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01.3 The newsletter of ltsn-01, August 2003

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

Welcome to 01.3

In this issue...

  • Core question bank linked to learning outcomes
  • Disability equality in clinical practice
  • Developing tomorrow's leaders
  • Miniprojects 2003 funding announcement

N.B. This issue is also available as a high quality PDF document suitable for printing.

Contents

Director's Overview

Project Focus

LTSN Miniprojects

Medicine - Disabled students, disabled doctors - time to change? - Dr Kathy Boursicot, Barts and the London

Veterinary Medicine - Development, teaching and evaluation of a consultation structure - Dr Alan Radford, University of Liverpool

Dentistry - A workshop study pack for gaining consenting skills in dentistry - Dr Jenny King, Barts and the London

Special report

LTSN in action

Network News

LTSN in action

Postgraduate update

Resource profile

Welcome to the third edition of 01, the newsletter of the LTSN-01

With the publication of 01.3 we continue to be staggered at the excellent feedback we have received at LTSN-01 for the two previous editions of 01. The high quality of the work being done to improve learning and teaching in our subject areas is inspirational and we are proud to showcase your work - keep telling us what you are up to and we will keep reporting it!

In 01.3 we find out about three more FDTL4 projects on three very differing topical areas - leadership, assessment, and incorporating disability equality in clinical practice. We learn about previously funded LTSN-01 miniprojects and announce the successful projects and workshops from our most recent call. Susan Eales gives us an overview of the JISC X4L projects (of which ACETS is one, featured in a previous issue), and there is a report on the interdisciplinary ETHICS project - a collaboration between a number of LTSN subject centres.

We have a short update on the JISC funded DEVIL project which explores the idea of libraries without walls, and uses a product showcased at the Breaking Boundaries conference earlier this year, ATHENS devolved authentication. Enjoy 01.3 and keep sending your ideas and contributions to newsletter@ltsn- 01.ac.uk, where you can also request printed copies of previous editions (01.1 no longer available, copies of 01.2 available on request). Online copies can be downloaded from http://www.medev.ac.uk/newsletter.

We'd like to thank Dr Sarah Marshall for her hard work and committment to LTSN-01 over the last 2 years and wish her luck as she returns to her first love, teaching, at Durham New College. Welcome to Paul Hollands, who joins the LTSN-01 team as Information and Web Support Officer. DfES e-learning strategy

There will be an opportunity to question and feedback to Diana Laurillard on the elearning strategy (recently published by the Department for Education and Skills) at the next CETIS Pedagogy Forum, to be held in October (details will appear on the Forum website at http://www.cetis.ac.uk/members/pedagogy/). To attend you need to join the Forum - joining is free.

Suzanne Hardy, Information Officer/C & IT Manager, LTSN-01

Erratum

Page 29 in 01.2 should have read anatomy.tv and not an@tomy.tv throughout the article. Our sincere apologies to Primal Pictures and thanks to Mike Smith for pointing this out.

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LTSN-01 Strategy: Director's overview

Professor Reg Jordan, Director, ltsn-01

There can be no doubt that higher education is working in a period of rapid and complex change. This is no more evident than in the provision of health professional education where the impact of Government policies and the changes to, and requirements of the statutory regulatory bodies, the professional bodies and the NHS have all to be taken into account.

Publication this year of the DfES White Paper on the Future of Higher Education, the final report from the Teaching Quality Enhancement Committee, and the HEFCE Strategic Plan 2003-08, all indicate a sea change in HE policy, mark new beginnings, and present real opportunities for the future. The DH's programme of modernisation for the NHS is also gathering pace. Revised national liaison arrangements between the DH and the DfES, previously restricted to medicine and dentistry, have been recast this year to ensure more effective joint working and strategic planning across all learning and research issues in health and social care.

To improve and oversee joint working at the interface between the health and social care and education sectors, the DH and the DfES have established jointly the national Strategic Learning and Research Advisory Group for Health and Social Care (StLaR), while at the regional level the Strategic Health Authorities are setting up Health and Education Strategic Partnerships (HESPs).

Achieving our aims

While change on this scale inevitably gives rise to uncertainty, I am grateful to the members of the Advisory Board and all the staff for their continuing support, enthusiasm, hard work, and commitment to ensuring that LTSN-01 not only continues to meet all its current aims and objectives, but is also positioned to adapt and contribute fully to the establishment and work of the new Higher Education Academy.

