Clinical Education - Full Function EqIA Assessment final 09

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					Full Equalities Impact Assessment Function
The purpose of the Full Equality Impact Assessment (EqIA) is to ensure that we do not discriminate against any of the Equality Groups (Age, Disability, Gender, Sexual Orientation, Race, Religion or Belief) and ensure that we promote equality in the provision and take up of our services and employment practices. Name of Function being assessed

Clinical Education (incorporating Resuscitation Training)
Department/Directorate Medical Education Lead Assessor responsible for impact assessment Name Tanith Turner-Lumb Job title Clinical Education Manager Telephone Ext 2052 Name Ursula Wood Kevin Ross Position/title Clinical Educator Clinical Educator Director/General Manager Maria Neary Department of Equality and Diversity advisor Name Lorraine Cameron Job title Head of Equality and Diversity Telephone Ext 2428 The EqIA Team Telephone/email Role on EqIA

What is the aim and purpose of Clinical Education? To teach, support and prepare undergraduate medical students and trust staff from varied backgrounds, how to competently fulfil their role within a multi-cultural, diverse and ever evolving NHS environment Who is Clinical Education intended to benefit? Medical students; Trust staff; Postgraduate and Patients Who are the main stakeholders? (eg patients, public, staff, partners) Who? Interest? Undergraduate medical students Postgraduate medical trainees Leeds Medical School Healthcare Professionals who need resuscitation training Other staff who use the services Is there any Legislation or National Guidance that affects the operation of this function? (if yes, please list) Legislation Guidance GMC Good Practice Guide for Junior Doctors GMC Tomorrows Doctors UK Resuscitation Council Is there any local policies or guidance that affects the operation of this function? (if yes, please

Full Equality Impact Assessment Clinical Education Function

Policy Supporting medical staff in training Resuscitation Policy Professional Appearance Infection Control Registration Date 31st March 2009 Draft Full EqIA Completion Date June 2009

list) Guidance Competency assessments for new junior doctors

Registration details EqIA Registration No F053 Timetable Consultation dates (from/to) Finalise EqIA (date) July – Aug 2009 September 2009

Full Equality Impact Assessment Clinical Education Function

1. Who will be affected and what are the equality issues? Please list below any particular individuals or groups that this function is likely to impact on differently/adversely and the potential issues that you need to consider. Think of the impact on the six Equality Strands • What is the profile of the people likely to be affected by the Function • How does the user profile relate to the local community profile? • Which equality groups are under/over represented and why this may be • What is the impact on the groups identified Groups likely to be affected by Clinical and Medical Education: Consider the barriers that might affect access. Barriers include: • • • Communication both written and verbal Staff Attitude • • • Physical barriers Inflexible procedures

Awareness of systems by patients/service users Human Rights examples: • Equality – ensuring people are not denied treatment solely on the basis of their age • Dignity – ensuring wet sheets are changed promptly to reduce risk of people suffering degrading treatment • Respect – understanding of cultural diversity and different family make-up • Fairness – ensuring concerns and complaints are listened to and there are fair processes in place to discipline staff equitably • Autonomy – ensuring people are involved in decisions about their treatment and care

Equality Strand

The nature of the barrier and its effect on access to service, function (state if none)

Can this barrier be removed/avoided? (√) Yes No Not Sure



The Medical School dictates the age of undergraduate medical students. There is no upper age limit. Risk issues around evacuation in the event of fire for mobility impaired people There have never been any visually impaired students. It is unlikely that they would be invited to join the medical school. Reasonable adjustments would be made for hearing impaired or deaf students. Reasonable adjustments would be made for any students who required it. For example extra pastoral care for a student with bi-polar condition. Similar for long term conditions.

