01.12 The newsletter of the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine, Autumn/Winter 2006

Issues and news on learning and teaching in medicine, dentistry and veterinary medicine

Print: ISSN 1740-8768

Online: ISSN 1479-523X

In this issue

Virtual patients
Communities of practice
Developing the faculty

Other publication formats

This issue is also available as a low resolution PDF document suitable for printing.

Welcome!

It is a new academic year and as usual the Subject Centre want to hear about innovations in learning and teaching which enhance the student learning experience.

A competition offers prizes for telling us about how you use technology in your teaching, a call for people interested in developing online communities of practice, and a plethora of fascinating articles, keeping the UK up-to-date with the latest developments in learning and teaching in our subject areas.

We are really pleased to be able to share with you the winning entries from the Student Essay competition 2006.

We always love to recieve unsolicited articles articles for the newsletter, and you can send articles at any time to newsletter@medev.ac.uk - read the guidelines and download a template at

www.medev.ac.uk/newsletter/guidelines

Finally, you may have noticed that the website looks a little different - your feedback on it's development is always appreciated.

Email webteam@medev.ac.uk with your thoughts and comments.

UK Council for Communication Skills Teaching in Medical Education - forming a community of practice Dr Jonathan Silverman, Associate Clinical Dean, School of Clinical Medicine, University of Cambridge
The launch of Intute: Health and Life Sciences Lisa Charnock, Intute Support Officer, Manchester Computing, University of Manchester Jackie Wickham, Service Manager, Intute: Health and Life Sciences, University of Nottingham
Measuring educational and training environments as part of QA Sue Roff, Project Development Officer, Centre for Medical Education, Dundee University Medical Schoo
Medical ethics, seminars and the virtual environment Georgia Testa, Lecturer in Medical Ethics, Inter-Disciplinary Ethics Applied, University of Leeds
Higher Education Academy student essay prize 2006 Farai Nhembe, University of Manchester. Nearea Fletcher, University of Glasgow
Unlocking virtual patients Dr Rachel Ellaway, eLearning Manager, College of Medicine and Veterinary Medicine, University of Edinburgh Dr JB McGee, Consultant Gastroenterologist and Dean for Medical Education Technology at the University of Pittsburgh School of Medicine, USA
RCVS introduces new modular postgraduate certificate for 2007 Freda Andrews, Head of Education, and Elizabeth Barber, Education Officer, Royal College of Veterinary Surgeons
Developing the faculty: staff development initiatives at the School of Medicine, University of Southampton Dr Faith Hill, Director, Division of Medical Education, University of Southampton
Viperlib:A web-based library of images in visual perception Peter Thompson, Senior Lecturer in Visual Psychophysics and Co-director of Viperlib, Rob Stone, Senior Experimental Officer and Co-director of Viperlib, and Elaine Pollard,Administrator of Viperlib,, Department of Psychology, University of York
Medicine and surgery without blood transfusion study guide: Facilitating patient autonomy with a new standard of care Dr Shekar Bheenuck, Principal Lecturer, Lynn Denning, Senior Lecturer, and Lesley Moore, Senior Lecturer, Faculty of Health and Social Care, University of the West of England, Bristol David Smith, Hospital Liaison committee for JehovahÕs Witnesses, Bristol
Patient safety in health care profession education curricula: Examining the learning experience Revd Dr Pauline Pearson, Deputy Head of School, and Dr Alison Steven, SResearch Associate, School of Medical Education Development, Newcastle University
Workshop report: Case-led learning in veterinary education, preclinical years Gill McConnell, Education Development Manager, University of Edinburgh
Educational funding opportunities
The IVIMEDS approach to virtual patients Dr David A Davies, Dr Steven R Smith, Prof. Ronald Harden, Mr Thierry Boucheny, and Mr Steven Allan, IVIMEDS, Dundee
Conference report: Learning, teaching and assessing medical ethics Kenneth M Boyd, Conference Chairman and General Secretary, Institute of Medical Ethics; Professor of Medical Ethics and Director of Clinical Skills, Personal and Professional Development, College of Medicine and Veterinary Medicine, University of Edinburgh
Forthcoming educational events and conferences
Workshop programme

Funding available to support online communities of practice (up to £3k each / ~£10k available

The Subject Centre is in receipt of funding from the Joint Information Systems Committee (JISC), to develop online communities of practice in medical, dental and veterinary education. A total of 10k is available to explore the development and sustainability of groups of educators, with common interests, communicating and collaborating using technology.

You can apply for funding to help set up communities with shared interests in areas of the undergraduate curriculum requiring online collaboration.

You might have a need to bring people together to kick off the group, but thereafter we would expect communication and collaboration to occur mainly some form of electronic space. You might want to develop collaborative guidelines or documentation, or you might be interested in sharing case studies or experiences in teaching a particular area of the curriculum, using, for example, blogs, wikis, discussion boards, a virtual learning environment or a simple email list.

Funding can support existing groups of educators who wish to develop online collaborative spaces, or for bringing new groups of teachers together in a virtual environment.

You can apply for up to £3,000, but as funds are limited, applications that request less than the maximum will be looked upon favourably.

You must have been involved in teaching in the UK on undergraduate programmes of medicine, dentistry or veterinary medicine for over a year and be currently teaching on such a programme to apply.

If you have an idea please call Suzanne Hardy on 0191 222 5888 (or email suzanne@medev.ac.uk) to discuss, prior to filling in the online form. Terms and conditions and the online form can be found at www.medev.ac.uk

See pp 4-5 for an example project. Deadline 31 January 2007.

Tell us about how you use technology in your teaching and you could win either:

1st Prize

Gyration wireless gyroscopic mouse and compact keyboard, or

2nd Prize

Egoman 256MB MP3 player

We would love to hear about innovative uses of technology in learning and teaching - do you use mobile phones? Electronic polling? Podcasts? Online mapping?

Tell us about some aspect of technology you have introduced into your teaching recently which has enhanced the student learning experience in 250 words or less and be entered into a competition to win prizes donated by TechDis

To enter and to see full terms and conditions go to www.medev.ac.uk/resources/competitions and fill in the online form

Prizes courtesy of TechDis www.techDis.ac.uk

Bidding for workshop funds

The subject Centre has an open rolling for workshop proposals, which you submit your ideas to at any time by filling in the form at www.medev.ac.uk/resources/proposals/workshops3/

To make sure you meet the subject centre's next review points for proposals, you should aim to get them to us by 31 October 2006 and 31 January 2007. A grant of £500 is available for each workshop and we also pay venue costs, though if you are able to offer a low cost venue that would be very helpful as we do aim to keep costs to a minimum.

UK Council for Communication Skills Teaching in Undergraduate Medical Education - forming a community of practice

Dr Jonathan Silverman,Associate Clinical Dean, School of Clinical Medicine, University of Cambridge

Over the last 10 years, effective communication skills teaching and assessment programmes have been established in all undergraduate medical schools in the UK. Yet despite this very rapid implementation of educational change, communication skills lead staff in these institutions had been working very much in isolation.

This article describes why there was a need to establish a community of practice amongst the leads of undergraduate communication skills teaching programmes. It then outlines how the UK Council for Communication Skills Teaching in Undergraduate Medical Education was formed and how this new body has successfully enabled a collaborative approach within our community of teachers, encouraging us to work effectively and supportively together.

A major component of the UK Council's success has been the development of a password protected weblog which enables dynamic and regular communication between the group and sharing of documentation through a searchable Web-based database. This was established with the considerable help of the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine (MEDEV).

Communication skills teaching has become a rapidly expanding component of undergraduate medical education in the UK over the last 10 years. For a new kid on the block, it has made astonishing progress in a very short time. Not only have effective, and in some cases extensive, teaching programmes been established in all schools but communication has also become a major feature in many schools' assessments of students' competence, including finals examinations. As a discipline communication has come of age and become part of mainstream medical education.

But as with any new development taking place simultaneously in many different locations, there is a need for dialogue and sharing of good practice. We can all learn from each other's successes and failures, avoid pitfalls, share practical examples of good practice and short-circuit the path to effective programmes. Clearly, the progress made so far would be considerably boosted by joint efforts to disseminate effective practice, critically appraise courses and establish joint working between schools

Yet two years ago, while attempting to research current educational practice in teaching explanation and planning skills to students, one of my research colleagues, Susan Gillard, discovered that there was no centrally held list of the lead educators in communication skills in the undergraduate schools and indeed, each individual lead knew only a very small proportion of their equivalents in the 32 schools. We had to construct our own list by contacting every school and doing some quite extensive digging. As a first step towards collaboration, we decided to send the list of names that we had collated to all schools for their future reference.

With the names to hand, we thought it worth seeing if there was a need for more collaboration in our community. In early 2005 I contacted the communication leads in all schools to discover what support there would be for a new collaborative organisation for the discussion and sharing of good practice. Up until this point, there had been no regular meeting of the leads of communication teaching in UK schools: communication skills teachers in these institutions had been working very much in isolation. Although there were other resources in the arena such as the RSM communication skills forum, the Northern network of communication skills teachers and the Medical Interview Training Association, none of these specifically represented undergraduate medical education or had a remit to represent all UK medical schools.

Overwhelming support for this idea led to the first meeting in Cambridge in April 2005 when 27 medical schools were represented and the UK Council of Communication Skills Teaching in Undergraduate Medical Education was born.

A further meeting in November 2005 was held in Birmingham with 23 medical schools represented and a third meeting in York in April 2006 with 24 schools. These meetings would not have occurred without the support of grants from MEDEV. The UK Council now meets every six months, rotating round the country, with one representative of each medical school attending each meeting. The next meeting will be in Nottingham in November 2006.

The aims of this new UK Council are to disseminate good practice, develop further improvements in the teaching of this relatively new subject, promote collaboration between schools, raise awareness of the national importance of this subject politically, develop consensus guidelines for wider publication, encourage scholarship and develop collaborative research projects. The outcomes of the work of the UK Council will include:

A core curriculum for communication skills teaching in undergraduate medical education.
A website for the sharing of teaching plans, simulated patient scenarios and assessment protocols between UK medical schools.
A weblog to enable electronic communication between the leads of communication skills teaching in all UK schools.
Collaborative research projects on communication skills teaching between UK medical schools.
The development of regular visits between schools.

One major development already achieved is a password protected web site for members of this group only which has been established to enable the sharing of simulated patient scenarios, OSCE assessment stations and teaching plans. With the considerable help of MEDEV, a weblog has been created which enables dynamic and regular communication between the group and sharing of documentation through a searchable web-based database.

The UK Council is a joint collaboration between all UK medical schools which we hope will increasingly be seen as a major advantage to all schools. Apart from being a force for the gradual improvement of educational quality, the Council has already provided one concrete outcome of considerable value. Over 20 medical schools have now contributed at least six scenarios each to the online database of patient scenarios, creating a resource which will significantly reduce expenditure of time and effort for all schools.

So far, we are very grateful to have received grants from the Subject Centre to enable the UK Council to exist for its first two years. However, the Subject Centre cannot be expected to fund the activities of the Council indefinately and we are now seeking external funding to enable the activities of the Council to be placed on a more stable and permanent footing. Funding is required for the organisation of six-monthly meetings, secretarial support, the continued collation of scenarios, teaching plans and OSCE stations for the online database, production of consensus statements, development of research projects, promotion of staff development and interschool visiting. We have approached each UK medical school to contribute a subscription to the Council to enable the group to flourish and produce outcomes of value to all undergraduate medical school curricula.

In summary, the UK Council has enabled our community of teachers to work effectively and supportively together. It has proved of particular value to those colleagues who are in the early stages of developing their school's communication skills teaching but all of us have very much benefited by our collaboration. Such communities only work if there is a genuine desire to share and benefit from each other and if communication skills teachers cannot achieve this, I doubt any other group will do so!

For more information please contact

js355@medschl.cam.ac.uk

The launch of Intute: Health and Life Sciences

Lisa Charnock, Intute Support Officer, Manchester Computing, University of Manchester Jackie Wickham, Service Manager, Intute: Health and Life Sciences, University of Nottingham

In July 2006, BIOME, one of the hubs of the RDN [1], was relaunched as Intute: Health and Life Sciences. Many of you will have used BIOME and its gateways, OMNI, NMAP, BioRes and Vetgate, and will have been familiar with their reputation for selecting and evaluating the best of the web for education and research.

