited over the academic year. These posts include a Professor of

Medical Education (also acting as the Head of Assessment) and a Lead for Work-

based Learning; some additional posts are still being recruited. Further recruitment at

West Cumberland Medical Education Centre (WCMEC) has also taken place, including

a Professor of Medicine, Professor of Primary Care Medicine and project manager.

The School recognises that as it grows, more staff will be required. See open

recommendation 6.

Appropriate level of clinical supervision (R1.8)

11 We were pleased to hear that no students we spoke to had concerns about their level

of supervision on placement. The GPs told us that students were heavily supervised

due to their early stage of training.

Appropriate responsibilities for patient care (R1.9)

12 We heard of one instance of a student being asked to perform a procedure that they

were not competent to undertake. The student had been given guidance by the

School about the steps to take in such situations, and felt able to decline. We were

pleased to hear that there were no other examples of students being asked to

undertake work outside their competence.

Induction (R1.13)

13 The inductions students received in advance of their placements seemed

comprehensive and appropriate. We heard from the Head of Work-based Learning

that students received an information pack and had an initial induction for their GP

placements in late January.

14 At the beginning of placements, students attached to Bridgewater received an

induction from their mentor for each new placement setting within the two weeks,

whilst GPs gave students an induction appropriate to the individual practice alongside

mandatory health and safety training. The students we spoke to seemed content with

the inductions they received on placements, and had found them useful.

Multiprofessional teamwork and learning (R1.17)

15 The School is committed to utilising the College’s various healthcare programmes to

provide high quality multiprofessional opportunities. We heard in our introductory

14

meeting that 350 students had taken part in sessions throughout the year; this

included a joint presentation between medical and pharmacy students.

16 In addition, students in Year 1 received one IPL session within each learning block.

Students looked at professionalism and policy in these sessions, with group work

looking at the role of the student. In Year 2, the School has planned four days of IPL,

where students will explore quality improvement.

17 The students we spoke to had mixed views of their experience of IPL: some felt that

whilst they understood the purpose, the sessions repeated skills they had already

learnt. Others felt that it would be more useful at this stage to learn the roles that

each profession played in the healthcare system.

Adequate time and resources for assessment (R1.18)

18 There appeared to be some concerns amongst students about the time and resources

available to prepare for their assessments. Students commented that their summative

assessments were grouped very closely together, with two or three days in between

each one. In addition, exams started immediately after the last block of teaching,

which students felt left them little time to revise. Some also felt that they did not feel

that they were given adequate time to prepare for their formative assessments.

Capacity, resources and facilities (R1.19)

19 There remain some concerns over the School’s available resources and facilities. In

particular, there are a limited number of rooms at the School, with further required

over the forthcoming years. The School does, however, show a real understanding of

the need to extend its facilities, and has undertaken long term planning with the

University to outline its anticipated need for the next five years. There is a plan to

move the University closer to the city centre, which will create more space.

20 The College Dean told us that the School is also looking to extend its teaching space.

The School is in regular meetings with the University executive team to discuss plans

for expansion, and is working on a 10 year development plan. We will follow this up

with the School during future visit cycles.

21 We felt that the School has prepared for Year 2 in terms of curriculum and resources

in a well thought-out manner. We heard in our introductory meeting that the School

has mapped the Year 1 and 2 timetables together to check for room or teaching

clashes, and made amendments as required.

22 While the School has prepared well for the expected Year 1 and 2 cohorts, we were

concerned that students may be over-recruited for the 2016/17 academic year. As a

result, the School could encounter challenges in terms of their resources and

community placements. In June, the Admissions Lead told us that the School has

thus far received over 60 provisional acceptances, which may increase after the

15

School’s final round of Multiple Mini Interviews (MMIs) in June 2016. The School aims

to recruit 50 students, but we heard that the resource mapping and contingency

plans would allow for a higher number of students in the 2016/17 Year 1 cohort. The

Head of Work-based Learning told us that there is also flexibility within GP

placements to allow for increased capacity.

23 During our meeting in June with staff responsible for placements, we heard that a

small number of Bridgewater placements were evaluated more poorly than

anticipated. Often, this was a result of the placement setting being too busy due to

service pressures, with supervisors unable to dedicate as much time to the students

as was expected. The School expects the Trust to make the necessary changes

before the next community placements in February 2017, and will review feedback

from these in collaboration with the Trust at monthly meetings.

24 In addition, the GPs we spoke to told us that supervisor time is always under

pressure. However, all GPs said that they would not take students unless they had

the capacity to provide adequate supervision, and told us about the organisational

changes (such as working hours) they had made in order to accommodate the

students. GPs also commented it is easier to absorb students and provide supervision

in larger practices.

16

Theme 2: Education governance and leadership

Quality manage/control systems and processes (R2.1)

25 We heard from the Programme Manager that the School has undertaken a large

amount of work on its governance structure, which has been streamlined in order to

reduce the burden on staff and to reflect the GMC’s new standards, Promoting

Excellence. The new structure is expected to be launched in September 2016, with

further mapping of the risk register planned. Previously, there were several

committees and subgroups, which took up a disproportionate amount of staff time.

The School has now reduced this to one overarching committee, the School of

Medicine Academic Committee (MAC), which is fed into by six School level Sub-

Committees. These Sub-Committees (Admissions and Marketing, Patient Safety and

Professionalism, Learning and Teaching, Work-based Learning, Assessment and

Evaluation, Staff-Student Liaison) cover the management and quality management of

the programme. The RRM group, which has been operating on a weekly basis for

leads and the Head of School, will sit within MAC and continue meeting on this basis

while retaining its original purpose for emergency situations.

26 In addition to the basic governance structure, there are various working, operational

and stakeholder groups. The working and operational groups are formed when

required, such as the fitness to practise panel. While the operational groups are

predetermined with set terms of reference, the working groups can be scaled in

proportion to what is needed. The Head of Work-based Learning told us that

Stakeholder groups, such as the Phase 2 groups within Local Education Providers,

report into the Work-based Learning Sub-Committee.

27 While the risk register has been updated, we noted that at present it does not include

any items relating to the School’s assessment policy and delivery. During the quality

management meeting in June, the School told us the risk register was developed

during the planning of the programme, and that they would review it now that the

School was in the delivery phase. We heard that assessment risks are currently

reported via the Assessment Subgroup to be addressed and resolved, then reported

to the board of examiners and MAC. See open requirement 6.

