Visit Report on the University of Central Lancashire (UCLan) medical school

This visit is part of the new schools quality assurance annual cycle.

Our visits check that 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

Sites visited

UCLan campus; Royal Blackburn Hospital

Programme MBBS

Date of visits

24 & 25 January 2018

07 & 08 June 2018

09 July 2018 (assessment observation)

Key Findings

Over the 2017/18 academic year we visited the University of Central Lancashire Medical School (the School) three times as part of our multi-year quality assurance review. We will continue the rolling cycle of annual quality assurance visits to the School and follow the first cohort of students through to graduation. During our visits this year we met with students from all years (1-3), as well as a range of staff from different teams across the School, East Lancashire Hospitals NHS Trust (ELHT, the Trust) and the West Cumberland Medical Education Centre (WCMEC). In addition, we observed the Year 3 Objective Structured Clinical Examinations (OSCEs). In January, we found that the School was managing the three cohorts of

2017/18 academic year

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students well and good progress had been made towards the development of the professionalism portfolio and inter-professional learning. The team was also impressed with the implementation of Phase 2 and the School’s plans for (and the University’s investment in) staff, resources and facilities. However, we were concerned that little progress had been made on the outstanding requirements and recommendations (such as teaching inconsistencies). As a result, we provided the School with a summary of all open requirements and recommendations in advance of our visit in June 2018; this indicated what progress we expected to see before the 2018/19 academic year. We also conducted a survey of all students prior to our second visit.

At this visit, we found real improvements on some longstanding concerns, including assessment item quality; we were also pleased to identify the effective expansion of the student support network in line with the growth of the School. In addition, we found evidence of an alignment between the School and both the University and region’s health and social care priorities, as reflected in the inclusion of third sector organisations into the curriculum.

We have been able to close a number of requirements and recommendations during this visit cycle, and noted significant progress to resolve those that remain open. We look forward to monitoring the School’s progress over the next academic year.

Update on open requirements and recommendations

Open requirements Update Report paragraph

1 The School must ensure that the learning outcomes in the curriculum align with those of the contingency school, Liverpool, by 1 December 2014.

The School has met this requirement. Liverpool Medical School has confirmed that the learning outcomes for all years are aligned. The mapping of the Phase 1 curriculum and learning outcomes with St. George’s, University of London is also complete.

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2 The UCLan MBBS curriculum must be mapped in detail to the Liverpool MBBS curriculum to ensure no students are placed at a disadvantage for future assessments. Were there to

The School has met this requirement. Liverpool Medical School is confident that any UCLan student transferring to Liverpool’s curriculum would not be placed at a disadvantage, and has confirmed that the full five years of the curriculum has been mapped.

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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.

3 The School must develop a clear mechanism to assess student professionalism that is separate from fitness to practise.

The School has met this requirement. We found that the School has taken significant steps to strengthen the teaching and assessment of professionalism, and has made good progress towards the development of the portfolio and professionalism lapse reporting.

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4 The School must review its curriculum and assessment content and attached guidance in order to improve student preparedness for summative assessment and programme progression.

The School has partially met this requirement. Improvements have been made to the student assessment handbook, and twice yearly student briefings are given to outline the assessment arrangements. However, during our visits, students raised concerns about the formative opportunities available to them.

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5 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

The School has met this requirement. UCLan Medical School has now successfully recruited an additional member of assessment staff. Furthermore, in-house assessment training and opportunities to attend external events are provided to all academic staff.

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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.

6 We welcome the review into the student selected components over the summer. In particular, the School must look to standardise the guidance available on this module for tutors and students, and allow an equitable access to topics of students’ choice.

The School has partially met this requirement. A peer review system was introduced in place of dedicated tutors for Phase 1 student selected components, which we found had introduced a new level of inconsistency. In June, we heard that the School had taken steps to standardise the students’ experience, but these have not yet been fully implemented. As such, we were unable to fully review the effectiveness of the School’s plans. We are, however, satisfied that the School now provides all students with an equitable access to choices.

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7 The School must review its interprofessional learning sessions to ensure that they adequately enhance students’ learning. We hope to see students given the opportunity to work and learn with and from other health and social care professionals and/or students to support multidisciplinary working.

The School has partially met this requirement. The School has revised its plans to encourage interprofessional learning and teaching, but these have not yet been fully implemented. As such, we have been unable to comprehensively review the effectiveness of the plans.

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8 The School must continue to work with its contingency School (Liverpool Medical School), and internally, in order to identify reasons for the continued high failure rate; to improve the summative examinations; to ensure assessment content

The School has met this requirement. The senior management team has taken steps to review the high failure rate; this includes its continued collaboration on standard setting with Liverpool Medical School.

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reflects taught content; and to ensure there is an increased likelihood of students meeting the annual progression requirements (above what was observed for 2016-2017). This collaboration must include a wider review of the School’s curriculum, learning and teaching methods, and learning outcomes to ensure an internal alignment between teaching, learning and blueprinting of assessment content.

Open recommendations Update Report paragraph

1 The School should review the information available to students about various aspects of the programme and ensure that student understanding improves.

The School has met this recommendation. The senior management team has made noticeable efforts to improve the timeliness and accuracy of its communications with students. This includes notifying the students of their placement locations at earlier stages of the programme, developing the student handbooks, and introducing assessment briefings at various points throughout the year. The School also has plans to include students as members of various committees in order to better inform the student body of key aspects of the programme.

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2 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.

The School has not met this recommendation. We continued to hear from students that there are inconsistencies between lecturers and teaching sessions; these findings are supported by our student survey. However, we are aware that the School has begun to implement steps to

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remove these inconsistencies, which we will review over future visit cycles. In addition, we are satisfied that students receive their lecture materials in a timely manner.

3 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.

The School has met this recommendation. Whilst we heard of minor issues, we found no instances where students were unable to meet their learning outcomes. We also heard of improvements in the consistency, preparedness and curriculum awareness of GP supervisors.

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4 The School should ensure that all equipment and simulated patients are standardised for each OSCE station to avoid unnecessary concerns from students.

The School has met this recommendation. We found that OSCE stations were well stocked with the equipment required by the students to carry out their assessments. The simulated and volunteer patients were well briefed and prepared at each OSCE station, and their behaviour and answers were observed as being consistent throughout the day.

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5 The School should review the discretionary powers of the progression board to award the option of resitting a year, and formalise this process.

The School has met this recommendation. The senior management team has amended the powers of the progression board to ensure that only those students who have met the requirements of the programme can progress to the next stage.

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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.

Number Theme Areas that are working well

1

R1.5; R3.2; R5.4

We found that the roll out of Phase 2 has been well implemented; this includes both clinical placements and faculty development. Both the School and Trust have responded effectively to student feedback, and there are good support mechanisms in place for

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students.

2 R1.19 There is continued investment by the University in educational resources and facilities on the main campus and across the region: this includes teaching and learning spaces, social spaces and accommodation. These facilities and resources reflect the student focussed and pedagogically oriented ethos of the University.

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3 R2.2; R2.3

There are strong links between the School and local education providers, with many examples of good joined-up working and evidence of an engaged and enthusiastic clinician team.

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4 R3.2 The student support network is being effectively expanded in line with the growth of the School; this is reflected in terms of both academic and pastoral support at the main and satellite campuses, including WCMEC.