BIOME and the other hubs of the RDN1 have now been integrated into Intute; one organisation with one identity, one name, and one point of access. In this article, we would like to give you a summary of how we have developed as a service, and share our vision for the future of Intute.

Why change?

Intute takes the best of the RDN, and brings together all of the web resources and value added services into one, easily accessible place. Inter-disciplinary searching and browsing has been improved and you can also focus on specific subject areas which each have their individual sub-site:

Health and Life Sciences
Science, Engineering and Technology
Social Sciences
Arts and Humanities.

In combining the resources and services of BIOME's popular gateways, Intute: Health and Life Sciences offers an easy to use tool for discovering the best free resources on the Web. As before, you can search and browse particular subjects e.g. Medicine, Veterinary Science.

The Wellcome Trust [2] remains a key partner and its gateways are a feature of the new site.

What does Intute: Health and Life Sciences have to offer?

A recent study of student information use in the health sciences, found that many students lack important competencies that may limit their ability to make informed health choices. [3] The study revealed that students lacked the skills to source and critically evaluate information, and failed to recognise bogus health information on the Internet. This will probably not surprise many of us and, indeed, other similar surveys have revealed that students place a higher value on currency rather than accuracy when choosing their information, [4] have difficulty recognising reliable sources, and do not double check their sources.[5]

Many of us will identify with the frustrations around student use of poor quality resources found through search engines, however, in the health sciences, there are the additional issues of clinical risk, and the growth of evidence based practice. As Haines and Horrocks point out, the need to address information overload and to ensure the integrity, relevance and high quality of information is paramount in clinical practice.[6]

Intute: Health and Life Sciences offers a searchable and browsable database of web resources, all of which have been selected, evaluated and described by subject specialists working within the UK's Higher and Further Education communities. Within an environment where use of the Internet for health research is high, yet awareness of the pitfalls of the web is low, we believe that there is a need for a service that is concerned with facilitating access to quality resources on the free web, and maintains a focus on evaluation and collaboration with the academic and practitioner communities.

It is widely accepted that a high percentage of students rely on search engines for their academic research, and it has been suggested that the dominance of search engines is due to their ease of use and familiarity.[7] Indeed, Griffiths and Brophy identified that students would be likely to trade quality of results for effort and time spent searching when conducting research.[8] We have introduced a new, improved, one box search interface that we hope will give users an easy to use alternative to the search engine for health research.

However, we know that it is not enough simply to provide access to quality information sources, because students also need to develop information literacy skills to be able exploit them effectively. Ivanitskaya and O'Boyle stress that individuals with limited health information competencies may fail to locate the best available information due to employing poor search strategies.[9] Intute provides free Internet tutorials, though the Virtual Training Suite [10], to help people to learn how to get the best from the web for education and research. We are currently updating and redesigning the tutorials with a fresh new look and feel, and the Internet for Medicine tutorial [11] has already been updated. The Internet Vet tutorial will be updated by early 2007.

Our database and our training services are the core of what we do, but we also offer a range of additional services for our users. [12] For example, the Hot Topics feature takes a subject of interest and provides links to useful resources from the Intute database. We have also just introduced our new personalization service, MyIntute. Currently in Beta, MyIntute allows users to email and tag selected records, and set up alerts to keep up to date with resources in their chosen field.

How can you work with Intute: Health and Life Sciences?

We want to make it as easy as possible for our users to exploit our resources. MyIntute is a new service which enables you to incorporate your chosen resources into web pages/VLEs and also set up e-mail alerts to keep up to date with new additions to the catalogue in your subject area. We have also developed a variety of ways to embed Intute in other websites and services. For example, we have a range of RSS feeds, and Intute can be embedded in federated search tools using Z39.50 targets.

What else does Intute do?

We are also pleased to be involved in projects such as the Higher Education Academy resource catalogue integration (an Institutional Repositories search service), and INFORMS.[13]

We have a long history of working with the Higher Education Academy, and we are currently collaborating on a project to integrate the resource collections of the Academy Subject Centres into a single database that will be maintained by Intute. Again, we hope that this will improve access to these resources for the education community. The Medicine, Dentistry and Veterinary Medicine Subject Centre is a key player in this project.

We are also pleased to be working in partnership with UKOLN and SHERPA on a project to develop a search facility across institutional repositories. Content deposited in institutional repositories is growing, and we want to make this material more accessible to the UK education community.

Since their inception, INFORMS tutorials have provided information professionals with an effective tool for use in information literacy education. Over 50 institutions have already created interactive information literacy tutorials using the simple INFORMS interface, and we are delighted that Intute will be continuing the work begun by the University of Huddersfield. The INFORMS tutorials will be moving to Intute over the Christmas vacation, and we will be engaging with our user community in order to improve the administration interface, and the accessibility and design of the tutorials.

What does the future hold?

Our mission is to advance education and research by promoting the best of the Web. This is a period of enormous change and development for Intute, and we look forward to consolidating our achievements to date and building a strong future for our service. We are keen to collaborate with the academic community to build a service that is relevant to the population it serves and the environment in which it operates. Nobody can predict exactly what the future holds, but our focus on collaboration, and the expertise of our staff, will ensure that we are able to recognise and respond to new developments, and achieve our vision to enable the education and research community to unlock knowledge from the Internet.

Intute: health and Life Sciences is hosted at the University of Nottingham in collaboration with other institutional and individual partners and contributors. It is part of the wider Intute service hosted by MIMAS at The University of Manchester. Intute: Health and Life Sciences is funded by the Joint Information Systems Committee (JISC).

If you would like more information about Intute, please visit our website at www.intute.ac.uk/healthandlifesciences/ We are always keen to receive feedback about any of our services. If you have any comments, or would like to find out more about working with us, please contact us by using our feedback form.

[1] For further information about the history of the RDN see: Hiom D, Retrospective on the RDN, Ariadne, 47, 2006, Available from: www.ariadne.ac.uk/issue47/hiom/ [Accessed 17th July 2006].

[2] www.wellcome.ac.uk

[3] Ivanitskaya L, OÕBoyle I, et al. (2006), Health Information Literacy and Competencies of Information Age Students: Results From the Interactive Online Research Readiness Self-Assessment (RRSA). Journal of Medical Internet Research 8(2) (Online). Available from: www.jmir.org/2006/2/e6/ [Accessed 15th August 2006].

[4] Wang Y-M, and Artero M (2005), Caught in the Web: university student use of Web resources. Educational Media International, 42(1) pp. 71-82 (online). Available from: taylorandfrancis.metapress.com [Accessed 12th July 2006].

[5] Graham L and Metaxas PT (2003), Of course it's true; I saw it on the Internet! Critical thinking in the Internet era. Communications of the ACM, 46(5) (online). Available from: portal.acm.org/ [Accessed 21st June 2006].

[6] Haines M and Horrocks G (2006), Health information literacy and higher education: The King's College London approach. Library Review, 55(1) pp. 8-19 (online). Available from: www.emeraldinsight.com [Accessed 14th August 2006].

[7] See for example: Markland M (2005), Does the student's love of the search engine mean that high quality online academic resources are being missed? Performance Measurement and Metrics: The International Journal for Library and Information Services, 6(1) pp. 19-31 (online). Available from: www.emeraldinsight.com [Accessed 19th June 2006].

[8] Griffiths JR and Brophy P (2005), Student searching behavior and the web: use of academic resources and Google. Library Trends, 53(4) pp. 539-54 (online). Available from: infotrac.galegroup.com [Accessed 25th June 2006].

[9] Ivanitskaya L, O'Boyle I, et al. Ibid.

[10] www.vts.intute.ac.uk

[11] See www.vts.intute.ac.uk/he/tutorial/medic

[12] For more information on our additional services see: www.intute.ac.uk/services.html

[13]. For further information about our project work, see: www.intute.ac.uk/projects.html

For more information about Intute please contact lisa.charnock@manchester.ac.uk and for more about Intute: Health and Life Sciences contact

jacqueline.wickham@nottingham.ac.uk

Measuring educational and training environments as part of QA

Sue Roff, Project Development Manager, Centre for Medical Education, Dundee University Medical School

The learning and teaching environments in which education and training occurs in the health professions has come in to focus in the UK with both the GMC and PMETB introducing mechanisms for postgraduate students and trainees to feed back their perceptions of the logistics and calibre of their experiences to centralised quality control systems through national surveys.

These initiatives have clear educational advantages and will be compatible with the increased emphasis on local detection and management of disciplinary issues that are foreshadowed by the recent Donaldson Report on the future of medical regulation. In recent years deaneries have used trainee questionnaires, but these new national initiatives will give respondents an input to UK-wide quality assessment.

Several years ago we developed a Postgraduate Hospital Educational Environment Measure (PHEEM) using grounded theory approaches including focus groups and Delphi processes. The PHEEM has 40 items and has been found to have high validity and reliability in administrations throughout the UK, the Netherlands, Australia and Japan. Variations on it have been developed using the same methodologies for the measurement of trainee perceptions of the Surgical Theatre Education Environment (STEEM - adapted to OREEM in Canada for the Operating Room); the Anaesthesia Theatre Teaching Environment (ATEEM) and for GP VTS training in Ireland.

This work builds on the Dundee Ready Education Environment Measure (DREEM) developed in the Centre for Medical Education in Dundee in the late 1990s. DREEM is now translated into more than 20 languages, including Chinese, Arabic, Malay, Portuguese, Dutch, Spanish and most recently Persian. It's 50 items help to diagnose problems in the students' perceptions of the undergraduate curriculum Ð with minor terminological changes it can be used in any of the health professions. It is increasingly used longitudinally and the data can be analysed by gender, year of study, ethnicity or any other variable that is programmed in to the demographic section. Many schools are now using electronic versions.

The DREEM gives a global score (out of 200) for the 50 items, and has five sub-scales relating to:

Students' Perceptions of Learning
Students' Perceptions of Teachers
Students' Academic Self-Perceptions
Students' Perceptions of Atmosphere
Students' Social Self-perceptions.

It has a consistently high reliability despite the widely varying cultural contexts in which it has been used, and data can be collected and analysed according to variables such as year of study, ethnicity, gender, age, and courses/attachments. Pololi and Price (1) have since developed a 31question survey in 4 US medical schools with three subscales. Their inventory does not claim to be non- culturally specific nor generic to the health professions beyond medicine; the two inventories do share several items, which might be taken as indication that there is something generic about what is considered to be an effective educational environment in the undergraduate health professions. The research literature is building a picture of the norms we should expect in a constructive undergraduate educational environment. DREEM has been used in nursing schools in the Middle East and Thailand, in dental schools (including hygienists) in Malaysia and Pakistan as well as a wide range of medical schools.

Ifere (2) administered DREEM to 127 Nigerian medical students in years 4, 5 and 6 and was able to identify their perceptions of the strengths and weaknesses of the medical school which had a mean total of 118/200. There were statistically significant gender and academic year differences in the results. Similarly, Bhattacharya administered the DREEM to 86 students in years 1, 2 And 3 of a Nepalese Health Sciences Institute and reported a mean total of 130/200 and significant gender and academic year differences. DREEM was administered to 70 final year and 36 first year medical interns in the West Indies and reported a total mean of 110/200 with various specific findings for the sub-groups within the cohort.(3) Till administered the DREEM to 407 Canadian chiropractic students in Years 1, 2 and 3 and reported radically declining overall means for each year - 111/200 for Year 1, 97/200 for Year 2 and 78/200 for Year 3 - with individual items and sub-scales indicating clearly where remediation was required.(4) UK medical schools tend to score around 130/200 - good, but with some considerable room for improvement.