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.

17

Accountability for quality (R2.2)

28 During the visit cycle, the support that the School receives from the Vice Chancellor

and University’s senior team, and the positive effect of this, was evident. We heard

from the College Dean that the University sees the business and research

opportunities that the School can bring as opportunities for the University. As a result,

the University is felt to be extremely supportive in terms of finance and project

management. See good practice 1.

Considering impact on learners of policies, systems, processes (R2.3); Informing curricular

development (R5.2)

29 We heard from the E&D team that the School, in response to feedback, has amended

its timetable so that students are able to attend Friday prayers. A precedent has also

been set for religious leave, and the E&D policy document updated to improve

student guidance. See open requirement 1.

30 In addition, the School has involved clinical staff and UCLan’s Community

Engagement and Service User Support (Comensus) in the development of the

curriculum and programme. It continues to consult extensively with these

stakeholders and students to ensure that new policies and systems are appropriate.

There is currently no Comensus or student involvement with fitness to practice

processes; however we heard that the School may review this in the future.

Systems and processes to monitor quality on placements (R2.6)

31 The School has made significant progress in developing its relationships with and

monitoring of placement providers. We heard from staff responsible for placements

that over the year that the School has signed Service Level Agreements (SLAs) with

nine GP practices and four local education providers. It is also in the process of

negotiating SLAs with an additional ten Trusts and various community placements;

each additional Trust is offering a small number of student placements. While the

School plans to use East Lancashire Hospitals NHS Trust (ELHT) as its main trust, it

would be helpful for the School to consider as the programme develops how students

will receive a standardised level of experience across the wide geographical area.

32 We heard from the Head of School that WCMEC at UCLan’s campus in Whitehaven,

Cumbria is in the early stages of development. This collaboration between the School

and the Trusts in the area aims to provide students with a rural experience, and is

also an opportunity for the School to develop a centre of excellence for rural

medicine. At present, some key shared posts have been appointed, and the School

has joint funding for a further seven appointments; it is hoped that these posts will

include clinical fellows. The School plans for students to first have placements at the

campus in 2018, with none of the current first cohort being placed at the site. We felt

that the development of WCMEC appears to have the potential to provide multiple

18

educational opportunities for the School, students and local healthcare economy. See

areas that are working well 2.

33 The School is well engaged with its placement providers, and this was echoed by all

groups we met with. The communication with the School and the preparation that

providers received in advance of placements was praised; Bridgewater staff told us

that they received an induction day in April 2015 and an additional session a month

before the first placement. We also heard that GPs and Bridgewater mentors had

received detailed guidance on what actions to take should they have concerns about

a student. The School also has a strong relationship with ELHT, which is

complemented with bi-monthly meetings between the Trust and Phase 2 staff. We

heard from the Head of Phase 2 that as new SLAs are signed, the School is looking to

set up better links with these additional Trusts in order to build relationships before

placements start. See areas that are working well 3.

34 The Head of Work-based Learning told us that all GP staff were fully inducted with

the appropriate training before the first placement. The School recognises the need to

provide regular updates to the GP teachers to keep practices informed about the

curriculum and learning outcomes, and has scheduled an update for July 2016. See

open requirement 3.

35 All GP practices are accredited with Health Education England working across the

North West (HEE NW). The School has an agreement with Manchester Medical School

where if a concern about a GP practice is raised by either school then this is shared

with the other. We heard from the Head of Work-based Learning that the School has

a contingency agreement with additional practices in Preston should major concerns

arise in practices.

36 The School’s collection and analysis of intelligence about providers is thorough. Staff

responsible for placement management told us that before the School undertakes

quality management visits, it reviews data from various external sources alongside

soft data and individual GP GMC records. Trusts and GP practices are then visited to

ensure that they are of an appropriate standard and that the educators understand

the School’s curriculum. The School is aware that there are placement settings within

the area that have been rated inadequate by the CQC. The School considers these on

a case by case basis, as it believes that often these providers can continue to offer a

high quality learning experience. See areas that are working well 3.

Sharing and reporting information about quality of education and training (R2.8);

Collecting, managing and sharing data with the GMC (R2.9)

37 The School continues to effectively build and expand on its external stakeholder

relationships. We heard in various introductory meetings that the School has met with

various stakeholders in the region, and has further meetings planned with groups

such as the University of Cumbria. The Project Board has representatives from all

19

stakeholder groups, including the various Trusts the School works with; these Trusts’

risk registers are monitored regularly. See areas that are working well 4.

38 The School continues to communicate with HEE NW and Manchester Medical School,

and feels that now the programme has started, relations are progressing well. Both

medical schools continue to work in parallel to manage placements where both

cohorts are placed in order to reduce the burden on educators and share information.

Additionally, we heard from the Programme Manager that HEE NW has recently asked

the School to provide their Physician’s Associate programme.

39 We heard during the quality management meeting in June that the quarterly risk

meetings with Liverpool Medical School continue via videoconference. The Schools

discuss all items on the risk register and update on any new or ongoing concerns,

including those that may impact on Liverpool. In addition, the two schools discuss the

development of the programme.

Systems and processes to ensure a safe environment and culture (R2.11)

40 We heard from the Director of Medical Education at ELHT that students will formally

be supervised by consultants while on placement at ELHT, although doctors in

training may undertake some informal supervision. As such, there appeared to be

some ambiguity over teaching arrangements by doctors in training. While placements

are not due to start until Year 3, the School would benefit from considering how

students can meet learning outcomes in the hospital environment if no doctors in

training are involved in teaching or supervision.

Managing progression with external input (R2.12); Meeting the required learning

outcomes (R3.15)

41 The School appears to have a clear policy on student progression. We heard from

assessment staff that students must pass all modules to progress, and are permitted

one resit per assessment. If students have not successfully completed all modules by

the end of the resit period then they can, at the discretion of the Assessment Board,

resit the entire year. Students can only resit each year once, and must complete the

programme within 2 years of their expected finish date.

42 Assessment staff told us that they had analysed the assessment results to look for

patterns that may help the School identify support requirements at an early stage.

The numbers are small, but the School did not find any correlation between the

International English Language Testing System (IELTS) and student results; there

was also an even split of results between routes of entry.

