GMC Council 180107

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GMC Council 180107 Powered By Docstoc
					20 January 2011

Undergraduate Board

To consider

Update on Swansea Medical School


1.      Quality assurance of Swansea University, College of Medicine.



        a.    To consider:

              i.     The progress of development of the programme at Swansea
              University, College of Medicine in response to the requirements in the
              2009/10 QABME cycle final report (paragraphs 11-21).

              ii.   The main findings of the visit to Swansea University, College of
              Medicine on 13 and 14 December 2010 (paragraphs 22-38).

        b.    To note regular communication between the GMC and the WAG during
        the QABME process for Swansea University, College of Medicine (paragraphs

        c.    To endorse the proposals for Undergraduate Board decision-making
        regarding the progress of the School towards meeting the standards in
        Tomorrow’s Doctors 2009 from September 2011 (paragraphs 42-45).

Further information

3.  If you require further information about this paper, please contact us by email: or tel. 0161 923 6602.

4.    The GMC is responsible for promoting high standards of medical education
and co-ordinating all stages of medical education under the Medical Act 1983. The
standards for undergraduate medical education are set out in the publication
Tomorrow’s Doctors. To ensure UK medical schools maintain these standards the
GMC has run a quality assurance programme called Quality Assurance of Basic
Medical Education (QABME), which involves regular assessments and visits to

5.      From 2004 Swansea University, College of Medicine (the School) delivered
the first two years of a four-year graduate entry programme, with Cardiff University
delivering the third and fourth years. In 2007 Swansea applied to award a primary
medical degree for its own four-year Graduate Entry Medicine (GEM) programme
independent from Cardiff. The QABME process has been monitoring the
development and implementation of this curriculum since 2008 and will continue this
monitoring until the first cohort of students graduate at the end of the 2012/13
academic year. The first cohort of students is currently enrolled in Year 2 of the

6.      The 2009/10 QABME annual report raised a large number of requirements
and recommendations. The visit team had significant concerns about the
development of Years 3 and 4 of the programme, particularly with respect to the
clinical placements and assessment.

7.     At its meeting on 14 October 2010, the Undergraduate Board considered the
2009/10 QABME annual report and noted the number and nature of these
requirements. It expressed concerns about the progress of the development of the
programme and whether the School has the resources to deliver a programme that
meets the requirements of Tomorrow’s Doctors 2009.

8.    Given the potential impact on the students currently enrolled on the
programme it was agreed that the Chair of the Undergraduate Board would write to
the Medical School, the Vice Chancellor and the Welsh Assembly Government to
express these concerns. These letters were sent on 22 October 2010. In order to
monitor the progress of the development of the programme it was also agreed that
the Undergraduate Board would receive an update at its next meeting and that this
update would include the main findings of the first quality assurance visit to the
School in the 2010/11 cycle, which took place on the 13 and 14 December 2010.

9.      After receiving the letters from the Chair of the Undergraduate Board the
School requested a teleconference with Professor Sean Hilton, visit team leader and
Kirsty White, Head of Quality (Education) to clarify the content and implications of
the letters, which took place on 28 October 2010. At this meeting the Head of School
at Swansea stated that the School had made progress since receiving the draft
2009/10 QABME report in July 2010, but after receiving these letters realised the
need to accelerate this process. We emphasised that the School’s progress was less
advanced than other new schools at the same point and that the School needed to
make up significant ground to be on track for GMC approval.

10.    The School’s formal response to this letter with a full action plan against the
requirements and recommendations in the 2009/10 QABME was received on
29 November 2010.


Swansea’s progress against requirements in the 2009/10 QABME report

11.    Documentation received from the School on 29 November 2010 showed that
considerable progress has been made since the 2009/10 QABME report. The team
found the documents to be more comprehensive than previous documentation
submitted by the School, providing clear answers to questions posed by the team.

       Requirement 17a. Provide clear learning outcomes for each clinical
       apprenticeship, mapped to Tomorrow’s Doctors 2009, which reflect the year in
       which students undertake them.