Full Equality Impact Assessment Clinical Education Function

“Communication across language barriers” does not include how to communicate with deaf people. Gender No gender issues. Students who become pregnant can take time out and return. Race and ethnicity All students should have a good command of English. Those who require extra communication skills are offered training through Leeds Medical School. A course is run for the third year’s on placement in primary care called: “Communication across language barriers”. Religion or belief Issues around compliance with Trust Professional Appearance and infection control for some religious groups. Leeds Medical School are very clear that dress should not interfere with care of patients. Sexual Orientation No specific issues. Human Rights Equality: See above Examples of Dignity: These issues are addressed at medical Human Rights school or through speciality training and through Issues in continual assessment for trainees Healthcare Respect: Clinical educators ensure that issues of respect are covered in providing care to patients. Fairness: Any disciplinary issues regarding a student would be referred back to the Medical School for consideration. That requires very clear evidence of lapse. Autonomy: Students always have to ask the patient about their “ideas, perceptions and concerns”. Clinical educators always advise students to use interpreters rather than family/friends.

Full Equality Impact Assessment Clinical Education Function

2. Existing information/research/consultation Now that you have identified the individuals or groups please check whether there is existing research, data or consultation relevant to this function which you can draw from to identify differential/adverse impact and the potential for practice to lead to discriminatory outcomes so that you are in a position to recommend changes. Information that should be considered includes: Results from previous consultations Complaints/Pals issues Incidents Research Surveys List below the methods you have used to inform the process Existing info/research/consultation Summary of Issues Raised Clinical Education session 3rd Year Clinical Educator Teaching Evaluations evaluations 2009.


250 Sessions helped me develop new skills Varied & interesting teaching methods Sessions were well organised & structured Sessions helped me to prepare for OSCE's Quality & content was of a good standard





Agre e e Disa gree ree gly A g Uns ur sagr e e

Stro n

Full Equality Impact Assessment Clinical Education Function

Stro n

gly D i

5th year clinical educator session evaluations 2008/2009.
Info received w as clearly presented 350 Info w as at the right level. 300 Teaching integrated w ith previous know ledge. 250 session addressed learning needs. Would recom m end to another student. Am ple opportunity to practise skills. Sufficient help w ith skills. 100 Opportunity to discuss perform ance. Increased confidence in clinical area. 0 Yes No Enhanced placem ent experience.




Some of students comments about the clinical educator sessions.

Receiving 1 to 1 teaching & feedback. Brilliant. Enthusiastic & helpful clinical educator. Really friendly & fun tutor who was keen to help us learn. Excellent teaching & lots of skills to practice. Very well organised, plenty of opportunity to practise.

Full Equality Impact Assessment Clinical Education Function

You’re fab, the sessions are great, we learned loads & practised all our skills. Fun times – learnt a lot. Presentations excellent. Fun, informal, no questions too silly. Very well presented in a relaxed informal way. Well structured & focused. Excellent, & easy to follow sessions. Very relaxed & friendly. Good atmosphere to learn in. Tutor was excellent. Very patient & focused in sessions. Excellent teaching & tips for OSCE. Sessions were flexible to cover what we wanted to learn. Good feedback from tutor, lots of tips to help brush up on skills for OSCE. Very good tutor, made sessions interesting & relevant. These sessions are a ray of bright light in our gloomy timetable. Very good sessions, should have these in Leeds. Plenty of instruction & advice. Lots of time to practice. The educators were really helpful & nice. Always keen to help you. Thanks the sessions were great. We learnt loads. Educators are helpful & supportive. Opportunity to revise history taking, examinations & practical skills under supervision, with constructive criticism & advice re OSCE techniques. Friendly educator. Can ask questions comfortably, conducive environment for learning. Interactive & enjoyable. Very thorough, able to practice on patients with signs. Would recommend to other students. Good advice to improve examination skills. More time with educator, less time not spent with educator. Practising examinations on real patients in a timed environment was very useful. Educator was very nice & informative – practical experience & critique. Ability to be flexible with timetable. Really helpful teacher. Always happy to give us extra information/ leaflets etc. able to ask any questions we wanted. Really interactive – able to ask specific questions & deal with specific learning needs. Really good teaching – excellent knowledge & explanations. Educator is very friendly & encouraging. Really good to go over exams etc with such close supervision. Great learning opportunity to perfect