Managing concerns about a learner (R2.16)

43 We heard from staff responsible for quality management that the School has

undertaken a large amount of work to develop how it identifies and manages

20

concerns about students. The professionalism and reporting system is the key

method for identifying professionalism, performance or welfare concerns. This

enables the School to trigger the appropriate processes and provide support. As well

as refining the design and use of SERF, the School has produced a flowchart which

shows how concerns about students can be raised, both by self-reporting or external

identification.

44 The E&D team told us that the submitted forms are triaged by one of two Designated

Officers, then passed to the appropriate staff member should the form meet the

threshold for reporting. Level 1 concerns raised through the professionalism and

reporting system are forwarded to the Academic Advisor, who will meet with the

student within two weeks. The SERF is discussed and any actions agreed. Students

write a reflective piece for their portfolio, and a SERF outcome is also uploaded to the

portfolio. Level 2 concerns are reported to the Academic Advisor and Head of Phase,

and the student is then met within one week. Level 3 concerns are forwarded to the

Head of School, and a meeting between the Academic Advisor, Head of School and

Head of Phase is initiated within 24 hours and an action plan agreed. Individuals

completing a SERF can also indicate that the concern is confidential by ticking a box,

so that the Designated Officers can redact the form when forwarding to the relevant

staff member. See open requirement 4.

45 During our visit in June, we heard that staff responsible for quality management have

begun more closely monitoring the SERFs reported in order to identify and track

patterns. At the time of our visit, 47 had been raised; the School has already defined

these by gender. The School has not yet identified any patterns with SERFs, but will

continue to monitor this as numbers grow.

46 We heard from several groups that there is a lack of clarity around the purpose of

SERF. This was most keenly felt by students, who saw it as a punitive measure that

was, at times, inappropriately used (such as for minor events where direct, verbal

feedback, at the time of the event, would have been more appropriate). Some

students also felt that it was used as a threat. Those raising SERFs are asked to

inform students; however we heard that this was not always the case and that this

could cause anxiety.

47 The School recognises the disparity between the purpose of the SERF and the

students’ perception of the process. The Head of School told us that a session was

held with students recently to demonstrate the balance between positive and

negative SERFs, and the School will continue to work to change how the process is

viewed. See requirement 1.

48 We heard in our assessment meetings that the School also uses the portfolio to

identify professionalism concerns. Whilst students would fail the portfolio if they failed

the reflective piece on ‘My Professional Journey’, the School does not formally assess

professionalism, nor has a clear strategy been developed. See requirement 2.

21

Sharing information of learners between organisations (R2.17)

49 We were concerned to hear that it is not compulsory for students to declare a

disability or support need at entry, and as such concerns may not be identified or

shared with appropriate bodies. E&D staff told us that the School encourages

students to declare any learning needs at entry or once on the course so that

appropriate support can be provided, and has taken steps to overcome the stigma

attached with disability. Further details on these initiatives are included under

requirement 3.4.

50 The GPs we spoke to had not received any information about students that required

adjustments or support. We will explore this area in more detail on future visit cycles.

Requirements for provisional/full registration with the GMC (R2.18)

51 We heard from the Head of School that the School continues to use the central

UCLan policy for its fitness to practise processes. The School is confident that its

procedures are appropriate, but will continue refining these to suit its needs. The

School is using external consultants to provide expert opinion throughout the

development of the process.

52 The School has not yet been required to initiate any fitness to practise investigations.

We heard in our E&D meeting that the School has planned additional training for staff

in June 2016 where senior staff will discuss thresholds and the difference between

support and sanction. At present no staff member is actively involved with the

University’s fitness to practise panels. See open recommendation 5.

53 The current fitness to practise policy has been disseminated to students, and staff

have run sessions on what concerns may trigger the fitness to practice procedures.

The E&D staff we met recognised that student understanding is at times lacking

around issues surrounding fitness to practise, including fitness to study. There are

plans to readdress these themes at the beginning of Year 2; these discussions will

include SERF and support vs. sanctions. While student understanding requires

improvement, the documents disseminated to staff about fitness to practise seem to

have been effective. See open recommendation 4.

Compliance with legislation (R2.19)

54 The School’s E&D policy sets out its compliance with the appropriate legislation. We

heard from E&D staff that all School and placement staff must undertake E&D

training before working with students. In addition, students will receive annual E&D

training as part of their placement inductions.

Recruitment, selection and appointment of learners and educators (R2.20)

55 The admissions system appears to be embedding well. We heard from the Admissions

Lead that there are three key steps to the application process. First, the School

22

receives the initial application where applicants must meet the set criteria; a selection

panel then reviews references and personal statements. Successful applicants are

invited to the MMI; the MMI panel is made up of trained school staff and Comensus

members, who also mark the personal statement. Previously the School used ten

stations, but will reduce this to eight stations in the next academic year. Offers are

made based on ranking at the MMI and passing a minimum of six out of eight

stations. The Admissions Lead told us that the stations in the recent admissions cycle

had received a Cronbach’s Alpha of 0.938, and we noted that the School has

developed and implemented a rounding policy for its borderline regression method

calculations. See open recommendation 2.

56 The School collects feedback on each station and makes amendments as necessary.

We heard in our January quality management meeting that the School has reduced

the time of each MMI station to seven minutes based on applicant evaluation.

57 The School has a target of 50 students for the 2016/17 Year 1 cohort. In our various

meetings in June, we heard that for the 2016/17 academic year, the School received

50% more applications than the previous year. The majority of the School’s MMIs

took place in January, but additional MMIs will take place at the end of June. At the

time of the June visit, over 60 students had provisionally accepted their offers. As the

School only has one year of admissions data, it recognises that it cannot accurately

predict the conversion rate.

58 We had previously explored the School’s required IELTS level for entry. In January,

assessment staff told us that from 2017, students entering the School with an IELTS

level of 7.0 (the minimum) must achieve a level of 7.5 before starting clinical

placements Year 3. We did not hear of the School’s contingency plans should

students fail to achieve this standard, and as such will review the impact of this

requirement over future visit cycles.

23

Theme 3: Supporting learners

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.

Good Medical Practice and ethical concerns (R3.1)

59 The School has effectively embedded E&D into the curriculum, with clear policies and

processes. We heard from E&D staff details of the training students have received

over the year; this included sessions on protected characteristics, disability, and

various E&D themes in the context of the workplace, as well as talks with guest

speakers. The School ran these sessions in an open forum to encourage discussion

and address prejudices; students were also given ‘homework’ to be mindful of

invisible groups in society. See areas that are working well 5.