If DREEM data are correlated with academic results, they may be able to be used prospectively to predict which students are struggling in a given educational environment. DREEM was administered to 508 medical students in the clinical years at an Indian medical school and found that DREEM scores were significantly higher for academic achievers as defined by their GPAs.(5) Similarly Sun administered the DREEM in Chinese to 885 students at his medical school and found a statistically significant difference (p<0.01) between the mean DREEM scores of high academic achievers (123/200), middling academic achievers (118/200) and low academic achievers (113/200) although they did not detect statistically significantly different mean scores between males (118/200) and females (119/200) or between the two types of courses that the students were studying.(6)

Further work will be undertaken to establish whether or not the DREEM can be reliably used to identify various types of academic achievers, and even perhaps to predict the probable academic outcomes of particular individuals and subgroups in the absence of intervention. While a poor perception of the educational environment may not necessarily correlate with poor academic performance, we hypothesise that it is likely to do so.

The DREEM was purposefully developed as an international, generic instrument that is not culturally specific to a given region. In Thailand, Wangsaturaka has explored the utility of developing culturally-specific instruments for a given country's undergraduate medical education at the same time as investigating if there are phases within the undergraduate curriculum that require different inventories in order to provide sufficiently sensitive quality assessment data for managers of a nation's medical schools.(7)

Virtually all of the development and validation work for these instruments has been undertaken by Masters and PhD students in the Centre for Medical Education. The instruments are fully in the public domain and youÕre welcome to use them if you think they will be a useful part of your quality assessment portfolio.

References

(1) Pololi L and Price J (2000), Validation and Use of an Instrument to Measure the Learning Environment as Perceived by Medical Students. Teaching and Learning in Medicine 12;4:201-207.

(2) Roff S, McAleer S, Ifere OS, and Bhattacharya S (2001), A global diagnostic tool for measuring educational environment: Comparing Nigeria and Nepal. Medical Teacher 23;4 378- 382.

(3) Bassaw B, Roff S, McAleer S, Roopnarinesingh S, de Lisle J, Teelucksingh S, and Gopaul S (2003), Students' perspectives of the Educational Environment, Faculty of Medical Sciences, Trinidad. Medical Teacher 25(5):522-6.

(4) Till H, Roff S and McAleer S (2002), Identifying the Strengths and Weaknesses of a New Curriculum by Means of the DREEM Inventory. AMEE Poster.

(5) Mayya, Shreemathi and Roff S (2004), Students' perceptions of educational environment: A comparison of academic achievers and under-achievers at Kasturba Medical College, India. Education for Health 17;3:280-291.

(6) Sun BaoZhi (2003), Reforming medical curricula in China Medical University. Masters dissertation, Centre for Medical Education, University of Dundee.

(7) Wangsaturaka D and McAleer S (2003), Factors influencing final year students' learning climate in Thai Medical Schools presented to AMEE, Berne.

For more information please contact s.l.roff@dundee.ac.uk

Medical ethics, seminars and the virtual environment

Georgia Testa, Lecturer in Medical Ethics, Inter-Disciplinary Ethics Applied CETL, University of Leeds

Pressure on the medical curriculum creates a challenge for introducing new courses and supplementing existing ones.This provides a particular challenge for medical ethics which, at Leeds, we believe is best taught through seminars and tutorials, where students can explore and develop their understanding of ethical issues under the guidance of an ethics tutor.

Seminars and tutorials though are time and labour intensive, and cannot easily be fitted into a busy curriculum. At Leeds we are developing what we believe to be an innovative solution. Utilising blogging technology, we will run virtual seminars to which students can contribute as part of their private study time and so which relieve pressure on the formal timetable. The aim is to mirror as closely as possible the dynamic of a face-toface seminar, where students debate and explore ethical issues together, while providing the time flexibility that will enable students to integrate their participation with the many other academic demands of the medical course.

Ethics teaching at Leeds Medical School

At Leeds Medical School, the teaching of medical ethics is integrated into the core curriculum, so that ethics sessions are embedded in clinical courses and make sense as part of those courses. So, for example, when students are prepared through the Personal and Professional Development (PPD) core unit for their first patient visit, they are introduced to the concepts of and issues surrounding conflicts of values, best interests, confidentiality, paternalism, patient autonomy and informed consent. These topics are explored through lectures and seminars, where the students are presented with case studies to help bring out the relevance of and difficulties with these concepts in practical settings.

The teaching throughout is designed to encourage the students to explore their attitudes towards ethical issues as

well as develop an awareness and understanding of those issues. Our view is that this is best achieved in an interactive learning environment, such as seminars and tutorials, under the guidance of ethics tutors. But time pressures within the curriculum make it difficult to integrate new seminars and tutorials on ethics even when they can be seen to be highly complementary to established clinical courses. And this presents a challenge for the development of ethics within the curriculum even in an institution such as Leeds that places a high value on developing sensitive and ethically competent practitioners.

For example, in year 2 PPD, the students have a course called Valuing Diversity. This, as the name suggests, is designed to develop their understanding and tolerance of the cultural and value diversity within contemporary UK society, as well as the pressures and problems this can create for medical practice and the provision of medical services. Currently, the students undertake community placements with organisations concerned with issues such as disability rights, domestic violence, care for prostitutes, drug and alcohol addiction, discrimination and mental health, gay and bi-sexual men, asylum seekers, health needs of specific cultural or religious communities, and alternative health therapies. These are supplemented with workshops and talks given by representatives of these and similar organisations.

However, there has been no formal ethics teaching integrated into this course, despite the relevance of ethics to the subject matter and aim of the course. The problem is that the existing lectures, workshops and placements themselves exhaust the contact hours devoted to this course. The PPD Course Manager, Dr John Sanders, suggested the innovative solution of running virtual seminars that will form part of the private study time set aside for the course. Students will be required to participate in one seminar of three weeks duration and spend six hours in total contributing to the seminar (approximately two hours per week). This could involve reading the contributions of others as well as preparing and posting one's own contribution.

The future

Each seminar group of about ten students will be given a virtual blogging space which will contain a record of the contributions made by all involved, and which will be private to that group. The aim is to mirror as closely as possible the dynamic of a face-to-face seminar, where students debate and explore ethical issues, guided by an ethics tutor. But, given that this seminar is part of students' private study, they will not have to be logged on, in the seminar room, at the same time, as would be the case in a real seminar. However, students and tutors will be notified when someone has made a contribution, which they can then read at a time convenient for them.

Students will have an incentive to contribute because, as part of their reflective portfolio, which is subject to summative assessment, they will be required to write a reflective piece on their experience of participating in the seminar. They will be asked to comment on what they have learned about themselves, others, the subject matter of the seminar and implications for medical practice or provision. There will also be formative assessment in the form of a process grade. This will reflect the students' contributions to the seminar and development in understanding.

A further advantage of this course is that it does not require tutors to be available at particular times on particular days. We often use, as ethics tutors, clinical or medical staff with some formal training in ethics. For example, doctors and nurses who have completed the BA or MA in Healthcare Ethics, previously run by the Department of Philosophy in Leeds and now run by the new Inter-Disciplinary Ethics Applied Centre for Excellence in Teaching and Learning (CETL). Medical practitioners have busy clinical schedules

and often cannot commit to a particular timetable slot over a period of weeks, as is usually required when tutoring an ethics seminar course. This means that the pool of available ethics tutors is reduced and a valuable teaching resource lost. But the virtual seminars have a flexibility that benefits students and tutors. Just as there is no stipulation for the students as to when they should log in to the seminar room, there is no stipulation for the tutors either. The only stipulation is that a certain amount of time per week should be devoted to the seminar. Both students and tutors can, therefore, fit their contributions around their other commitments, guided by the notifications they will receive that someone has made a contribution to the discussion.

Of course, how this will work in practice we have yet to find out. We plan to publish pedagogical work once the seminars and the associated summative assessment component of the reflective portfolios have been completed next academic year. Our hope is that the virtual seminars will provide a valuable addition to existing teaching methods and that the methodology will engage both students and tutors. Colleagues are very keen to integrate the use of new technology into the curriculum and so develop the use of podcasts and blogs, with which most of today's students are familiar in their non-academic lives. Students at Leeds already use blogs as part of their learning experience and the virtual seminar is an extension of this.

For more information please contact g.testa@leeds.ac.uk, or j.e.sandars@leeds.ac.uk

Rewarding excellence in learning and teaching 2006/7

Win FREE registration at educational conferences!

AMEE,Trondheim, Norway 25-30 August 2007: www.amee.org/AMEEConfsNew.html

ASME, Annual Scientific Meeting 2007 - Medicine's Role in Future Healthcare Provision, Keele University, UK 11-13 July 2007: www.asme.org.uk/conf_courses/2007/asm.htm

ADEE, Dates tbc Dublin, Ireland: adee.dental.tcd.ie/index.php?file=annual_meetings.html&knap;=6

AVTRW, Dates tbc, Royal Hotel, Scarborough: avtrw.mri.sari.ac.uk

JASME, Keele University, UK 11-13 July 2007: www.jasme.org.uk

The Subject Centre has secured places at these prestigious events, as prizes for rewarding excellence in learning and teaching. Winners will receive financial support towards attending one of these major conferences, which offer exciting opportunities to hear more on current educational topics through a programme of seminars, lectures, workshops, interactive discussions and poster sessions.They also offer a forum for debate and the exchange of information via excellent national and international networking opportunities.

For more information visit: www.medev.ac.uk/resources/competition

Higher Education Academy student essay prize 2006: How does your course compare with any expectations you may have had?

The winning essays from Medicine, Dentistry and Veterinary Medicine

The Higher Education Academy coordinated a national Student Essay Prize, based on competitions that many Subject Centres had been running independently.There was a single essay title, set of guidelines, and rationalised prizes.

Winners from each of the 24 Subject Centres won £250 cash plus the chance to join over 550 delegates at the Higher Education Academy Annual Conference at the University of Nottingham in July 2006. The MEDEV competition was won by Farai Nhembe from the University of Manchester and Nearea Fletcher, University of Glasgow (runner up who attended AMEE 2006). Their essays are reproduced below. Nine students considered to have achieved merit each received a £25 book token.

All 24 winning essays were entered for the national prize (a Toshiba laptop) which was taken home by Liz Piper from St Martins College. Liz was nominated by Health Sciences and Practice and her winning essay will appear in our next edition of the newsletter. Thanks to the winners for allowing us to reproduce their essays, and congratulations to all those who took time to enter for making this a very tough competition.

Winner	Farai Nhembe	University of Manchester
Runner Up	Nearea Fletcher	University of Glasgow
Merit	Emily Chung	Barts and The London, Queen Mary University of London
Merit	Bilal Hassam	University of Nottingham
Merit	Laura Lefley	University of Southampton
Meit	Sinead McGuinness	Queen's University Belfast
Merit	Sinan Mir	St Georges' University of London
Merit	Nimalan Sanmugalingam	St Georges' University of London
Merit	Mary Sattenstall	University of Manchester
Merit	Sinead Sullivan	University College Dublin
Merit	Daniel Wilmer	St Georges' University London

WINNER Farai Nhembe

University of Manchester

Dentistry was not the planned final destination of my secondary education. I was in actuality a confused A- level student since I lived and breathed Art, found Biology fascinating and had a natural ability to understand Geography. My parents, both of whom are scientists, patiently listened to me argue how I would be better off doing both science and art subjects at A level so that I could figure out what I wanted to do. I won the battle after arguing that I would rather paint a landscape than describe the ionic, covalent or whatever other type of bonds exist in acrylic paint. Art -1, Chemistry- nil. Two years later, armed with good grades in my "Artyscience" subjects, I found myself confused once again. My plan had failed.

I went to a careers office where I browsed through information on various careers. I decided that a "grownup post A- level student" would have a logical and mature plan for choosing a career and so I did it alphabetically! A, being for Artist was out of the question since I knew my parents would say Art was a hobby not a career. B was for Biology. As much as I loved Biology I couldn't fathom three long years of pure biology, surely it would drive me insane. I got to the C's and was fairly interested in Cinematography, but I was advised that I would be slightly disadvantaged since the software was fairly expensive and I certainly couldn't afford a Mac computer. I then got to D. D is for Dentistry. I wondered if a person like me could ever be a dentist. I was definitely interested and went to visit a local dentist to see what it entailed. I was hooked. I had been in and out of the dental surgery as a child, mostly out as I was constantly turning on my heels as soon as I realised where we were really going. Working as a dental nurse allowed me to the other side of dentistry and it was then that I decided that I really wanted to be a dentist.

