01.19 The newsletter of the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine, Summer 2009

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

Print: ISSN 1740-8768

Online: ISSN 1479-523X

IN THIS ISSUE:

Assessment focus
A focus on animal health programmes and collaboration
Ethics and legislation

01 is published three times a year by the Subject Centre for Medicine,Dentistry and Veterinary Medicine (MEDEV), part of the Subject Network of the Higher Education Academy. We are a publicly funded service, providing UK-wide support and services for higher education in medicine, dentistry and veterinary medicine.Details of our activities are available on our website: www.medev.ac.uk

As well as updates on MEDEV work, 01 features a wide range of articles on topics relating to medicine, dentistry and veterinary medicine.We welcome contributions. If you would like to submit an article (of between 500-1000 words), propose a book review or respond in a letter to an article published in 01, please contact the editor, Suzanne Hardy (suzanne@medev.ac.uk).

Views expressed in 01 are those of the author and do not necessarily represent those of MEDEV. Website links are active at the time of going to press.

Collaboration is the key to learning
Caroline Bell, Sarah Sherman, Bloomsbury Colleges; and Nick Short, eMedia Unit, Royal Veterinary College
Using transparency of assessment criteria with self-assessment to improve student performance in a dental practical skills examination
Jenny Good and Lorna Dysart,Teaching Fellows in Restorative Dentistry, School of Dentistry,Queen’s University Belfast
**A postgraduate certificate in education for dentists: A ‘first’ for Beds**
Trevor Austin, Peter Cranfield,Dr John Sweet and Clare Morris, Bedfordshire and Hertfordshire
Postgraduate Medical School, University of Bedfordshire Using the SLICE model to teach legislation in medicine
Dr Daniel M Bennett, Royal Cornhill Hospital,Aberdeen
The knee bone connected to the thigh bone: Teaching anatomy to engineering students using anatomical software
Dr Tom Joyce, Centre for Rehabilitation and Engineering Studies, School of Mechanical and Systems Engineering, Newcastle University
Miniproject report: Teaching in veterinary public health
Malcolm Cobb, Professor of ComparativeVeterinary Medicine, School ofVeterinary Medicine and Science, University of Nottingham
Using a website to promote best teaching practice in medicine and dentistry
Dr Jennifer Cleland, Medical Education Research, University of Aberdeen
Conference report: Medical ethics and law
Dr Carolyn Johnston and Elaine Paris, School of Medicine, King’s College London
Launch of new veterinary nursing and bioveterinary science degree programme
Dr Frank Taylor, Department of ClinicalVeterinary Science, University of Bristol
Developing stage-specific, consistent, reliable and valid learning, teaching and assessment methods for PolyProfessionalism in the health professions
Sue Roff,Dr Sean McAleer, Dr Madawa Chandratilake and Kabir Dherwani, Centre for Medical Education, Medical School and John Gibson, Dental School, University of Dundee
How can we improve the numeracy competencies of students studying animal related qualifications?
Dr Catherine Douglas,Agriculture, Food & Rural Development and Dr Bill Foster, Mathematics & Statistics, Newcastle University
Miniproject report: Teaching, learning and assessment of law in undergraduate medical education
Judy McKimm,Visiting Professor of Healthcare Education and Leadership, and Michael Preston-Shoot, Professor of SocialWork and Dean of the Faculty of Health and Social Sciences, University of Bedfordshire
Workshop report: Towards common standards. Issues and possibilities in collaborative assessment in veterinary education
Susan Rhind, Professor of Veterinary Education, Department of Veterinary Pathology, University of Edinburgh
Conference report: Medical students and professional behaviour
Dr Megan Quentin-Baxter, Subject Centre for Medicine, Dentistry and Veterinary Medicine
Medical students and lifelong learning: The journey starts here!
Victoria Silverwood, Carla Swift, Sarah Peters, James Whitehurst and Andrew Higgins, 2ndYear Medical Students, Keele University and David Brigden, Professor of Health Sciences Education, University of Chester, and the Educational Development Unit, University of Bolton
Assessment and learning without boundaries: A mobile assessment and e-portfolio system
Ceri Coulby, Educational Staff Development Officer; and Nancy Davies, Learning Technologist,ALPS CETL, University of Leeds

Collaboration is the key to learning

Caroline Bell, Sarah Sherman, Bloomsbury Colleges; and Nick Short, eMedia Unit, RoyalVeterinary College

The development of new web 2.0 technologies has encouraged the higher education sector to utilise some of these tools to support collaborative learning. The Royal Veterinary College (RVC) is currently leading a JISC funded APT STAIRS project (Appropriate & Practical Technologies for Students, Teachers, Administrators and Researchers) which aims to identify the real needs of users and how innovative but simple web solutions can help enrich teaching, learning and research practices.

The RVC works closely with five other Bloomsbury colleges (Birkbeck College, Institute of Education, London School of Hygiene & TropicalMedicine, School of Pharmacy, School of Oriental and African Studies) on eLearning development. This includes sharing a common Blackboard externally hosted platform and working together on examples of best practice such as podcasting and content management systems. In January 2008 the group started work on a JISC-funded APT STAIRS project under the Users and Innovation programme. The aim was to utlise new ‘Web 2.0’ tools to help different user groups (e.g. lecturers, students and researchers) adopt new collaborative working practices.

The project worked with the JISC Users and Innovation Development Model (UIDM) to help understand users' approaches to technology for work and study. This initially involved conducting a Bloomsbury-wide web use survey to collect data and help identify the different types of web user in the colleges. It was clear from this initial research that there was a wide diversity in competency between and also within user groups. So whilst most students were familar with podcasting, the majority of staff had never listened to a podcast.

The final stage of APT STAIRS has been to capture successful innovative approaches and see how their impact could be extended. Once again using the UIDM the project team have worked on extending and adapting the existing applications to better suit the needs of the users. For example this has included everything from developing systems to embed and Google apps within Blackboard to creating simple sets of templates for use by students.

For example, we used the UIDM approach to identify possible innovations that would be of value to users. Out of these, seven demonstrator projects were selected from across the colleges to pilot different approaches but all using collaborative technologies based around Google Docs. For example, the library at the RVC piloted managing the process of ordering new stock and collecting book suggestions using a collaborative spreadsheet, shared between librarians across two sites. Another project involved Birkbeck students using notebook laptops in laboratories to record results from experiments straight into a shared spreadsheet. The whole class is able to view collected data instantly and easily, being able to discuss results immediately with the lecturer.

The APT STAIRS project has been judged as a significant success in terms of achieving its aims and engaging stakeholders in working together online. The funded project comes to an end in March 2009 but many of the collaborative practices have already become embedded in day to day teaching and learning. Anybody wishing to find out more about the project should visit the web site at www.bloomsbury.ac.uk/apt For more information contact: clbell@rvc.ac.uk, ssherman@rvc.ac.uk or nshort@rvc.ac.uk

Using transparency of assessment criteria with self-assessment to improve student performance in a dental practical skills examination

Jenny Good and Lorna Dysart,Teaching Fellows in Restorative Dentistry, School of Dentistry,Queen’s University Belfast

Having taught and examined one cohort of students in the Dental Clinical Techniques module we were concerned with the low pass rate (45%), at the first attempt, in their practical skills exam. Our aim was to improve the pass rate by increasing the transparency of the assessment criteria.

Theory and methods

The Clinical Techniques module is the first significant exposure that third year dental students have to the practical aspects of the dental course and they learn how to use drills and hand-instruments for the first time. The new skills are practised on plastic teeth and students must pass the module before they are allowed to treat patients. The module runs throughout September, October and November of Third Year.

The assessment for this module takes three forms: - continuous assessment of procedures carried out during each teaching session; - a written short answer exam paper; - a practical skills examination.

Traditionally the assessment of the practical skills examination involved the students being told, two weeks in advance of their exam, the nature of the procedures that they would be asked to perform on the day. They were also given a brief guide of what mistakes would be counted as minor or major errors. The pass rate for this exam was 45%, at the first attempt, in 2006.

During 2007 we were both at different stages of writing up assignments for a Post Graduate Certificate in Higher Education Teaching and had been considering the issue of transparency of assessment in the practical skills examination. We found ourselves asking the question – ‘What could be done to help students achieve pass grades in their practical exam at their first attempt?’

We were very interested to read in Rust1 that ‘giving students explicit assessment criteria alone is unlikely to result in them producing better work’. He goes on to say that at the very least the criteria should be thoroughly explained to the students but that it would be much better to give the students a chance to actually apply the criteria to pieces of work before they undertook the assessment for themselves. Rust reveals that ‘a research study has shown² that this can significantly improve the students’ performance when they subsequently undertake the task, and that this improvement continues in other similar pieces of work in which similar criteria are used at least a year later’.

The part of the above sentence which we have highlighted in bold is of particular relevance to the assessment of the practical skills examination during which the students prepare and restore two cavities. The intended learning outcomes for the module, however, clearly state that they should be competent in their techniques for five different cavities. If the students can perfect the art of applying the assessment criteria to their own work then it follows that this can be done for any cavity or restoration that they are required to undertake. Moreover, as there is a time lapse between passing the practical skills examination and actually getting to treat patients on the clinics, it would be beneficial if the skills learned through critical assessment of their own work could remain with them indefinitely.