Full Equality Impact Assessment Clinical Education Function

Complaints (February 2009)

techniques. Educators constant enthusiasm. Always happy to help & really friendly. All very relevant & well taught. Useful for exams & future practice. All really helpful. The most worthwhile aspect of my GP placement. Best bit of placement. Enjoyed educators methods of teaching, especially examinations with OSCE style format. Excellent knowledgeable teacher. Very clear & comprehensive teaching. Good review of previous knowledge & built upon this in sessions. Hope all students get the chance to come to these sessions. Informal environment makes it easy & pleasurable to learn & develop essential skills. its been brought to my attention, about a confrontation you saw fit to have on the ward this morning, with the professional development nurse. it appears that one of you didnt tie your hair up and one of you went to the wards with a bag, and when you were, quite rightly challenged, you asked for 'supporting evidence'. although i agree its great to be inquisitive, this behaviour, girls, is not acceptable. you can not have a confrontation in the middle of the ward! you may feel we are being over cautious regarding infection control issues, but not only are these issues in the forefront of everyones minds, and indeed should be in yours too, we also have a visit from the health care commission pending, and also these issues (tying hair up, washing hands, no jewellery etc) are now our hospital policy. if we had a member of bradford hospital trust not adhering, they would be going through a disciplinary. so why do you think you dont have to adhere to our trust policy? i look forward to your reply regards ++++ I am not wishing to drag this situation out, however, i just wanted to run something by you. After familiarising myself with the trust infection control policies and protocols there is no mention of not being able to use bags on the ward. Please could you clarify this for me as i still believe i am right in saying that carrying all of my stuff and having to put everything down to do simple tasks such as washing hands etc is ridiculous and more of an infection risk than a bag that does not come into any contact with patients. After our conversation i appreciate that infection control is

Full Equality Impact Assessment Clinical Education Function

important and needs addressing, i am unsure whether targetting us in such a way is the best way to do it. I understand that this is not within your control. I would be happy for you to forward this email onto [name] if you so wish to clarify the matter, and if i am found to be wrong about there being no mention of bags in the dress code policy then i apologise for wasting everyones time. I hope you dont think i am wasting your time on the matter but i just didnt want to start using my bag again without running it past you first. Please dont think im trying to be awkward in any way at all but having to carry everything really does make wards rounds etc awkward and also means that we are unable to get involved with the practical side of the ward round. Although i question the approach to this situation and her professionalism, i dont see any point in persuing it further i simply want to carry out my training. I dont want to turn up on the wards with a bag if it is in the infection control policy that i shouldnt have it. Many Thanks ++++++ I was copied into this correspondence to answer your queries about infection control policy. You are correct that there is currently no mention of wearing shoulder bags in the Professional Appearance Policy, although this will be so in the amended version which will be released shortly. However, the problem with shoulder bags is that they have a habit a dangling when examining patients or leaning over notes so that they might come into contact with the patient or the patient's immediate environment. Hence this comes under the statement in the Standard Precautions Protocol to 'Ensure loose items of your clothing do not come into contact with patients'. I understand the difficulty of having things in your hands making hand hygiene impossible so best to leave most things behind when on the wards. A compromise could be a small bag attached to the waistband (a 'bum-bag' - made of wipeable material) which could store pens, wallet, a small notebook and stethoscope (or big pockets!). Therefore you are requested to avoid using a shoulder bag while on the wards. All people who have patient contact are targeted in Bradford, which may explain why we have had such an impact in improving our MRSA bacteraemia rates and our success has only happened because of the enthusiasm of Infection Control lead clinicians such as Jane Palmer.

Full Equality Impact Assessment Clinical Education Function

A tip I would share with you is that the 'professional' way of behaving is for you to always respect the advice and knowledge of staff working in a Trust where you are attached as a student rather than questioning their professionalism. Yours sincerely Risk Incidents – Advance Life Support reports Research One incident relating to the competence of a junior doctor. Aseptic Technique research (powerpoint presentation on file and policy and assessment tool available on Intranet)

If you do not find sufficient information to enable you to move forward on an informed basis please say how you are going to gather this information and give some timescales for doing this. Enough evidence found

Full Equality Impact Assessment Clinical Education Function

3. Findings from analysis of information/consultation Building on the information you have developed in the previous sections this is your opportunity to state what gaps or possible discriminatory practice, if any, there are in the function you are assessing. There may be two aspects to what you have found out. One may be the unmet needs of particular individuals or groups and the second may be the opportunity to promote good relations between communities and equality of opportunity. Please list the key findings and what the implications are for your function. (copy and paste tables below for additional actions)