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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.

Number Theme Requirements Report paragraph

1 R5.5; R5.6 The School must review the Year 2 written assessment items to ensure students can demonstrate an application of scientific knowledge to the clinical setting.

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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’ e.g. where things are working particularly well or where there is a risk that standards may not be met.

Theme 1: Learning environment and culture

Standards 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 During the 2017/18 visit cycle we found evidence of a culture that allows learners and educators to raise concerns, with effective processes in place to do so. The placement team at Royal Blackburn Hospital, ELHT, told us that the organisational culture within the Trust encourages students to feedback and raise concerns openly without fear of adverse consequences. This was confirmed by the Year 3 students on placement at the Trust: they told us that they feel able to raise concerns, and that the process for doing so was covered twice in inductions and set out in their handbooks.

2 Both the Year 1 and 2 student groups told us that they too feel encouraged to raise concerns, and know how to do so. For example, we heard that this may be done via an event form or by speaking to various staff members, including module leads and academic advisors. Our findings from the visits are reinforced by the positive results of our student survey: 97% of Year 1 and 2 students told us they feel able to raise a concern and 96% are aware of the processes to use.

Supporting duty of candour (R1.4)

3 We were encouraged to find that all Year 2 and Year 3 students we met during the 2017/18 visit cycle were able to explain the principles of the duty of candour. Whilst not being aware of the phrase ‘duty of candour’ when we met them in January, the Year 1 students had addressed the concept in a communications session. In addition, we were pleased to hear from the Year 3 students at ELHT that they have seen consultants display the duty of candour in practice.

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Seeking and responding to feedback (R1.5)

4 We were pleased to hear from students that the School demonstrates a culture that seeks and responds to feedback. Throughout the 2017/18 visit cycle, students from all cohorts told us they are able to give feedback on different aspects of the programme through various means and channels, both within the School and whilst on placement. We found that in the main the School continues to be highly responsive to student feedback, with the School making changes on a module by module basis. For example, the School informed us it has increased the number of expert half-day sessions to better cover the specialties following student feedback. The Year 2 students also told us in June that certain lectures (such as microbiology) have significantly improved following feedback from earlier cohorts, and are now more focused on the required core knowledge.

5 The placement supervisors and Year 3 students we met throughout this visit cycle agreed that the School has been particularly receptive to feedback during the rollout of Phase 2, with student feedback passed to the Trust within a matter of days. The Year 3 students and placement management team cited guidance being given to supervisors on how to introduce students to patients, and changes made to shadowing arrangements, as examples of improvements that have resulted from feedback given. The ELHT placement team informed us that feedback on students’ placements is compulsory, though this is not yet enforceable due to the small cohort size and confidentiality issues. See area working well 1.

6 Despite the opportunities available to students to give feedback, we were concerned to hear in January that all three year groups are not always aware of what actions are taken by the School as a result of their feedback. Some students were able to talk about the Staff Student Liaison Committee (SSLC) and the ‘You Said, We Did’ feedback (which is presented to students via the virtual learning environment, Blackboard, and on noticeboards), but others appeared unsure of how they would find out whether changes had been made.

7 However, we were pleased to note during our visit in June that the School has taken steps to close the feedback loop. A news board has been added to Blackboard, and face to face ‘You said – we did’ meetings are now held with students. The Year 3 students spoke very positively about these meetings, and reported that the School has become very good at keeping them in the loop following feedback. These improvements are reflected in the results of our student survey: the combined results indicate that 83% of students strongly agree or agree that the School tells them what changes have been made as a result of their feedback.

Appropriate capacity for clinical supervision (R1.7)

8 The School continues to take steps to ensure that there are enough suitably qualified staff members at both the School and on placement. Throughout this visit

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cycle, the senior management team outlined its plans for recruiting additional School staff in line with the growing number of students; this includes a number of lecturers and support staff. We were also pleased to hear of plans to decrease the number of staff working on multiple programmes through the identification of a dedicated BMedSci team, which the School hopes will reduce the likelihood of pressure on MBBS staff.

9 At ELHT, the placement management team told us in January that the Trust is experienced at educating medical students (it has previously provided placements for Manchester Medical School students), and is confident it has the capacity to provide an appropriate level of supervision and support for future cohorts from UCLan. In June, we heard that there is a placement support and facilitation unit within the Trust that maps learners across departments to ensure capacity; we look forward to reviewing how this unit will support supervisors and students.

10 In addition, we learned from UCLan’s senior management team that WCMEC, where students will undertake both GP and hospital placements, will provide out of programme opportunities and employ non-training grade doctors to teach at the site to ensure there are no capacity issues with clinical supervision. We will monitor the effectiveness of these plans during future visit cycles.

Appropriate level of clinical supervision (R1.8); Appropriate responsibilities for patient care (R1.9); Identifying learners at different stages (R1.10)

11 We have previously heard that students receive tuition on clinical procedures in clinical skills laboratories, as well as during placements, prior to undertaking procedures on patients. In January, we were concerned to hear that a small number of Year 2 students had taken blood samples from peers; students received tuition first from, and were supervised by, their clinical supervisor. This incident appeared to arise from a lack of clarification on policies relating to practising clinical skills, including student sign off and levels of competence. The GP and hospital supervisors we spoke to told us they receive a handbook which states the various skills taught to specific cohorts, but not at which stage of the academic year. Additionally, it was not a requirement for GP supervisors to check student portfolios or sign off in advance of permitting them to perform procedures.

12 These concerns were fed back to the School after the January visit, and we are pleased to note that action has been taken to prevent a reoccurrence and ensure that learners’ responsibilities for patient care is appropriate for their stage of education. We heard in the placements meeting in June that the School has clarified the learning outcomes and expectations for placements with both students and supervisors; both groups have also been reminded that no student should undertake any invasive procedure on a peer. The School also told us of the educational events for supervisors it is arranging, which will cover areas such as clinical skills and direct observations of procedural skills (DOPS) sign off.

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13 The ELHT placement supervisors we met in June told us that medical students are easily identifiable on placement: both UCLan and Lancaster students wear the same uniform but their name badges clearly state the relevant school. In addition, students from all years reported that they receive an appropriate level of clinical supervision and are given the opportunities to meet their learning outcomes whilst on placement. The Year 1 students completed their first placements in February and May, and told us the School made it very clear to them what they can and cannot do. Importantly, this cohort told us they felt this message had also been made clear to the placement providers. We were encouraged to hear these sentiments echoed by Year 2 and 3 students.

Induction (R1.13); Undergraduate programmes and clinical placements (R5.4)

14 We were pleased to hear that students from all year groups found their School and placement inductions useful. For example, Year 3 students moving into Phase 2 of the programme receive a welcome pack and an induction from ELHT at the end of Year 2, and from UCLan at the start of Year 3. Year 2 students told us they receive information and guidance through handbooks, emails and talks before their placements start, and have direct access to a placement manager at all times. Various school staff told us that these inductions make it clear what students can and cannot do on placements, and this was echoed by the students themselves.

15 However, we did note that no formal evaluations of the inductions have been carried out; this would allow the School to make any necessary improvements. We also heard during our placements meetings that Year 3 students had said that they would have benefited from more senior year groups being involved in the induction process to provide peer support: this was not possible as there is no Year 4 or 5 cohort. Nevertheless, the current Year 2 students have confirmed this has been introduced in the Phase 2 inductions for the 2018/19 academic year.