60 The School continues to use Comensus as a teaching and assessment aid for

students. Students practice their communication skills with Comensus volunteers in

one to one consultations, and the students we spoke to praised these sessions.

Learner's health and wellbeing; educational and pastoral support (R3.2)

61 Students praised the support they receive from the School; this was both informally

via the relationships they have with staff and formally through the provision of

reasonable adjustments. All students we spoke to told us that the School was

supportive, with staff seen as very approachable and happy to provide guidance and

assistance where they could. The behaviour of the staff following the death of a

student in December 2015 was picked up on by the students, who emphasised how

the School worked around the students to best support them; this included moving

exams and lectures.

62 We were impressed by the School’s development of the academic advisor scheme.

The students we spoke to praised the support of their advisors: many told us that the

academic advisors would be their first port of call for both academic and pastoral

support, and that they would receive the support or guidance they needed. Students

have four mandatory meetings with their academic advisors per year, but the

advisors appeared to be available for additional ad hoc meetings. Assessment staff

told us that the academic advisors will run additional training sessions with those

students who have failed assessments; these will include study plans, note taking and

time management. See good practice 2.

63 We heard that some students felt thought the Pastoral Tutor was based off-site and

therefore remote, but that they were able to approach other members of staff

instead. The Head of School told us that the Pastoral Tutor is based on-site on a

different floor from other teaching and administrative staff. Some of the students we

spoke to had successfully accessed support from the central University services such

24

as counselling, and more locally through teachers. All students we met were also

aware of the services were available, including the central UCLan careers service. In

addition, the School also has a ‘buddy system’ for its Year 1 students, and will extend

this for the next academic year so that the Year 1 cohort has Year 2 ‘buddies’.

64 Staff responsible for student support told us that the School has provided guidance to

central University support services about specific medical school policies and referral

thresholds. In addition, training on mental health triage will be run in September

2016 for both School and College staff. Security and accommodation staff have

already received mental health training, particularly to support international students.

65 The School also plans to provide a session for students on learning styles and note-

taking at the beginning of the 2016/17 academic year. Revision items and study aids

have also been uploaded to the Virtual Learning Environment, and staff have notified

students of when they are available for advice over summer.

66 We heard in our meeting with staff involved with student support that some students

were referred or asked to seek additional English language support. They commented

that the students’ command of English had improved noticeably, and had no concerns

about students achieving an IELTs score of 7.5 by the end of Phase 1.

Undermining and bullying (R3.3)

67 We were pleased to hear that no students or staff members had experienced bullying

or undermining behaviour. We will continue to review this area during future visit

cycles.

68 The E&D team told us that SERF would be the recording mechanism for any bullying

or undermining behaviour, which would automatically be raised to a Level 2. If the

School cannot resolve the incident, it will be passed to the central University systems.

Students can also report directly via this route.

Information on reasonable adjustments (R3.4); Support for learners in difficulties (R3.14);

Reasonable adjustments in the assessment and delivery of curricula (R5.12)

69 The School has undertaken a large amount of work to encourage students to report

support needs. We heard in our E&D meetings that the School is aware that students

are unwilling to declare a disability on their application as they believe this may affect

their chance of being accepted onto the programme. The School is working with the

central admissions team to try and address this perception with better guidance and

wording to avoid negative connotations; the University is also tightening up its

processes in order to capture better equality data on applicants. In addition, the

School has worked hard to create an open and positive culture around E&D and

disability to encourage students to declare any disabilities or difficulties they have and

receive the support they need. We heard that some students are now undergoing

disability assessment after having declared a potential need for support.

25

70 The School has also been working in conjunction with the central UCLan support

services to develop their policies for identifying and supporting learners in difficulty;

they hope that creating a holistic approach will allow multiple routes for students to

access support. The E&D team told us that they will exhaust all fitness to study

options before starting fitness to practise procedures. In addition, the School has

been working with other medical schools to establish best practice.

71 We spoke to some students who had experience of requesting and receiving

reasonable adjustments. These students felt that the School had worked with them to

identify needs and put support in place.

72 In our meetings we were told that each student’s request for reasonable adjustments

is treated on a case by case basis: the School looks at the Disability Office’s

recommendations and explores what can be adjusted for the student, such as

providing audio recordings of lectures. The School then meets with the student on a

one to one basis to develop a personal plan. If a declaration is made on the initial

health questionnaire, then students will automatically be referred to occupational

health services for an assessment. Occupational health will also make a

recommendation as to whether information should be shared with placement

providers.

73 We heard in our E&D and student support meetings that information about

reasonable adjustments is included within the E&D policy handbook, which is

provided to students and is also available on the e-portfolio. The students we spoke

to were aware of how they could declare a health issue or disability. Students are not

given a list of what should be declared, but that they felt that they were aware of

what was appropriate and necessary.

Supporting transition (R3.5)

74 We were pleased to hear that the transition meetings have now taken place, which

students said were informative and helpful. In June, we heard from E&D staff that at

present, all students are interested in applying for the UK Foundation Programme,

with 40% looking to stay should they meet the requirements. The remaining 60% of

the cohort plan to register in a variety of countries, and the School has made contact

with the GMC registration team to ensure the information it holds about registration

requirements is up to date.

Information about curriculum, assessment and clinical placements (R3.7)

75 The amount of information provided to students about their curriculum, assessments

and clinical placements appeared to be variable. The students we spoke to all felt that

the School had prepared them well for their community placements; this was

reflected by the educators who were impressed with the calibre of students. In

addition, assessment staff told us that students are provided with learning outcomes,

assessment weightings and marking schemes. The students we spoke to also felt that

26

the formative OSCEs and corresponding feedback were helpful in preparing them for

the summative. See open requirement 9.

76 However, students had requested additional formative written questions, as they did

not feel that they had been provided with a sufficient number with which to practice.

The School does not release its questions or return papers after assessments, but

assessment staff told us that students had been provided with a small number of

example questions for their examination in January.