The next few months consisted of researching dental programmes at different universities. I found that with my Arts background, I was eligible for the University of Manchester pre-dental programme. The concept of Problem-Based Learning kept coming up while I was researching the Manchester Dental Course. In all honesty, although I had read that Problem-Based Learning was proving to be a successful teaching method, I didn't fully comprehend what it was, but I applied anyway. As well as Problem-Based Learning, the Manchester programme also encouraged Self-Directed Learning. Self-Directed Learning to me meant directing myself to as many coffee breaks and siestas that I desired. Would it be possible to turn such a misguided, art-loving, non self-directed student into a dentist?

The pre-dental programme was an excellent start to the dental course. The course allowed us to be introduced to Problem-Based Learning, which I found to be a fun way to learn. Chemistry was no longer irrelevant when considering the pH of blood or gaseous exchange. The conduction of electricity along a cable would never have held my interest before, but when asked to compare this conduction to that of a nervous impulse, I wanted to know more. The pre-dental year was so well organised that it didn't feel as hard as I thought a university course would. I was also surprised to find that there were many "normallooking" people in the library and very little dust. So many preconceptions! My greatest lesson during that year was that using search engines to find information was part of Self-Directed Learning. I could google away to my heart's content in the name of getting an education. The pre-dental year, like all good things, came to an end. Although I was sad to say goodbye to the pre-med students, I was excited to be progressing to the main course with the other six pre-dental students.

The first two years of the course were a slight disappointment. Problem-Based Learning was still an interesting and relevant way to learn, however I felt more like a medical student than a dental one. For two years there was very little mention of teeth. The examinations also got progressively harder and I discovered the sting of negative marking. Anatomy lessons were not what I had expected at all. I knew that a dentist probably knows the anatomy of the skull as well as the back of their hand but I never dreamt that Cadavers would be my new textbook. A few weeks after the initial shock, I immersed myself, quite literally, into this new learning tool. I found that I learnt a lot more from using a cadaver than I had from my A level lab rat Snowy. My only regret, that I later realised in third year, was not paying enough attention to the position of the pterygo-mandibular triangle. Had I paid more attention, I wouldn't have had so many sleepless nights worrying about where to give my ID blocks.

Third year was probably one of the most adrenaline-fuelled years of the course. It was during this year that I was reminded that I was studying to become a dentist. The reality of being a dentist meant treating patients. I will never forget taking my first history with a shaky, barely audible voice and rapid, shallow breathing. The teaching was not as in-depth as I had thought it would be. In reality, I had expected to be spoon fed, but realised that I had to go back to the library. Self-Directed Learning wasn't that much fun anymore. The Junior Operative skills Course was the highlight of third-year teaching. I had a drill in my hand so surely I was almost a dentist? Yes I had a drill in my hand but the question was whether or not I could use it. At times, the course was frustrating as I found my hands refusing to do what they were told, but tutors were always on hand to give helpful tips from practice. Another bit of teaching came in the form of clinical partnerships. The partnerships were an invaluable way to learn to work in a team, as well as support a fellow student.

During the fourth year, I continued to build on the foundation laid in the previous years. The outreach clinics made a refreshing change from the confines of the dental school. Teaching in the community clinics was personalised and the tutors encouraged us to develop our skills and strive for excellence. Slowly, I was becoming a dentist (realising my dream).

As I now reflect on the course in my fifth year, I find the analogy of Eric Carle's "Very Hungry Caterpillar" is appropriate to describe my journey. I started as the little caterpillar with no real direction. The dental course has been my "cocoon phase", where I was protected, nurtured and allowed to grow. At the end of it all, I shall emerge a butterfly, equipped to survive in the great garden of dentistry. What can I say? I guess the artist in me lives on.

RUNNER UP Nearea Fletcher

University of Glasgow

I love walking into lecture buildings and seeing horses trotting along the road beside me. I even appreciate the farm smells that are so present at the vet school. The environment reminds me that after the hard work and years of studying, eventually this will be my career. I read James Herriot, Jilly Cooper and any book featuring animals when I was younger. I have always been intrigued and fascinated by animals. My love of wildlife programs fuelled many childhood squabbles for the TV remote control.

My personal expectations have always been very high. From when I first decided to try for Vet Medicine, I never had an expectation of the course. I simply hoped that I would have the opportunity to study it. I was acutely aware that it was the degree I wanted to study. I was aware of the difficulties and competition involved in getting a place. I was not driven by a need to compete, and yet my competitive edge compelled me to reach my goal. I imagined the involvement with animals that I would get on the course and I was desperate for the knowledge it would teach me. I wanted to progress from my limited experiences with animals to one where I would be able to advise others about them. I attended an open day at Edinburgh Vet School and I remember coming across a preserved specimen cross section of a dog in the anatomy laboratory. It awoke in me the desire to reach a stage where I was certain that I would be learning a course that I was really interested in. In retrospect I have found this to be very true. Much of the course is of great interest to me, and I hardly feel like I am studying because I am enjoying it so much. I was well prepared for the course. By the time I started as a zoology graduate entrant into the second year, I was as much aware of what lay ahead in terms of academic demand and social life as I could possibly have been. I attended interviews at four vet schools during 2005.

Glasgow was my first interview and I arrived flustered and late having been stuck in snow on the motorway. However I was greeted warmly and shown around by students who were encouraging and sociable. The impressive reception was not equalled in my other interviews. I felt energised and hopeful after the interview. The experience gave me high expectations of Glasgow Vet School. I looked forward to studying alongside like-minded students, driven by the same interests as mine.

Glasgow is renowned for its friendliness and I expected no less from the University. As one of seven direct entrant students, we were warmly received by the class. We met and had classes with our lecturers during a "catch up" summer school and were familiar amongst ourselves by the beginning of term. The transition was painless. We got to know our class in practicals and at vet school social events. I could never have imagined the energy of the social life at vet school. I had believed that I would have little free time with the quantity of work, having missed 1st year and with working to pay my tuition fees.

However the vet school is very inclusive and socialising is central to the life at the vet school. Free time spent with friends keeps the pressure of the workload manageable. We were advised from the beginning to take out insurance policies regarding our holiday work experiences. We were lectured on the zoonotic diseases we may encounter. Following lambing, farm and stable yard placements, the only injury I have so far received is bruising from ceilidh dancing at the vet ball! I will never get used to the smell of the anatomy laboratory - the cadavers hanging from hooks in plastic bags. In anatomy labs we must find our dog hanging among the others and carry it to the dissection lab for the practical. The putrid smell of decaying dogs is stomach turning and only when we were told to abandon a practical session in which our dogs looked particularly worse for wear did I realise this was not acceptable! The anatomy practical exam took me by surprise. Around 50 stations were set up with x-rays, specimens and histology slides. Arrows indicated the direction we were meant to head in. We had a minute and a half at each station, and had to answer questions referring to each specimen. With the adrenalin and panic of exam time, not only was my spatial awareness challenged but we all started in different positions, so I managed to mix numbers and questions in a spectacular fashion. I'm baffled that I managed to pass! Now that I am settled in vet school I realise that each challenge we face prepares us a little more for the next one. Hopefully I will gradually build my knowledge so that when I graduate I will have the ability and capacity to practice as a responsible veterinarian. I believe that expectations change with experiences and for me, to my delight, vet school has met and surpassed most expectations I had.

Congratulations to the winners of the Rewarding Excellence in Learning and Teaching Competition 2006

Dr Christine Hanson, University of Dundee Dental School

Dr Theo De Waal, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin

Dr Anita Laidlaw, Bute Medical School, University of St Andrews

Dr Jonathan Richardson, Old Age Psychiatry, Institute for Ageing and Health, Newcastle University

Unlocking virtual patients

Dr Rachel Ellaway, eLearning Manager College of Medicine and Veterinary Medicine, University of Edinburgh

Dr JB McGee, Consultant Gastroenterologist and Dean for Medical Education Technology at the University of Pittsburgh School of Medicine, USA

Although healthcare education encompasses knowledge acquisition, it is its effective application in a context of practice that is its goal. Designed learning activities in healthcare education therefore need to be as close to real- world practice as possible.A great deal of learning takes place in real world clinical settings and is still highly dependent on bedside teaching and learning.

However, with ever-increasing student numbers, patients spending less time in hospital, changing clinical contracts and increasing concerns over liabilities associated with unlicensed students in care settings it is getting harder to provide adequate real world experience in all areas of the curriculum.

We need, therefore, to find alternatives that have equivalent validity and applicability to real world practice but that can be delivered outside the increasingly problematic context of the clinical workplace. In addition there is an ongoing move towards integrated curricula and assured core clinical experiences. A key heuristic or design for learning in healthcare is the virtual patient.

Virtual patients

A virtual patient has been defined as an interactive computer simulation of real-life clinical scenarios for the purpose of medical training, education, or assessment.(1) Educational use of physical simulators, standardised patients and electronic health records have, for instance, been described as virtual patients. However, it is the application of information and communication technologies (ICTs) and a narrative framework that defines the virtual patient. There are many ways in which virtual patients can be used as designs for learning.(2) These pedagogical modalities employ explorative and/or didactic techniques as well as aspects of problem-based learning (PBL).

Although lacking the sensorial richness of embodied encounters, virtual patients can potentially support many different kinds of learning activities such as critical decision-making, exploring diagnostic and therapeutic strategies and formative and summative assessment. In that virtual patients can equate to a case, they can

also be used as triggers and resources for PBL activities and, where appropriate, the environments through which PBL activities are conducted. There are many different ways in which virtual patients may be used, including online paper cases, world simulators (akin to game worlds), patient records, standardised encounters, and open professional narratives (such as clinicians' war stories).

However...

Despite the many opportunities and advantages they afford, the use of virtual patients can also introduce a number of problems and pitfalls. Not least of these is the time and cost that can go into their development. Faster, simpler and less specialist means to develop virtual patients are required to address these problems. Probably the greatest problem is that of portability and reuse. Until now there has been no common standard for developing virtual patients and as a result they are tied to the context in which they were created. In order to address this, an international working group under the aegis of MedBiquitous (3) is developing a common data standard for virtual patient interoperability.

The MedBiquitous virtual patient

The MedBiquitous Virtual Patient Working Group was established in 2005 to develop an XML based common data standard for the educational application of virtual patients for as many different kinds of uses as possible. Co-chaired by the authors and with nearly 40 members worldwide, the group has developed a five-component model for virtual patients:

Virtual patient data (VPD) Ð this is contains raw clinical data and other static information, similar to that in an electronic patient record. It also contains any predetermined interactions such as questions to and answers from the patient.
Media resources (MR) Ð this contains all of the supporting files such as images, audio, video, documents (such as patient letters) and links.
Activity model (AM) Ðthe AM codifies the intended student activity and interaction with the virtual patient, potentially the most complex part of the standard, and as such needs to be highly abstract in nature thereby encompassing anything from a single user page turner to an emergent multi-user collaborative game-world.
Data visibility model (DVM) Ð this acts as a dynamic bridge between the AM and the VPD and MR components. It allows data or resources to be released only in response to user progress.
Global state model (GSM) Ð this is a way of marshalling a number of different activities such as a patient caseload or progression through a complex task.

It is anticipated that there will be many players that can either play the XML directly or import it in to a virtual learning environment or learning management system and play it from there. Since the MedBiquitous virtual patient standard will be made publicly available, there is no restriction on whether players are commercial, open- source, home grown, or some hybrid of these, it is just a data standard and does not dictate how it is implemented. Reference implementation players are already being built in Edinburgh, Pittsburgh and Tufts, Boston.

It is anticipated that the development and implementation of the MedBiquitous virtual patient standard will enable wide-scale authoring, reuse and adaptation, exchange of best practice and greatly improved sustainability and availability of virtual patients worldwide. Furthermore it is hoped that the standard will facilitate connections with electronic health records and clinical decision support systems.

The first beta version of the VPD was released at the start of July and other components will be released as they become available. Anyone can participate in the process and the will be freely available as an ANSI (American National Standards Institute) standard - please join us if you want to help shape the standard or become an early adopter.

Thank you to MEDEV for some financial support of this work.

