Royal Free and University College Medical School
UNIVERSITY COLLEGE LONDON
SIFT Site Visit to
East & North Hertfordshire NHS Trust
Lister & Queen Elizabeth II Hospitals
January 27th 2006
The SIFT QA Team
Prof Margaret Lloyd (ML), Vice-Dean and Chair Education Committee, Pratibha
Kothari (PK), Year 5 Administrator, Lee Walker (LW) SIFT Co-ordinator and Ann
Glasser (AG) SIFT Administrator.
Names of those in attendance in each section are in addition to the SIFT QA Team.
The E&N Herts NHS Trust Undergraduate Education Team
Mary Lynch (MLy) Undergraduate Tutor Lister Hospital, Sigismund Wilkey
Undergraduate Tutor QEII Hospital, John Saetta (JS) Training Co-ordinator, Christine
Crick (CC), Postgraduate Centre Manager, April Hall (AH), Undergraduate
Administrator QEII
Date of Last Visit: 24th January 2005
1. INTRODUCTORY SESSION
1.1 MLy gave an update of developments at both sites over the past year. There
are 2 dedicated clinical skills teaching sessions per week at the Lister, although this
has reduced to 1 since Christmas. They are hoping to restore the second session
with the appointment of an Educational Fellow. There have been two unsuccessful
attempts to appoint a clinical skills trainer and it is now being advertised again.
There is still input from a consultant anaesthetist who is covering one session and
the post for the educational fellow has been advertised. It will consist of 3 full days
teaching and 2 days in a speciality. It’s aimed at someone who’s eligible for a SpR
post or is already a SpR. There is an Associate Specialist providing ½ day teaching
in the skills lab for the Year 5 students. The Education Centre has been in touch with
Deirdre Wallace. There are skills rooms on both sites. Detailed records are kept of
what courses each student has taken.
1.2 They are continuing to encourage inter-professional learning; an example of
this is the use of the Simulation Centre at Hatfield. Students have been giving
consistently positive feedback since February 2005 when they first attended the
Centre. The course ran again in October. SW commented that the A&E students
consistently ask to go on it but unfortunately there are limited places and it has to be
restricted to Medicine and Surgery students.
1.3 A new postgraduate centre is being planned at the Lister which should be
ready for use by June. It will be located in the old Glaxo Building and have meeting
rooms, a lecture theatre and dedicated skills room.
Lister & Queen Elizabeth II Hospitals, E&N Hertfordshire NHS Trust QA SIFT Lite Visit - February 2006
1.4 With regard to bedside teaching, it is not possible to give students dedicated
teaching at the moment due to service pressures but they do get this on ward
rounds. The Trust hopes the appointment of the educational fellow will improve this.
They do, however, all get the opportunity to do case presentations. The current block
of students have been very focused on organised teaching sessions although MLy
has been encouraging flexibility.
1.5 Work is underway to build new accommodation at the QEII and, in the
meantime, some of the QEII accommodation has been redecorated. The feedback
has improved although it still does not yet reach necessary standards. The cost will
be higher for the Trust as it will be outsourced to Griffin Homes whom they will have
to pay in advance.
1.6 The A&E attachment at the QEII is going very well and receiving positive
feedback. The Paediatrics and O&G attachments at the Lister are excellent although
there are still problems because of competition with midwives.
1.7 The Paediatrics attachment is combined over both sites; the 2-weeks at the
Lister is highly rated but feedback is not so good at the QEII where there is only a
busy admissions ward which closes at 5pm (it used to close at 11pm). There is no
formal teaching. Dr Kandala is overall lead for both sites. SW suggested it may be
possible to have dedicated resuscitation teaching on Wednesday mornings.
1.8 The Trust is attempting to reduce supporting PAs from the current 2/2.5 per
person and this will include time for undergraduate teaching. Teaching consultants
are lobbying for the time to be specifically recognised in teachers’ job plans. Both
MLy and SW get ½ PA for teaching as Undergraduate Tutors.
1.9 As a result of SIFT funds becoming more transparent, some firms are more
willing to take students. The Lister is happy to take students at the MAU and are able
to take students for SSMs in Oncology and Respiratory Medicine.
1.10 At the QEII there is no dedicated consultant for MAU, so it is difficult to take
more students although there are two very good staff grades. ML confirmed that it
would be acceptable for students to present to staff grade doctors.
1.11 Gemma Haslam has been appointed at the Lister Postgraduate Centre as
Undergraduate Administrator and is funded from SIFT. The School is tightening up
on students missing teaching and undergraduate administrators should inform PK if
students are taking unauthorised absences.
1.12 The Trust requests a formal letter to say that there is no longer any need for
them to provide Occupational Health certification to students.