77 Additionally, there appeared to be gaps in student knowledge about various School

policies. We heard from students that they were unsure about whether a minimum

number of station passes was required to pass the OSCE in addition to meeting the

overall pass mark, or of the difference between fitness to study and fitness to

practise. Most notably, students told us that had not been aware of how the Year 1

curriculum content would be sampled in the summative written exams, and, as such,

many had revised selectively. We also noted that while guidance on the Educational

Performance Measure was provided, the documentation did not provide any

information on how each year was weighted. See open requirements 10 and 11, and

open recommendation 3.

78 We heard from assessment staff that, in addition to the guidance available, students

had attended sessions on the standards needed to pass assessments; for example

students are given the theme breakdown of each examination. Nevertheless, it was

recognised that additional guidance may be beneficial. See recommendation 1.

Out of programme support for medical students (R3.9)

79 The School appears to have a clear policy on breaks from study. It differentiates

between two different types of break: academic and non-academic. We heard from

the Head of School that students returning from either type of break will have a

meeting with their Academic Advisor to identify any learning needs. At present, no

student has yet requested a break in studies.

Feedback on performance, development and progress (R3.13)

80 The feedback provided to students about their performance appeared to be

comprehensive. Assessment staff told us that students are provided with a range of

feedback; this includes student ranking and scores, as well as the standard mean and

cut score, while generic feedback about which questions all students struggled with is

provided as a group.

81 We heard from the students that they had received grades and ranking for each

summative exam, as well as the mean score of the class and the cut score. The

assessments are broken down by topic and students receive their percentage score

for each one, allowing them to focus on areas that require improvement. For the

OSCEs, students received a pass/fail mark for their summative, but we were told that

27

during the formative OSCE, students received an immediate verbal feedback.

Students also receive feedback on their portfolio pieces; this is provided by the

portfolio tutor. As a result of the recent assessment results, the School will look to

provide more feedback to students in order to better prepare them for summative

assessments.

82 Comensus inputs to the delivery of OSCEs through the provision of volunteer and

simulated patients. The volunteer and simulated patients are trained to contribute to

assessment by providing feedback about students’ performances. Patients are directly

asked whether they would recommend the student to friends and family based on the

level of care they provided using a scale of 0, 1 or 2 (would not recommend, may

recommend, would recommend).

83 We heard in our meetings with GPs that students complete a primary care placement

form for each practice placement, and receive continuous individual informal

feedback. This provides students with a large amount of feedback from their

supervisors. At Bridgewater, students have individual meetings with supervisors at

the end of each week where they review their logbooks.

84 The School has a three week turn-around policy, within which it must provide

feedback to students on their assessment performance. Assessment staff told us that

currently they are able to provide feedback much quicker due to the small number of

students, but recognises that this will not always be the case for summative

assessments and as the School grows.

28

Theme 4: Supporting Educators

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)

85 Training for staff appears to be comprehensive and readily available. In our meetings

with quality management staff, we heard that staff receive a range of training that

includes PREVENT training, safeguarding courses and question writing sessions. Staff

are also offered the opportunity to attend a national communication skills residential

course; we were told that two staff members have attended this so far. There is a

rolling programme of training for volunteers, and the University runs a mentoring

scheme for staff.

86 The College of Clinical and Biomedical Sciences also runs a peer review programme

that is used as a developmental tool. Staff are paired with another staff member

within the college, usually at a similar level. Lesson plans are reviewed and discussed,

and a lesson is observed before a feedback form is completed.

87 The Pastoral Tutor told us that any new member of staff is required to undertake

training in order to meet their objectives and attend a series of assessment

workshops. New members of staff have a year-long probation, and meet with their

line manager at three months, six months and at the end of their probation to discuss

progress and further development. See areas working well 6.

88 GPs and staff at Bridgewater were positive about the training they received from the

School. GPs had received UCLan training (the Facilitating Learning in Healthcare

Practice programme), which provides 20 CPD points. GPs felt that this was a good

training refresher, as all had initially received training from Manchester Medical

School.

89 The examiner briefing prior to the OSCE we observed was very well organised and

comprehensive. This included the agenda and the structure of the day, and was a

refresher of the main points of the training that had been provided before the day of

the examination. Examiners were provided with a booklet including all the slides that

were presented in the meeting and a CD with the examiner training.

90 Nevertheless, during the briefing we did not hear about any procedures covering

incident reporting. Examiners were not reminded on how they should record or act

with regards to procedural irregularities (such as mobile phone ringing) or potential

unprofessional behaviour. We understand that these topics may have been covered

29

during the extensive examiner training; however, we believe it is good practice to

include them as reminder during the examiner briefing.

Time in job plans (R4.2)

91 We heard from educators and Academic Advisors that they are currently able to

balance teaching and academic roles. They noted that the academic scheduled

meetings they have with students often do not take up much time; however,

unscheduled pastoral meetings can. Each Academic Advisor will be allocated an

additional six more students in Year 2, but they believe that this will be a manageable

workload. We will explore this and the changes to their job plans in more detail over

subsequent visits.

92 The Academic Advisors told us that the School has built a detailed picture of each

staff members’ different roles: many staff have multiple responsibilities, but often

these roles will overlap. This enables the School to ensure that staff have sufficient

time for each of their responsibilities.

93 We heard from the GPs that they were asked in advance whether they could

accommodate students at the practice and within their job plans; they have also been

asked again for the 2016/17 academic years. The GPs told us that they would not

accept students unless they were confident that they could accommodate them.

Accessible resources for educators (R4.3)

94 The resources available for educators appear to be comprehensive. We heard from

educators that there is a variety of accessible resources, such as teaching and

learning news articles and a detailed guidance document.

Educators' concerns or difficulties (R4.4)

95 The problem based learning (PBL) facilitators told us that they encountered some

early issues with the consistency of their sessions. The School provided guidance to

both the facilitators and students about what they should expect from their PBL

meetings, and subsequent sessions were monitored for consistency. We were pleased

to hear that students are now reportedly far more positive about their PBL sessions.

96 Educators told us that monthly meetings are held between the Pastoral Tutor and

Academic Advisors to provide support and allow staff to discuss concerns and training

goals. We were also told that there was a lot of informal support between staff

members.

Working with other educators (R4.5)

97 The GPs we spoke to expressed a wish to increase communication between

supervisors by setting up a group to discuss common themes and concerns. A

30

meeting between the School and GPs is planned for late June where this will be

raised; we will follow the progress of this up over future visit cycles.