For more information please contact

rachel.ellaway@ed.ac.uk

References

(1) Ellaway R, Candler C, Greene P and Smothers V (2006), An Architectural Model for MedBiquitous Virtual Patients. Baltimore, MD, MedBiquitous.

(2) Ellaway R (2004), Modeling Virtual Patients and Virtual Cases. MELD. meld.medbiq.org/primers/virtualpatients cases_ellaway.htm

(3) MedBiquitous is a Baltimore-based ANSI-accredited standards development organisation for healthcare education - www.medbiq.org

RCVS introduces new modular postgraduate certificate for 2007

Freda Andrews, Head of Education, and Elizabeth Barter, Education Officer, Royal College of Veterinary Surgeons

The Royal College of Veterinary Surgeons (RCVS) is replacing its current certificate with a new modular postgraduate certificate and is asking universities (not just veterinary schools) to become involved in providing accredited Continuing Professional Development (CPD) courses and assessing modules. RCVS has agreed to delegate the assessment of the new modular certificate to universities, who are better equipped to manage this process, with established quality assurance systems already in place.

Universities will be encouraged to collaborate with other CPD and course providers in the delivery of modules. New skills have been introduced, that have not previously been assessed in the RCVS veterinary certificates. These skills are relevant to a wide range of professions, as well as veterinary practice, and include subjects like communication skills, data handling, clinical audit, business and management skills and ethics. With this broader range of skills RCVS hopes to attract the interest of a number of universities that have not previously had involvement in the provision of postgraduate courses for veterinary surgeons.

History of the current RCVS certificate

RCVS (the statutory body for the veterinary profession) has been running postgraduate examinations for veterinary surgeons since the 1960s, with most of the subjects available today being introduced in the 1980s and 1990s.

The current RCVS Certificate is the first level of qualification, designed for those who have been qualified for at least two years. Available in 19 different subject areas, it leads onto the RCVS Diploma - which provides the basis for recognition as a specialist in one of the many veterinary fields recognised by the College. Although the certificate- level qualification has been successful in encouraging a number of vets to continue studying, it has been less appropriate for the majority of vets who work in general practice and who do not want to commit themselves to studying for only one specialist area. A survey of the profession revealed that there was high demand for a broader-based, more flexible qualification.

In order to address these concerns, and to support and encourage participation in the life-long learning of its members, RCVS has come up with a radical new certificate structure. It is based around modules, which are compatible with the Quality Assurance Agency's (QAA) national framework for higher level qualifications, and equates to a university postgraduate certificate. In order to improve the link to the various CPD courses that have been provided by universities, commercial providers and specialist associations over the years, RCVS has agreed to delegate the assessment of individual modules to universities which may, if they wish, work in collaboration with other associations.

Structure of the new modular postgraduate certificate

The certificate itself is made up of 60 credits (which equates to about 600 notional study hours, including taught and private study) and is divided into three types of module.

Professional key skills

Historically, professional key skills, such as communication, personal and business development and data handling skills, have often been overshadowed by clinical skills and have not previously been assessed in RCVS Certificates. Professional and clinical key skills are now regarded with equal importance as both are intrinsic to the veterinary profession. ItÕs worth noting that many of the complaints received by RCVS about vets arise from communication problems between client and veterinary surgeon. RCVS has set about redressing this imbalance by developing the Professional Key Skills module. We've made this a compulsory component of the full qualification to ensure that is not an option that can be disregarded.

Benefits for the candidate

Whilst the concept of modules is in itself not particularly radical, the flexible structure of the modular postgraduate certificate is.

For the first time, veterinary surgeons will be able to design their own postgraduate certificate by choosing a combination of modules that reflects their areas of interest and is directly relevant to their work, whilst accruing credits for their efforts as they progress through their life-long learning.

All of the modules have been designed to be taken on a freestanding basis, either as part of the general Certificate in Advanced Veterinary Practice (CertAVP), or as part of a species-/discipline-based certificate, for example, in Farm Animal Practice or Veterinary Public Health. And because the structure matches that of many university credit systems, it will be feasible for modules to be integrated with other MSc courses already run by universities, and vise versa, so that modules from existing taught Masters programmes can be credited towards the RCVS Certificate.

We hope that the facility for candidates to mould their life-long learning to suit their particular interests, needs and circumstances will remove many of the existing barriers and result in increased take- up of postgraduate qualifications.

Benefits for the provider

The benefits of a flexible structure will extend not only to the candidate but to the provider as well. The level of the qualification has been set at a Masters Level 4, with the qualification descriptor very closely aligned to that set by the QAA. Universities will be free to define their own assessment arrangements, within broad criteria, or follow RCVS's recommendations (any new proposals will be subject to RCVS accreditation). And RCVS will encourage universities to work in collaboration with private course providers to open up more opportunities for course delivery.

Universities will also be able to suggest new modules to RCVS that are not currently provided for (although content will need to be quite different to those already drafted by RCVS to avoid a proliferation of similarly-styled modules).

Accreditation process

The process of applying for accreditation has purposely been kept as straight-forward as possible. Following approval of the Byelaws and Rules for Administration of the CertAVP on 1 June 2006, information packs have been distributed to the seven veterinary schools and some universities not currently involved with veterinary education with an invitation to submit proposals in September so that some modules can be ready for enrolment from 2007 onwards. This date is open-ended, however, and applications will still be welcomed beyond this time frame. Other universities will also be welcome to submit proposals for accreditation, and are invited to contact RCVS to discuss their ideas and possible involvement in the scheme.

More information on the accreditation process and the modules being developed, along with the Byelaws and Rules for Administration, can be accessed at

www.rcvs.org.uk/modcerts

For more information please contact the Education Department of the RCVS education@rcvs.org.uk Tel: 020 7202 0778.

Staff development initiatives at the School of Medicine, University of Southampton

Dr Faith Hill, Director, Division of Medical Education, University of Southampton

The School of Medicine at the University of Southampton was pleased to be placed in the top three places in the Times Good University Guide last year and to be joint first for medical schools in the National Student Survey.We were pleased to improve our scores further in 2006.

In recent years we have embarked on a series of exciting changes, including the development of a four year graduate programme, a widening access programme and interprofessional education. The challenges facing our teachers are increasing all the time as they adapt to changes within the NHS, more diversity in the student body and changing public expectations. In response to the demands on teachers and to enable changes within the medical curriculum, we have invested heavily in staff development.

Our main approach - embedding staff development

Much of the staff development in Southampton is intrinsically linked to curriculum development and, wherever possible, we embed staff development in the programme structures. For example, a staff development consultant has been employed to work alongside the programme directors throughout the planning stage and first few years of our graduate programme. Co-ordinators of the widening access programme have developed programme specific staff development. In the five-year programme, each of the component course leaders run events designed to review and develop the curriculum and staff development is an integral part of these events.

Teaching Tomorrow's Doctors

We encourage staff to attend education courses offered by the local NHS Trusts and Postgraduate Deanery, the Royal Colleges and our University Centre for Learning and Teaching. We also offer a range of in-house staff development programmes similar to those available in most medical schools. Our most successful programme is called Teaching TomorrowÕs Doctors (TTD). This is a four day course, divided into two two-day modules. It is open to anyone who teaches our students but primarily attracts clinical staff with a significant teaching role. The course is designed to be highly interactive and participatory. For example, small groups working on the concept of student-centred learning build physical models of the concept, using clay, crepe paper, rubber bands, balloons, string and other assorted stationery. In another activity, designed to explore the principles of positive feedback, the participants teach each other how to make paper hats - an activity that the surgeons prove particularly good at! A key feature of the course is micro- teaching - small teaching demonstrations by participants with detailed feedback on their skills. The highlight of the course involves final year students joining a session to help participants explore student perspectives on learning and teaching.

Negotiated leadership training

At Southampton we have paid particular attention to the needs of staff with educational leadership roles. In 2003, we undertook a consultative needs assessment with over fifty course co-ordinators and, through a process of negotiation, designed a leadership programme that has proved both relevant and useful. Over the last three years we have run a series of events covering topics such as:

transformational leadership
chaos theory
adaptive leadership
team building
managing change
valuing and supporting teaching staff
delivering staff development.

In addition to our in-house leadership series, we have supported staff in attending national and international training events and conferences. For example, staff have attended and contributed to Harvard Macy courses, ASME, AMEE and the Ottawa Medical Education Conferences and Higher Education Academy Subject Centre events.

Developing the evidence base

Although we have a long history of evaluating the medical curriculum at Southampton, we have only recently embarked on staff development specifically aimed at educational research activities. The Medical Education Division has recently set up a series of research seminars designed to encourage medical education research and we are currently looking at others ways of developing this area of our work

Recognition and rewards - providing a decent lunch!

Nearly all of our courses are voluntary and we always appreciate the time that busy people give to these events. We run sessions in comfortable venues with decent facilities and a good lunch. It's amazing the difference this can make! We try to develop a supportive group environment and model that learning can be fun. And, of course, we also award CPD points.

Evaluation and oversight

The staff development events are regularly evaluated through the use of end-of-event questionnaires with both closed and open sections. Most courses are very highly rated by participants and the evaluations regularly include positive comments such as:

"This has been the best course I have attended over the years to help develop my teaching progress and competency. Thank you."

In addition to the end of course happy sheets, we conduct follow-up questionnaires for key events to see how successful they are in the longer term. These follow-up surveys suffer from a low response rate but do seem to support the comments received at the end of events. Recently, we undertook more in-depth follow up of the TTD course, involving interviews with fifteen past- participants chosen at random from two previous courses. The interviews confirmed the findings from end-of-course questionnaires and provided additional evidence of the long-term benefits of the course.

It is more difficult to evaluate the effectiveness of staff development that is embedded in programme structures. However, we have an Education Staff Development Committee which oversees the wide variety of staff development that is on offer. This Committee is part of the education management structure of the School and includes representatives rom the different programmes.

Conclusion

In Southampton we are committed to a broad approach to staff development that includes a wide range of activities at different levels, offered by a range of different providers. We believe it is important to embed staff development as closely to the management and delivery of programmes as possible. We also recommend a negotiated approach to the design and delivery of staff development courses and that these courses should be as interactive and participatory as possible. We always encourage the involvement of students in the training of staff. Finally, we recommend that staff development events should be structured in a way that values the participants.

For more information please contact f.j.hill@soton.ac.uk

Acknowledgements

Thanks to all of the staff and students who contribute to staff development at the School of Medicine, University of Southampton.

Viperlib:A web-based library of images in visual perception

Peter Thompson, Senior Lecturer in Visual Psychophysics and Co-director of Viperlib, Rob Stone, Senior Experimental Officer and Co-director of Viperlib, and Elaine Pollard,Administrator of Viperlib, Department of Psychology, University of York

Can you remember what life was like before PowerPoint? In the space of a few years, all types of presentations - lectures, seminars and conference talks - have been transformed. Lecturers around the globe have struggled to transform their lecture courses from battered OHPs and cracked slides into shiny bright (and often garish) presentations. Conferences too have been transformed and now the laptop and data projector are essential for every presentation.

This technology allows a whole range of new possibilities in presentations; colour (of course), embedded film clips, sound files, animations and even boring lists can fly in from every direction. The problem is that you have to create the animations, find the pictures and draw the diagrams Ð and this all takes an enormous amount of time. However we noticed that some people have found that time and we found ourselves listening to talks and making a mental note to ask the speaker for that image or that film clip. It was then that the idea came to us that it would be wonderful if there were a searchable central resource, freely available for educational use, where we could collect images and animations that would drop into presentations.

Perhaps one reason why the idea appealed to us was that we work in the area of visual perception Ð the study of the visual system, its anatomy and physiology, and all aspects of our processing of visual information. Unsurprisingly pictures are particularly important in this area; pictures of the visual portions of the brain, pictures of visual stimuli used in experiments and pictures of visual effects like visual illusions. And so it was that the idea for the idea for Viperlib was born.

Getting off the ground

We realised from the outset that a successful project would need a lot of work. And work costs money. Fortunately we were successful in securing a £75k grant from HEFCE's Fund for the Development of Teaching and Learning, and our project could really take off.