Issue Implications

Risk issues around evacuation in the event of fire for mobility impaired people Need to ensure that fire evaluation procedures are put in place for mobility impaired students. Adjustment may be necessary for other disabled students Understanding of what adjustments are available as and when necessary. “Communication across language barriers” course does not include how to communicate with deaf people. Students are not given the opportunity to understand and consider the needs of deaf people. Unclear of exactly what Leeds medical school guidance is to students on induction regarding Infection Control / professional appearance Need to ensure consistency of approach to these issues.

Issue Implications Issue Implications

Issue Implications

Full Equality Impact Assessment Clinical Education Function

4. Consultation

You are now in a position to consult on what you have found from existing information/evidence. The pages above form the basis of your consultation. Ask stakeholders for comments. The following are prompts/examples of the areas you would like comments: • • • • Are there any errors/omissions? Are there any additions? What ways can the service can be amended to remove discriminatory practice? Any examples of good practice?

Ensure you give sufficient time for responses (6-8 weeks generally adequate to allow for discussion)

Who you consulted Breakdown of who consulted by:

Student response #1

What they said Internal staff GP’s Students Staff at Leeds Medical School Just some points: My year did have deaf awareness training as part of PPD in 2nd or third year, though it wasn't part of the "Communicating Across Language Barriers" day specifically. I've wondered how easy it would be for a student with mobility problems to get about Field House with seminars upstairs and all over. It's not just about evacuating them when there's a fire but accessing the building and its facilities. Are there any stair lifts for access? I don't know if there are any med students or nursing students with mobility problems but I wonder how easy it would be to get about? My mum's in a wheel chair in Dundee and sometimes it's a nightmare to get about and find access to buildings. Apart from that I can't think of much else to say. I feel most of us think you guys at Bradford are ace when it comes to attitudes and clinical skills. We certainly feel a lot more confident and prepared than others who weren't at Bradford - that's for sure.

Equality Implementation Group

No specific comments other than those highlighted below from Estates.

Full Equality Impact Assessment Clinical Education Function

Consultant Response

We have had disabled students, we have had to put special examinations on for them, so the practice is that they are catered for. I'm not sure how I can help with this but from what I've read it looks fine. I definitely agree with the point about communication across language barriers with the deaf. I'm not sure whether this is relevant or not as an addition but I feel it is important for students to have some guidance when on placement as to where to go for social and welfare issues/support. Who is responsible in this area-the hospital placement coordinator or medical school? Kind regards and enjoy summer.

Student #2

Fire Officer Report Following our conversation, i have carried out an inspection of the rooms below (on 31/7/09) that maybe used by mobility impaired persons. These are my findings and recommendations: All the first floor rooms are suitable from your list ie Ramp access is available. (via new lecture theatre) The only ground floor room suitable from your list would be the clinical skills lab ie Ramp access. (at the back of the reception area) If the students were semi mobile ie would be able to negotiate 4 steps safely (not permanent wheelchair user) then the remaining ground floor rooms would suitable.

GP Response

RE the comment about the language barriers training I run. It does not include communication with deaf people. Initially we did have a simulated patient scenario with deaf person and his relative acting as a informal interpreter using BSL but unfortunately the person involved moved away. We sometimes discuss issues about communicating with deaf or hearing impaired people if the subject comes up but the students tell me they have sessions on this centrally at the med school. Also note that the language barrier workshops will no longer be running in Bradford but from academic year 09/10 will be incorporated into teaching done by the AUPC centrally. it will be delivered to 4th years (3rd years after the new 2010 changes come in) and although slightly watered down this will mean all students will have exposure to this session not just those allocated to Bradford and Airedale PCT practices

Full Equality Impact Assessment Clinical Education Function

Response from Medical Administrator at Leeds Teaching Hospitals.