12.   There are nine five-week, clinical apprenticeships (placements) across the
programme in a range of clinical specialities and clinical settings, in which a pair of
students is placed with a named clinical teacher. The team is satisfied that the
School has provided documentation clearly mapping learning outcomes to all
apprenticeships across the programme, including where these outcomes will be
assessed. The apprenticeships have been split into four groups: early, intermediate,
development and transitional, and outcomes and assessments increase in
complexity across the four years. The team is reassured by this recognition of the
need for student involvement and responsibility to increase as they progress, as in
Requirement 17a. The School provided a helpful explanation of what will be
expected during these attachments and the team considers this a significant step

       Requirement 17b. Provide clear evidence demonstrating how the
       programme’s learning weeks run in a six-week cycle to reinforce student

13.    After reviewing the detailed plans for the delivery of Year 3 of the programme
from September 2011 there remains some concern about how the learning weeks
build over the course of the programme. The School is currently reviewing the
consistency in response to Recommendation 18b of the QABME report, To revisit
the sequencing of the timetable to ensure that the material included in the learning
weeks builds appropriately in complexity... The School is due to provide a document
clearly explaining this curriculum structure in February 2011.

      Requirement 17c. Provide the instructions for teachers regarding the provision
      of advice for students on the pursuit of their self directed learning, following
      formal teaching sessions. Also provide an example from each year (1, 2, and
      3) of the advice given to students in a range of topics.

14.      The team is satisfied with the School’s response to this requirement. The
examples of advice given to students were appropriate and provided a good basis
for self directed learning. The team will check this with Year 1 and 2 students during
its visit in March 2011.

      Requirement 17d. Provide a list of the seven five-week specialty attachments
      which all students will rotate through and the related learning outcomes for
      each attachment.

15.     The team considers that the School has provided clear evidence of student
coverage of the key specialties through the seven five-week specialty attachments
planed for Years 3 and 4 of the programme. The outcomes have been clearly
mapped to Tomorrow’s Doctors 2009 and listed within student specialty handbooks.
The School has explained how the specialties will be organised and structured and
how prepared they are to implement them. Each specialty has a designated leader
and administrator already in place. The team was encouraged by the high standard
of this documentation.

      Requirement 17e. Define how clinical placements (apprenticeships, specialty
      attachments and Learning Opportunities in a Clinical Setting, or LOCS) are
      planned and structured to give each student appropriate experience across
      the full range of specialties.

16.     Detail regarding the planning and structuring of clinical placements was
incorporated into the detailed information provided about the clinical apprenticeships
and specialty attachments. The Scheme of Assessment that was provided after the
December site visit included information about the increasing requirements for
assessments in the apprenticeships and specialty attachments. The team is much
less concerned than previously about the strategy and the assessments for the
clinical placements and consider that the School have provided the requested
information. The team will continue to monitor this aspect of the programme.

      Requirement 17f. Continue to provide detail of the specific agreements with
      Health Boards about the delivery of clinical placements for the programme.

17.     The team received an update on the School’s relationship with its NHS
partners, including the Wales Deanery, and was pleased to note clear progress in
this area. The service specification, developed in consultation with its key NHS
provider Abertawe Bro Morgannwg University (ABMU) Health Board, was considered
a strong platform for the School to develop positive relations with its NHS partners.
This will see the establishment of a Joint Undergraduate Board between the ABMU
Health Board and the School to oversee the delivery and quality assurance of
teaching with review of the agreement annually. An equivalent service specification
will be discussed with its two remaining partners; Hywel Dda Health Board and
Public Health Wales NHS Trust.

18.    Engagement with the Wales Deanery has been formalised through the
establishment of the School of Medicine – Postgraduate Deanery Liaison Group. The
team notes that the School is working closely with the Deanery on a number of
projects including; a systematic review of relationships between medical education
providers and clinical placement providers; harmonising final year undergraduate
teaching and assessment with that of Foundation Year 1 (F1); development of
quality assurance mechanisms for clinical teaching and tracking the progress of
graduates in F1 posts and beyond.