We thought that applying Rust’s¹ recommendations with regard to transparency and self-assessment may help the students to attain better grades in their practical exam and decided to draw up a self-assessment sheet for the students to use during their practice sessions leading up to the practical test. The sheet included all the marking criteria that we would use when marking the students in their practical test. It clearly denoted which faults would be considered as minor or major and what combinations of these would result in failing the test. The selfassessment purpose of the sheet was outlined clearly on the front page.

The criteria were fully discussed with the students and ample time was given for explanation of any points that then still remained unclear. Particular attention was paid to explaining how marks could be gained and lost. The students were encouraged to use the sheets as a form of formative self-assessment in the weeks leading up to their practical exam. This was done in an attempt to nurture the self-reflective skills of the students, reduce their reliance on their teacher’s evaluation of their work and promote life-long learning.

Results

Following the practical exam the 2007 results were compared with those of the 2006 cohort. It was found that 55% of the students passed all four procedures on their first attempt (a 10% increase on 2006). Throughout the course, the students had been taught in exactly the same way, by the same teachers, using exactly the same equipment as their 2006 cohort. The practical test was marked by the same examiners in both years. The only variables were the students themselves and the new selfassessment practice sheets.

When considering the improvement in test results achieved by the 2007 cohort, it is important to acknowledge the fact that, as a cohort, they may have had better practical skills to start with than the previous cohort of students. However, the selection procedure for students entering first year, and the curriculum for first and second year students, was the same for both cohorts. It could, therefore, be assumed that their practical abilities should be comparable.

The students completed a feedback paper with respect to their experience of using the self-assessment sheet. It was clear that the students recognised the benefit of the selfassessment sheet, along with the transparency of the assessment criteria. 100% of students felt that being able to see the marking criteria for the practical test, in advance of doing the test, was helpful and that using the sheet as a self-assessment aid had helped them to better prepare for the test. The reasons that they gave have been summarised here.

Knew exactly what examiner was looking for.
Could easily identify where marks were being lost.
Focused mind on what was important.
Clarified ideal properties of preparation and restoration.
Able to focus revision towards criteria on sheet.
Helped you become better at recognising your weaknesses.
Allowed me to see if I was doing the same thing wrong each time.
Through repetitive use of the marking sheet, the ‘goals’ for the perfect cavity and restoration became easier to remember.

Our thanks goes to Dr Christina Mitchell, Consultant and Senior Lecturer in Restorative Dentistry, for all her help and guidance during the Clinical Techniques module and the preparation of this report.

References

Rust, C. (2002). The impact of assessment on student learning. How can the research literature practically help to inform the development of departmental assessment strategies and learner-centred assessment practices?, Active Learning in Higher Education 3(2): 145- 15.
Price, M., Rust, C., Donovan, B. (2003). Improving students’ learning by developing their understanding of assessment criteria and processes, Assessment and Evaluation in Higher Education, 28(2): 147-64.

For more information contact j.good@qub.ac.uk

A Postgraduate Certificate in Education for Dentists: A ‘first’ for Beds

Trevor Austin, Peter Cranfield, Dr John Sweet and Clare Morris, Bedfordshire and Hertfordshire Postgraduate Medical School, University of Bedfordshire

Staff from the BHPMS responded to a growing number of requests from dental professionals to provide a dedicated education course, to meet their educational development needs, extending what is covered in the one year Vocational Training (VT) Primary Dental Care programmes for newly qualified dentists. Dental Vocational Trainees are fully qualified dentists, able to work in private practice, who must complete VT before working in the NHS.

A PgCert in Dental Education that was sensitive to ‘dental’ cultures and practices (c/f medical or clinical education courses), and would foster the development of a community of practice¹, was developed in consultation with senior staff and Vocational Trainers from the East of England Deanery, and academic colleagues from across the UK. It recognises that the teaching of dentistry and the effective supervision of trainees in dental practices requires a set of skills that reflect the special features of the dental environment, such as teaching at the chairside, utilising the dental environment for learning and developing learners through the assessment of their clinical skills.

The course team was particularly mindful of two contrasting views of staff development, that:

teachers learn their craft best within and through their discipline (practices, cultures and the knowledge base should directly influence the way in which a discipline is taught);
teaching is a craft that exists outside its disciplinary base and can be taught or acquired in a generic way, usually alongside other novice teachers from a range of disciplines.

One module delivered by and to a group of dentists focuses on workplace teaching skills, learning and assessment. Another, with a more theoretical focus, includes dentists, doctors, vets, nurses, midwives, osteopaths and others.

Twenty (mainly) Vocational Trainers were recruited in year one from across the eastern region. The Regional Adviser was 'thrilled with the way in which academic staff at BHPMS took up the challenge of developing an educational course specifically for dentists and by the speed with which places on the course had been filled'. Recruitment to the programme next year will broaden to academic dentists and dental care professionals with a role in education.

References

www.ewenger.com/theory/

Using the SLICE model to teach legislation in medicine

Dr Daniel M Bennett, Royal Cornhill Hospital, Aberdeen

**In 2008 Roff published the Structured Learning in Clinical Ethics (SLICE) model in 01.¹ This article describes how the SLICE model could be used within the undergraduate curriculum to teach on the ethical use of legislation in medicine. The conflict between the ethical principles of beneficence and respect for autonomy is a feature of everyday psychiatric practice although has much wider relevance.**

Within the University of Aberdeen undergraduate medical curriculum final year students have integrated teaching in psychiatry and general practice and ethical dilemmas are covered in that forum. The SLICE model is concerned with the areas of conscience, compliance, concurrence, conversation and conversion. The first element conscience refers to the individual’s sense of moral and ethical issues and developing a position on these issues. The remaining topics are intended to stimulate the student to develop in this area and it would not be addressed individually but during the overall experience.

Compliance is the area of practice which ensures that the doctor operates within the legal and social framework.
Concurrence is the aspect where the students are required to practice alongside others who may have differing points of view.
Conversation is that aspect of ethics where the student ascertains the views of others through conversing with them.
Conversion refers to accepting and incorporating others’ views, and basing a decision on the clinical benefit.

Outline of teaching programme

Learning objectives

To revise knowledge of the ethical principles guiding medical practice.
To develop knowledge of the philosophical basis of using legislation.
To develop knowledge of relevant legislation.
To develop skills in applying relevant legislation.
To develop skills in communicating decisions to patients and healthcare team members.

Competences

Knowledge:

principles of autonomy, justice, beneficence and nonmaleficience;
philosophical basis for use of principles and legislation;
relevant legislation.

Skills; to:

develop skills in interviewing with a view to using legislation;
consider information gained from the patient interview and how this is compatible with legislation;
complete the paperwork to utilise legislation;
ascertain and consider the views of the healthcare team, patient, family and others to decide upon using legislation.

Attitudes; to:

consider personal views towards using legislation;
acknowledge the views of others and incorporate these.

Components

Introductory session led by Consultant Psychiatrist (Course Leader) outlining the teaching programme, learning objectives, revising the principles of medical ethics and setting the scene for the conflicts which arise in practice using a vignette.
Interactive lecture with the Professor of Moral Philosophy outlining the philosophical basis of medical ethics and the principle of autonomy in particular, developing into a discussion of the circumstances in which this principle may require to be overridden and another session on the philosophical basis for using legislation to do so.
Session with Consultant Psychiatrist, Solicitor (specializing in Mental Health Law) and a Mental Health Officer (Social Worker) to deliver information on practical uses of the legislation used focusing on the potential ethical conflicts raised when using these pieces of legislation (Mental Health (Care and Treatment) (Scotland) Act 2003, Adults with Incapacity (Scotland) Act 2000 and special situations such as the Public Health etc. (Scotland) Act 2008)², ³, ⁴ in clinical practice.
Small group session facilitated by teaching staff on the issues raised by the sessions on philosophy and legislation.
Small group sessions with feedback using actors to develop the necessary skills.
Whole group debate, in teams, on the topic ‘This house believes that the Mental Health Act is ethically unjustified and should be repealed’.
Students submit a 1500 word essay exploring their views rather than a predefined debating position. Written feedback on performance provided for the essay and debate is provided.
Final session with the course leader to provide feedback, clarification and suggest ways in which learning needs generated by the teaching programme can be addressed.

Assessment methods

Formative assessment by the tutor leaders in the small group aspects of the teaching programme are fed back to the students at the end of each session. Students also receive feedback on their performance in the group sessions from the actors. Summative assessment combines the marks from the final debate session and essay submission. The debate mark will be contributed to by the group assessing the contribution of each student to the team. The debate contribution is assessed using a structured protocol. This is 50% of the mark for the course. The remaining 50% will be from the essay submission which will be graded using a structured protocol.

The end of year OSCE and written exams contain elements pertaining to clinical ethics teaching.

Within this teaching programme compliance is addressed in all sessions. The issue is introduced by the course leader in the introductory session; there is a multidisciplinary session which covers the specific knowledge objectives relating to the legislation. These knowledge objectives are then developed in the small group sessions using feedback and tested in both the debate and the written essay component.