2. STUDENT FEEDBACK QEII
2.1 Paediatrics
2.1.1 The Paediatrics students (x2) were in week 2 of their attachment. They spent
the first week in the Ambulatory Unit (PAU) at QEII and this week have been in the
community. All students had been met and shown around by a junior doctor and a
registrar, although they had not been told where to report on their first day.
2.1.2 The student in the PAU, despite the patients not being very ill, were able to
see some very unusual cases. In the second week in the community they saw
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Lister & Queen Elizabeth II Hospitals, E&N Hertfordshire NHS Trust QA SIFT Lite Visit - February 2006
mainly patients with ADHD and autism. There has not been any formal teaching
although students have not requested it. Neither student had used the log book yet.
1.2 Medicine
1.2.1 The Medicine student (x1) was in the final week of his attachment. The
induction was good and the administrative staff have been very helpful.
2.2.2 The attachment to Mr Winocour’s firm was not as useful as it could have been;
its focus was too specific (mainly endocrinology) and Mr Winocour did not allow the
student to move between firms. The timetable appears to be flexible but in reality it
is limited by the consultant’s attitude. It would be a better learning experience if
some time were spent in the MAU, but this has not been open for negotiation. The
student decided to “go off and do what (he) wanted” but is now concerned that he
might be marked down – as Mr Winocour validly points out, it is difficult to mark a
student at end of an attachment if he hasn’t spent time with him.
2.2.3 The student remarked that the simulation training at Hatfield was the best
thing he had done in 5 years.
2.3 Surgery
2.3.1 The Surgery students (x2) had both been attached to Mr Lemox’s firm and
were very happy with the amount of teaching they’d received from him, his registrar
and other consultants. There was a teaching ward round every week and the chance
to be present in theatre. He had been very supportive to the students and helped
them to find the appropriate teaching. They were looking forward to attending the
Hatfield training.
2.3.2 The student (x1) on the A&E attachment said it was the best attachment he
had done. Staff treat the students with respect and students react well to this; this
student had been allowed to complete a very long shift because he was interested in
learning. Mr Wilkey and his staff include the students in all activities and are lovely!
3. STUDENT FEEDBACK LISTER
3.1 A&E
3.1.1 The 3 Students on the A&E attachment at the Lister said it was “Brilliant!” and
“one of best firms”. They appreciated being treated like a junior doctor. Middle-
grade doctors were looking after them and supervising their work although there has
been no formal teaching. Students felt that they were learning a lot although they
would like to be given 1 hour per week with a consultant on relevant A&E techniques.
They have been encouraged to carry out a wide range of activities including an audit
in the management of asthma in A&E. They’ve learnt many practical skills and feel
better prepared for FY1.
3.1.2 They have all done nights – about two per week - and were advised to try and
experience one Friday or Saturday night and one week night. They were also sent
out with the ambulances at night which they thought was an excellent learning
experience and thoroughly enjoyed.
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Lister & Queen Elizabeth II Hospitals, E&N Hertfordshire NHS Trust QA SIFT Lite Visit - February 2006
3.1.3 The less positive feedback was about the teaching scheduled for Tuesday
afternoon which never materialised, and the Wednesday morning teaching which
only happened two out of four times. They were told they could attend the HO
teaching and Thursday pm A&E teaching but found that it is not undergraduate
oriented.
3.1.4 Usually there is an ATLS course but this did not run during the week they were
there. Students were also allowed to go to SHO induction which was very
interesting.
3.1.5 Not all students had been issued with bleeps, but they did not feel they
needed them.
4. ACCOMMODATION
4.1 QEII
4.1.1 Only three of the six students were using the accommodation. One student
said “it’s rubbish”. It is very noisy from 8am (sometimes 7.30) because of building
work.
4.1.2 CC promised to ensure that students doing Surgery and A&E attachments are
allocated the rooms at the back of building which should be quieter.
4.1.3 There is nowhere to buy food on-site after 6pm and most doctors bring their
own sandwiches.
4.1.4 From this week, hot food is only available from the restaurant until 4pm. This
is because of Trust financial savings plan. However, the Garden Café is open until
7pm. Furthermore, in the accommodation block there is a kitchen with freezer and
cooker.
4.2 Lister
4.2.1 All three students thought the accommodation very good. There is a
Sainsbury’s a short drive away which is open to 10pm and the students were self-
catering.
4.2.2 They also found the Library and IT facilities to be very good.
5. FINANCE
Dr Ken Farrington (KF) Deputy Medical Director Mike Greenwood (MG), Finance
Manger for Corporate Services and Jane Berry (JB) Assistant Finance Manager for
Corporate Services
5.1 LW commented that after last year’s visit there was an action point to ring
fence SIFT. The statement the Finance Department has provided this year shows
that they have been working at this and it would be useful to go through some areas.
MG had also brought next year’s plan for funding and said that they hope to
demonstrate the Trust’s plan for use of SIFT.