19.   The School will provide the detailed agreements in place with its partner
Health Boards, including the agreed number of students at each site, in February

      Requirement 17g. Review its faculty development strategy to ensure that all
      clinicians receive appropriate induction and training for the new style
      attachments in the curriculum.

20.     The School is currently working with the Wales Deanery to review its staff
development strategy. The School intends to run a series of workshops for its Senior
Clinical Tutor team from January to June 2011, to manage the transition from the old
style placements to the new style specialty attachments and apprenticeships, which
the team supports. The team will receive an update on this from the School in
February 2011.

      Requirement 17h. Provide a clear scheme of assessment to reflect the
      assessment strategy.

21.     The team’s main concern has been the lack of a clear assessment strategy
for the programme. The team considered the submitted Assessment Practices
document, which provided an overview of the School’s assessment strategy, to be
vague and missing important levels of detail. The School acknowledged that further
development would be required for this document to become an open source of
information for students and teachers. However, a substantially re-written Scheme of
Assessment was submitted within one week of the visit on 13 and 14 of December
2010. With evidence of major input from the new Head of Assessment, it is a
considerably improved document that now looks fit for purpose. Much more evidence
is provided on blueprinting, at curriculum, term and individual assessment level. This
provides the team with evidence that we can pursue further at our next visit.

      Recommendation: To consider the progress of development of the
      programme at Swansea University, College of Medicine in response to the
      requirements in the 2009/10 QABME cycle final report.

Findings of the quality assurance visit to consider assessment on
13 and 14 December 2010


22.    The QABME team conducted a quality assurance visit on
13 and 14 December 2010 focusing on the assessment of the programme. During
the visit the following activities took place:

      a.     A meeting with members of the School responsible for assessment.

      b.   Observation of the Year 2, end of term 1 Objective Structured Clinical
      Examination (OSCE).

23.   This visit was informed by additional documentation requested by the visiting

24.   A key focus for this visit was on the School’s assessment blueprinting and
mapping documents. The team requested evidence of blueprinting and mapping the
outcomes in Tomorrow’s Doctors to each assessment type and event across an
appropriate range of disciplines for the full programme. This was not provided in
advance of the visit as required, which was a concern.

25.     During the visit the School provided a document mapping its assessment
types for all years of the programme to the top level outcomes in Tomorrow’s
Doctors 2009. However when interrogated the team noted that this appeared to be
aspirational. For example during observation of the Year 2 OSCE the team saw no
evidence of coverage of some outcomes that it was mapped to. After the visit, which
included feedback from the visit team leader regarding the mapping document
provided during the visit, the School provided more detailed blueprinting for the
programme. This demonstrated significant progress in this area (see paragraph 21
for further detail).

26.    The team considers that the School previously lacked sufficient expertise to
develop a satisfactory assessment strategy for the four-year programme. This recent
improvement in blueprinting and the assessment scheme is encouraging. It indicates
that additional expertise recruited by the School, including a new Assessment Lead
(who has been working with the School in advance of his January 2011 start date)
and Advisory Panel (see paragraph 32), has brought additional knowledge and
experience required to develop and implement an appropriate assessment strategy.
There remain concerns about the amount of sampling for assessments, which the
team will be able to follow-up during their visit in March 2011, now that they have
much better blueprinting information.

Year 2 OSCE

27.    The School assesses its students at the end of each term through a
knowledge exam (an Extended Matching Questions (EMQ) paper) and an OSCE. In
Year 2 the first and second term OSCEs comprise 12 stations: four practical and
eight theory. The term 3 OSCE comprises 16 stations: 10 practical and six theory.
Students who fail one or more of the three OSCEs during the year sit a
supplementary examination of 12 practical stations and six theory stations.

28.      The team observed the Year 2, term 1 OSCE and has concerns about the
reliability of a four station OSCE as a summative assessment. The School combines
this assessment with eight theory stations and two anatomy spotters and students
must pass all three elements to progress. However the team noted that the paper
based theory stations are completely separate from the clinical OSCE and that the
School’s Assessment Strategy is misleading in listing these all as OSCE stations that
assess practical skills. The team questioned the validity and the benefit of combining
these three elements into one assessment.