The multidisciplinary nature of the sessions ensures concurrence by providing a number of points of view which stimulate an understanding of the different attitudes and points of view. The students learn to establish the views of the patient, their family and the wider team in the sessions with the actors and incorporate these into their decision making. Particular emphasis is given to this in these sessions as these are important principles in both the Mental Health and Adults with Incapacity Acts.

The students are given the opportunity to develop the conversation aspect of the SLICE model in small group sessions with actors allowing them to practice skills in both eliciting and giving information whilst respecting the other person’s point of view. Conversation is also necessary in the debate. This is element may be incorporated into the essay submission.

Conversion is encouraged in all parts of the programme and is particularly developed in the small group sessions where the patient, family and healthcare team played by actors will have differing views on how to proceed. The student will also be allowed the opportunity to discuss the theoretical underpinnings with the academic lecturers and convert these into appropriate clinical tools.

Using the SLICE model it is, therefore, possible to produce a package of teaching on a clinical ethics topic which covers knowledge, skills and attitudes. I also hope that the style used can be used by others to develop teaching packages on ethical topics.

References

Roff, S. (2008). Transplantation ethics for the 21st century: Structured learning in clinical ethics (SLICE) module for undergraduate medical students, Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine, Newsletter 16: 23-24.
www.opsi.gov.uk/acts/acts2007/ukpga_20070012_en_1
www.opsi.gov.uk/legislation/scotland/acts2003/asp_20030013_en_1
www.opsi.gov.uk/legislation/scotland/acts2000/asp_20000004_en_1

For more information contact danielm.bennett@nhs.net

The knee bone connected to the thigh bone: Teaching anatomy to engineering students using anatomical software

Dr Tom Joyce, Centre for Rehabilitation and Engineering Studies, School of Mechanical and Systems Engineering, Newcastle University

Human anatomy is a complex subject, vital to the instruction of medical students. Given the overlapping and multi-disciplinary nature of many areas of modern technology and education how can engineering students be quickly and effectively taught anatomy to allow them to appreciate the complexity of the human body?

There are many calls to introduce and increase innovation and creativity in teaching of university students. Bioengineering, which is defined as the application of engineering principles and techniques to the medical field, contributes towards the improvement of medical interventions in many ways. One of bioengineering’s most important contributions has been through the design of artificial joints, a development which has been hailed as the major advancement in orthopaedics of the twentieth century. Millions of joint replacements have been implanted leading to improved quality of life for many thousands of people suffering from crippling musculo-skeletal diseases. These artificial joints are designed by engineers but how do engineering students quickly gain experience of human anatomy and a full understanding of the associated medical language such as coronal, metacarpophalangeal and inversion-eversion?

It was hypothesized that dedicated software related to the anatomy and physiology of the human body, when combined with small group teaching so that peer-to-peer learning could be facilitated, would quickly and effectively allow engineering students to understand human anatomy and the function of human joints. Primal Pictures Systemic Edition¹ was chosen, of which joint anatomy is but one part. The software is used in over 450 universities in more than 20 countries and in 2009 it will be used by over 500,000 students will use it to learn anatomy. Anecdotal comments regarding the Primal Pictures software are positive, and the testimonials on the Primal Pictures website are also, as expected, upbeat.

To date no formal independent evaluation of Primal Pictures Systemic Edition appears to have been published.

The Primal Pictures software was used by students undertaking the Bioengineering module offered by the School of Mechanical and Systems Engineering at Newcastle University to describe a specific human joint, with respect to total joint replacement.

Each student was assigned an individual project to critique a currently available artificial joint. Students were asked to describe the anatomy of the natural joint, describing the main bones, muscles and ligaments. When these projects were marked, the anatomical descriptions were very good (average mark 62%). Almost all students had used the Primal Pictures software to describe the appropriate natural joint, indicating that they found the software straightforward to access and to then transfer images and information to their reports. The author noted that students appeared to interact well with the software and the pairing mechanism encouraged discussion and sharing of opinion . Students mimicked the actions of natural joints shown on computer screens by, for example, lifting their shoulders to imitate elevation or ‘wagging’ fingers to copy the flexion-extension motion.

The software can be accessed from any computer connected to the internet via login and password. An introduction to the software was provided for students in the form of a bespoke handout (produced by the author), which guided them during dedicated sessions in a computing suite working in pairs (to encourage peer to peer learning), at their own pace. The author led these sessions and was available to answer any questions which arose.

Anonymised, written feedback was gathered from the students and was overwhelmingly positive regarding the Primal Pictures software: ‘the software was a lot of fun and made learning about the different anatomical terms really easy’ and ‘the Primal Pictures software made me appreciate what a sophisticated and still not fully understood bearing the natural elbow joint is’. This data supported informal comments made by the students as well as the tutor’s perception gained while the students were learning the software. The students’ projects included very good anatomical descriptions, indicating that this aspect of assessed learning had been achieved. Although the financial cost of the software is significant (approximately £4,300 for one year’s access for ten seats including any updates which are immediately available) the experience of using the Primal Pictures software in the teaching of Bioengineering students was very positive.

Access to the Primal Pictures anatomical software improved the student learning experience for the Bioengineering students. It appeared to facilitate deeper learning and highlighted the positive learning benefits of non-hierarchal, small group and peer-to-peer learning, however results of the evaluation should be regarded cautiously due to Hawthorn and other effects.

Funding support from a University Teaching and Learning Committee award was greatly appreciated.

References

www.primalpictures.com

For more information contact t.j.joyce@ncl.ac.uk

Miniproject report: Teaching in veterinary public health

Malcolm Cobb, Professor of Comparative Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham

A Higher Education Academy-funded collaborative project¹ has been established to build on existing partnerships which exist between the UK’s veterinary schools to facilitate the teaching in veterinary public health (VPH). VPH is an important part of veterinary education and is now a recognised specialty in the UK and the rest of Europe. The scope of VPH is wide and multi-disciplinary. It involves governmental and nongovernmental veterinarians, private institutions and other professions such as physicians, nurses, microbiologists, environmental specialists, food technologists and agricultural scientists.

VPH has continued to evolve rapidly in the face of globalisation, the development of new technologies, changes in farming methods, climate change and emerging and reemerging zoonotic diseases. In recent years, VPH teaching within the veterinary schools has been expanded to include risk management, risk communication, cost benefits analysis and economics. All this makes a collaborative approach to VPH teaching critical. Within government also, protection of public health is a high profile issue which significantly influences animal health policies.

Most of the UK veterinary schools are in the process of reviewing their undergraduate veterinary public health curriculum. This was therefore, an opportune time to explore the potential of a Community of Practice supported by an online collaborative tool for interaction not only amongst the seven UK veterinary schools but also enabling the policy makers among the Government Veterinary Surgeons (GVS) to contribute to the VPH curriculum development in the UK.

Since its inception, the project has built on and developed an existing network which involved all of the UK Veterinary Schools and representatives of all the different branches of government in which there is a significant veterinary presence. This Community of Practice has met, and continues to meet, at least twice a year, with the veterinary schools hosting the meetings in turn and the GVS providing the secretarial and administrative support. Standing items discussed and developed at each meeting have been developed into projects for which different members of the group have responsibility.

As part of one of these projects, in an effort to ‘join up’ VPH teaching nationally and produce a consistent output in terms of graduate competences and ensure compliance with EU and national requirements with respect to VPH teaching across all schools the COP has been reviewing the existing policy document covering VPH teaching in the UK which is supported by the Education Committee of the Royal College of Veterinary Surgeons. In addition, a document giving guidance to veterinary students concerning placements working within the various GVS organisations has been developed and distributed. Finally, Glasgow University is hosting an on-line forum to facilitate collaboration within the COP on their Moodle virtual learning environment.

The development of the COP has already proved to be a success, as evidenced by the continuation of the meetings and collaborations which have developed as a result of the initial Academy funding. As a result of the development of the COP the GVS provide consistent teaching into the VPH course in four of the UK Schools (previous GVS involvement tended to be organized locally on an ad hoc basis and therefore very variable in terms of content) and already through the Moodle environment all UK veterinary schools have access to resources used by the GVS during these sessions. The COP also provides an improved mechanism for providing teaching teams access to updated, relevant policy & legislation information of relevance to this subject area as well as access to veterinary expertise across government. In addition it offers the potential for VPH teaching teams to share insights and knowledge, learn from each other and establish methods of collaborating together on this important subject of veterinary education. Finally the COP provides an opportunity for GVS policy makers to contribute directly to the development of future vets and contribute to an enriched learning experience for students as well as research activities through shared resources.

In future it is hoped that the COP will develop and that additional material will become available for teaching teams and their students - particularly in relation to increasingly interactive learning opportunities, case study information and teaching teams are now actively discussing the sharing of examination questions and material.

References

www.medev.ac.uk/dinky?dinky_id=783

For more information contact malcolm.cobb@nott.ac.uk

Using a website to promote best teaching practice in medicine and dentistry

Dr Jennifer Cleland, Medical Education Research, University of Aberdeen

A website aimed at encouraging best practice in teaching medicine and dentistry, was launched recently by the University of Aberdeen.