There is a section the Patient Evaluation study guide on dress code etc: - Dress Code How you dress as a student will affect a patient's reaction to you. Please be smart at all times, particularly now that you cannot hide behind a white coat! As a guide, an edited version of the Leeds Hospitals Trust Dress Code Policy is included below. Similar guides are available at other hospital Trusts. * Trust photo ID badges or, where relevant, the ID badges of the employing organisation or educational institution must be worn and visible at all times. * Where own clothing is worn in roles where contact with patients or visitors is expected, it should be clean and smart presenting an efficient and professional appearance appropriate to the job role/s. * All visible own clothing should be modest with e.g. no low cut skirts/trousers or short cut or cropped tops which reveal midriffs or underwear, no plunging necklines, see through garments or miniskirts. * Casual clothing such as ripped faded or frayed jeans, jogging bottoms, combat trousers, flip flops and tops with slogans are not acceptable. * To ensure effective communication, clothing which covers the face is generally not permitted for any staff in contact with patients, carers or visitors. * Hair should be clean, neat and tidy. * All male staff should be either clean shaven or beards and moustaches should be clean, neatly trimmed or rolled and tucked. * Make up should be natural looking. * To respect patients and colleagues, all staff should pay attention to their personal hygiene including oral hygiene and avoid wearing strong perfumes/aftershave. * Where jewellery is permitted it should not present a health and safety risk. * Religious symbols may be worn discretely provided they comply with health and safety, and infection control guidelines. You should also be aware of the 'bare below the

Full Equality Impact Assessment Clinical Education Function

elbows' policy, which relates to infection control. If you ignore this, you can reasonably expect to be removed from a clinical area. Please note that there are no exceptions to this in any of the Hospital Trusts where third year students are sent. If (for religious or other reasons) you do not feel that you can adhere to this, you will not be able to progress through the MBChB course. There are clear guidelines on this from both the Medical School and the General Medical Council. PLEASE NOTE THAT YOU MAY BE REFUSED ACCESS TO WARD TEACHINGS IF YOUR DRESS IS CONSIDERED INAPPROPRIATE. -Local Policies When on attachment, whether in hospital or in a General Practice, you are subject to the same local policies as other employees in that workplace. These may include policies on infection control, health and safety etc. You are not exempt by virtue of the fact that you are a Leeds University student, so please act accordingly. With regard to infection control, we do mandatory handwashing training for all 2nd Years during the Intro Course at the start of Patient Evaluation (January), prior to their first experience of clinical areas. There are videos on both the Trust website and in the Clinical Skills section of the University VLE. There are also posters showing how to wash the hands with soap/water and gel. The students also get info prior to the handwash day (attached). We are planning to extend the handwash training to take in asepsis as well (for the January intro course), which should make life easier over there if you don't have to do it for the whole 2nd Year! Obviously, in the new curriculum, we will have to do this for 1st years, (Remember documentary evidence of consultation will be required to meet legislative requirements)

Full Equality Impact Assessment Clinical Education Function

5. Proposed Actions

You have now reached the stage where you have identified aspects of your service that need addressing. This section should be the basis for clarification on exactly what action you are going to take, who will be responsible and when will it be completed by. • Consider what desired outcomes are needed and what steps will be needed to get there • Are they Specific, Measurable, Achievable, Relevant and Time related • Consider how those consulted or equality groups can be part of setting these actions (copy and paste tables below for additional actions) See action plan at end.

Full Equality Impact Assessment Clinical Education Function

6. Giving Feedback

You now need to publish the results of either the existing research/consultation or the new consultation you have undertaken and in particular, how you intend to change the service. It is important that you feedback to those who have taken part in any consultation to inform them of what has happened to their contribution and how/if it has changed the service. State below how you will do this

Who you consulted (copy from 4 above)

Comments incorporated? (√) √

If not, justification

Feedback given? (√) √

Internal Staff (Consultant & Fire Officer) General Practitioner √ Medical Students √ Staff at Leeds medical √ School (Medical Administrator)

√ √ √

If you have used the Foundation Trust Membership Database, have you completed the Evaluation Form – Appendix I of Strategy for Patient and Public Involvement? Yes/No (Remember documentary evidence of consultation will be required to meet legislative requirements)

Full Equality Impact Assessment Clinical Education Function

7. List of all documentary evidence You have to demonstrate that you have consulted appropriately, responded and amended your function based on evidence you already have or have received during the consultation process. All evidence used in the development of the EqIA must be sent to DED for audit purposes. Documentation you should forward includes: • Patient monitoring data relating to the function • Notes of consultation • Membership of consultative forums (demographic profiles) • Notes of meetings • Written responses This list is not exhaustive.