Recognition of approval of educators (R4.6)

98 We heard in our meeting with staff involved in quality management that the School

keeps a record of the training that staff receive in order to ensure that they meet the

GMC requirements.

31

Theme 5: Developing and implementing curricula and assessments

GMC outcomes for graduates (R5.1)

99 We heard in our introductory meeting in June that the Year 1 and 2 curriculum has

now been aligned with Liverpool Medical School. The School mapped what they

wanted to include in the curriculum and aligned this with Liverpool, as well as taking

on board Liverpool initiatives such as a ‘cancer week’. The Head of Phase 1 told us

that the School’s Phase 2 is aligned on a very close structural basis, due to the similar

block system of placements. By definition therefore, the placements will align on a

learning outcome basis. The School is currently working with Liverpool to align later

years of the programme. See open requirements 2 and 5.

100 In addition, the School has made some small revisions to the curriculum, including

changes to neurology and endocrinology teaching in order to make these areas more

comprehensive. More space has also been generated in the timetable for Years 1 and

2 in order to provide additional study time for students.

101 The senior management team told us that the School has now mapped the

Tomorrow’s Doctors’ learning outcomes to each of its three ‘themes’ over the first

four years of the programme, and we saw detailed timetables for the teaching of

each outcome. The School plans to map these to Promoting Excellence, and we will

review their progress on future visits.

Undergraduate curricular design (R5.3)

102 We were able to explore the School’s curriculum in detail over this visit cycle with

various groups of staff and students. Students undertake placements in a range of

specialties, becoming more specific as the course progresses. Broad specialties such

as general medicine, surgery, paediatrics and mental health are covered in Years 3,

with subspecialties, cancer care and other specialties being added in Year 4. Students

in Year 5 undertake more advanced placements of urgent/emergency care, acute

medicine & surgery, community medicine and a specialism of their choice. We will

explore placements in more detail as the course progresses.

103 One of the three ‘themes’ that students undertake each year is ISCM (known as

Medicine in Clinical Practice in Years 3 and 4). This aims to link basic and clinical

sciences in the clinical context. Throughout the course, students revisit key scientific

concepts in greater depths and different contexts via the spiral curriculum to help

integrate knowledge. PBL and clinical skills sessions alongside traditional lectures aim

to facilitate this. In addition, EIPOM explores sociological and psychological impacts

on health through case based learning to integrate basic and clinical sciences.

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.

32

104 Students in Years 1-4 undertake a Student Selected Component (SSC) each year,

which sits under the EIPOM ‘theme’. We heard from the Theme Lead for EIPOM that

in Year 1, the SSC takes the format of a 3000 word literature review with a poster

presentation to introduce research skills. Students were provided with a range of 60

options for their SSC, with 89% getting their first or second choice. While the School

is still refining its SSC strategy, it plans to focus the second SSC on audit, and link

later SSCs to clinical practice. SSCs in Years 3 and 4 become more highly weighted,

which we will explore in more detail on forthcoming visits.

105 Curriculum staff told us that the School has set learning outcomes for Year 5

placements and student assistantships. At the end of Year 5, students will sit the

Preparation for Practice Assessment, followed by a four-week assistantship

shadowing a foundation doctor.

106 The students we spoke to felt there was a lack of standardisation in the recording,

duration and delivery of their lectures. We heard that some lectures overrun or are

too short, and only some are recorded due to some external staff not giving consent.

At times, these recordings are sent or uploaded so late that students have already

completed the learning block. See recommendation 2.

Undergraduate clinical placements (R5.4)

107 The 2015-16 visit cycle also provided us with an opportunity to explore the MBBS

programme in greater detail. We heard in our various meetings with staff and

students that students completed a two week GP placement and a two week

placement with a community health provider. Due to capacity, the cohort was split

into two groups which alternated between the blocks. The majority of community

healthcare placements were based at Bridgewater, but a small number of students

were placed at Blackpool Teaching Hospitals NHS Foundation Trust. During the

community placements, students worked with a variety of providers within the Trusts

including midwives, district nurses and walk in centres. On the Fridays of these

placements, students received teaching at the central Bridgewater site.

108 We heard from the educators and staff involved with placement management that

the students had been eager to start working with patients and doctors immediately,

rather than other primary healthcare staff. This was fed back to the School who

reiterated the aims of the placement to the students; educators noted that the

second group of students was more prepared as a result. The Head of School told us

that it has been difficult to prepare student expectations for the community

placements, which aim to introduce students to the NHS and a holistic view of

medicine. To try and rectify this, the School held a session with students to discuss

the NHS and student experiences of other healthcare systems elsewhere in the world.

The School and educators feel that the students now understand primary and

community care, and that the placement experience was invaluable for this.

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109 Students’ experience of their Year 1 primary care placements appeared to be varied.

Student experiences were mostly positive; however, we did hear of some disparities

in the teaching and organisation of practices. The level of responsibility and freedom

to practise skills was varied, and we heard that this could also differ within GP

practices with different supervisors. Much of student evaluation about their

Bridgewater placements was positive, but many students expressed that they would

like exposure to a wider range of community services. The Trust is looking into the

feasibility of this for the next cohort. See recommendation 3.

110 Students complete a primary care placement form with their supervisors in Year 1,

where students can record their learning and development while receiving feedback

on their performance. We heard from the Head of Phase 2 that students are given

logbooks in each year that stipulate the skills that students must perform. In Year 1

there are only two, and these are covered under the Direct Observation of Procedural

Skills undertaken at the School. In Year 3, the start of Phase 2, students will have a

set of learning outcomes that are linked to commonly presenting symptoms that

students must see. The School is trying to encourage students to focus on the patient

and not the underlying condition. We will explore this area in more detail in future

visit cycles. See open recommendation 8.

111 We heard in our introductory meeting in January that the School held a two week

induction that gave students access to School specific and wider University events.

During this, students attended course introductory lectures, occupational health

sessions and central UCLan international student events. The students were mainly

positive about their experience, with some feedback regarding the bunching of

lectures. The School will use this feedback to improve the induction for the 2016

cohort.

112 The students we spoke were satisfied that they have access to the clinical skills lab

through drop in sessions. Students can also arrange extra sessions with the clinical

demonstrators.