One of the first tasks for Dr Jennifer Cleland, who took up the new post of Lead for Medical Education Research, School of Medicine and Dentistry, University of Aberdeen, was to identify the medical education research activities already ongoing at Aberdeen. This highlighted that individual interests had expanded into research expertise and Aberdeen was well-known for its innovations in several areas of medical education research. These include: assessment; student performance and ‘failure to fail’ under-performance;¹ and patient safety and prescribing.

Aberdeen’s leadership role in collaborations with other educators, particularly NHS Education for Scotland, industrial psychology and pharmacy colleagues and the other Scottish medical schools, was notable. Thus, one aim of the website was to showcase the high calibre of work ongoing at Aberdeen.

Developing the website also highlighted that specific structures and innovations have played a major role in developing medical education research activity at Aberdeen (details of these are given on the website²):

clinical teaching fellows;
medical education journal club;
summer studentships;
Medi-Cal;
the Medical Education Special Interest Group (MED-SIG);
and, more recently, the Certificate in Teaching and Learning (Medicine).

The summer studentships in medical education research are likely to be of interest to the MEDEV community. This innovative programme funds up to eight bursaries in medical education per year (6-8 week projects). The process is competitive. Any staff member who teaches on the MBChB can submit a research project. These are reviewed by the Lead for Medical Education Research and the Curriculum Manager. Successful applications are advertised to all MBChB students. Interested students are asked to submit a brief resume and are invited for interview. These projects have lead to publications in Medical Education and presentations at medical education conferences (e.g. ASME 2008).

Carefully evaluating how the subject areas of medicine and dentistry are taught and assessed is essential towards ensuring best practice. The website is an extremely useful tool providing an insight into how the University is analysing and using evidence in order to ensure our teaching methods are of the highest possible standards. The process of developing the website enabled us to decide a medical education research strategy.

A further aim of the website is to encourage medical and dental educators who want to carry out educational research to do so. It is a means of communicating to local colleagues that support and advice are available to help them research teaching and learning. The Lead for Medical Education Research will advise on methodology, possible collaborators/supervisors, where best to seek funding or present work.

References

For more information contact jen.cleland@abdn.ac.uk

Conference report: Medical ethics and law

Dr Carolyn Johnston and Elaine Paris, School of Medicine, King’s College London

The Institute of Medical Ethics (IME)¹ is a charitable organisation dedicated to improving education and debate in medical ethics. The IME is currently engaged in a three-year education project to support the teaching and learning of medical ethics and law in UK medical schools. A key aim of this project is to review and update the existing UK core curriculum for ethics and law.

On 23rd January 2009 the IME hosted the third conference on Medical Ethics and Law at BMA House, London. The themes of this conference were:

review of the core curriculum;
methods of assessment.

Over 100 delegates participated in the conference which included representation from 29 UK medical schools, undergraduate medical students and representatives from the medical defence societies, Department of Health, the GMC and the BMA.

The conference opened with the first Lewis W. Headley memorial lecture given by Professor Sam Leinster, Dean of the School of Medicine, Health Policy and Practice, University of East Anglia. He chose to speak on Establishing a Core Curriculum in Medical Ethics and Law - a Dean's View.

This set the scene for the next part of the conference, the review of the core curriculum on ethics and law. The UK core curriculum is based on a consensus document which is now ten years old. The GMC is currently revising Tomorrow’s Doctors, which sets the standards for undergraduate medical education² and therefore it is timely that a review is undertaken.

The views of the delegates were sought by way of workshop consultation. Delegates broke into eight workshops, each with a facilitator and collator. A review of the 1998 Consensus Statement³ was carried out using a ‘nominal group’ variation of the Delphi technique. Each person was asked to rank the themes and topics in the Consensus Statement as ‘high’, ‘medium’ or ‘low’ priority. These topics include:

genetics;
medical research;
confidentiality;
informed consent;
human reproduction;
mental disorders;
disabilities and children.

Delegates were also asked to add any comments and topics they thought should be included. These rankings were then collated to produce a first revised set of themes and topics. The workshop groups were then asked to reconsider and prioritise topics that had not reached a threshold for inclusion in the first round. A second round of collation was then performed to produce a conference wide view of the topics that were recommended for inclusion in the revised core.

The afternoon session started with a keynote lecture How best to assess Medical Ethics and Law? delivered by Dame Lesley Southgate, Professor of Medical Education at St George’s, University of London and President of the Association for the Study of Medical Education. Thereafter delegates broke into workshops to consider ‘how can the Medical Ethics and Law Curriculum lead to the development of appropriate skills and attitudes?’

The conference concluded with Professor Gordon Stirrat, Chair of the Education Project asking ‘where do we go from here?’ He described the proposed process and timescale for producing a new consensus statement on the core curriculum and moving forward on assessment of Medical Ethics and Law.

This was a very successful conference and received positive feedback from the delegates. The conference produced a first draft of a reviewed core curriculum which will go out to relevant stakeholders for consultation. Interested parties may also give the IME their views through the Educational project website.⁴

References

www.instituteofmedicalethics.org/
https://gmc.e-consultation.net/econsult/
Consensus Group of Teachers of Medical Ethics and Law in UK Medical Schools (1998). Teaching medical ethics and law within medical education: A model for the UK core curriculum, J Med Ethics, 24: 188–92.
www.instituteofmedicalethics.org/educational.html

For more information contact carolyn.johnston@kcl.ac.uk

Launch of new veterinary nursing and bioveterinary science degree programme

Dr Frank Taylor, Department of Clinical Veterinary Science, University of Bristol

The University of Bristol’s new BSc in Veterinary Nursing and Bioveterinary Science programme will be launched in October 2009. In designing this programme, the University has moved away from the more traditional veterinary nursing undergraduate programmes currently on offer.

This move is part of a new strategy to educate undergraduates in both veterinary nursing and bioveterinary science so that they gain a greater depth of understanding and knowledge in areas such as biochemistry, infection & immunity, and cellular & molecular pathology along with the potential to expand the boundaries of the veterinary nursing profession through research at undergraduate and postgraduate level.

The new programme combines a strong bioveterinary science knowledge-base with a high standard of clinical training, which will be provided by veterinary surgeons and nurses working within the Department of Clinical Veterinary Science at Langford, a considerable number of whom are experts in their chosen fields. This unique combination of science, research and practical nursing training should go a long way towards ensuring that students gain the essential knowledge and skills required for employment within veterinary and allied professions. A particular feature of the University of Bristol is its strength in research-informed teaching. Specific strengths in veterinary-related research include the healing of bones, the alleviation of pain in animals, the welfare aspects of animal behaviour and housing, infection and immunology and the viral autoimmune diseases of animals.

The veterinary nursing component of the curriculum will continue to incorporate the Royal College of Veterinary Surgery (RCVS) veterinary nursing syllabus¹ and Lantra National Occupational Standards². Successful completion of these elements will allow entry onto the RCVS’ veterinary nursing register upon graduation. To fulfill the RCVS requirements, students will spend a minimum of 70 weeks within approved training practices. The university will provide students with suitable term-time veterinary practice placements, which will occur in year three (45 weeks) and year four (5 weeks). In addition, students are required to spend a total of 20 weeks in approved vacation placements of their own choice. This will be on the basis of 10 weeks at the end of the first year and a further 10 weeks during the summer vacation at the end of year two.

Year 1

In their first year, students will be taught the fundamental concepts of anatomy and physiology as well as being introduced to the principles of nursing and pre-clinical science. They will also be able to develop communication and study skills.

Year 2

The second year builds upon the basic sciences delivered in year one with the opportunity to take a number of units, which may include: biochemistry; physiology 2; veterinary anatomy, and cellular & molecular pathology, as well as infection and immunity. The veterinary nursing component will also be expanded in year two with four nursing units focusing on diagnostics & treatment, anaesthesia & fluid therapy, surgical nursing & theatre practice and the application of veterinary nursing care.

Year 3

Year three is spent entirely on placement within both first opinion veterinary practice and the referral hospital at the School of Clinical Veterinary Science. This clinical placement will consolidate the knowledge of basic veterinary nursing theory gained in the earlier years and enable students to apply it within a clinical context. During their time on placement students will be expected to complete a portfolio of practical tasks (known as the clinical assessment tool). During year three they will also study veterinary practice administration by means of a combination of lectures and on-line tutorials.

Final year – year 4

Final year students spend the first 5 weeks of the year in a clinical placement within the veterinary school referral hospital. This is followed by classroom-based study comprising the compulsory unit on welfare & ethics plus three additional units selected from a range of options, such as advanced medical or surgical nursing, advanced anaesthesia, extracellular matrix in health & disease or the pathogenesis of infectious diseases. Alongside these four units, students are also expected to undertake a 10 week research project on a topic of their choice, which provides an opportunity for individual indepth exploration of an aspect of veterinary nursing or bioveterinary science. This involves the planning and execution of a piece of original research under the supervision of one or more members of academic staff. It is envisaged that many of these research projects will contribute to the emerging field of veterinary nursing science through research publications in veterinary and related journals.