Multiprofessional teamwork and learning (R1.17); Undergraduate programmes and clinical placements (R5.4)

16 We previously set a requirement for the School to review its interprofessional learning (IPL) sessions in order to ensure they add value to students’ learning. During our visits, and in evidence submitted by the School, we found good progress has been made towards the development of IPL, with a highly structured approach in place to deliver this. Documents reviewed in advance of our visits showed that the School has adopted a threefold approach to IPL: learning about other professions, learning from other professions, and learning with other professions. In addition, during our meetings with the School, the new lead for IPL told us that the School’s plan is to map and integrate interprofessional opportunities through the curriculum. For example, from 2018/19, Phase 1 students will engage in four one-hour sessions in Year 1 and five one-hour session in Year 2 with GPs and other professions. Phase 2 students will receive five IPL

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sessions, delivered by other health professionals, across Years 3 and 4. Specific plans for Year 5 IPL have not yet been finalised, but we learned this is likely to involve simulation based learning with other healthcare students.

17 Whilst Year 3 students told us that there are plenty of timetabled multidisciplinary team working opportunities during placements, we found that the School’s plans have not yet been fully implemented and that many students are unaware of the new curriculum. We will continue to monitor the School’s progress in embedding IPL opportunities within the curriculum over future visit cycles. See open requirement 7.

Adequate time and resources for assessment (R1.18)

18 In the 2016/17 final report, we commented that the School may benefit from considering noise levels when designing OSCE assessments to minimise distraction between stations. During this visit cycle, we observed the Phase 2 OSCEs, which took place in the School’s clinical skills facility. Although the assessment continues to give a good representation of working in a hospital environment, in July the Phase 2 students told us that the background noise remains noticeable and is at times distracting. In addition, we observed that the space in some of the stations was restrictive. On a few occasions this led to students knocking items over during the assessment, which contributed to their anxiety. Whilst we recognise that it is difficult to control noise levels and space in ward setting practical assessments, we would encourage the School to continue considering these issues when planning OSCEs.

Capacity, resources and facilities (R1.19)

19 We continue to be impressed by the School’s plans to ensure that there are the facilities, capacity and resources in place to deliver safe and relevant learning opportunities. A new social space was opened during the 2017/18 academic year alongside a human anatomy resource centre on the main Preston campus, and further investment has been made in facilities at the WCMEC and Burnley campuses; this includes plans for new student accommodation. We also heard that the central university continues to provide financial support to the School. As a result, the senior management team is confident that it has the capacity and resources required for its growing cohort of students. See area working well 2.

20 During our visits, we were pleased to hear from the ELHT placements team that there is sufficient capacity for all Phase 2 students to undertake clinical placements at the Trust. Year 4 students will be placed primarily in different specialties to Year/ 3, and where there is an overlap we were told that the number of supervisors will be increased. We will continue to monitor this area over future visit cycles.

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21 In our meetings with the senior management team, we heard that the School is resource mapping for possible new programmes, such as an ‘earn as you learn’ part time medical degree. The team assured us that it is a university policy that the MBBS programme resources and facilities are ring-fenced and protected from changes, and that regular meetings are held with the Senior Team of the University to ensure this.

Accessible technology enhanced and simulation-based learning (R1.20)

22 All students throughout the 2017/18 visit cycle told us that they have access to technology enhanced and simulation based teaching, and that this is predominately beneficial to their learning. For example, the Phase 1 students told us that access to the use of prosthetics and anatomy tables has contributed to their learning as it allows them to apply theory to practice. More specifically, the Year 2 students have a formal clinical skills session with these resources every week, and can access the resources at any time. Students from this cohort told us they have also had prosection teaching at Liverpool medical school which they valued. However, Year 3 students noted that their technology enhanced and simulation-based learning opportunities are not always relevant to what they are learning on their placements or campus days; we will monitor this area over future visit cycles.

Access to educational supervision (R1.21)

23 During our visits we consistently found that the remit and use of academic advisors is widely praised by the students. All three year groups are scheduled to meet with their academic advisors at least four times a year (once for each module); a meeting form is uploaded to students’ e-portfolio to record the discussion. All the students we spoke to report that they can, and are encouraged to, approach their academic advisor for ad hoc meetings, and that they feel comfortable to discuss a wide range of matters with them, such as academic and pastoral issues.

24 In addition, Phase 2 students on placement meet with their clinical supervisor a minimum of once every two weeks after which a form is completed; these meetings and forms are monitored via an e-portfolio system. We were encouraged to hear from Trust staff that almost all scheduled supervisor meetings took place over the 2017/18 academic year, and that the Year 3 students find these meetings support their development. We are satisfied that the School has effective processes to ensure that students are provided with high quality educational supervision.

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Theme 2: Education governance and leadership

Quality manage/control systems and processes (R2.1); Accountability for quality (R2.2); Considering impact on learners of policies, systems, processes (R2.3)

25 The changes implemented by the School to its governance structure and quality management processes this academic year are a positive step to improve and better integrate educational and clinical governance. For example, we heard from the senior management team that the terms of reference of the Work-based Learning Sub-Committee have been reviewed, and now include the receipt of data on incident/event reporting, pastoral care, and the quality management of placement provision for the School. In June, we also heard of an aim to incorporate students as members of key meetings and sub-committees to enable the development of joint solutions and improve the ability to quickly raise and respond to issues. See open recommendation 1.

26 From our document review and visit findings, we learnt that the School has introduced a number of new processes to help manage risk and quality. This includes an integrated governance meeting; the key focus of this monthly meeting is to manage risk across the School, and attendees include the Head of School, two Deputy Heads of School, Strategic Development Co-ordinator, Strategic Project Manager, and the Assistant Deputy Head of School. Additionally, in our quality management meeting in June, we heard the University has implemented a revised risk management framework; within the School each sub-committee reviews the relevant risks, and all risks are then reviewed by the new integrated governance meeting. The School continues to manage risk and quality with its placement providers through methods such as a risk register of placements with ELHT. We look forward to reviewing the effectiveness of these processes over future visit cycles.

27 In our meetings with the ELHT placement management team, we learned that the Trust has established a Directorate of Education within its governance structure to manage all forms of education, including undergraduate education. We were also provided with an overview of the Trust’s strategic alliance with UCLan. We learnt that the School has a seat on the Trust’s Executive Board (which facilitates a rapid

Standards 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.

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response to any issues), and that educational issues can be raised directly to the Executive Board via a Quality Committee. In addition, joint appointments between UCLan and ELHT have been created, which aim to strengthen the relationship and understanding between the two organisations. We see these initiatives as positive methods of facilitating high quality clinical placements, and will explore their impact in future visits. See area working well 3.

28 In advance of our visit in June, the School submitted evidence of its new contingency arrangements with the University of Liverpool and St George’s, University of London (SGUL). In the event of the medical students being removed from UCLan before it has approval to award a primary medical qualification, Liverpool Medical School will take all students from the first three cohorts plus a further 50 from each cohort from the 2018/19 intake onwards, and SGUL will take those remaining above the 50 from the 2018/19 intake onwards. The School will confirm to students which school will act as the contingency school in the applicants’ offer letter. We are satisfied that there are robust contingency plans in place.