Assessing GMC outcomes for graduates (R5.5)

113 We were concerned to hear in our assessment meeting that 16 (44%) students had

failed one or more modules and therefore were unable to progress to next year of the

programme. Only 19 (56%) students had met the requirements for progression to the

next year. Most resits are from the ISCM module, with nine students failing the

multiple choice questions (MCQs) section and ten failing the short answer questions

(SAQs) section. The School told us that the students who require resits were known

to be struggling, and that their individual results were expected. The School

commented that some students were not aware of the requirements prior to

assessments and were confident that many students would pass the resits.

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114 Since our visits, we heard from the School that all students have now passed their

resits and progressed to Year 2. We will explore the School’s resit process in more

detail over the next visit cycle.

115 The School is aware that its curriculum has a high volume of content; this is partly

due to its alignment to the United States Medical Licensing Examination, which was

commented on by Liverpool Medical School. The School recognises that it must

review its curriculum and assessment content, as well as attached guidance and the

standards it has set; this process is already underway. We heard that the School

plans to review its question bank by applying the Ebel methodology and tagging

questions as ‘core, essential, supplementary’ and ‘easy, moderate, difficult’, and work

with the assessment staff to provide further training. See requirement 3.

116 The assessment team told us that they continue to use Maxexam to store their exam

questions. There is now a bank of 1000 items, which the School is building up by

linking questions to the learning outcomes. Educators are asked to contribute five

assessment items per teaching session to ensure the number of questions in the bank

is not depleted. Once questions are used in assessments, formative or summative,

the School’s software is able to flag these so that they cannot be reused. The

software is also able to provide data on the success of each question so that the

School can ensure it is assessing the learning outcomes effectively.

117 The School continues to use questions from the IDEAL bank where possible, and has

sought guidance on how to adapt these to the School’s house style and international

cohort. Questions written by the School are entered to the IDEAL bank and are

available for other schools to use.

Fair, reliable and valid assessments (R5.6)

118 We had significant concerns about the number of students who required one or more

resits at the end of Year 1. The high fail rate is likely to be a product of a variety of

factors, including test design, item writing, curriculum sampling and content coverage

in each test, marking, standard setting, or students being under-prepared. We also

expressed concerns that the School did not have adequate experienced staff for

setting and marking assessments. The School told us that they had expected it to be

difficult to accurately standard set their assessments, as the students, assessment

instruments, and many of the staff are new. The newly appointed Professor of

Medical Education will work closely with assessment staff and as the School grows, it

expects to gain a better understanding of the minimally competent student; staff will

also develop more experience at writing and assessing questions. See requirement 4.

119 We heard that the School has explored the appropriateness of various standard

setting methods for its summative assessments. For the OSCE, three methods were

considered. First, the School planned to use the borderline regression method for the

OSCE, but found that the cohort was too small for the use of this method. Second,

the Angoff process was completed by a number of school staff but the resulting

35

station cut-scores, when averaged across stations, produce a standard that was

deemed too lenient. Third, the School then applied a modified Angoff approach which

produced a cut-score that was deemed to produce appropriate and fair outcomes.

The MCQs for the EIPOM module used the Angoff method, while the SSC was marked

against descriptors with a sample, and all borderline passes and fails were double

marked.

120 There were particular difficulties in standard setting the SAQs for the ISCM module.

We heard that the original standard set for this module would have resulted in a high

number of students failing the SAQs, which the School did not feel was correct. As a

result the School double marked the answers against the model answer, then used

the equipercentile test equating method to equate the MCQ results to the SAQ results

(based on the premise that, when the scores were correlated, the instruments

produced a similar rank ordering of students). The School has proposed these

methods and corresponding results to the external examiners, and we will follow up

on the outcomes of the programme board at our wrap up meeting.

121 We heard in our assessment meeting that assessments, including the portfolio, are

marked by two staff members to set descriptors. For SAQs, if there is a mark

discrepancy of more than 15% then the two assessors meet to discuss their mark. If

an agreement cannot be reached, the assessment is passed to a third marker. Staff

told us that they believe the model answers for SAQs to be flexible, and are able to

contact the Examinations Officer to request that an alternative answer be added to

ensure that students are able to gain marks for all variations of a correct answer.

122 We heard from one group of students that there was some disparity between the

marking of the formative and summative lab reports: markers had been asked to

make comments on the formative report for students to take on board when

resubmitting for the summative. Some students received good comments for the

formative but then received lower marks for the summative; students expected this

was a result of a disparity in the standards applied between markers.

123 We reviewed the School’s first summative OSCE in May. The examination was very

well organised, and the facilities in the clinical skills centre allowed for a setting that

reflects the real hospital environment. The timekeeping of staff was meticulous and

accurate, and there was a sufficient number of staff members to guide and supervise

the students. Students had minor comments about the set-up of some of the

stations; however, they praised the general organisation of the examination.

124 The examination consisted of twelve stations, six taking place on the first day (Part 1)

and seven stations on the second (Part 2). Day one stations are ten minutes in

duration, with those in day two lasting five minutes each. The school has used a

panel of expert clinicians to identify the minimum competencies students should

demonstrate during the examination and set the pass mark. Candidates are allowed

to fail 25% of the stations; taking into consideration the difference timings of

36

stations. Deliberation might be given to students being allowed to fail 25% of the

examination time as opposed to station numbers.

125 We were told that the School publishes its OSCE station titles 24 hours in advance at

our observation in May. The assessment team told us that this was to avoid

quarantine, and that, as the OSCE is a skill based, not knowledge based, assessment

it was considered that this would have little effect on the students’ results. By Phase

2, the School will be able to run two OSCEs at the same time in different locations

and will no longer be required to quarantine students. The School will therefore cease

releasing station titles.

126 The students we spoke to did not feel receiving the station titles in advance of the

assessment gave them a significant advantage. While they were able to revise the

procedures and skills required, they noted that if they did not know already how to

perform a specific skill the extra time would have been little help. Some students we

spoke to were expecting the School to continue the practice of releasing titles

throughout the programme, including finals. See recommendation 4.

127 The students we spoke to told us that there was a lack of standardisation of the

equipment and simulated patients used in their summative OSCE. Students were

provided with different types of blood pressure equipment; some students had used

these while on placement and therefore felt more comfortable. This caused anxiety

within the cohort. Student told us that they were also told to expect a ‘normal’ patient

for their neurological station, but for many students this was not the case, again

causing concerns within the student body. See recommendation 5.