5.2 KF said that it had been a blow that the appointment of the clinical skills
teacher had failed twice. He is pleased to confirm that the post for the Educational
Fellow is being advertised. Some administrative posts have also been identified.
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Lister & Queen Elizabeth II Hospitals, E&N Hertfordshire NHS Trust QA SIFT Lite Visit - February 2006
5.3 He went on to say that the Education Committee may be able to use the
slippage (from non-appointed posts) for helping to equip the clinical skills lab and pay
for simulation training. It may be possible to do this training here (instead of Hatfield)
but maintenance costs will need to be factored in.
5.4 MG pointed out that a considerable amount of money (about £85k) will need to
be spent on the accommodation when it is no longer owned by the Trust.
5.5 The Finance Department is working towards moving SIFT into a central
budget area and this will clarify any spending. LW added that identifying the SIFT
money that is directed to the departments would be very good for PR and will
encourage people to teach. Ideally, staff should know that SIFT is being used for
education; the Finance Department should convey this to department and teachers.
The only concern is that once at departmental level, it should not lose its educational
focus. It is good use of SIFT to spend the extra £10K on clinical skills and a
contribution to the library. LW was pleased with the progress made in making the
SIFT accounts more transparent. The Trust as a whole is clearly committed to
medical education.
5.6 KF informed the Team that staff have been getting 2.5 supporting PAs in line
with BMA recommendations. It is likely that in the near future, the Trust will try to
dedicate PAs to specific activities. He is working to get undergraduate teaching
recognised in job plan. It’s very easy to identify the individuals who do most of the
undergraduate teaching and it would be good to link it to the budget; however it is
difficult to make the distinction with PAs, between undergraduate and postgraduate
teaching.
6. IT AND LIBRARIES
6.1 NHS Direct has now moved out of the Library at the Lister and there is now
out of hours access to 9 PCs with internet access and study tables. It has not been
possible to provide 24 hour access for books although there has not been much
demand for this.
6.2 CC TV has been installed and entry through the main building is monitored.
The QEII also has cameras although these are not monitored, just recorded. There
is a new training room with 6 PCs at the Lister and there are 5 PCs for training at
QEII. There are 5 more PCs in the book section at the Lister. Following
recommendations from the library’s accreditation process (for which they were
awarded a high 2), they have amalgamated the journals and books.
7. FEEDBACK SESSION
Mr Medhat Michail (MM) Associate Specialist A&E, Christine Crick (CC)
Postgraduate Centre Manager, QEII & Lister Hospital, April Hall (AH), Medical
Student Administrator, QEII Hospital, Gemma Haslam (GH) Medical Student
Administrator, Lister Hospital, Danny Mortimer (DM) Human Resources Director, Dr
Shahid Khan (SK), Clinical Tutor, Lister Hospital, Mr John Saetta (JS) MMC Training
Programme Director, Dr Spencer Ellis (SE) Rheumatology, Mr Tom Holme (TH)
Surgery + KF, ML, SW, MG, JB.
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Lister & Queen Elizabeth II Hospitals, E&N Hertfordshire NHS Trust QA SIFT Lite Visit - February 2006
7.1 ML thanked the QEII/Lister Team for having us once more. The School is
very grateful to the consultants and administrators for having our students and for
seeing us today. Overall, the visit has been very positive. The students have found
staff at the hospital very supportive and friendly; they have enjoyed their time and
they praised the administrative staff. A&E was particularly highly praised and
students liked the flexibility of their surgery attachment at the QEII.
7.2 The accommodation is variable although work is being done to improve it at
the QEII and the Lister’s is generally very good. Since the amount of accommodation
available is limited and is the only thing preventing the Trust from taking more
students, the School will aim to send some students who would not need
accommodation.
7.3 The induction seems to be very good with the exception of paediatrics which
received mixed reports. Students thought that their time on the clinical skills course
at the University of Hertfordshire was one of the best things they have done and A&E
students would also like the opportunity to do it.
7.4 Although we did not meet any O&G students, the on-line feedback indicates
that there is no formal teaching. This needs to be addressed.
7.5 We fully support the development of the new postgraduate centre. We know
there have been problems recruiting to the new clinical skills post and hope
someone will be in place in the near future.
7.6 The presentation of the SIFT statement of account is much improved.
7.7 The School will help the Trust to work towards associated university status,
and the increase in FTEs over the coming years. The appointments of a clinical skills
trainer and an educational fellow will strengthen the Trust’s case for attaining this
status.
8. RECOMMENDATIONS
Essential
• Move towards job plans including PAs for undergraduate teaching (5.6)
• Students should be given some flexibility to move between firms (2.2.2)
• Paediatrics should provide dedicated, formal teaching (1.7)
• O&G should provide dedicated, formal teaching (7.4)
Desirable
• A&E Lister to ensure that the timetabled formal teaching is delivered (3.1.1)
• Ensure that Consultants are aware that they can access the on-line student
feedback and encourage them to do so
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