Evaluating and reviewing curricula and assessment (R2.4)

29 The School continues to evaluate and review the curriculum and assessments in response to feedback from learners and educators. The senior management team informed us it has reviewed Phase 1; as a result the School has added more embryology teaching to Year 1 and more pharmacology in Year 2. In addition, we heard that a curriculum review away day has been planned for the summer of 2018, and part of this will involve looking at student feedback.

30 Throughout our visits and survey findings, Year 3 students told us that they found the learning outcomes for Phase 2 to be too broad. As a result of this feedback, we heard from the Phase 2 Lead that the School is in the process of reviewing all outcomes to ensure they guide students’ learning. In addition, work is underway to integrate the expert half days and case based learning sessions to reduce omissions and duplications. We look forward to exploring these in more detail over future visit cycles.

Systems and processes to monitor quality on placements (R2.6); Sharing and reporting information about quality of education and training (R2.8)

31 We were pleased to hear that the School continues to sign service level agreements with placement (especially GP) providers; these set out the School’s expectations and processes for monitoring standards. During our meeting with staff involved with the management of placements, we heard that the School is collaborating on GP recruitment with medical schools across the North West; this will help the School better monitor capacity and quality. More widely, we were pleased to hear that the Head of Work-based Learning meets with their counterparts from other medical schools in the North West to discuss capacity.

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32 All placement staff (including supervisors) we met with during our visits reported that the School is well engaged and meets with providers in advance of their first cohort of students. We were pleased to hear that all supervisors we spoke to had received the learning outcomes in advance of students arriving on placement.

33 To allow the School to monitor and manage placement quality, we heard from the Phase 2 Lead that there is a risk register for each trust associated with the programme; these risks are monitored at every operational meeting. For example, these meetings take place with ELHT every three months, with full quality evaluation reviews happening twice yearly. Quarterly Phase 1 and Phase 2 meetings also take place between the School and providers to keep an overview of how standards are being met and to help improve the quality of education and training; these meetings are intended to complement the local measures in place. For example, the ELHT placement management team told us that it uses a placement evaluation dashboard to monitor and track any concerns.

Concerns about quality of education and training (R2.7)

34 We have reviewed extensive documentation which shows how the School manages concerns about the quality of education and training; this is primarily done through the reporting process and associated event forms. During the 2017/18 visit cycle, we were pleased to hear that all students are aware of these processes and could tell us of instances of when this had led to improvements. For example, in January, a small number of Year 3 students told us they had missed out on learning opportunities whilst on placement at ELHT as patients would not consent to them being in the room during intimate examinations. The students felt this was in part attributable to the way they were introduced to the patients by some healthcare professionals. As a result of students raising their concerns, we heard that student names are now put on the board outside the consulting rooms to make patients aware of their presence beforehand, advice has been given to staff on how to introduce students, and male students are partnered with male consultants where possible. In June, we heard from the Year 3 students that the above issue, particularly within the Obstetrics and Gynaecology department, is improving, and that the Trust has started to use volunteers and models to ensure adequate learning opportunities are provided.

Managing progression with external input (R2.12)

35 We previously set a recommendation for the School to review the discretionary powers of the progression board and formalise its processes. In advance of our first visit, the School provided evidence which showed that the powers of the progression board had been clarified; this will ensure that no student progresses to the next stage of study without meeting the requirements of the programme. The regulations now stipulate that the progression board will not use its discretion to allow a student to progress to the next year of the programme having failed a

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module, and that any such student will be expected to repeat all the modules of that year (including those they passed) to avoid ‘de-skilling’. Students who fail more than one module, or who fail by more than five percent, will have their MBBS studies terminated; they will also receive guidance from their academic advisor about exit awards or other suitable programmes at the University. We were also pleased to hear from the senior management team that the rules for progression are available to the students in their assessment handbooks and are set out in the frequently asked questions area of Blackboard. As such, this recommendation has now been met. See open recommendation 5.

Managing concerns about a learner (R2.16); Good Medical Practice and ethical concerns (R3.1)

36 We previously set a requirement for the School to develop a clear mechanism to assess student professionalism that is separate from fitness to practise. During the 2016/17 academic year, the School provided its initial plans to develop this area of the programme. We explored this further during our 2017/18 visits, and found that good progress had been made. The Clinical Professionalism Lead explained how the School plans to embed both professionalism teaching and assessment throughout the programme: this includes small group teaching sessions for each cohort, health and wellbeing sessions, and the use of the portfolio to record reflective writing. Various assessment tools will be used, including professionalism scores (linked to event forms), portfolio assessment, and written assessments; we also heard of plans to embed a professionalism judgement within the OSCEs. We are satisfied that the School has appropriate plans to assess professionalism separate to fitness to practise and, as such, this requirement has been met. See open requirement 3.

37 Whilst the School has established clear mechanisms to assess professionalism, we heard from students in both January and June that the portfolio (one method of assessing professionalism) is disorganised, and that out of date forms have not been deleted. The Clinical Professionalism Lead told us that the School is aware of these concerns, and work will start over summer 2018 to remove any unnecessary documents. We also heard that the School has found inconsistency between portfolio tutors and will therefore undertake a significant amount of quality assurance during the 2018/19 academic year to resolve this. We will review this area over future visit cycles.

38 We were pleased to learn from the placement supervisors that systems and processes are in place to identify, support and manage learners where there are concerns about a student when on placement. This includes event forms, which are triaged and actioned by the Professionalism, Wellbeing and Safety (PWS) tutor. We also heard that on a more informal level, supervisors feel able to email or speak directly to the PWS tutor or School to discuss their concerns. Students with

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known disabilities meet with their academic advisor before a placement starts and are given an individual learning plan if required.

Sharing information of learners between organisations (R2.17)

39 We were pleased to hear that the School has a process to ensure the effective sharing of information between organisations. For Phase 2, we heard from the senior management team that the PWS tutor is the main tool for facilitating the flow of information; this is supported by a transfer of information form. The School also uses a ‘Starfish’ system to record student support needs and reasonable adjustments. This creates a central point from which to share student information, and we understand that the appropriate placement staff have access to the Starfish system. In addition, the GPs we met with in January told us they receive an email in advance of a placement to introduce the student(s), and this includes information about any fitness to practise, professionalism or wellbeing concerns. This also happens for other placement providers, and is done with student consent.

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

40 We have previously explored the School’s fitness to practise processes, and are confident that these are appropriate. There have been no fitness to practise cases involving a medical student to date, but we were told by staff in our student support meetings that steps are in place to ensure staff do not ‘de-skill’. For example, the Head of the Medical School has a seat on the central university’s fitness to practise committee and sits on other panels. We will continue to monitor this area over future visit cycles.

41 We were pleased to hear from School staff that students attend fitness to practise sessions and refresher training throughout the programme. These sessions have also been provided by the GMC and indemnity organisations, and cover various aspects such as the use of social media. Our student survey also shows that the School provides good guidance on Fitness to Practise: 92.4% of students stated that the available guidance is either very helpful or helpful.