The University prides itself on the quality and standards of the education it provides for all of its undergraduates. This new programme upholds these standards and will not only produce excellent veterinary nurses to fulfil the needs of the veterinary profession, but will also provide graduates with a range of career options.

References

For more information please contact f.g.r.taylor@bris.ac.uk

Developing stage-specific, consistent, reliable and valid learning, teaching and assessment methods for PolyProfessionalism in the health professions

Sue Roff, Dr Sean McAleer, Dr Madawa Chandratilake and Kabir Dherwani, Centre for Medical Education and John Gibson, Dental School, University of Dundee

The UK General Medical Council (GMC) now requires proof of fitness to practice before a graduate can provisionally register as a doctor. Medical schools are expected to have fitness to practice procedures in place¹. The General Dental Council’s Education Strategic Review Group recommended in 2008 that ‘The Council should place a greater emphasis on ensuring the professionalism of would-be registrants than it has done previously’².

What the Group means by professionalism is the attitudes, values and behaviours needed for registration which are articulated in the guidance Standards for dental professionals², which sets out six key principles dental professionals are expected to follow:

putting patients’ interests first and acting to protect them;
respecting patients’ dignity and choices;
protecting the confidentiality of patients’ information;
co-operating with other members of the dental team and other healthcare colleagues in the interests of patients;
maintaining professional knowledge and competence;
being trustworthy.

Most other health care professions have similar principles embedded in their Codes of Conduct. The RCP and the King’s Fund issued a report on Understanding doctors: harnessing professionalism³ in which they suggested that professionalism in the health professions involves:

integrity;
compassion;
altruism;
continuous improvement;
excellence;
working in partnership with members of the wider healthcare team.

But there is actually very little elaboration of what constitutes good or poor professionalism in each of these domains, and very few actual teaching materials especially at the early levels of undergraduate learning. There are several guidance documents from the GMC for medical students and practitioners on issues ranging from consent to withholding and withdrawing life-prolonging treatments that elaborate the general principles in Good Medical Practice⁴.

It may be that teaching and assessment of PolyProfessionalism⁵ in the health care professions should be staged into a continuum of:

pre-clinical;
early clinical;
autonomous practitioner phases.

It might also be possible to develop sequenced teaching and assessment techniques that amount to a progress test, while also involving reflection and self assessment as well as peer assessment.

It is important that the teaching and the assessment should be normed to consensus standards of Professionalism in the context in which they will be applied. In a preliminary review of more than 30 assessment studies in Professionalism, no normed inventory or rating system has been identified.

Many of the approaches are profoundly culturally specific. ‘Professionalism is a basket of qualities that enables us to trust our advisors’ Dame Janet Smith told the Working Party on Professionalism⁶ in 2005. But there may be a lack of consensus about what those qualities are. She also said ‘I do think that a sense of vocation is important although I do not think it necessarily needs to be associated with altruism. No professional should be expected to provide services without proper remuneration; nor in this day and age should a professional lack the support systems necessary to enable him/her to live a normal family and social life.’⁶ We owe it to our learners to clearly define the ‘basket of qualities’ and to check where the normed consensus of acceptable professional performance lies. We should not set impossible standards. Several studies found that Israeli women health professionals were less willing than males to leave their children in the ‘sealed rooms’ of the 1991 Gulf War to go to their hospital duties, not least because the schools had been closed.

One of goals should be to develop robust teaching/learning/assessment strategies that are both feasible and cost-effective. While it may be possible to develop scenarios that robustly test the learner’s reflective writing abilities in the field of PolyProfessionalism, they would be complex to norm in a way that would permit non-labour-intensive assessment and objective scoring.

Our first aim therefore has been to develop and validate a robust, normed, cost-effective strategy for teaching, learning and assessing elements of Professionalism at the first, pre-clinical stage of health professions education. By combining some of the methodologies in the research literature, we should be able to develop and validate an inventory that delivers professionalism:

helps the respondent to recognise/learn good/poor polyprofessionalism – i.e. teaches the content of PolyProfessionalism;
as normed within the context – i.e. identifies the consensus of ‘acceptable/ unacceptable’ answers in a given school/region/specality/ country;
enables the respondent to locate him/herself in the normed consensus for feedback;
permits staging analyses as the respondents move from novice to expert;
is machine markable/ electronically deliverable and therefore cost-effective;
is valid and reliable.

This would be ‘an approach that merges the two propositions and offers a way forward: Assess each principle of professionalism at each stage of a medical career, but contextualize the principles, set stage-specific achievement levels, and approach assessment of professional-ism from a developmental perspective.’⁷

It would also begin to meet the GMC’s call for strategies ‘to balance a positive approach to professional behaviour of medical students with more specific advice for medical schools on how to develop consistent fitness to practise procedures.’⁸ It would also help to substantiate the ‘Declaration of good character’ required to be signed by the head of school for an individual’s registration NMC.⁹

We have now developed a preliminary Dundee PolyProfessional Inventory I: Academic Integrity for Junior Undergraduates in the Health Professions. More than 30 studies in the research literature were identified and their methodologies and items reviewed. One hundred items were identified in the field of Academic Integrity in the Health Professions at junior undergraduate level. Two research assistants condensed these into 36 items which were reviewed by the other researchers. Two types of query were identified from the literature – three questions about the respondent’s knowledge of/willingness to take such an action and 10 items about the appropriate sanction to be applied.¹⁰, ¹¹ Additional items were added in review.

Since it is considered that factor analysis should be performed with no less than 5 times the number of items/respondents we are about to administer the inventory electronically to all dental, medical and nursing students at Dundee University. We will then refine the instrument according to the statistical indicators and factor analysis.

The refined instrument is available. Let us know if you would like to work with us to validate it on other populations. Development of the second instrument for the ‘protoprofessional’ phases of undergraduate health professions learning is well under way.

References

www.gmc-uk.org/education/undergraduate/undergraduate_policy/professional_behaviour.asp
www.gdc-uk.org/Current+registrant/Standards+for+Dental+Professionals/
www.rcplondon.ac.uk/PROFESSIONAL-ISSUES/Pages/medical-professionalism.aspx
www.gmc-uk.org/guidance/good_medical_practice
Roff S. (2008). Towards POLY professionalism? Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine Newsletter 17: 31-32.
www.rcplondon.ac.uk/wp/medprof/
Arnold, L. and Stern, D.T. (2006). What is medical professionalism? In Stern (ed) Measuring medical professionalism, Oxford University Press, 28-29.
www.medev.ac.uk/dinky?dinky_id=936
Semple M., Kenkre J. and Achilles J. (2004). Student fraud: The need for clear regulations for dismissal or transfer from healthcare training programmes for students who are not of good character, Nursing Times Research, 9: 272-280.
www.rcplondon.ac.uk/wp/medprof/medprof_prog_050225.asp
Teplitsky, P.E. (2002). Perceptions of Canadian dental faculty and students about appropriate penalties for academic dishonesty, Journal of Dental Education, 66(4): 485-506.

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

How can we improve the numeracy competencies of students studying animal related qualifications?

Dr Catherine Douglas, Agriculture, Food & Rural Development, and Dr Bill Foster, Mathematics & Statistics, Newcastle University

….by making maths fun.* and giving students plenty of opportunity to practice on an interactive IT resource with clear relevance to their discipline and lots of interesting examples.

Introduction

The rationale behind the VETNET Lifelong Learning Network (LLN) funded Fun.* Animal Maths project, led by Newcastle University’s school of maths and statistics and animal science, was developed to support learners pre-HE and during their degrees, by providing guided steps, using calculations set in an animal-context, on ‘problem’ mathematical areas. Fun.* denotes ‘functional’, i.e. the maths that students will actually need on their course, is applied to their interests and relevant to their future careers.

Applications for Fun.* Animal Maths include:

formal whole group teaching;
where students experience difficulties in certain areas they can be identified and referred to practice and improve at their own pace;
FE lecturers can use the resource to stretch students considering HE who would otherwise only develop competencies to ‘Key Skills Numeracy, level 2’ (basic GCSE level) within the current prescribed FE curriculum.

Background

Lecturers teaching on vocational subjects including veterinary, agriculture, equine, animal science, animal management and veterinary nursing, from (Further Education) FE colleges to fifth year vets were asked which areas of maths they felt were necessary for their course; which the students were actually taught; and in which they felt students would benefit from support. Teachers identified numeracy, data presentation and interpretation, and statistics. They said: ‘I generally find the level of basic numeracy poor in students with little apparent ability to do simple arithmetical calculations, and no apparent ability to estimate a correct answer to check that their final answer is of a sensible magnitude’; ‘Students are taught maths in an applied manner as there is no specific numeracy module. Support packages would be very useful’ and ‘Numeracy skills of students have worsened over the years. Such a project is to be welcomed’.

Areas of numeracy

calculation of ratios from data;
common mistakes in ratios and percentages;
decimal notation and conversion to fractions;
decimal places;
definition of logarithms to base 10;
estimation of calculations and errors;
magnitude of large integers, units and their relative sizes;
manipulating fractions;
manipulating powers of ten;
powers of numbers and rules;
scientific notation for large and small numbers;
significant figures;
using brackets and grouping arithmetic calculations in a series of calculations.