The study of the visual pathways and visual perception is taught in departments of physiology, psychology, biology, medicine and even computer science. We realised that in order to be a success, our website needed academics to contribute pictures, visual effects, illusions and graphs to the project. The problem was how to encourage this altruism. Giving academics money was ruled out on two grounds. Firstly the project could not afford to pay for material, and secondly it is well- known that academics don't do things for money; that's why they're academics. The solution was, of course, a free T-shirt, emblazoned with Viperlib's snake logo.

Expansion and growth

Our Viperlib team was soon busy promoting the project at conferences and via email, and quickly received a tremendous response from vision scientists around the world. The Viperlib website was launched on the unsuspecting world in August 2003.

The site grew rapidly and continues to develop and thrive: at the time of writing (August 2006) we have nearly 2,800 images with well over 3,000 registered users. Each month, the site regularly has around 2,000 unique visitors, who collectively manage to make 200,000 monthly hits. The statistics make fascinating reading. (Why is the site overwhelmingly popular in Japan one month and in Hungary the next? Why did usage suddenly leap on that Tuesday in February? HavenÕt people got anything better to do with their Sundays?) Detailed analysis of the statistics would be a rewarding project in itself.

Of all the problems we encountered in the early days perhaps the knottiest of all was the question of copyright. Many contributors kindly sent us images that they had scanned from journals and textbooks. Even if this practice is legal for your own personal use it probably isnÕt legal to put such images on a web-site like ours. Just as an example, HolbeinÕs painting of The Ambassadors is of interest to people working in visual perception because of the image of a skull hidden by distortion at the bottom of the painting. The National Gallery in London, who own the painting have a photo of it on their web-site and they hold the copyright for the photograph. I think that the painting itself is not subject to any copyright but taking your own photograph of the painting in the gallery is not allowed. The National Gallery allows personal use of their image, defining personal use as non-commercial, domestic use by an individual involving the making of only single copies of each digital image. A quick search on Google Images reveals over 330 sites displaying the picture. A similar search for the Mona Lisa finds over 31,000 sites...

We took the decision early on that we must make sure that all our images were legal. However dealing with issues of copyright, data protection, agreements, permissions, conditions of use and associated record-keeping has taken far more time than initially anticipated. Our advice to anyone undertaking a similar project would certainly be not to underestimate the thorny issues around copyright and the time and organisation needed to obtain all the necessary permission and conditions of use.

How Viperlib works

Users who are looking for specific items can search for images by keyword, contributor, description, file format or filename. For those simply curious to see what's on offer, the images are categorised in subject areas to facilitate browsing through the collection. Each image is associated with metadata. Search results are presented as a series of thumbnail images which can, if the user chooses, be accompanied with a brief description. Clicking on a thumbnail produces a full downloadable view with more detailed information. For example a full acknowledgement, the description, any references, links to sources of further information and perhaps some additional related images. Users must register and accept conditions of use before gaining access to the full-size high-resolution images.

Very often the images in the collection come from individuals or organisations with their own website containing other material of interest, so we have built up a useful collection of links to associated websites, journals, organisations and conferences in the field.

Viper2go

Viperlib has quickly become a highly successful, shared international resource provided by experts for experts. However, as the project progressed, it became clear that the concept could be enhanced to create valuable eLearning materials. Viperlib images are accompanied by the briefest of details, which (while perfectly adequate for experienced vision scientists) can provide a rather sparse environment from the viewpoint of learners and nonspecialists.

A small grant from the Higher Education Academy's Psychology Network has enabled us to develop the site further by constructing value-added tutorials from the raw ingredients of the Viperlib collection: complete tutorial sessions targeted at undergraduate or postgraduate level. We think of these tutorials as being akin to a fast-food outlet, somewhere to pick up a ready made meal when you don't want to cook the ingredients yourself, and so we have dubbed the new venture Viper2go, with, of course, its own Viper2go logo, figure 5, and its own T- shirt for contributors!. We already have our first 25 tutorials and we are looking to expand Viper2go further.

The future

Although our original funding is now at an end, Viperlib is set to continue. We have just secured a generous gift from Microsoft of £25k which will allow us to correct all the mistakes that we now realise we have made in the project. Chiefly we want to simplify and rugged-ise the software underlying Viperlib. Primarily we want to reduce the day to day running costs of looking after the site, for example by allowing users to upload material more directly without any danger of destroying the site in the process. If we can reduce these running costs we can ensure the site's future.

And there's always the challenge of extending the site to cover other sensory modalities as well - we're actively looking at incorporating material on audition and the auditory pathways...

Conclusion

Visit the site at www.viperlib.com, take a look to see whatÕs available and let us know what you think. We have many plans for future development of the site but we welcome all ideas and comments, so do get in touch at info@viperlib.com. If you see anything thatÕs wrong, we need to know about that, too!

Viperlib is a non-profit project: no payment is made for material provided, and images are held only as a collection for use as an educational resource. Reproduction or distribution of items for commercial purposes is prohibited.

We have learned many lessons that might be of value to anyone who might want to set up such a resource in other subject areas. We would be happy to pass the information on, but it'll cost you a T-shirt...

For more information please contact pt2@york.ac.uk or info@viperlib.com

Medicine and surgery without blood transfusion study guide: Facilitating patient autonomy with a new standard of care

Dr Shekar Bheenuck, Principal Lecturer, Faculty of Health and Social Care, Lynn Denning, Senior Lecturer, Faculty of Health and Social Care, and Lesley Moore, Senior Lecturer, Faculty of Health and Social Care, University of the West of England, Bristol; and David Smith, Hospital Liaison committee for Jehovah's Witnesses, Bristol

The study guide is designed to help professional practitioners handle cases where bloodless medicine or surgery is sought by a patient for religious or other reasons. Whilst there is emphasis on religious grounds for refusal, the principles and approaches advocated within the guide apply equally to other situations and arguments.

The study guide is a collaborative venture between the Faculty of Health and Social Care, University of the West of England, Bristol and the Hospital Liaison Committee (a committee representing the interests of Jehovah's Witnesses). Critical readers with specific expertise in critical care, ethics, and law contributed to the development of the guide. In addition two medical schools were consulted on the applicability of the guide for undergraduate medical education. An early version of the guide was piloted with nursing staff, from critical care settings, undertaking post-qualifying courses.

Aim of the guide

The aim of the study guide is to enable appropriate professional staff explore the medical and surgical techniques which are increasingly becoming available to deliver treatments without blood transfusion and to set these alongside issues of patientsÕ rights, personal autonomy and health care ethics. The guide draws on a number of case studies and activities to inform the decision making process helping practitioners to:

Understand why transfusion medicine is changing
Adhere to the principles of patient choice and autonomy
Identify and describe some of the available bloodless medical and surgical techniques
Understand fundamental legal and ethical principles informing patient choice
Consider the needs of patients who choose transfusion alternatives for religious or other reasons.

The changing context of blood transfusion

The transfusion of blood and blood components continues to represent a key element of hospital care throughout most parts of the world. In Britain between 3.0 and 3.5 million units of whole blood and blood components are administered annually. The costs associated with this provision for the UK in 2000-01 are calculated at £898m.1 In addition to the mounting costs of homologous blood transfusion there are also concerns about the associated health risks.(2),(3) A wide range of transfusion alternatives are now available. The drive to maximise blood conservation and develop the application of transfusion alternatives has been given further impetus by the decision of Britain's Department of Health in 2004 to exclude from eligibility to donate blood anyone who had received a blood transfusion after 1980. This followed the revelation that an elderly British man was the first person in the world to catch variant Creutzfeldt-Jakob disease from a blood transfusion rather than from eating meat. Other Department of Health initiatives are also contributing to the process of reducing use of allogeneic blood. The DOH Health Service Circular HSC 2002/009 (4) describes donated blood as a limited resource and urges Trusts to explore alternatives to blood transfusion.

Rationale for developing a study guide

The opening years of the 21st century see both patients and health care professionals living in an increasingly diverse world where values and beliefs conflict and can often cause complex dilemmas. Also with the appropriately increased focus on patient choice and autonomy in health care, the importance of reflecting the principles of informed, patient centred care in collaborative working has become paramount. Hence, within the context of the

Human Rights Act (1998) and the emphasis on patient centred care in the new NHS, informed decision making has become a priority. A long standing dilemma for health care professionals has been how to accommodate issues concerning life sustaining treatments, for example when a patient refuses a blood transfusion. Challenges of this nature may lead to tensions in professional decision making, particularly in emergency situations. With advances in medical science and technology there are now well recognised evidence based alternatives to blood transfusion. Patients may choose an alternative to blood for a number of reasons. Although in the past this has been primarily on religious grounds, informed patients are now likely to exercise their right to alternative treatments for a variety of reasons. Increased concerns amongst surgeons about the risks associated with blood transfusion, associated with the rising costs of the procedure, have resulted in a rise in alternative interventions.(5)

Using the guide

The guide is useful to all members of the multi-professional health care team involved in decision making concerning transfusion. Section one of the guide provides an introduction to and the rationale for considering transfusion alternatives. Section two provides an overview of the changing context of blood transfusion, section three explores blood conservation methods and alternatives to allogeneic blood transfusion, section four inquires into relevant ethical issues, whilst section five and six specifically focus on the needs of patients who seek bloodless medicine on religious grounds. Professionals can use the guide individually or in groups (uni- or inter-professional). Where the guide is to be used with a group it is advisable that an informed and skilled facilitator is available to lead the session and enable effective exploration of the relevant issues.

We hope to make the guide available to download. See www.medev.ac.uk for further news.

For more information please contact shekar.bheenuck@uwe.ac.uk

References

(1) Varney J, Guest J (2003), The Annual Cost of Blood Transfusions in the UK. Transfusion Medicine, 13, 4, 205-218.

(2) Berger C (2002), Science Commentary: Why is it important to reduce the need for blood transfusion, and how can it be done? British Medical Journal, 324, 1303.

(3) Smith W (2002), Major Surgery Without Blood Transfusion. Current Anaesthesia and Critical Care, 11, 42-50.

(4) Department of Health (2002), Better Blood Transfusion. London: HSC 2002/009.

(5) Gohel MS, Bulbulia RA, Slim FJ, Poskitt KR, Whyman MR (2005), How to approach major surgery where patients refuse blood transfusion (including Jehovah's Witnesses). Annals of the Royal College of Surgeons of England, 87, 3-14.

National teaching fellowship scheme: Call for project bids

The Higher Education Academy closing 23 October 2006

Teams can bid for funds to work with National Teaching Fellows for up to £200k, for use over a period of up to 3 years.

www.heacademy.ac.uk/ntfsprojects.htm

Patient safety in health care profession educational curricula: Examining the learning experience

Revd Dr Pauline Pearson, Deputy Head of School Reseach Associates, and Dr Alison Steven, School of Medical Education Development, Newcastle University

Patient safety is one of the new buzz-words of practice - but little is known about how people learn to practice safely. A collaboration of five institutions led by Newcastle University has been funded by the Department of Health (Patient Safety Research Programme) to undertake an exciting new research project into education for patient safety.

This two and a half year project is firmly based in educational theory and should give us some important insights into the ways in which patient safety and problems around patient safety are framed in different professions and in the academic, organisational and practice contexts.

Project aim

The overall aim is to study the formal and informal ways pre- qualification students from a range of healthcare professions learn about keeping patients safe from errors, mishaps and other adverse events (broadly known as patient safety).

Our objective is to identify, describe and try to understand things which influence the way in which students are taught about, and learn about, keeping patients safe, and the ways in which patient safety education translates into day to day practice.

Who is involved?

This national project focuses on four professional groups:

Medicine
Nursing
Pharmacy
Physiotherapy.

The following partner institutions are working in collaboration to carry out the study:

Newcastle University Revd Dr Pauline Pearson

University of East Anglia Professor Amanda Howe

University of Edinburgh Professor Aziz Sheikh

University of Manchester Dr Darren Ashcroft

University of Surrey Professor Pam Smith

Background

Education and training for health professionals needs to be designed to reduce mishaps and errors, and ensure the safety of patients. Education, be it formal or informal, is the key to how health care professionals think about, talk about and write about mishaps, errors and keeping patients safe (1).