The last period has been an exciting and highly successful year. Despite being a period of considerable change and challenge at both the operational and strategic levels, excellent progress has been made.

New publications

Outcomes from this year's work with which we are particularly pleased, include our new high-quality publications, release of our fully re-designed and improved website, launch of a comprehensive and well-attended workshop programme, enhanced engagement with key subject associations, increased collaboration and partnership working, increased response to our highly successful mini- project scheme, and strategic, added-value engagements with other major quality enhancement programmes such as FDTL4. All-in-all, after two years of establishing its role in the constituency, we believe that LTSN-01 has delivered some meaningful, high-impact results.

While we remain acutely aware of the complexity of our constituency, representing the three subject disciplines of medicine, dentistry and veterinary medicine, and endeavor at all times to ensure that each receives a service appropriate to its particular needs, we recognise the increasing requirement to work in partnership with Health Sciences & Practice and Social Work & Policy in promoting the shared agenda in health education. The launch this year of the TRIPLE project is one tangible example of the work of this LTSN health cluster in promoting key DH objectives in health professional education.

Many people other than the core staff have been involved in promoting this year's activities and contributing to our success and I would like to take this opportunity to thank them publicly.

We are justly proud of what has been achieved over the last year and keenly anticipate the exciting opportunities offered by incorporation into the new Academy. We look forward now with confidence to our continued involvement in learning and teaching enhancement in health beyond December 2004.

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FDTL4: A core question bank linked to learning outcomes for undergraduate medicine

Andrea Owen, Ged Byrne, Paul O'Neill. University of Manchester

Medical schools have failed to match quality assessment to learning outcomes, according to a recent subject overview. This FDTL4 project seeks to establish a core question bank for undergraduate medicine which will address this need. High quality assessment of students is required throughout an undergraduate programme for certifying the competence of graduating doctors. However the Quality Assurance Agency's subject overview reported that most medical schools failed to match assessment to learning outcomes, particularly those proposed in the General Medical Council's publication Tomorrow's Doctors. Schools also failed to provide prompt and consistent feedback. Other recent published studies have demonstrated the lack of knowledge of technical aspects of assessment including the use of blueprints or matrices, the setting of appropriate passing standards and the evaluation of question quality. Given the resources required for producing good quality assessments, it is desirable for medical schools to work in partnership.

Working in a consortium

Following a successful funding application to the FDTL4 funding program, the University Medical Assessment Project (UMAP) began in January 2003. A consortium of the Medical Schools of Manchester, Leeds, Liverpool, Sheffield and Newcastle manages UMAP. The project will run for three years and the aims are to establish a high quality question bank, improve skills and understanding in setting assessments, and develop an assessment process to share with all medical schools and other relevant faculties.

Question formats

The most reliable and widely used method of testing knowledge and understanding linked to learning outcomes is through use of multiple choice questions (MCQs). More recently, new formats such as extended matching questions (EMQ) have been developed that provide less cueing to the student of the correct answer.

Well-designed MCQs or EMQs test more than simple recall of knowledge and require the candidate to apply their knowledge in some way to a clinical problem. Using the example of the National Board of Medical Examiners in the United States, the consortium has opted to use these two question formats within the new bank.

Building the bank

A programme of workshops has been carefully designed to allow for production of good questions. In all 25 workshops are planned over the three-year period. Each workshop will be attended by 20 medical practitioners or medical academics.

Through careful structuring of the workshops and appropriate instruction on writing, we will not only develop a usable bank of questions but also allow participants to develop question setting skills. Arguably, the developmental focus is the most significant element of the process.

It is essential that assessment expertise outlives the term of the project to allow for successful continuation following the end of the project in December 2005. To date, we have held five such workshops. A steep learning curve has been encountered along the way, not just for workshop participants, but also for the project team!

Assuring quality

Once the questions are written at each workshop, each item is subjected to a review process in which experienced staff consider each question in terms of content and quality.

The review mechanism, which must necessarily act as a gatekeeper to the bank, presents a demanding challenge. There is significant pressure to review large volumes of questions; the first five workshops, have generated 800!

Each question is examined to ensure that it is:

  • Pitched at a level appropriate for newly-qualified doctors
  • Logical and correctly structured
  • Written with correct answers and appropriate feedback

To further ensure quality, some questions are being tested with newly qualified doctors to assess their ease of use and accessibility. Tailor-made software will allow further assessments of validity and reliability once questions begin to be released for use in partner schools.