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

42 We have previously reviewed the School’s four step selection process, and are satisfied that plans are in place to allow the School to recruit students in an open, fair and transparent manner. During our 2016/17 visit cycle, we heard that the School would admit its first UK students as part of locally funded schemes; in January 2018 the senior management team told us that the School has successfully recruited a number through these schemes. Both staff and students confirmed that the UK students had been well embedded within the School. Further to this, we learnt that the School had been awarded 15 publicly funded medical school places by the Higher Education Funding Council for England

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(HEFCE, now the Office for Students), and that these would be ring-fenced for applicants living in the North West. We were advised this had been discussed with UCAS, the University and HEFCE, and all are happy with the process. We were also pleased to hear that the School had written the mini multiple interview (MMI) stations in a way that they are accessible for all applicants, regardless of background.

43 Further changes to the School’s admissions processes include plans to consider an aptitude test, a dedicated selection panel team from 2019, and the addition of two new posts (the deputy lead for MBBS admissions and the admissions coordinator). The School also hopes to be able to better monitor its admissions process for potential discrepancies in terms of protected characteristics; this will be facilitated by the larger number of applicants leading to more valid conclusions. We look forward to reviewing these plans over future visit cycles.

44 The Academic Lead for Clinical Skills told us how the School manages requests for reasonable adjustments during admissions fairly. We heard that adjustments are made through the central university’s disability office; these include extra time, changes to the colour of the paper used, and provision of audio transcripts.

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Theme 3: Supporting learners

Standard 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.

Learner's health and wellbeing; educational and pastoral support (R3.2); Career support and advice (R3.16)

45 During the 2017/18 visit cycle we found strong evidence that the School provides access to services aimed at supporting students’ health and wellbeing. This was supported by our student survey, where an average of 85.7% of students rated various aspects of support provision as very good or good. Students from all years reiterated these findings during our meetings in both January and June; we were particularly pleased to hear that the Phase 2 students had been very well supported by supervisors and the Phase 2 and Medical Skills and Quality Care (MSQC) leads. Students also continued to praise their academic advisors, who were described as an excellent support network. See area working well 1.

46 In addition, students from all years told us that they know how to access career guidance. Year 2 students were specifically enthusiastic about the level of support and engagement they receive from their academic advisors, who help to direct them towards exploring potential career goals. This has included inviting students to attend conferences and supporting them with internship opportunities. We also heard from staff involved with quality management that specific careers advice and student support is available for those leaving the programme.

47 The senior management team told us that the School encourages learners to take responsibility for their own health and wellbeing, with dedicated sessions held for students, and reminders about support services given during placement inductions. We also learned that training has been provided for school staff on the central services available to students. The Phase 1 students we met described the health and wellbeing services as helpful, and told us that they know how to access these resources. This cohort also spoke positively of the university-led WISER programme, which offers study skills training to students to help them learn how to study more effectively and communicate at an advanced and professional level.

48 Looking forward, the School is taking steps to expand the support available to students to meet the needs of the growing cohorts. For example, in our student support meeting in June, we heard that peer to peer student mentoring has been established for each year group. As of June, 41 students have been trained as mentors, with 89 students being mentored across the three cohorts. The School also told us it is resource mapping for each cohort to decide on the support that is required across the medical school, with an increase in resources having already been made available at the WCMEC and Burnley campuses. We look forward to

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reviewing these services in more detail over future visit cycles. See area working well 4.

49 Despite the positive feedback we received about student support, we were concerned to hear during our meetings in January that students from across all three cohorts found the role and remit of pastoral tutors unclear; we felt that this was a missed opportunity for the School to identify and resolve any potential support needs. We reported this to the School, and were pleased to hear in the student support meeting in June that the senior management team has taken steps to resolve this. Pastoral tutors have been promoted to the students through a ‘Faces of UCLan Student Support’ poster campaign and via student representatives on the SSLC. We will assess the outcomes of these actions to improve the visibility of the pastoral tutors through future visits.

Undermining and bullying (R3.3)

50 We were encouraged to hear that Phase 1 students have not been subject to bullying or undermining behaviour by any school or placement staff at any point in the 2017/18 academic year. We did hear reports from Year 3 students in January that they had been subject to comments made by ELHT staff and patients about the colour of their uniform, which undermined their confidence and self-esteem. However, the students confirmed that the School and Trust were quick to act when this was reported, with a communication sent by the Director of Medical Education to all staff; in June we were assured that no similar incidents had occurred.

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

51 We previously set a recommendation for the School to review the information available to students about various aspects of the programme. In January, we were disappointed to hear from Year 1 and 2 students that they believe the School has made changes and introduced new policies with little notice. Particular concerns were raised regarding the perceived vagueness of the information provided to them about WCMEC placements. Some students had incorrectly assumed a placement at WCMEC was optional; but we heard that the School had recently informed Year 2 students that it is a requirement for all students to undertake a placement in Cumbria during the programme.

52 We also heard from students across all years that the information provided about the content of their curriculum and assessments could be improved. More specifically, the Year 1 and 2 students advised that whilst they have found the module and assessment handbooks useful, they are too general and they are not sure which areas to concentrate their studies on; similarly, the Year 3 students told us the learning outcomes in their handbooks are too vague. Students also noted that they are often unsure what they are required to learn in order to perform well in their assessments.

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53 However, during our student support meeting in June we learned the School has updated its marketing materials to clarify placement locations, and the timing of WCMEC placement choices will be brought forward in the next academic year with information incorporated into the Year 1 induction. No student concerns were identified by the visit team in June regarding the timing of placement notifications; this was supported by the findings in our student survey where the majority of students informed us that they were aware of placement locations throughout the programme.

54 We were also pleased to hear during our meetings in June that the School has responded well to students’ concerns; this was reinforced by the positive findings in our student survey. In our meeting with the senior management team, we heard the School is constantly reviewing how it communicates with students in order to improve the timeliness and accuracy of the information about the curriculum, assessment and clinical placements; in addition, significant work is ongoing to enhance the curriculum materials for 2018/19. We also learned that, in response to a request to better prepare Phase 2 students for OSCEs, the School has created a handbook and now holds workshops to improve student awareness of this assessment method. We are satisfied that processes are in place to ensure students receive accurate and timely guidance about their curriculum, assessments and placements, and that the open recommendation can be closed. See open recommendation 1 and open requirement 4.

55 In January, we heard from students that the global and detailed timetables are not integrated on the virtual learning environment: the Year 2 students explained that they need to look at two separate timetables to manage their time and coordinate activities. Students told us they believe it is not possible for the system to integrate the two timetables, but felt other ways of doing so could be considered. Staff in the student support meeting confirmed the problem is difficult to resolve, but told us that a student experience coordinator has been appointed to explore the issue. We were pleased to note in our meeting with Year 1 students in June that emails are sent to students if any changes are made to the timetables, but we will monitor this area over future visit cycles.

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

56 Throughout our meetings with the School during the 2017/18 academic year, we heard of the various ways in which students receive feedback on their performance, development and progress. For example, in our January meeting with assessment staff, we heard that Year 2 students who failed two of the formative OSCE stations were invited to a meeting to discuss feedback; any student who failed one station was also offered this opportunity. We also heard that Year 1 and 2 students were provided with three minutes of verbal feedback after each station of their formative OSCE. Whilst some students commented that it was not always possible to effectively take in this feedback, all were able to

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discuss comments in more detail with the module lead and found the feedback helpful.

