Hemel Hempstead Hospital by JoeSouthwick


18th December 2006


•   Professor Irving Taylor (IT), Vice Dean, Clinical Studies
•   Lee Walker (LW), SIFT Co-ordinator
•   Ann Glasser (AG), Quality Assurance Officer
•   Pratibha Kothari (PK), Year 5 Administrator

•   Mr Tahir Bhatti, Surgery (representing Mr Amin, Undergraduate Tutor, Surgery)
•   Mr Howard Borkett Jones, A & E
•   Dr Colin Johnston, Medicine
•   Dr A Bhagat, Radiology
•   Dr T Angel, Physician
•   Dr J Pace, Physician
•   Dr L Thangaraj, Physician
•   Dr Graham Ramsay, Medical Director
•   Dr I Barrison, Deputy Medical Director for Education and Training
•   Dr R Makker, Clinical Tutor
•   David Goodier, Postgraduate Centre Manager
•   Carolyn Evans, Undergraduate Administrator
•   Mr Dinesh Majithia, Deputy Director of Finance
•   Diane Levey, Librarian

The Medical School would like to thank Carolyn Evans, Undergraduate Administrator for help with
planning and organising the day‘s schedule as well as all the staff and students who met with them.

The School visited earlier in 2006 but had been unable to unable to carry out a comprehensive
appraisal of the undergraduate teaching at Hemel Hempstead Hospital (HHH) as preparations for visit
were incomplete. Since negative feedback from the students had been increasing throughout 2005-
06, it was decided that an early visit would be beneficial.
In the intervening months, the Postgraduate Centre has employed a permanent, full-time
Undergraduate Administrator, Carolyn Evans (CE). There is no doubt that there has been a significant
improvement in the students’ experience since this appointment has been made.
The Trust is undergoing many changes over the next couple of years; the acute medicine, acute
surgery and trauma will be moving to the Watford site, elective surgery will move to St Albans and
eventually Hemel will only be for out-patients. There is much uncertainty about the future of Hemel
and so it is difficult to plan ahead with certainty but it appears that the School will be able to continue
to send roughly the same number of students at least until December 2007. The Education Centre will
keep the School informed of any upcoming changes which will affect the students.
Students are given a comprehensive induction to the hospital and the facilities available to them
including the library and the training website. It is made clear to students that CE is available to them
for both practical and pastoral support. This offers a substantial improvement for students as such
support had not been consistently available previously due to staff shortages.

The Student Experience
Students report that they are made to feel very welcome at the Hemel Hempstead Hospital, both by
the Postgraduate Centre and within each firm.
The lead for Surgery encourages students to attend clinics rather than theatre. They are asked to
carry out clerking and do case presentations which the surgeons will evaluate. Although they may be
attached to a particular firm, they are also encouraged to move around different firms in order to gain a
broad experience of different specialties. A timetable is provided so the students are aware of what is
available to them. According to recent feedback, this timetable, whilst very helpful, needs some
correction and updating. Bedside teaching provided by the junior doctors was highly praised by the
students as was the range of cases and the opportunities for learning.
There have been several complaints in the feedback that there are too many students in the A&E
Department to provide an effective learning environment. HBJ confirmed that the department has
broad swings in the level of activity but this does not need to affect the students’ educational
experience; the Department will design a simple roster system which will spread the students’
attendance time over the day. It may also be possible to arrange for students to shadow the doctors
working in the Rapid Access Unit (RAU). A slightly more structured timetable should be developed for
students to ensure they are able to receive a good grounding in A&E, whilst still being allowed some
flexibility in how they spend their time and being able to use their initiative to seek out experiences
which could enhance their knowledge.
The Medicine team are very keen to teach but there is scope to include more formal teaching.
Teachers have found the new portfolio very helpful for guidance on the curriculum. Within the
attachment students are required to swap between firms in order to cover all the essential topics but 1
hour of bedside teaching per week should still be provided, as well as clerking and some opportunities
for carrying out practical procedures. Students find the attachment extremely good, with plenty of
bedside teaching and clerking but were unaware that they could swap between firms and gain a more
varied experience.
The clinical skills teaching (which had been provided twice during the 4 week attachment) was
extremely highly rated by the students.

No issues raised.

No issues raised.

Student feedback on the accommodation continues to be very poor. The Trust will be undergoing
many substantial changes over the next few years and is therefore reluctant to invest greatly in
expensive refurbishments to property that may not be used in the future, however, significant
improvements could be made with the purchase of some basic cooking implements, cutlery and
crockery, and with some essential renovation of the kitchens and bathrooms.
The accommodation at St Albans is very good and it may be available in the future for student use.
There is a seminar room attached to the A&E Department which could be available for teaching
although it would need to be booked ahead.
All students are offered bleeps at induction.
Although the library closes at 5pm, students can access it at any time if they liaise with the Librarian.
This information is included in the induction packs which are issued when students arrive.

SIFT Allocation
Central administration running costs are top-sliced as well as costs for the accommodation and the
remainder is passed on to the different departments according to the amount of undergraduate
teaching they provide. There are specific funds to pay for improvements to the accommodation.
The accounting for and general use of SIFT by the Trust is good although slightly more detail on a
divisional level would be helpful. Currently SIFT is distributed by the Trust Finance Department to the
different divisions but they are not clearly below this level. Also, Clinical Leads within the Trust are not
made aware that SIFT funding is devolved in this way.
More work needs to be done to identify and allocate programmed activities (PAs) for undergraduate
teaching. Once identified, it may be possible to ring-fence some SIFT funds to the relevant
departments, thus helping to protect the funds. DM agreed to make it more widely known that the
finances are passed onto the divisions and the undergraduate tutors are able to influence how this
funding is used by contacting their divisional finance leads.

The visit ran smoothly with good attendance and overall was extremely well organised by CE.
Although the visiting Team suggest some minor improvements, the feedback on teaching is generally
very good indeed.

If the standard of teaching and facilities across the Trust continues to be consistently good, and the
Trust continues to provide teaching for over 20 FTEs, it may apply for Associate University status. A
letter should be written to Professor Mike Spyer and copied to Lee Walker.
There will not be any Undergraduate Tutors on this site from mid-2008 and plans will need to be in
place to manage the group of students across sites.

Good practice
          Students made to feel very welcome
          Appointment of a permanent, full-time Undergraduate Administrator
          Students on the Surgery attachment encouraged to move around different firms in order to
           gain a broad experience of different specialities
          24 hour access to library


                                       THESE AIMS                ACHIEVING THESE STEPS    WILL BE COMPLETED
A&E to limit the number of students
attending department at any one time
Develop a more structured timetable
for A&E
Surgery timetable requires some
correction and updating
purchase basic cooking implements,
cutlery and crockery, and carry out
essential renovation of kitchens and
Explore possibility of students
shadowing the doctors working in
Develop more detailed accounting for
SIFT funding at divisional level and
inform Undergraduate Tutors about
divisional SIFT allocations.


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