Creating a valid blueprint

Each medical school designs its own learning outcomes and our intention is to create a dynamic blueprint that reflects the educational taxonomies of each partner institution.

Despite reference to the learning outcomes stipulated in 'Tomorrow's Doctors', the task remains a difficult one. Rather than unpick this particular problem at present, the project has opted to allow question writers to interpret our guidance on house officer level learning outcomes as they wish, thereby contributing items on areas they feel to be of significance.

As a result, the initial bank is a relatively freeform structure. As the bank grows, experienced question writers will be required to write questions in more specific areas to allow under-examined knowledge to be assessed.

External resources

Thankfully we have been able to anticipate a number of potentially confounding issues with the help of Professor Cees van der Vleuten, of Maastricht, and Dr Susan Case, formerly of the National Board of Medical Examiners in the United States.

We have learned a great deal through our interactions with our expert consultants, and are mindful to pass on their teachings to others, particularly through our question writing workshops.

The future

An additional series of 8out-of project8 workshops are planned later on in the year. These events are being run in conjunction with LTSN-01 and are open to non- consortium health care audiences. The first of these is to be held at the ASME conference in Edinburgh this September and will be followed by others in London, the Midlands, the South West and Northern Ireland. Further details will be released via our website:

Contact details

If you wish to find out more please email our Project Manager, Andrea Owen, at andrea.c.owen@man.ac.uk.

As the project heads towards its next phase of workshops in September we are only too happy to hear from those interested to attend. Please see our website for up to date information, or contact the project direct, as above.

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FDTL4: Incorporating disability equality within clinical practice

Dr Margaret Byron, Project Director, University of Bristol

This article outlines the objectives and progress of the Partners in Practice project to incorporate disabilty equality within clinical practice, which held a major workshop in Bristol earlier this year.

Disabled people have a history of discrimination and that includes access and use of health services. What sounds more familiar to you?

  • Segregation = Us and Them
  • Integration = Us with Them
  • Inclusion = Us as Them (We)

The main aim of this project is to develop a curriculum framework around disability equality education for all health professionals. Disabled people teaching medical students at Bristol have already identified attitudes, communication and partnership as the most important factors in empowering individuals to access and use health services on an equal basis.

But what does that mean in practice and how should it be taught? In Bristol we have experience of running a disability course for medical students since 1993. Disabled people are involved from design through to delivery, evaluation and more recently assessment.

The course is underpinned by the social model of disability concentrating on the on the barriers people meet that disable them, rather than on their specific condition. Disabled people are introduced as teachers rather than patients, reversing the traditional power relationship.

Challenging course

Our students find the course challenging but especially appreciate the small group work led by disabled people. Feedback includes comments that students feel less nervous or embarrassed in approaching disabled people, knowing that they have some skills in communicating with people who have specific requirements.

Assessment however suggests that whereas students can express quite clearly the principles involved, they find difficulty translating this into a clinical context. Similar reports come from our colleagues who teach nurses, therapists, radiographers etc.

This is not enough. We want learning, which will enable health practitioners to use their knowledge and skills in the light of positive inclusive attitudes and behaviour.

Our consortium consists of the University of Bristol (UoB), the University of the West of England (UWE) and the new Peninsula Medical School (PMS). Currently we are sending out into practice each year approximately 160 medical students, more than 500 nurses, 160 physiotherapists, 60 occupational therapists and 70 radiographers. This partnership brings together diverse experience in embedding disability issues within the curriculum, totally different models of delivery in which to test our curriculum framework and an extensive network of disability organisations and professional bodies.

Objectives

We have ambitious objectives:

  • To develop the curriculum framework
  • To identify ways in which disability equality can be taught as a theme running throughout the undergraduate courses whilst maintaining a consistent philosophy.
  • To identify issues around staff development and their understanding of the social model of disability with its implications for clinical practice.
  • To develop a disability equality audit tool.
  • To critically review measures of attitude change and
  • To develop guidelines for working in partnership with disabled people.

Essential to all of this are the experts - disabled people. Areas of good practice do exist where disabled people make significant contributions to disability equality learning, as in Leicester's course Learning from Lives and St George's course where students make presentations to people with learning difficulties.