57 For Phase 2 students, we heard from the ELHT placement team that feedback is provided by the clinical supervisor, who fills in a log book to track student progress; supervisors also told us that they try to provide regular informal feedback. At the end of the placement a more detailed form is completed that is uploaded to the e-portfolio, assessed by the portfolio tutor and discussed with the respective student. Year 3 students can also track their progress and development through the opportunity to perform formative DOPS and mini-CEXs, which are not uploaded to the portfolios but act as learning opportunities; the Year 3 students described the feedback from these workplace based assessments as helpful. To ensure feedback is meaningful, we were told in the placements meeting that there are video examples available on the ELHT intranet for supervisors to see what good feedback looks like.

58 We previously set a requirement for the School to standardise the guidance available for tutors and students about student selected components (SSCs). During our visit in January, we heard positive reports from Year 3 students, and learned of the guidance available to them from tutors and handbooks. However, students in Years 1 and 2 raised serious concerns about the new peer review system which had been introduced in place of SSC tutors. Particular concerns surrounded the variety in students’ prior academic experience, a poor understanding of how to conduct the SSC, and a real variation in the quality of peer feedback. Students were concerned that without experienced support, feedback, and guidance they would be unable to achieve good marks. In our meeting with the curricula and senior management teams, we heard that the SSC peer review system was introduced to resolve the inconsistency amongst SSC supervisors, and that the new framework would be more scalable as student numbers increase. However, we were concerned that the change had resulted in a new level of variability.

59 In advance of our June visit, we conducted a student survey which included questions on their experience of the SSC peer review system: 41.7% of Year 1 students and 50% of Year 2 students reported that they found the peer system to be poor or very poor. During our visit, we discussed our concerns with School staff: we heard that the School intends to continue with the use of peer reviews for Phase 1 SSCs as it believes this will give students the experience of giving and receiving feedback. To better facilitate this, immediate extra support for the 2017/18 cohort has been provided: this included additional SSC peer review workshops, question and answer sessions led by relevant leads, and the creation of a Blackboard folder with clear and concise online resources linked to each SSC task to lessen marker discrepancy. The SSC1 Lead also offered individual formative feedback to all student feedback.

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60 The Year 1 students confirmed this support was promoted and available to them. However, only 68% of the students took up the offer of individual feedback, so the School has timetabled this in for the following academic years to make it standard practice for all Phase 1 students. An additional staff member will be made available to support this. In addition, weekly small group tutorials focusing initially on developing research and peer review skills, and drop in sessions in later weeks for students to access individual support will be introduced; peer review events after each formative submission will also be arranged. We will continue to monitor this requirement over future visit cycles. See open requirement 6.

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Theme 4: Supporting Educators

Standards 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); Recognition of approval of educators (R4.6)

61 We have explored the School’s methods for ensuring that staff receive appropriate training, inductions and appraisals over previous visits. During the 2017/18 visit cycle, we were pleased to hear that School staff continue to feel well trained and supported. In addition, the clinical supervisors we spoke to at ELHT and WCMEC told us that their induction (which provides information on their responsibilities and relevant guidance documents) sufficiently prepares them for their role. All placement supervisors we met have received training and an appraisal for their educational role; these supervisors had also been supported by the School if necessary in registering as a recognised trainer.

62 Evening training sessions are available for GP supervisors to attend which cover areas such as the appropriate use of DOPS; we also heard that the GP tutor will visit practices to deliver training if necessary. The visit team noted that the majority of GPs who supervise UCLan’s students have experience of teaching medical students. As such, we intend to explore what training and support is made available to new practices that sign agreements with the School, when appropriate, during later visits.

63 In the curriculum meeting in June, we were told that the School is in the process of identifying staff training needs through feedback and mentoring. The academic teachers confirmed the peer review process for staff continues to support their development and directs their training needs. We also heard that sharing good practice sessions have been introduced to allow staff to learn more about different approaches taken to teaching and learning, as well as how they might use these to enhance their own practice. We will monitor the effect of this additional staff support through future visit cycles.

Time in job plans (R4.2)

64 We were pleased to learn from the placement supervisors that there are no current issues with their job plans, and that the time allocated is sufficient to allow them to meet their educational responsibilities. In our meeting with WCMEC, we were told all tutors have detailed job descriptions which lead into their job plans. We will

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continue to monitor this area over future visit cycles to ensure that supervisors’ job plans meet the needs of the growing student body.

Accessible resources for educators (R4.3)

65 All academic and clinical supervisors told us that they are satisfied with the resources available to support their role. For example, in our January meeting with GP supervisors, we heard that the School provides funding for professional development as well as access to Epigeum (higher education courseware). In addition, the academic teachers told us that there is a ‘Train the Tutor’ course for those delivering communication, ethics and professionalism skills sessions; many staff also spoke highly of the opportunities for in-house and external assessment training.

66 The academic teachers we met have the opportunity to study for a postgraduate qualification related to their role, and we were encouraged to hear of plans to give clinical supervisors access to qualifications up to master’s degree level as part of their professional development. We look forward to reviewing these plans in more detail over future visit cycles.

Working with other educators (R4.5)

67 During the 2017/18 visit cycle, we heard of positive plans to support educators to work together and develop a consistent approach to teaching. We learned from the GP supervisors that there is a WhatsApp group which enables them to share concerns and good practice amongst peers, and they have found this to be helpful in allowing rapid communication and problem solving. The School told us that it can provide updates and share news with the group through this tool.

68 At the School itself, the academic teachers told us that there are various teaching and learning forums, meetings, and good practice sessions which allow them to discuss what is working well and develop new initiatives. In addition, the academic teachers informed us that they work together (both within and across themes) to create timetables and teaching materials; this allows for a better understanding of the curriculum and learning outcomes. Finally, the senior management team told us that there are a number of education events held by UCLan which allow for cross team working, such as the annual UCLan/ELHT conference.

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Theme 5: Developing and implementing curricula and assessments

GMC outcomes for graduates (R5.1)

69 We previously set requirements for the School to align the MBBS curriculum and learning outcomes with those of its contingency schools. From a review of evidence submitted in advance of our visits, and through conversations with representatives from Liverpool Medical School, we are satisfied that Years 1-4 are adequately mapped to ensure that no student is placed at a disadvantage should contingency arrangements need to be initiated. Whilst the Year 5 curriculum has not yet been fully developed, we have reviewed evidence submitted by Liverpool Medical School which confirms that both the learning outcomes and planned curriculum align sufficiently to allow students to transfer to the Liverpool curriculum with no disadvantage. These requirements can therefore now be closed. See open requirements 1 and 2.

70 In our June curriculum meeting, we heard from the Phase 1 Lead and representative from SGUL that detailed mapping between the two schools had taken place. As a result of the new contingency arrangements, UCLan added additional activities around anatomy, pharmacology and pathology to the Year 1 curriculum; but, as the two curricula are very similar, UCLan has not needed to make any significant changes. We are satisfied that students would not be placed at a disadvantage should these contingency arrangements be required.

Informing curricular development (R5.2)

71 We were encouraged to note that the development of the medical school curriculum is informed by a range of stakeholders. The senior management team told us that a stakeholder group workshop was held to help inform the design of the final year curriculum; this group included clinical module leads, patients, and foundation year doctors. In addition, a clinical education fellow from ELHT has collected data from foundation years and senior doctors about what should be included in the Year 5 curriculum.