Areas of data presentation and interpretation

creating data tables from raw data to answer questions in discipline;
data collection;
knowing what form of presentation is appropriate to what form of data;
organising data (various forms of tables);
pie charts - area and proportion;
plotting simple graphs (scatter) and bar charts;
reading data tables and answering elementary questions about the data;
reading simple graphs and charts;
using an appropriate scale on graphs;
using computer packages to select and display data.

Statistics is a major area with the following areas highlighted as priorities for support

correlation;
elementary statistics: Means and standard deviations, median and mode;
introduction to hypothesis testing;
regression;
sampling design and applications;
simple distributions;
size of samples and confidence intervals;
understanding populations and samples;
use of appropriate computer packages;
using random data to find out about populations.

The resource

Student cohorts across the country are undertaking the diagnostic quiz. The data within questions can be randomised so that when students return to the resource they have new parameters for their calculations, be it based on breed of dog, percentage of various body weights, size of herd, speed of horse, rehydration drip rate. A version of the test is used in the medical school in order to assess entrants knowledge and skills in concentrations, dilutions and units, which is being incorporated into a test for students studying animal-related qualifications.

Fun.* Animal Maths can be used in ‘practise’ mode at any pace, which offers optional step by step guidance or ‘timed’ practise. The resource can be used in ‘test’ (quiz) mode to test either the initial level of competency or acquired competency. This enables competent students to merely sit the test to demonstrate their ability, while other students are able to practice and improve at their own pace and sit the test when ready.

The initial analysis for the quiz, identifying the areas of maths where students need most support will be competed soon. We will then be in a position to populate the resource.

A stats quiz/resource is also under development.

Future work

VETNET LLN is still looking for institutes/individual lecturers or students to offer animal-context maths examples, and for lecturers to run the new stats quiz with students (which can be at any time, from anywhere, providing students have access to internet).

Where students contact us with feedback on the test or to offer details of relevant maths examples (from their course or work placements) we are sending gift vouchers to a random student from every 10 correspondence (further details are included at the start of the quiz).

Acknowledgements

Thanks to all lecturers and students involved so far, especially to those at Edinburgh Vet School, Nottingham Vet School, Liverpool Vet School, Myerscough College and Askham Bryan College for their support in the veterinary and veterinary nursing sector.

For more information please contact catherine.douglas@ncl.ac.uk or w.h.foster@ncl.ac.uk

Miniproject report: Teaching, learning and assessment of law in undergraduate medical education

Judy McKimm, Visiting Professor of Healthcare Education and Leadership, and Michael Preston-Shoot, Professor of Social Work and Dean of the Faculty of Health and Social Sciences, University of Bedfordshire

MEDEV and the UK Centre for Legal Education (UKCLE) Subject Centres jointly funded this project,¹ which includes a practice survey of how law is taught, learned and assessed in the 31 UK undergraduate medical programmes and a systematic literature review of law teaching in medical education complementing ethics works by the Institute of Medical Ethics.² The project, which builds on earlier work funded by an Academy National Teaching Fellowship (NTFS)³ awarded to Michael Preston-Shoot.

Findings from the project will be disseminated initially through publication of reports on the subject centre websites and a national workshop which will involve a wide group of those interested in how professionals ‘learn law’ and apply law in practice. One of the aims of this collaborative project is to share learning between subject disciplines and professions as to how law might be most effectively included in professional programmes.

Background

The drive towards integrated services and changing professional roles mean that different health and social care professionals need to be ever more confident and clear about their professional and legal responsibilities. The NTFS study compares teaching, learning and assessment of law in medical and social work education, involving eight social work schools and four medical schools. Preliminary data analysis indicated varying perceptions and understanding of the law and how it is used in practice within and between the two professional student groups, with evident implications for their future working together. Our research indicates variation in practice in how law is taught, learned and assessed in undergraduate medical education. These variations are not only between the medical education programmes offered by different institutions but also within medical programmes themselves, where law is sometimes taught as a discrete topic; is very commonly learned alongside ethics teaching; included as part of preparation as a professional practitioner but is often embedded within clinical attachments where the learning is often opportunistic and assumed.⁴, ⁵ We have found no evidence to date from the literature as to how law is systematically assessed in undergraduate medicine.

The medical profession is undergoing further reform (by the Department of Health, Postgraduate Medical Education and Training Board and General Medical Council) around ensuring fitness to practice, regulation and licensing and there is an increasing research and practice emphasis on professionalism. The GMC consultation on Tomorrow’s Doctors 2009⁶ (p39) includes a section on Doctor as Professional which notes:

The graduate will be able to behave according to ethical and legal principles…

understand and accept the legal, moral and ethical responsibilities involved in protecting and promoting the health of individual patients, their dependants and the public including vulnerable groups such as children, older people and people with mental illnesses.
demonstrate knowledge of laws, and systems of professional regulation through the GMC and others, relevant to medical practice, including the ability to complete relevant certificates or legal documents and liaise with the coroner or prosecutor fiscal where appropriate.

It is therefore timely to review and evaluate how medical students acquire their knowledge and understanding of the law relating to medical practice; legal rules, concepts and constructs, and the skills needed to apply the law in a range of potentially complex clinical and community situations, including consulting with and referring to other professionals.

Practice survey

The practice survey provides a baseline from which we can begin to examine the nature and the pedagogy of law teaching in undergraduate medical education, develop new research questions and identify areas for debate and discussion. It provides new knowledge for deepening understanding of how law teaching is conceptualised in medical curricula and, more importantly, how UK medical schools approach and address the teaching of law as it relates to professional medical practice. The practice survey describes how law is currently taught, learned and assessed in UK medical schools, identify common themes and approaches, and offer examples of good practice and challenges to teaching and learning law in medical education. We highlight implications for curriculum development and reveal variations in how curricula support medical students in developing a professional identity and ‘professionalism’ which incorporates a real understanding of law as distinct from personal values, attitudes, morals and beliefs and professional ethics and codes of practice.⁴

The practice survey also identifies the ‘profiles’ (background and expertise) of those involved in teaching and assessing law in medical education with a view to developing resources to support the professional development of those involved in law teaching. A detailed questionnaire has been circulated to teachers with an identified responsibility for law teaching in all UK schools. The questionnaire has been adapted from that used in a national practice survey of law in social work teaching, learning and assessment that was carried out in 2005.⁷ Survey responses were due back by March 2009, after which the results will be collated and analysed to provide a basis for interviews with key stakeholders. We will also be holding a national workshop where the results of the survey and linked research will be discussed and plans made for further development and research.

Systematic literature review

Generally the literature has not reported the quality, effectiveness or outcomes of different methods of teaching, learning and assessment of law in medical education. Understanding of the law tends to be coupled with medical ethics,³ introduced as part of the development of professionalism⁸, ⁹ or acquired during clinical attachments relating to different client groups. The focus to date has been much more on the ethical and regulatory dimensions of practice than the legal aspects which, in curriculum and learning terms, have tended to be assumed, tacit and implicit rather than overt and explicit. The systematic literature review will provide an evidence base from the published literature on law as it relates to medical education and to medical practice. This work will also contribute to the current debates and interest on all aspects of ‘professionalism’ and the development of professional identity.

This project has benefits for the wider community of healthcare educators as well as law teachers and practitioners, providing opportunities for sharing practice and approaches to the teaching and learning of law. Parallels will be drawn with the data already available on teaching law to social workers.¹⁰ Ultimately of course, it is patients and service users who will benefit from improvements to the way in which health and social care professionals learn and apply the law in practice.

Further information about the project (including publications and reports) can be found:

On the MEDEV website www.medev.ac.uk/dinky?dinky_id=911
On the UKCLE website www.ukcle.ac.uk/research/projects/mckim m.html

References

www.medev.ac.uk/dinky?dinky_id=911
www.instituteofmedicalethics.org/educational.html
www.heacademy.ac.uk/ourwork/professional/ntfs
McKimm, J., Preston-Shoot, M. and Morris, C. (2008). Teaching, learning and assessment of law in medical education: Exploring medical students’ perceptions and understanding of law as it relates to professional practice and behaviour, poster presented at ASME/MEDEV, Medical Students and Professional Behaviour conference, June.
Consensus Group of Teachers of Medical Ethics and Law in UK Medical Schools (1998). Teaching medical ethics and law within medical education: A model for the UK core curriculum, J Med Ethics, 24: 188-92.
General Medical Council (2008). *Tomorrow’s Doctors 2009: A draft for consultation*, 27 December 2008 to 27 March 2009, London: GMC.
Braye, S. and Preston-Shoot, M. (2005). SCIE knowledge review 8: Teaching, learning and assessment of law in social work education, London: SCIE, available at www.scie.org.uk/publications/knowledgereviews/ kr08.asp (accessed 20 February 2009).
Goldie, J., Dowie, A., Cotton, P. and Morrison, J. (2007). Teaching professionalism in the early years of a medical curriculum: A qualitative study, Medical Education, 41(6): 610-17.
Jha, V., Bekker, H., Duffy, S.R.G. and Roberts, T.E. (2007). A systematic review of studies assessing and facilitating attitudes towards professionalism in medicine, Medical Education 41(8): 822-29.
Braye, S., Preston-Shoot, M. and Johns, R. (2006). Lost in translation? Teaching law to non-lawyers: Reviewing the evidence from social work, The Law Teacher, 40(2): 131-50.