There is however little research or other evidence explaining how thinking about patient safety can be effectively incorporated into health care education, either before or after qualification/registration. Evidence suggests that attention to safety, error or mishap in UK undergraduate/preregistration education is buried or hidden rather than being plainly obvious, and that practice varies for different professional groups (2). Many different professional groups are involved in providing patient care

(e.g. nurses, doctors, pharmacists, physiotherapists, radiographers). The situation is complex with each profession having their own education and training packages involving different types of:

teacher - university lecturers and clinicians
student - young, old, qualified, unqualified
setting - university, hospital, doctors surgery
environment - classroom, ward, office, patient's home.

Although formal, university or college based education is important, seeing it as the only solution to patient safety problems is likely to be of limited value as people learn things in many ways and in many situations. It would be useful therefore to identify the ways in which formal planned programmes of education translate into practice, and how ways of thinking, understandings and beliefs, related to keeping patients safe develop in different environments. Indeed what is learned informally, on the job during training or working may be more important than formal programmes of study in shaping attitudes towards error and safe practice. This study aims to develop an understanding of the ways in which professionals learn about error, mishap and keeping patients safe. It should offer a basis for future initiatives and is necessary if we are to understand the issues which influence teaching, learning and practicing patient safety in different contexts.

Theoretical framework

This study is based upon the work of educational theorist Michael Eraut (2) who refers to professional knowledge as being in three distinct contexts:

The academic (university or college) based upon written theories and principles which are taught and tested for in exams.
The organisational (management or policy) based upon agreed agendas and policies.
Practice (day to day working) based upon individual practitionersÕ experience and knowledge, accepted ways of working, ritual and tradition.

What is viewed as useful or valuable knowledge in one context may be seen differently in another. Eraut suggests that we learn from, formal planned education (undertaken in university or college or as part of ongoing studies) and from informal education (in all settings) which includes common ideas, ways of thinking, traditions, rituals and beliefs that are unwritten but form a part of our day to day life. This study is designed and structured around his three contexts. In this way the study will be linked to existing theory and will also help challenge and develop that theory.

Study design

A two phase design using multiple methods is being employed. In Phase 1 we will look at course content as planned, delivered and received. We will access a convenience sample of universities running traditional and innovative courses for doctors, nurses, pharmacists and physiotherapists, and gather examples of existing curriculum documents for detailed analysis.

In phase 2 we will explore organisational influences and how patient safety is undertaken in day to day working practice. This phase will employ an illuminative evaluation approach3 in up to 8 case studies of practice areas where students are sent for work experience or practice placements.

We will be contacting potential participants for the study in the next couple of months and look forward to meeting many of you during the project. If you have any questions, suggestions or queries please feel free to get in touch.

For more information please contact alison.steven@ncl.ac.uk or p.h.pearson@ncl.ac.uk

References

(1) McPherson K, Headrick L, and Moss F (2001), Working and learning together: good quality care depends on it, but how can we achieve it? Quality in Health Care, 10: 46 - 53.

(2) Eraut M (1994), Developing Professional Knowledge and Competence. Falmer Press, London.

(3) Parlett M, and Hamilton D (1977), Evaluation as illumination., in Parlett M, GD (ed.), Introduction to illuminative evaluation: studies in higher education. California, Pacific Soundings Press.

Workshop report: Case-led learning in veterinary education, preclinical years

Gill McConnell, Education Development Manager, University of Edinburgh

Dr Phil Bradley, Sub-Dean from Newcastle Medical School, led a lively and enjoyable workshop on case-led learning at the Royal (Dick) School of Veterinary Studies, Edinburgh, in April 2006.

Case-led learning is highly topical, with new curricula being developed in a number of veterinary schools, all with increased focus on vertical integration of clinical material into the early years of veterinary courses as well as horizontal integration between courses. The topicality ensured a full-house of 22 delegates from Edinburgh, Glasgow and Nottingham, with more who would have liked to attend.

During the workshop, delegates explored the educational uses of cases, shared experiences and then, using learning outcomes from preclinical subjects, devised case stories that could be used in a variety of contexts. There is no single way to use cases and examples included now familiar e-learning case studies, diagnostics classes and other clinical contexts. Possible applications include contextualising teaching, promoting discussion, promoting enquiry and problem solving, with cases providing proxies for realistic settings for situated learning. Cases should allow the learner to link in their prior knowledge and experiences, provide opportunities for elaboration of learning and offer appropriate closure.

Other important points that were drawn from the workshop included presenting cases in a story-telling way as opposed to merely relating a case history, or a clinical example at the end of a lecture. The introduction of the case at the beginning of a preclinical module, with every lecture referring back to it Ð even if only in passing Ð provides immediate motivation, particularly if the story appears authentic, is well told, with interesting characters and a measure of suspense. Cases should, of course, be appropriate to the learning needs of students, and not contain all the answers. The same story may be returned to later in the course in a number of contexts, right through to the clinical years.

This emphasis on story-telling certainly engaged the delegates, who, given more time, could have made a fair attempt at a complete novel. Those present were enthusiastic in expressing their thanks to Dr Bradley for providing such a useful and very enjoyable workshop.

For more information about the MEDEV workshop programme please contact nigel@medev.ac.uk or gillian@medev.ac.uk

Educational funding opportunities

Have you got an idea for an educational research project? Or perhaps you would like to try out an innovative approach to learning and teaching, but donÕt have access at your institution to sufficient funding or resources. If so, you might like to look at the funding opportunities section of the website: www.medev.ac.uk/resources/fundops/ where you will also find A Guide to successful bid writing and A Bid writers checklist.

We run a partner search service, matching up those with similar educational development interests. Email enquiries@medev.ac.uk for more information.

Forthcoming closing dates:

JISC capital programme call for project proposals. Joint Information Systems Committee Close date: 23rd November 2006

December 2006

1, Royal Society conference grants, The Royal Society

1, Dorothy Hodgkin fellowships The Royal Society

1, Grant application for participation in a business meeting of the ICSU family,The Royal Society

1, Knowledge transfer grant, RNID (Royal National Institute for the Deaf)

8, New graduate prize, British Society for the Study of Prosthetic Dentistry

10, Wyeth Education & Training Award, United Kingdom Clinical Pharmacy Association

15, International joint projects,The Royal Society

January 2007

1, Summer studentships/pump priming grants,Yorkshire Cancer Research

1, Wellcome Trust research resources in medical history,Wellcome Trust

1, Incoming fellowships - USA/Canada research fellowship,The Royal Society

31, Medical electives bursaries,Association of Commonwealth Universities

31, Philip Leverhulme prizes, The Leverhulme Trust

February 2007

1, Cochrane prize, Faculty of Public Health

28, Education partnership grants (schools), The Royal Society

The IVIMEDS approach to virtual patients

Dr David A Davies, Dr Stephen R Smith, Ronald Harden, Professor of Medical Education, Thierry Boucheny, Stephen Allan, IVIMEDS, Dundee

The International Virtual Medical School (IVIMEDS) is an international collaboration of leading medical schools. It offers a blended solution in which eLearning is combined with face-to-face clinical learning experiences. One of the educational components of the IVIMEDS approach is the Virtual Practice and Virtual Patients.

IVIMEDS has created a virtual practice with 69 virtual patients covering the key areas of medical practice. The virtual patients do not replace face-to-face clinical experience but provide a powerful adjunct and support for student learning. We have incorporated reusable learning objects (RLOs) including photographs, radiographs and other materials from the IVIMEDS repository to add clinical authenticity to our virtual patients. We believe that virtual patients may be useful in a range of educational applications.

Virtual patients provide a strong context for introducing interactive exercises to illustrate principles and concepts. For example, a computer-based interactive exercise on visual field disturbances is given a clinical content by forming part of the supporting material for a virtual patient who has suffered a stroke. Although the exercise can stand alone, when presented to the student as part of the Virtual Patient the clinical context is more strongly reinforced. In current virtual learning environments, students are free to select whether they access such supporting materials separately, or via the virtual patient, whichever is most suitable for their learning needs.

As the basis or framework for a curriculum, integrated virtual patients present with symptoms across the range of body systems and discipline areas. Individual patient visits to the virtual practice cut across horizontal and vertical curriculum themes. In this way a whole curriculum can be defined from the sum total of patient visits. Some schools are approaching this as an alternative approach to organizing the curriculum as well as integrating virtual patients into systems-based curricula.

The IVIMEDS approach to virtual patients is flexible and presentation of the patient is adaptable to meet the needs of the learning style. In a problem-based learning (PBL) course, access to supporting learning resources such as in the previous visual pathways example can be turned off by default, allowing students to use a conventional PBL approach to identify their learning needs based upon their interactions with the virtual patient. Students are then free to browse or search repositories of content to find learning resources to meet their own learning needs. In this way, virtual patients in the eLearning domain become a complement to more traditional learning approaches.

Anatomy of a virtual patient

We have developed our virtual patients using an XML information model to provide consistency and compatibility with other systems including the opportunity of sharing virtual patients with other groups. The XML records are converted to conventional web pages and so can run in any web browser. They are distributed either as simple IMS content packages or as SCORM objects. Our virtual patients are interoperable with all eLearning platforms that support these standards.

Our editing tool allows teachers to create virtual patients for their own curriculum context. Alternatively IVIMEDS partners may select one of more than 60 existing patients that have been carefully created to define the virtual practice curriculum.

For more information about IVIMEDS please visit www.ivimeds.org or contact enquiries@ivimeds.org

Conference report: Learning, teaching and assessing medical ethics

Kenneth M Boyd, Conference Chairman and General Secretary Institute of Medical Ethics; Professor of Medical Ethics and Director of Clinical Skills, Personal and Professional Development, College of Medicine & Veterinary Medicine, University of Edinburgh

How should medical ethics be taught and assessed? Around a hundred clinicians, academics and students from UK medical schools met in London in March 2006, to discuss the findings of a national survey of medical ethics teaching and learning. The conference was organised by the Institute of Medical Ethics, the British Medical Association, and the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine, and was supported by the Medical Defence Union.

Introduction

In a keynote address, Sir Kenneth Calman, Vice-Chancellor of Durham University and President of the Institute of Medical Ethics, observed that medical ethics education needed leadership at all levels and methods of learning and assessment relevant to its knowledge base. The key was investment in people, and collaboration between science, the arts and humanities.

Dr Karen Mattick of Peninsula Medical School, lead researcher of the national survey, presented its key findings. Responding on behalf of the General Medical Council, Dr Roger Worthington noted that knowledge of medical law and ethics was increasingly emphasised as a GMC requirement, and that the chair of the Shipman enquiry had stated that professional conduct and ethics must be taught from day one. It was a matter of concern therefore, that not every medical school yet had at least one dedicated subject specialist.

Workshops

In workshops on designing, delivering, and assessing medical ethics in the undergraduate curriculum, examples of good practice were shared and ways forward discussed. Among issues on which there was broad agreement were the following.

Designing the curriculum

The aims of medical ethics learning are both normative and critical. Tension in the curriculum, between formation and education, is unavoidable in practice-oriented medical education. Medical students moreover are not expected to become specialists in all of the scientific disciplines in which they must gain a basic competency.

The Core Curriculum of the 1998 Consensus Statement3 requires reconsideration. Questions now arising include:

What are critical skills in medical ethics and what teaching methods help students learn them?
How might the core curriculum be characterised in terms of an outcomes-based approach?

Delivering the curriculum

The ethics and law curriculum should be integrated with students' current learning in each undergraduate year and form a continuum with Foundation years 1 and 2. Attention should be paid to the hidden curriculum, and to where ethics learning is actually taking place: the ethics and law content of the curriculum should be mapped by consulting students and key clinical and basic science teachers. Small group work is optimal: interactive processes can be used effectively by trained facilitators even in large lecture groups. Portfolios can encourage ethical reflection.

Specialists in Medical Ethics and Law, of whom there should be at least 1.0 WTE in even the smallest medical school, should be appropriately resourced to lead curriculum development. Active in research or scholarship, they should be the champion for the topic area, with strong connectivity to senior staff within the school, medical ethicists at similar institutions, and clinical and non-clinical teaching staff. Since much of ethics learning is facilitated by interested generalists, mainly clinicians, who can serve as positive role models, this network needs to be appropriately identified, supported and developed by the specialists.