72 Placement supervisors also confirmed that they are able to provide input to curriculum development and that their views are considered, with a cited example being case-based learning. These individuals have a key role in delivering the curriculum, and their input to programme development allows a keen understanding of the learning outcomes.

Standard 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.

S5.2 Postgraduate curricula and assessments are implemented so that doctors in training are able to demonstrate what is expected in Good medical practice and to achieve the learning outcomes required by their curriculum.

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Undergraduate curricular design (R5.3)

73 We previously set a requirement for the School to review the SSC component of its curriculum in order to allow an equitable access to topics of students’ choice. In advance of our June visit, we conducted a survey where we asked students about the SSC choices available to them. 81.1% of students stated that the choices available were very good or good, and no students reported that access to topics was unequal. Whilst we heard some complaints about the number of available choices during our student meetings, again there were no concerns about fair access. We will continue to monitor this area with students over future visit cycles, but are satisfied that the School has met this part of the open requirement. See open requirement 6.

74 We previously set a recommendation for the School to take steps to standardise the duration and depth of detail of class based lectures. Throughout our visits in the 2017/18 academic year, students were able to provide positive examples of excellent teaching and tools for signposting learning outcomes. Nevertheless, in January, we were disappointed to hear from Year 1 and 2 students that variability remains in the content, detail and comprehensibility of some lectures and teaching in Phase 1. Students also voiced a concern that not all lectures are taught by those with the necessary expertise, with some lecturers failing to signpost key learning points or being unable to answer questions about the content. Students were concerned this will affect their ability to learn all the required material and adequately prepare for the summative assessments.

75 This issue was raised with the senior management team in January; nevertheless, we continued to hear reports of variability during our student meetings in June. However, we also had a positive meeting in June with curriculum staff and academic teachers, where we heard that staff are aware of the students’ concerns. As such, a new process has been introduced: if students raise a concern about a lecture then the appropriate management staff will listen to the lecture recording and take action if necessary. This may include providing the lecturer with additional support or stopping their contribution to the specific module. In addition, the senior management team advised us that some staff had been required to cover a number of teaching sessions, which could explain the comments surrounding poor expertise; the School has since put measures in place to better manage any future instances. We also identified that, other than the aforementioned good practice seminars and peer reviews, the School does not provide a template or framework to help academic teachers structure their lectures. As such, the specific content and level of teaching sessions (other than the inclusion of the relevant learning outcomes) is based on the length of the session and lecturers’ knowledge of the subject. We would thus encourage the School to review this area to find ways to promote better consistency. See open recommendation 2.

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76 The School introduced third sector placements during the 2017/18 academic year; these allow students to gain experience of working with patients from diverse backgrounds. In January, staff involved with placement management provided us with details of the third sector involvement, which includes student placements with a homelessness charity, disability services and other charitable projects. The School provides teaching sessions for the third sector organisations to help them understand the purpose of the placements, and the learning objectives for these placements are recorded in the student handbooks. In June, Year 3 students informed us that the third sector placements felt too long; however we heard that this structure cannot yet be changed due to curriculum mapping between UCLan and Liverpool Medical Schools. We will explore third sector placements in more detail over subsequent visit cycles.

77 We were previously told that Phase 2 students would receive teaching during their weekly ‘campus days’; these include expert half days and case based learning sessions. In January, we heard reports from Year 3 students that there were significant inconsistencies in the quality of these teaching sessions: in particular, some half days did not cover all curriculum outcomes, others required too much prior reading or the teaching material had not been uploaded, and there was variation in the depth of detail. Phase 2 staff told us that they were aware of the students’ concerns, and had already taken action to resolve these. Extra sessions and e-resources had been put in place, and the School had reiterated the aims of the half days in order to manage student expectations. In June, there were a small number of comments (including concerns that there had been very little in the way of paediatrics teaching), but students were aware of the School’s plans to improve the teaching sessions. We will continue to monitor this area over future visit cycles.

Undergraduate programmes and clinical placements (R5.4)

78 We previously set a recommendation for the School to take steps to improve the standardisation of students’ experience of primary care placements. In June, we heard positive reports from all students about their placements in GP practices, and no reports of students being unable to meet their learning outcomes. Students told us that there was a good level of consistency between the experiences they are exposed to on placement, and also noted that if needed they were able to change practices. We learned in the placements meeting that the Year 1 students on a GP placement have weekly workshops on how to gain the most value from this placement type; we also heard that all students receive an induction which outlines the placement learning outcomes. We are satisfied that students receive an equitable experience across GP placements, and that this recommendation can be closed. See open recommendation 3.

79 Whilst students praised their GP placements, we were concerned to hear that some Phase 1 students reported that there is variability in the quality of the community placements, describing their experience as ‘luck of the draw’ in terms of the

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opportunities provided. As a result, some Year 1 students told us they do not want to spend as much time in a community placement in Year 2, believing their core knowledge will be better developed on a GP placement. Some Year 2 students also told us that they found their 2017/18 academic year community placements to be a repetition of Year 1. We will explore these concerns in more detail over future visit cycles.

80 We were pleased to hear from various students and staff that the roll out of Phase 2 is progressing well. The Year 3 students seem well prepared with an understanding of the curriculum and how their placements fit within their programme, and are receiving good experiential learning in clinical settings. Students reported that they feel well supported to meet their learning outcomes by both School and Trust staff. The ELHT placement team informed us that the learning outcomes for each placement are mapped to the curriculum and are given to the supervisors to ensure sufficient practical experience and opportunities are offered; it was noted that the ELHT staff that interact with the students on placement can access the learning objectives via the Trust’s intranet. We look forward to monitoring the School’s progress over future visits. See area working well 1.

81 Students undertook their first GP placements at WCMEC during the 2017/18 academic year; we were pleased to hear that these had gone well with students receiving a good level of practical experience, and that supervisors had been well prepared. The first Phase 2 students will undertake placements at WCMEC during the 2018/19 academic year, and we look forward to learning about their experiences.

82 Placement supervisors informed us that teachers from certain specialities, such as paediatrics, provided taster sessions for the Year 2 students in the previous academic year to help develop their clinical skills and generic professional capabilities before they started specialty placements in Year 3. From this meeting we heard that, from the ward perspective, these taster sessions were beneficial as students seemed well prepared in how to take histories, and had good bedside and ward etiquette.

83 Medical students should be provided with the opportunity to develop their clinical, medical, and practical skills and knowledge with the support of teachers before using these skills in a clinical situation. In January, the Year 1 and 2 students told us about a shift in how anatomy is delivered and taught: classes were no longer interactive but more facilitation based with the emphasis on self-learning. The students felt that these classes were previously a strong point of the programme as the teaching was clinically relevant. In our meeting with the academic teachers, the medical demonstrators told us that they had been told by the School to change their style of teaching to act more as a facilitator.

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84 We reported these concerns to the senior management team, and were pleased to hear during our meetings with students in June that practical sessions have since improved, and support the learning from lectures by going into greater depth; these comments were reflected in the positive findings from our student survey. The Year 1 students have found the medical demonstrators particularly helpful in answering questions and in offering additional clinical skills teaching. The Year 2 students, whilst recognising the shift back to the previous interactive teaching style, told us that they feel there is variability in the quality of teaching during these sessions. As such, we will continue to monitor the opportunities given to the students to develop their clinical, medical, and practical skills over future visits.