29.      It was noted that there are few stations to sample a large number of areas
and that the School is not, at this stage, using a wide range of stations (such as
difficult communication scenarios or diagnostic procedures). The team expects to
see an increase in the range and complexity of tasks assessed in the end of Year 2
OSCE which has 10 clinical stations and will return in July 2011 to observe this

Workplace based assessments

30.     The School realised that the planned Safe, Effective, Professional,
Practitioner assessments for Years 3 and 4 were too ambitious and has replaced
them with the more commonly used mini clinical evaluation exercise (mini-CEX) to
assess practical clinical skills. Students will undertake two or three mini-CEXs during
each of their clinical apprenticeships in Years 3 and 4. The mini-CEX is a validated
assessment tool in both undergraduate and postgraduate assessment and is used in
the Foundation Programme. The team considers it sensible for the School to use an
established assessment tool for its workplace based assessments.

31.    From January 2011 Dr Wyn Harris (Foundation Programme Director for ABM
West and Senior Clinical Tutor) will have two days per week to work on faculty
development with the new Assessment Lead. This will include developing a
programme of training for assessors of the mini-CEX that will be rolled out from
mid-January 2011. The team was impressed with the strategy for assessor training
and noted that the School has already identified two consultants to take a lead on
this, who will be seconded from their clinical duties. The School is confident that it
has the capacity to successfully deliver this training and stated that its partner Health
Boards are committed to making this a success and have agreed to give the clinical
teachers the time required to attend training.

The Advisory Panel

32.    The School acknowledged the need to draw on external expertise in a more
structured and sustained way by establishing an Advisory Panel to assist in the
development of the programme. This panel consists of five external advisors with a
medical school and quality assurance background. The Panel has considered the
School’s progress against the requirements in the 2009/10 QABME report in
December and provided additional advice. The School intends to meet the Panel
before and after each QABME visit, with additional communication as required, until
the QABME process is complete.

Strengthening the academic team and administrative support

33.    In response to the Board’s concern that there may not be sufficient resources
or expertise within the School to undertake the work required to deliver a new
programme that meets Tomorrow’s Doctors 2009, the School is recruiting for two
new posts: a Professor and a Lecturer in Medical Education. The intention is that
these posts will strengthen the governance of the programme. In addition five new
administrative and clerical posts have been secured to support the programme, one
of which is a manager role funded by the Welsh Assembly Government.

Succession planning

34.    The Dean of Medicine is due to retire at the end of March 2011. The School
will seek nominations from the senior academic staff to replace the Dean of Medicine
(now called the Dean of Medical Education) and an appointment should be
completed by the end of December 2010. The Director of Clinical Teaching has also
arranged sabbatical leave from mid January until April 2011 to increase his
experience in medical education in New Zealand. His post will be covered by the
current Deputy Director of Clinical Teaching and he will keep in regular contact with
the School.

35.    The team remains concerned about the academic sustainability of the
programme in the long term, as responsibility still rests with a relatively small number
of key individuals.

Contingency plans

36.    The School has proposed two options for students currently enrolled on the
programme should the programme not gain GMC approval. The first is that current
Year 2 students would join Year 4 of the five-year medical programme at Cardiff
University to complete the final two years of their studies. Although the School has
not yet raised this with Cardiff University the Welsh Assembly Government has
discussed this with the medical school and asked them to plan for this scenario.

37.     The second option is that students would join graduate entry programmes at
medical schools across the UK in groups of 10. The School recognises that this
would impact negatively on NHS Wales who are trying to increase the numbers of
medical graduates who remain in Wales for training. It would also be more disruptive
for the students who are based in Wales. The School has not yet approached other
medical schools with this proposal.

38.    The Welsh Assembly Government has expressed concerns about Swansea
students leaving Wales to complete their programme of study and has a strong
preference that the students should to transfer to Cardiff University to complete their

      Recommendation: To consider the main findings of the visit to Swansea
      University, College of Medicine on 13 and 14 December 2010.