For more information contact j.mckimm1@btinternet.com

Workshop report: Towards common standards. Issues and possibilities in collaborative assessment in veterinary education

Susan Rhind, Professor of Veterinary Education, Department of Veterinary Pathology, University of Edinburgh

A workshop held at the Royal Veterinary College in September 2008 focussed on the potential for national collaboration in assessment. The workshop was facilitated by Richard Wakeford (University of Cambridge), Mei Ling Denney (Royal College of general practitioners), Sarah Baillie (Royal Veterinary College) and Susan Rhind (Royal (Dick) School of Veterinary Studies), and was part of a larger project funded by the RCVS trust focussing on clinical competency assessment in veterinary medicine.

The session started with a summary of the findings from the best evidence medical education review of the literature on veterinary assessment and a description of the ‘Guide to Assessment Methods in Veterinary Medicine’ which was produced as part of the project.¹

Richard Wakeford then discussed the pitfalls in combining marks and the importance of analysing the internal reliability of examinations.

Participants discussed the development of a collaborative assessment tool which highlighted the extreme variation that can exist in markers interpretation of performance and need for clear guidelines and marking schemes.

Finally, participants discussed potential models for future national collaboration with two potential areas seen as relevant for further exploration – the development of common assessment items and the development of standardised examiner training. It is anticipated that both these areas will be taken forward by the community over the coming months.

References

www.live.ac.uk/documents/assessment_guide.pdf

Conference report: Medical students and professional behaviour

Dr Megan Quentin-Baxter, Subject Centre for Medicine, Dentistry and Veterinary Medicine

Over 120 participants attended the joint ASMEMEDEV Medical Students and Professional Behaviour conference, which was co-sponsored by the Association for the Study of Medical Education (ASME) and the Centre for Medicine, Dentistry and Veterinary Medicine (MEDEV). The conference took place on 5 June 2008 at the Royal Institute of British Architects, London.¹

Presentations

Professor Tony Weetman (TW) outlined the background to the development of the Medical Students: Fitness to Practise and Professional Behaviour guidance, emphasising a more balanced interpretation of existing statues (such as removing the link between automatic registration following graduation from an approved programme). This would feed into the revised version of Tomorrow’s Doctors (2009).² He reminded schools that the GMC had no authority over admissions, therefore Fitness to Practice (FTP) issues had to be dealt with in medical schools. The committee had not supported ‘pre’ registration of students, as this was deemed excessive, rather, the GMC would expend energy in supporting schools. Some literature pointed to correlations between behaviour at medical school, and later FTP issues and other participants praised the guidance.

TW noted that work needed to take place for schools to share experience of FTP procedures in order to improve consistency and defensibility.

Dr Maxine Papadakis (MP) described her experiences (since 1995) in the US, how implementation of a new process and subsequent research had informed policy development. For example, a consortium of schools found that MCAT results had no predictive quality for professional behaviour; whereas those disciplined at medical school were three times more likely to be disciplined later. Multiple miniinterview (MMI) was the best predictor of performance in later objective structured clinical examination (OSCE). They had attempted to put the onus for professional behaviour on students (it was their responsibility to graduate). Students must seek, for example, counselling or occupational health; the school is there to help them but not to initiate. Where evaluation studies of ‘respect’ had taken place staff (e.g. 360 degree appraisal) turnover had reduced by 25%, and quality indicators had improved (e.g. University of Texas).

Professionalism ‘leads’ (teachers with responsibility for FTP) needed some discretion to decide what disclosure to make about students; distinguishing a potentially one-off mistake from systematically flawed behaviour.

There followed a lengthy and informative Q&A; session, covering topics such as students with ‘learned good behaviours’ (as opposed to intrinsic); the role of the institution in supporting (or, perhaps, undermining) a school’s attempts to implement FTP; the role of peerreporting unprofessional behaviour (and generally involving students in FTP procedures); a tendency to mark with an ‘S’ (satisfactory) but really harbouring concerns – failure to fail – (MP recommended telephoning clinical tutors and writing down what was discussed); the need for schools to ‘own’ whatever procedures that they adopted; whether the size of the average cohort today had hampered identification of FTP issues; etc. There was a very positive feeling towards MMI, and at least two participants indicated, during questions, that they had implemented MMI, (incidentally, saving thousands of pounds on interviewing for admissions).

Andrew Wilson (AW) gave an excellent presentation from the student perspective, based on a story of a witch-hunt, demonization and ‘moral panic’ following the Shipman enquiry. He touched on commoditisation, proletarisation and new folk-devils; and the tendency to over-regulate in response to media influence. He encouraged fostering a new sense of ownership and negotiating a new contract with society.

PowerPoint and PDF files are available from the remaining presentations, which can be downloaded from the ASME website.³

Conclusion

A panel reiterated the highlights of the day including a need to consider carefully admissions processes, and creating regular opportunities for students to be demonstrate professional behaviour (assuming that an absence might signpost unprofessional behaviour – not yet proved). Getting professionalism ‘out of proportion’ with other education was considered important. It was pointed out that if a patient presented with incurable cancer that they might wish to be treated with respect. If they had a ruptured appendix they would probably be more interested in the competence of the clinician in managing treatment and pain. Somehow professionalism had to be developed in parallel with other skills and competences.

The medical profession is unique. However students cannot be expected to be god-like at all times. As clinicians however they must accept the responsibility that society trusted them with. During the SARs outbreak some clinicians (abroad) refused to treat, citing personal circumstances which should not be acceptable in the UK.

The delegates thanked the speakers, panel members and organisers for an insightful and stimulating event.

References

For more information contact megan@medev.ac.uk

Medical students and lifelong learning: The journey starts here!

Victoria Silverwood, Carla Swift, Sarah Peters, James Whitehurst and Andrew Higgins, 2nd Year Medical Students, Keele University and David Brigden, Professor of Health Sciences Education, University of Chester, and the Educational Development Unit, University of Bolton

Lifelong learning is an essential component of a doctor’s life. It is important for this to be recognised by medical students early in their careers so that they are prepared for the challenges that a commitment to lifelong learning will present. In this article, we will examine why lifelong learning is so important, what the obstacles and difficulties may be encountered, how it is carried out, and what impact lifelong learning has on the quality of care provided to patients.

The history of lifelong learning

In 1995, Jean Claude Paye, Secretary General of the Organisation for Economic Co-operation and Development (OECD) is quoted as saying ‘Much has been said over the years about lifelong learning but, in truth, it is still a reality only for a tiny segment of the year cycle in which practitioners not only have to be aware of new ideas and developments but also apply them to clinical practice for the well being of their patients.’¹

In 1997 A National Advisory Group for Continuing Education and Lifelong Learning was formed which published the ‘Fryer Report’. This stated, ‘The country needs to develop a new learning culture, a culture of Lifelong Learning for all. It is essential to help . . . All of its people to meet the challenge they now face as they meet the 21st Century.’ ²

In response to this, the Government published, in February 1998, a consultation paper ‘The Learning Age – A Renaissance for a New Britain’. Its aim was to encourage the workforce to become life long learners.³

Although the concept of lifelong learning has been around for several years it has only just started to be fully implemented in the UK.

The importance of lifelong learning

Lifelong learning is of vital importance in the medical profession. A recognition of this, whilst a student, helps to ensure that there is no ‘culture shock’ when a newly qualified doctor begins their first job and finds that they are expected to commit a great deal of time to learning.

Firstly, lifelong learning helps medical students and doctors to acquire the skills necessary for practise. As the medical profession advances, for example, in terms of advised ‘best techniques’ and newly developed technologies, doctors who do not engage in lifelong learning will very quickly find themselves ‘out of date’. This may well prevent them from providing their patients with the best possible standard of care. In some cases, ‘lifelong learning’ will involve learning from experience. For example, selecting which treatments are most appropriate to use in varying situations.

On an individual level, both students and doctors must keep up to date with changes in order to fulfil their potential. A lack of commitment to lifelong learning will result in an inability for these doctors to satisfy the requirements of appraisal and revalidation and maybe not reach the positions they aspire to or make the most out of their careers.

Difficulties adapting to lifelong learning

Initially adjusting to the concept of lifelong learning can be quite daunting. With regards to medical students it can be a little overwhelming, as there is already a lot to think about in terms of the future. For example, medical students have only really just started to learn but are usually already thinking about what speciality to follow. It is different for medical students than many other students, as medicine is a vocational course and therefore its requirements vary from many other degrees.

There is a danger that people might dismiss lifelong learning once they reach a certain level of their career. However, as medical students, one of the main difficulties is more than likely related to time management. Sometimes lifelong learning may become low on the list of priorities when other work is more pressing. There is often a lot of pressure to remain on ‘top of your game’ with regards to academic work, and sometimes ‘extras’ such as lifelong learning can be pushed to one side.