128 The School has facilitated the electronic evaluation of students during OSCEs by

providing each examiner with a tablet with electronic mark sheets. Examiners were

also given paper mark sheets as a backup in case they experienced any issues with

the electronic devices. However, we noticed that some examiners were using the

paper mark sheets for evaluating the students and then transferring the marks onto

the electronic spreadsheets in between candidates, which may cause unnecessary

transcription errors. See recommendation 6.

129 The School has given thought to which assessments are necessary for progression.

Some assessments are now deemed as ‘permissive’: students must pass these

assessments, but can take multiple resits and have access to resources to rectify any

learning deficiencies. If all other summative assessments have been passed but

students have yet to pass the permissive assessments, the student will be allowed to

progress to the next stage under license. The School advised that if the permissive

assessments are not been passed within two years, then the student will not be

allowed to progress further.

130 We reviewed the e-portfolio with the Head of Phase 2, who told us that there had

been a number of changes to the content and processes over the course of the year.

Students no longer have to complete the blog, as this proved onerous for students

37

and staff. In addition, the School has reduced the complexity of the reflective pieces.

Work that students upload is tagged to the relevant learning block, and will be tagged

to Good medical practice from Year 2. Students can see all of their submissions and

feedback received, as well as their assessment results. The School should develop the

e-portfolio so that it can better assess student professionalism. See open

requirement 7 and requirement 2.

Mapping assessments against curricula (R5.7)

131 The students we spoke to told us that their various assessments tested their

curriculum, but that the appropriateness for their level of learning was variable. For

the OSCE, students had been taught all tested procedures and had been given the

opportunity to practice these. However, some written assessments did not meet their

expectations, with the content too broad-ranging and set at too high a level.

Examiners and assessors (R5.8)

132 The School is developing its pool of examiners. We heard in assessment meetings

that all assessors had received assessment and E&D training; this included a question

writing session in April 2016. Many staff are relatively new to assessing medical

students, and additional training is planned for staff involved in the writing and

marking of assessments.

133 During the OSCE, the examiners we observed were very professional in their manner.

They behaved in a consistent fashion, and refrained from making any verbal prompts

or cues during the examination. Examiners demonstrated a competent understanding

of the assessment protocols with no deviation. In addition, the simulated patients

were well prepared and consistent across stations and circuits. They were

collaborative with the students, but avoided giving cues or prompts to the candidates

and performed very well in their roles.

134 The senior management team told us that the board of examiners includes the Head

of School, Head of Phase, E&D lead and Exams Officer, amongst others. The

proposed examination results have been sent to the external examiners, and will be

considered at the programme board. External examiners will consider all papers due

to the small size of the cohort. We will review the School’s exam board in future visit

cycles.

38

Team leader Professor Judy McKimm

Visitors Professor Suzanne Chamberlain

Professor Gill Doody

Dr Tom Foley

Dr Russell Peek

Mr Thomas Shanahan

GMC staff Ms Lucy Llewellyn (Education Quality Analyst)

Ms Samara Zinzan (Education QA Programme Manager)

Evidence

base

1 Signed mapping exercise

2 Implementation plan (October update)

3 Risk register (October update)

4 Year 1 Timetable 2015-16

5 Fitness to Practice Procedures

6 Bridgewater risk register

7 ELHT risk register

8 5 BPs risk register

9 SERF alert report summary

10 GP staff list and resources

11 TD practical procedures mapping

12 BLS DOPS checklist

13 Handwashing DOPS checklist

14 Marking criteria for assessment of reflective piece

15 SC injection

16 SSC marking rubrics

17 GP practice visits

18 List of community placements

19 Dignity at work procedure

20 Student harassment policy

21 Dates of summative OSCEs 2015-16

22 OSCE examiner training

23 Portfolio assessment

24 Year 1 portfolio handbook

25 MBBS staffing list

26 Year 1 MSQC mapping for 2016-17

27 EIPOM resource mapping

28 ISCM mapped 2015-16

29 Writing multiple choice questions

30 MBBS SERF guidelines

31 Assessment training sessions

32 Clinical skills sample marking cardiac examination

33 Communications skills sample marking explanation – smoking

39

cessation

34 Calendar of examiner training 2015-16

35 Student career break

36 Progression rules

37 LTHTR risk register

38 FtP thresholds – staff guidance

39 Grade descriptors

40 Placement contingency report

41 Disability – guidelines for clinical placement providers

42 FtP training handout

43 The challenges of Fitness to Practice

44 External examiner training pack – programme

45 External examiner training pack – the role of the external

examiner

46 External examiner training pack – working with the academic

regulations

47 Equality & Diversity policy

48 Flowchart for identifying and raising students concerns

49 Academic Advisor job plan

50 Confirmation of mapping to Liverpool Curriculum for Year 2

51 Educators and Academic Advisors presentation

52 Feedback and evaluation overview year 1 presentation

53 FtP and evaluation presentation

54 Introduction - School Management Team presentation

55 Admissions presentation

56 Learning and Teaching Presentation

57 QM and Governance presentation

58 Student Support and E&D teams presentation

59 Student Assessment FAQs

60 Risk register 2015 - 16 (April 2016)

61 Standard setting

62 Information provided to students about EPM

63 Weightings across assessment components

64 MBBS Exam Board membership

65 EIPOM Resource Mapping Year 1

66 EIPOM Resource Mapping Year 2

67 IPE Year 2 Resource mapping

68 Y1 MSQC mapping for 2016-17 for 50 and 65 students

69 Y2 MSQC mapping for 2016-17 for 35 students

70 ISCM Resource mapping Year 1

71 ISCM Resource mapping Year 2

72 SSC Resource mapping Year 2

73 External examiners

74 MBBS Year 1 LO Coding and Assessment Blueprint

75 MBBS Fitness to practise guidance

40

76 Equality & Diversity policy

41

Annex A – Glossary

OSCE A type of examination to test clinical skill performance and competence in skills such as communication, clinical examination, medical procedures or prescription, exercise prescription, joint mobilisation or manipulation techniques, radiographic positioning, radiographic image evaluation and interpretation of results.

MMI The Multiple Mini Interview is an interview format using multiple

stations where applicants can display their non-academic skills, such

as communication.

PBL In Problem Based Learning, students work in small groups with set

clinical cases or scenarios. A style of active learning, students identify

learning objectives before undertaking self-directed study to present

possible solutions to the group.