Assessing GMC outcomes for graduates (R5.5); Fair, reliable and valid assessments (R5.6); Collecting, analysing and using data on quality and on equality and diversity (R2.5)

85 We previously set a requirement for the School to work with its contingency school (Liverpool Medical School), and internally, to improve various aspects of its assessment load. As well as working with Liverpool Medical School, we were pleased to hear from the senior management team that the School is now an associate member of the Medical Schools Council and the Medical Schools Council Assessment Alliance (MSC-AA); this will allow the School access to the MSC-AA’s question banks and to calibrate its assessment ranking within UK medical schools.

86 In addition, the senior management team told us that it is confident that it has established the causes of early high failure rates, and has put steps in place to prevent reoccurrence (such as better awareness of students’ academic needs). In June, we were able to review student progression rates, and were encouraged to see that this is much improved. We also heard that an analysis of progression to date has been carried out, and the findings show there are no identifiable characteristics of those that have failed, such as gender or nationality. As such, we are satisfied that this requirement can be closed. See open requirement 8.

87 As in previous visits, we reviewed a sample of the School’s written assessments for all three cohorts. We were encouraged to see a real improvement in their quality, with a clear plan to embed clinical knowledge. However, we identified a number of Year 2 assessment items where the item could be answered without reference to the clinical scenario provided. The Year 2 students we spoke to had also noted that questions did not test clinical competency or application, but rather knowledge recall. To improve the quality of these items, we have set a requirement for these to be reviewed so that students are able to more clearly demonstrate an application of scientific knowledge to the clinical setting. See requirement 1.

88 During our review of written assessments, we also learned that the Integrated Science and Clinical Medicine assessment is split into two papers due to the length of time a single examination would take to complete. The marks are combined and students must reach an average mark to pass, with compensation given between the papers. The students receive their marks and feedback for both papers and, if

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necessary, only have to resit the paper they failed. We raised concerns that the means of identifying the pass and fails of these written assessments lacks clarity; however, the School has confirmed that these papers have been renamed Part 1 and Part 2, and are treated as one assessment with a single pass mark.

89 The 2017/18 academic year was the first in which Phase 2 students sat their OSCE assessment without the station titles being released in advance. To mitigate student anxiety, we were pleased to hear from the MSQC Lead that Year 3 students were given a list of skills that may be tested through OSCE stations, which included the DOPS and mini-CEX skills they had performed over the year. The MSQC Lead and Workplace Based Skills Facilitator also ran a number of additional formative DOPS and mini-CEX for further learning opportunities to help prepare Phase 2 students for their practical assessments; this is in addition to the workshops and formative stations discussed elsewhere in this report. We met with the Year 3 students after their OSCEs in July, who confirmed they were given meaningful opportunities to prepare for the assessment. Students told us that the briefing and information given in advance of the assessment provided clear instructions on what to expect.

90 To help encourage dialogue and feedback, the School has created forums on Blackboard for students to comment on assessment issues or even particular assessment items. We also heard in our June assessment meeting that the School has plans for students to be invited to join the Assessment Sub-Committee; this aims to facilitate better communication and understanding of core concerns. We look forward to reviewing these plans in more detail over future visit cycles.

Mapping assessments against curricula (R5.7)

91 During our meetings with students in January, we heard that students were concerned about the formative opportunities provided by the School and poor mapping of the curriculum to assessments. Whilst Year 1 students undertook formative assessments (as advised in GMC guidance), Year 2 and 3 students told us that the School did not offer them the opportunity to sit formative assessments under examination conditions. This had led to a high level of anxiety amongst the student body about their preparedness for summative assessments. We did, however, hear that in response to their feedback students in Year 2 and 3 did receive a short circuit of formative OSCE stations, and that lecturers had written a number of formative questions as well as providing access to assessment software. Students found the formative OSCE very helpful (the Year 3 students particularly praised the OSCE workshops run by foundation doctors), but were concerned that the available questions and software would not be reflective of the summative items.

92 Due to the timing of our visits, we have not been able to discuss the outcomes of written assessments with Year 3 students; however, we were able to talk to Year 1 and 2 students about their experiences. Year 1 students were satisfied that their

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summative written assessments were fair, and reflected their teaching. Year 2 students, however, told us that the summative written assessments did not match the formative questions, and that there were instances of discrepancies between teaching material and assessment content.

93 We discussed the students’ concerns in some detail with the School during both visits. We heard that the School prefers to address gaps in knowledge closer to the point of teaching, and that as lecturers write formative questions at the same time as summative questions, there should be no difference in style. Assessment staff told us that further formative questions had been provided via end of block multiple choice questions (MCQs) and quizzes. In addition, the Phase 2 and MSQC leads told us in June that there are plans to review the formative opportunities available to Year 3 students for future cohorts (such as plans to integrate MCQs into case based learning sessions). We look forward to exploring these initiatives and their impact on preparing students for summative assessments, and will continue to monitor this area over future visit cycles. See open requirement 4.

Examiners and assessors (R5.8)

94 In a previous visit cycle we set a recommendation for the School to ensure all equipment and simulated patients be standardised for each OSCE station to avoid unnecessary student anxiety. The School employs real patients for clinical OSCE stations and clinical skills days, and simulated patients for the communication stations. Reserve patients are in place to address fatigue issues. We observed the Year 3 OSCEs in July and found the examiners and simulated/volunteer patients to be well supported, and appropriately briefed both in formal sessions and at each of their respective stations. Briefing sessions are held with the patients in advance of the assessments, and clear written guidance is provided alongside the learning outcomes. The simulated and volunteer patients were well prepared at each station, and their behaviour and answers were consistent throughout the day. In addition, no students raised concerns about the consistency of equipment or patients. As such, this recommendation can be closed. See open recommendation 4.

95 We also previously set a requirement for the School to ensure there are sufficient numbers of experienced and trained assessment staff to ensure the quality of assessment processes. During our visit in January, we were pleased to hear that an additional staff member had been recruited to work on the School’s assessment load; we also heard that the School plans to recruit a SSC coordinator. In June, we met with assessment staff, and learned that the additional support had had a positive impact on the operational running of assessments. School staff also told us that they feel well supported through in-house training and opportunities to attend external conferences. As such, we are satisfied that the School has adequate members of experienced and trained assessment staff. See open requirement 5.

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96 During our visits, we found evidence of effective processes to monitor the work place based assessments (primarily DOPS and mini-CEX) undertaken by Phase 2 students at ELHT. These are assessed by various Trust staff, including nurses and doctors of all levels. Foundation doctors are now included within this bank, something that the Year 3 students told us they found invaluable due to the high quality of feedback. As discussed in previous visits, we were pleased to hear that each assessor receives a training pack and half day training session, as well as ongoing monitoring and one to one meetings, from the MSQC Lead. In addition, the Lead undertakes random spot checks of the assessments in order to monitor the quality of assessors; any instances where standards are not met will be followed up and additional training delivered as required.

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Team leader Professor Judy McKimm

Visitors Professor Suzanne Chamberlain

Dr Carol Gray

Mr Dylan McClurg

Dr Russell Peek

GMC staff Eleanor Ewing (Education Quality Analyst)

Martin Hart (Assistant Director, Education and Standards)

Lucy Llewellyn (Education Quality Assurance Programme Manager)

Gareth Lloyd (Education Quality Analyst)