Evidence Equality Implementation Group Student Response -1 Student Response - 2 Fire Officer Response Gp Response Medical Administrator Response Consultant Response

Format (electronic, Paper) Electronic Electronic Electronic Electronic Electronic Electronic Electronic

Attached? yes yes yes yes yes yes yes

All electronic/paper based evidence to be forwarded to DED with the EqIA Registration Number (see page 1)

8. Monitoring/Review Now that you have a clear set of actions to implement, it is important that you have processes in place to monitor the impact of those actions to ensure they are being effective. Future actions should be reflected in your service planning processes and be reviewed, monitored alongside other business activity. • Consider how those you have consulted and equality groups can be included in monitoring and review

Please state here how you are going to monitor/review your actions Advanced notice of students with disabilities is provided by the medical school and in this situation the induction of that student would include fire evacuation procedures. Overall monitoring of the student experience is through the Undergraduate Business Meeting. How do you intend to incorporate the actions required from this impact assessment process into your own Departmental Plans? Advanced notice of students with disabilities is provided by the medical school and in this situation the

Full Equality Impact Assessment Clinical Education Function

induction of that student would include fire evacuation procedures. Overall monitoring of the student experience is through the Undergraduate Business Meeting.

9. Sign Off

Agreed by Director/General Manager

Name (√)

Date 12 October 2009 13 October 2009

Head of Equality and Diversity

Notice to the Public
If you would like to comment on this [Draft/Final] Full Equality Impact Assessment please contact: Department of Equality and Diversity on telephone on 01274 382412 Or email

Full Equality Impact Assessment Clinical Education Function

Full Impact Assessment Action Plan Clinical Education
Risk issues around evacuation in the event of fire for mobility impaired people

Action Required Lead
Devising Evacuation Plans with students with impairments in conjunction with the Fire Officer.

Ongoing. As and when required, dependant on student needs.

Resource Implications


Full Equality Impact Assessment Clinical Education Function

Equality Strands
• Age o Older people (65+) o Young people (16-25) o Children (0-15) Disability (disabled people) o Physical impairment o Sensory impairment o Mental health condition o Learning difficulty o Long standing illness or health condition • Gender o Women and girls o Men and boys o Trans (gendered) people Religion or Belief o Buddhist o Christian o Hindu o Jewish o Muslim o Sikh o Other Sexual Orientation o Lesbians o Gay men o Bisexual people o Same sex couples o Heterosexual people




Race o White British o White non-British o Mixed race o Asian or Asian British o Black or Black British o Chinese and other minority ethnic groups


Full Equality Impact Assessment Clinical Education Function

Examples of Human Rights Issues in Healthcare
Article 2 – Right to Life - Dignity • • • • • • Severe abuse Malnutrition and dehydration Do not resuscitate orders Refusal of life-prolonging treatment or saving medical treatment Deaths through negligence Investigating where deaths are suspicious

Article 3 – Prohibition on torture, inhuman and degrading treatment • • • • • • • Physical or psychological abuse Neglect/carelessness e.g. bed sores, not being fed properly Poor conditions in hospitals Washing or dressing without regard to dignity Excessive force used to restrain Authorities failing to protect individuals from abuse Malnutrition and dehydration

Article 8 – Right to private and family life, home and correspondence • • • • Lack of dignity in respect of personal care needs Lack of privacy on wards Refusal to allow family visits or contact whilst in hospital Inappropriate use of restraint or medication

Full Equality Impact Assessment Clinical Education Function

• •

Negative and patronising attitudes Insufficient attention paid to confidentiality

Article 14 – Prohibition of Discrimination • • This must be linked to one of the rights, it cannot be used on it’s own to bring a claim under the Human Rights Act. It prohibits discrimination for any reason e.g. disability, race, gender, carer status. (Source: British Institute of Human Rights)

Full Equality Impact Assessment Clinical Education Function

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