Assessing the curriculum

The quality of assessment is constrained in some schools by lack of resources, particularly of staff, and also by attempts to assess ethics learning with tools which are not wholly appropriate, but require less resource for marking. Assessment should be longitudinal, taking account of studentsÕ prior learning, ethical maturity and increasing levels of responsibility. Progress through the curriculum should require demonstration of competence in ethical awareness and consistent moral reasoning. Summative as well as formative assessment is necessary for this. The GMC should be encouraged to insist on evidence from medical schools that students' competence in this respect is being tested.

Medical ethics curricula involve assessing student understanding of what is expected of them in terms of professional development and fitness to practice, but assessment of fitness to practise itself is the responsibility of the medical school as a whole and not specifically of medical ethics teachers.

National resources are needed to support local initiatives. For example:

Web-based dissemination of case materials and course outlines
A national bank of assessment tools
An assessor training course as part of CPD or leading to a diploma for medical teachers interested in expanding their knowledge and skill in medical ethics.

Conclusions

Responding to the workshops, Professor Raanan Gillon, Chairman of the Institute of Medical Ethics, drew the conference to a close by securing general approval to the following recommendations.

Every medical school in the UK ought now to employ:

At least one full-time medical ethics academic to champion, coordinate and bring intellectual rigor to medical ethics learning, teaching and assessment.
A recognised supporting team of clinicians and scientists committed to integrating medical ethics teaching and learning throughout the curriculum

An updated consensus on the core curriculum in medical ethics and law should be developed.

The Institute of Medical Ethics, in consultation with the BMA, the Higher Education Academy and the MDU, should convene a working party of stakeholders to enquire into medical ethics and law learning, teaching and assessment, and should seek funding to create a national web-based network, organise further conferences and develop learning packages and a data base of assessment tools.

For more information please contact

kenneth.m.boyd@dial.pipex.com

References

(1) Mattick K, Bligh J (2006), Teaching and assessing medical ethics: where are we now? J. Med. Ethics 32:181-185.

(2) Mattick K, Bligh J (2006), Undergraduate ethics teaching: revisiting the Consensus Statement. Medical Education 40: 4: 329-332.

(3) Ashcroft R, Barton D, Benatar S, et al. (1998), Teaching medical ethics and law within medical education: a model for the UK core curriculum. J. Med. Ethics 24: 188-192. teaching and assessment.

Understanding Medical Education

Understanding Medical Education is a series of extended papers designed to meet the needs of all newcomers to medical education whether undergraduate or postgraduate, including those studying at certificate, diploma or masters level. It provides an authoritative, up- to-date and comprehensive resource summarising the theoretical and academic bases to modern medical education practice.

Contemporary in style,easy to read and above all,useful. After reading a publication in the series the reader should not only be better informed about their field of interest but be able to assimilate their new knowledge into their clinical teaching or academic activities.

Principles of curriculum design - Janet Grant

eLearning - Jean McKendree

Supervision, mentoring and coaching - John Launer

Teaching and leading small groups - Peter McCrorie

How to design a useful test - Lambert Schuwirth and Cees van der Vleuten

www.asme.org.uk/pub_ume.htm

Forthcoming educational events and conferences

Further details on these and other forthcoming educational events and conferences are available from

www.medev.ac.uk/resources/events

Subject Centre workshops are listed at

www.medev.ac.uk/resources/meetings/workshops

These fill up very quickly after they are announced via the mailing list, which you can join at

www.jiscmail.ac.uk/lists/medev.html

October
17th		Tackling plagiarism, collusion and cheating in HE Changing cultures and sharing good practice
18th		Practice development, action research and reflective practice, 6th international conference
19-21st		Improving quality in teaching & learning: Developmental work and implementation challenge, 1st European conference on practice based and practitioner research
19th		SEDA fellowship briefing and development day
20th		SSelf forum: Organisational change, culture and learning
20th		TASI: Building a departmental image collection
20th		Psychology in medicine (PIM) network meeting
22-25th		MLearn 2006
25th		Research-based learning in higher education: The Warwick experience
25-29th		Professional and organizational development conference
26th		Part-time study in higher education
27th		TASI colour management
November
3rd		Assessing interprofessional learning
3-5th		Communication summit for veterinary medicine professionals
6th		Optimising the contribution that service users and carers can make in learning and teaching
8-9th		Staff development conference
8-9th		UCISA-CISG 2006: Learning from others
9-12th		The 3rd annual meeting of the International Society for the Scholarship of Teaching and Learning (ISSOTL)
10th		Mental well-being and learning: Exploring the connections)
13th		MMC conference 2006:The future of medical training
14-15th		An introduction to evidence-based practice Tuesday, 14 November 2006 to Wednesday, 15 November
15th		Joint BeSST / ToPToP meeting to discuss core curriculum in progress
15th		The Times Higher awards 2006
16th		Making management work:A course for practising managers
16th		Health Sciences and Practice special interest group: Problem-based learning
17th		TASI introduction to image metadata
21st		Mapping educational development: Locations, boundaries and bridges
24th		TASI rights and responsibilities: Copyright and digital
27th		Health Sciences and Practice special interest group: Interprofessional education
27th		Development in HR and employment
27-29th		Transformations conference 2006: Culture and the environment in human development
28th		New chairs and deputy chairs workshop
28th		Duty of care for under 18s: Implications of the safeguarding vulnerable groups and age discrimination legislation for higher education institutions
29th		IV international conference on multimedia and ICTs in education (m-ICTE2006)
29th		Creative applications of OSCEs in health professional education
30th		Key performance indicators in measuring institutional performance
30-31th		UVAC annual conference 2006: Putting work based learning into practice
December
4-15th		An introduction to management for staff in computing, library and information service departments
5th		Health sciences and practice special interest group
7-8th		Going global 2:The UKÕs international education conference
7th		Alternative approaches to educational research conference
7-8th		Leadership development centre
8th		SSeLF forum: Personalisation of learning
10th		Health Sciences and Practice special interest group: Ethics
12th		Learning clinical and communication skills for practice
12-13th		Beyond Boundaries, new horizons for research into higher education, SRHE annual conference 2006
13th		Multisource feedback.Association for the study of medical education
13th		Effective eLearning: IT is about pedagogy as well as technology
19th		Preparing for academic practice
January 2007
4th		The third international conference on environmental, cultural, economic and social sustainability
8-10th		Creativity or conformity? Building cultures of creativity in higher education
15th		Principles of teaching and learning
15th		Assessment, examinations and standard setting
15th		The curriculum

Workshop programme

Our workshops are open to anyone involved in learning and teaching in undergraduate medicine, dentistry and veterinary medicine. They all attract CPD points and there is currently no charge for attendance.The key feature of our programme is that workshops are all designed and delivered by members of our constituency and thus reflect current concerns in the field.

Details of the workshops are available on our website and we place new ones on the site as soon as dates and venues have been finalised, so keep an eye on our website to see if there is something of interest to you. We also send email notification of each workshop to everyone on our mailing list as soon as it is finalised. If you are not on our contact list and would like to receive information about our workshops as well as our regular monthly update on current issues, funding opportunities etc then please go to www.jiscmail.ac.uk/lists/medev.html or email enquiries@medev.ac.uk

To book your place on any of our workshops fill in a registration form online.

www.medev.ac.uk/resources/meetings/workshops/

The following workshops are currently open for booking on our site:

October
11th	Developing consenting skills in dentistry, London
18th	Curriculum maps: what are they and why would we want one? York
23th	A health policy master-class for senior managers, Belfast
November
30th	Standard setting for undergraduate examinations: a beginners practical guide, London
March 2007
29th	Innovation and integration: learning and teaching in the new medical schools, Brighton

Future workshops

Eight new workshops were approved following the May 2006 round of proposals. As usual, the quality of applications was very high and we are very grateful to all those who took the time and trouble to enter proposals. At present we have fourteen workshops planned for the next academic year.

Tools for feedback, Leicester
Developing the resource archive for teacher trainers,York
Moan, moan, moan. Complaints from students; opportunity, threat, or just a pain in the neck?, Manchester
Students in difficulty - the role of the personal tutor, Leeds
Developing a common vision. The development and the delivery of the student selected component (SSC) of the medical undergraduate curriculum, Liverpool
Two linked workshops on the scholarship of learning and teaching,TBA
New external examiners - a practical survival course, London
Teaching and assessing patient centred professionalism in the undergraduate curriculum, London
Integrating spirituality into undergraduate medical education,Warwick
Safe communication skills education for health care practice, Dundee
Essential skills for problem based learning and clinical competence, Manchester
Introduction to on-line assessments for learning and assessment, Oxford
Bringing the patient voice into learning and assessment, Leeds

These will appear on the website as soon as dates and venues have been finalised.

The Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine

School of Medical Education Development, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom, T: +44 (0)191 2225888, F: +44 (0)191 2225016,

enquiries@medev.ac.uk, www.medev.ac.uk,

Our mission is to work with institutions, discipline groups and individual staff to provide the best possible learning experience for all students postgraduate as well as undergraduate. We also work with the governments of the UK and their funding bodies to create the best policy environment to enable this to happen. We provide an authoritative and independent voice on policies that influence the student learning experience.

Discipline-based support is provided through the Academy's Subject Network of 24 Subject Centres. These are a mix of single-site and consortium-based centres located within relevant subject departments and hosted by higher education institutions.

Resource groups

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For staff new to teaching (14)
For staff undertaking educational cpd (6)
For students (49)
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MEDEV is part of the Subject Network of the Higher Education Academy

The Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine School of Medical Sciences Education Development, Faculty of Medical Sciences, Newcastle University, NE2 4HH

enquiries@medev.ac.uk
twitter.com/hea_medev
+44(0) 191 222 5888

01.12 The newsletter of the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine, Autumn/Winter 2006

In this issue

Welcome!

Contents

Funding available to support online communities of practice (up to £3k each / ~£10k available

Tell us about how you use technology in your teaching and you could win either:

1st Prize

2nd Prize

Bidding for workshop funds

UK Council for Communication Skills Teaching in Undergraduate Medical Education - forming a community of practice

The launch of Intute: Health and Life Sciences

Why change?

What does Intute: Health and Life Sciences have to offer?

How can you work with Intute: Health and Life Sciences?

What else does Intute do?

What does the future hold?

Measuring educational and training environments as part of QA

Medical ethics, seminars and the virtual environment

Ethics teaching at Leeds Medical School

The future

Rewarding excellence in learning and teaching 2006/7

Win FREE registration at educational conferences!

Higher Education Academy student essay prize 2006: How does your course compare with any expectations you may have had?

The winning essays from Medicine, Dentistry and Veterinary Medicine

WINNER Farai Nhembe

RUNNER UP Nearea Fletcher

Congratulations to the winners of the Rewarding Excellence in Learning and Teaching Competition 2006

Unlocking virtual patients

Virtual patients

However...

The MedBiquitous virtual patient

References

RCVS introduces new modular postgraduate certificate for 2007

History of the current RCVS certificate

Structure of the new modular postgraduate certificate

Professional key skills

Benefits for the candidate

Benefits for the provider

Accreditation process

Staff development initiatives at the School of Medicine, University of Southampton

Our main approach - embedding staff development

Teaching Tomorrow's Doctors

Negotiated leadership training

Developing the evidence base

Recognition and rewards - providing a decent lunch!

Evaluation and oversight

Conclusion

Acknowledgements

Viperlib:A web-based library of images in visual perception

Getting off the ground

Expansion and growth

How Viperlib works

Viper2go

The future

Conclusion

Medicine and surgery without blood transfusion study guide: Facilitating patient autonomy with a new standard of care

Aim of the guide

The changing context of blood transfusion

Rationale for developing a study guide

Using the guide

References

National teaching fellowship scheme: Call for project bids

The Higher Education Academy closing 23 October 2006

Patient safety in health care profession educational curricula: Examining the learning experience

Project aim

Who is involved?

Background

Theoretical framework

Study design

References

Workshop report: Case-led learning in veterinary education, preclinical years

Educational funding opportunities

Forthcoming closing dates:

December 2006

January 2007

February 2007

The IVIMEDS approach to virtual patients

Anatomy of a virtual patient

Conference report: Learning, teaching and assessing medical ethics

Introduction