Communication with the Welsh Assembly Government (WAG)

39.    We have been corresponding regularly with representatives from the WAG
throughout the quality assurance process for Swansea and continue to keep them up
to date on the progress of the review.

40.     On 20 December 2010 a response to the Undergraduate Board Chair’s letter
of 22 October 2010 was received from the Chief Medical Officer (CMO) for Wales,
on behalf of the Welsh Assembly Government. The CMO noted that the WAG are
liaising with the School regarding a number of the concerns raised by the
Undergraduate Board. The Deputy CMO for Wales met with the School on
18 November to discuss the 2009/10 QABME report for Swansea, and the WAG
have made suggestions on how the School can improve liaison with the Health
Board. The CMO also noted that the WAG are involved with the development of
contingency plans to ensure that Swansea students would be able to graduate in
2013 with a primary medical qualification in the event that the Swansea programme
did not meet the GMC requirements.

41.    A meeting with senior representatives from the WAG is scheduled to take
place on 4 February 2011 to provide an update after the considerations of the Board.

      Recommendation: To note regular communication between the GMC and
      the WAG during the QABME process for Swansea University, College of

Conclusions on the School’s progress and next steps

42.    The School has made good progress towards meeting the requirements of the
2009/10 QABME cycle visit report and, specifically, has responded well to concerns
raised by the team regarding assessment blueprinting and mapping arising from the
13 and 14 December 2010 visit. The team does still have concerns about the
programme and the School will need to continue to demonstrate this level of
progress and responsiveness in order to meet the standards in Tomorrow’s Doctors
2009. The team consider that this is achievable for the School and will therefore
continue the planned programme of QA activity with the School. We will continue to
closely monitor the School’s progress and will provide the Undergraduate Board and
the WAG with regular updates.

43. A two-day site visit to the School will take place in March 2011 to meet
members of the School responsible for:

      a.     Assessment.

      b.     Delivery of Year 2 and preparation for Years 3 and 4.

      c.     Student support and fitness to practise.

      d.     Strategy for staff training, development and appraisal.

      e.    Engagement with service providers and the postgraduate deanery for

      f.     Quality management and control mechanisms.

      g.     Placements in general practice.

44.    Following the visit in March 2011, if we do not consider the School to be
making adequate progress and we think that the programme will not meet the
standards in Tomorrow’s Doctors 2009 from September 2011 we would like
endorsement from the Board to convene a meeting of the Chair of the
Undergraduate Board, two additional members of the Undergraduate Board (one to
be lay) and the QABME team leader. At this meeting the group would agree on a
course of action. We do not want this decision to be made at the Undergraduate
Board meeting on 10 May 2011 because we consider the timing of this Board to
pose too great a delay for a decision which will affect medical students at Swansea.

45.    If we consider that the School is making appropriate progress and will meet
the standards in Tomorrow’s Doctors 2009 from September 2011 we will bring an
update paper to the Undergraduate Board meeting on 10 May 2011. The Board
would then receive the final report of the 2010/11 QABME cycle at the meeting on
14 September 2011, which would include findings from a visit in July 2011 to
observe the OSCE examination at the end of Year 2.

      Recommendation: To endorse the proposals for Undergraduate Board
      decision-making regarding the progress of the School towards meeting the
      standards in Tomorrow’s Doctors 2009 from September 2011.

Resource implications

46.  The resources required for the QABME visit activities are included with the
GMC Education Directorate’s budget and headcount.


47.     As part of the QABME process we will continue to consider whether the
School has a fair and transparent student selection processes, whether the School
participates in a policy aimed at widening participation and how student support is
provided, including support for students with disabilities. We will assess the School’s
progress in meeting the standards in Domain - 3 Equality, diversity and opportunity
in Tomorrow’s Doctors 2009.


48.   This report will be published on the GMC’s website and shared with Swansea
University, School of Medicine, the QABME team for Swansea and the Welsh
Assembly Government.


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