Changes in medicine: prompting lifelong learning

Lifelong learning is essential in order to keep up with the constant developments in medicine and medical practice. One only needs to observe how often NICE guidelines are changed to see how often new practices are implemented.

As we move further into the technological age, there is increased pressure on doctors and other medical professionals to ‘keep up with the times’ in order to fully utilise the technologies available to them. The rate at which technology improves and evolves can be attributed to its acceptance by key nations around the word, in particular the USA, which has only recently accepted the use of stem cells in medical research. Therefore, lifelong learning can also benefit the medical profession as a whole by leading to advances in research.

Who are lifelong learners?

Lifelong learners are those who continuously develop their skills. There are many qualities that a ‘typical’ lifelong learner needs to possess. Firstly, a lifelong learner needs to be able to recognise informative, reliable and accurate sources. Medical students might seek alternative sources of information in order to gain a different view and opinion and to discuss the views they themselves are forming. They may participate in shared learning which enables them to discuss developments, information and experiences and to gain from the experiences and opinions of others. Secondly, they need to be autonomous and possess the ability to make judgements for themselves about the reliability of information and how useful it may be.

A lifelong learner needs to have the ability to analyse new information, and then apply this information and any new developments to their medical practice. This means they are able to continuously provide care of the very best standard. Lifelong learners need to be reflective practitioners⁴,⁵ and possess the ability to learn from their own experiences and the experiences of others. They need to learn and adapt along with the changing healthcare needs of the population and be able to apply newly learned information to their practice.

Medical students and doctors have to develop lifelong learning skills in order to adapt to the changes and advances in medicine. With the many changes in medicine over the last ten years, doctors and medical students need to be aware of these changes and if applicable be able to apply them to clinical practice. It can be easier for students and recently qualified doctors to develop these skills, as they are introduced to new technology and its applications from a much younger age. Although a lot of medical students might dismiss the importance of lifelong learning, if they develop the pattern of reflecting and analysing whilst at medical school they are more likely to follow that through into their practice after qualification.⁶

Conclusion

Lifelong learners recognise that learning is an essential part of medicine and make it a priority to learn about advances and new developments. Perhaps more importantly, they ensure they have the time in which to do this and use the information gained to enhance their skills and opinions. Lifelong learning can be the difference between a good doctor, and a great doctor, and as medical students it is important to get into the mindset now, as then it will become more natural as time progresses. If we as medical students can adapt to the concept of ‘lifelong learning’ now it can only be beneficial for both our future, and that of our patients.

References

Paye, J.C. (1995). Making lifelong learning a reality for all, Organisation for Economic Co-operation and Development.
Fryer, R. (1997). Learning for the 21st Century: First report of the national advisory group for continuing education and lifelong learning, London: Department of Education and Employment.
Department for Education and Employment (1998). The learning age: A renaissance for a new Britain, London: HMSO.
Brigden D.N. and Purcell, N. (2004). Becoming a reflective practitioner, Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine Newsletter 6: 21-23, ISSN 1740-8768.
Raw, J., Brigden D.N. and Gupta, R. (2005). Reflective Diaries in Medical Practice, Reflective Practice, 6: 165-169.
Stephenson, P. and Brigden, D.N. (2008). Reflective medics, Student BMJ, 16: 156-157.

For more information please contact dnbrigden@btinternet.com

Assessment and learning without boundaries: A mobile assessment and ePortfolio system

Ceri Coulby, Educational Staff Development Officer, and Nancy Davies, Learning Technologist, ALPS CETL, University of Leeds

ALPS (Assessment and Learning in Practice Settings)¹ is one of the 74 HEFCE funded Centres for Excellence in Teaching and Learning.² ALPS is a collaboration between five Universities; Leeds (Lead Partner), Bradford, Huddersfield and Leeds Metropolitan and York St John, and three commercial partners. ALPS’ aim is to increase the confidence and competence of graduating health and social care students.

Background

Due to the nature of health and social care curricula a high proportion of each undergraduate course is taught within practice settings, such as a hospital ward, community clinic or increasingly the patient’s own home.

Whilst this type of learning in practice is essential to training health professionals, often the practicalities of these placements can be difficult for students. They may feel isolated from both the University and other students, have difficulty in securing PC access to obtain information or update their portfolios and have limited feedback from their assessor due to time constraints. With these issues in mind ALPS has produced an inter-professional mobile assessment and e-portfolio system. This allows students on placement to use mobile devices to supplement feedback on their generic skills from a range of sources accessible to their tutor at the University.

What type of assessments are the students expected to complete?

The 16 health and social care professions involved in ALPS worked together to create Common Competency Maps for Communication, Team Working and Ethical Practice. These maps reflect the core skills of all health professions regardless of clinical responsibility.

From these maps a set of assessment tools were developed, intended to allow any health and social care student to evidence as many competences as possible from everyday situations they would encounter when out in practice. Written by an interprofessional group, these tools assess the skills involved in ‘gaining consent’, ‘working interprofessionally’, ‘demonstrating respect for service users and carers’, ‘providing information’ and ‘knowing when to consult or refer’. Alongside the ALPS resources, tutors have also created profession specific tools, resources and maps to maximise use of the mobile devices, assessments and ePortfolio.

In the virtual university

Using Question Builder a tutor can create assessments and then, using Compendle, send them out along with learning resources such as lecture PowerPoint slides, videos and websites, at the click of a button to a cohort of students. Both pieces of software are part of the web based ALPS system, allowing a tutor to create and set assessments on any PC or laptop. Once completed on a mobile device assessments are automatically uploaded to the student’s ePortfolio. The student can then review their work and the tutor add comments and guidance; allowing tutors to monitor student progress remotely.

When an assessment arrives in the eportfolio the competency frameworks within the suite allow the tutor to map the skills the student has demonstrated against interprofessional and profession specific performance criteria. The system can store multiple competency frameworks, allowing students to use an assessment to evidence a variety of professional requirements.

By simply checking a tick box the tutor can demonstrate that the student has achieved relevant performance criteria. The student can then track their progress in an easy to view display of multiple frameworks. The e-portfolio can be used at undergraduate and postgraduate level allowing the student to extend the portfolio into professional life and foster life long learning skills. As part of their reflective learning students also have the opportunity to record blog or diary entries within the ePortfolio.

In practice

Each ALPS assessment tool has four different assessment perspectives; self, peer, practice assessor and patient perspective. The student can chose to complete one or several of these options dependent on opportunity. The student identifies with their practice assessor a suitable assessment scenario. The student can collect audio or written feedback from peers, colleagues and patients with suitable consent.

All of the ALPS assessments are based on reflective practice models and require the student to action plan. Once the student has completed an assessment they can choose to save the assessment to their device (for example if they get interrupted and cannot finish the assessment in one go) or upload it to the ePortfolio. When an assessment is signed off as completed by the student or assessor it is no longer editable; demonstrating the potential for use of the suite to deliver summative assessments.

Measures have been taken to ensure that student data is properly transferred and protected. Intellisync software allows a seamless, automated transfer of assessment packages and learning resources to and from the mobile devices whilst SafeGuard software encrypts all data being transferred and on the device.

Currently over 200 students are piloting the assessment tools and ePortfolio, whilst an additional 700 already have the devices and are using them for learning purposes. Feedback so far indicates that the assessment tools are easy to use and helpful to learning, and some great examples of tutor led initiatives are appearing. Whilst we will be publishing research findings towards the end of the project, if anyone is interested in the systems we are using please feel free to visit our website.

References

For more information contact alps@leeds.ac.uk

www.alps-cetl.ac.uk

Workshop programme

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

Details of the workshops are available on the website and we place new ones on the site as soon as dates and venues have been finalised, so keep checking 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 find out more or book your place on any workshop go to: www.medev.ac.uk/resources/meetings/workshops/

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The Higher Education Academy
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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.

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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

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01.19 The newsletter of the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine, Summer 2009

Contents

Collaboration is the key to learning

Using transparency of assessment criteria with self-assessment to improve student performance in a dental practical skills examination

A Postgraduate Certificate in Education for Dentists: A ‘first’ for Beds

Using the SLICE model to teach legislation in medicine

The knee bone connected to the thigh bone: Teaching anatomy to engineering students using anatomical software

Miniproject report: Teaching in veterinary public health

Using a website to promote best teaching practice in medicine and dentistry

Conference report: Medical ethics and law

Launch of new veterinary nursing and bioveterinary science degree programme

Developing stage-specific, consistent, reliable and valid learning, teaching and assessment methods for PolyProfessionalism in the health professions

How can we improve the numeracy competencies of students studying animal related qualifications?

Miniproject report: Teaching, learning and assessment of law in undergraduate medical education

Workshop report: Towards common standards. Issues and possibilities in collaborative assessment in veterinary education

Conference report: Medical students and professional behaviour

Medical students and lifelong learning: The journey starts here!

Assessment and learning without boundaries: A mobile assessment and ePortfolio system

Workshop programme

Resource groups

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