Workshop for change

To build on these we invited disabled people, educators and anyone interested in this field to join us on March 6th, 2003 in a Workshop for Change in Bristol. Our keynote speaker was Tom Shakespeare. He gave an inspirational talk challenging us all to acknowledge our own assumptions, about disability, about disabled people, about impairment and about health professionals. Disabled people already involved in teaching or assessing undergraduate health professionals also gave presentations and it was good to see a few examples of the range of work already done in this area.

The afternoon session provided an opportunity for small groups to work together on what they saw as the fundamental issues that health professionals should learn about to promote disability equality in their clinical practice. By the end of the day we had our embryonic curriculum framework from which we began to develop learning outcomes. These were returned to people who attended the workshop for comments, clarification and any additions.

Consultation process

We now have a document to go out for general consultation and consensus using the Delphi process. Our aim is to get as many disabled people as possible to contribute but we are also interested in the opinions of educators and health professionals.

After two or three iterations of the ranking the learning outcomes will have been refined, many people will have had input and our networks will have widened. But, most important of all disability equality will have a much higher profile. The rest will flow from this - but that's for another newsletter.

Disability Equality in healthcare practice is a neglected area. This project will challenge existing practices and attitudes and provide exemplars of good practice. Partnership between disabled people and health educators will become a reality and will enable disabled people to have a direct influence on the education of their future healthcare providers. Join us.

Core Project Team

  • Project Director - Dr Margaret Byron, Margaret.Byron@bristol.ac.uk
  • Project Co-ordinator - Caro Howell, Caro.Howell@bristol.ac.uk
  • Project admin support - Marcia Dring, Marcia.Dring@bristol.ac.uk, Centre for Medical Education, UoB, 39-41 St. Michael's Hill, Bristol, BS8 8DZ. Tel: 0117 954 6537
  • Co-applicant - Shekar Bheenuck, Principal Lecturer, Faculty of Health and Social Care, UWE, Shekar.bheenuck@uwe.ac.uk
  • Professor Paul Bradley, Director of Curriculum Design, PMS, Paul.bradley@pms.ac.uk
  • Claire Wickham, Director of the Centre for Disability and Communication Studies, Claire.Wickham@bristol.ac.uk
  • Co-applicant, Professor John Bligh, Associate Dean and Director of the Institute of Clinical Education. John.bligh@pms.ac.uk

A website, including the Delphi process, will be up and running soon

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FDTL4: Developing tomorrow's leaders in health and social care education

Dr Judy McKimm, Project Manager, Leicester Warwick Medical School

Creating the health and social care leaders of the future is a key challenge for the medical education profession. This project sets out to develop a framework for excellence in training.

The project aims to develop and deliver a development programme for aspiring leaders of health and social care education, modelled on an agreed specification for skills and competencies. The framework will include opportunity for up to 70 staff to be equipped with the skills necessary to:

  • Manage and enhance the quality of students' learning experience across the HEI/ NHS/ Social care interface
  • Manage change and the development of health and social care education
  • Work within a well established network to ensure rapid spread of good practice.

It is planned that the final version of the programme will be rolled out to HEIs and embedded in institutional staff development programmes to assist organisations in succession planning for leaders in health and social care education. The programme is being developed through consultation with HEIs working in the area of leadership, with participants, with mentors and with an expert group. The findings from interviews with experts and a residential event, a literature review, questionnaire survey of participants on the first programme and a focus groups of mentors have contributed towards developing a framework for the leadership programme.

Outcomes of the project

  • A validated, accredited and tested educational leadership programme available to institutions which can be embedded in organisational staff development programmes
  • A VLE (virtual earning environment) which includes development activities relating to educational leadership and supporting resources
  • A cohort of 70 individuals who have been through the programme and who are better prepared to lead in health and social care education.

Leadership development

Aims of the programme:

  • To develop the leadership potential of aspiring future leaders in health and social care education
  • To provide participants with the opportunity to reflect on their own personal and professional leadership development needs and provide support for enabling participants to meet those needs.

Outcomes

As a result of participating in the programme, participants should be able to:

  • Demonstrate effectiveness in aspects of leadership and management appropriate to their own context
  • Utilise more effectively their ability to use interpersonal, organisational and coping skills
  • Use their specialist skills and knowledge appropriately in the HE context
  • Produce a realistic and achievable Personal Development Plan for meeting the goals associated with leadership in health and social care education through reflection on their personal and professional needs, and in particular, their continuing professional development with appropriate support and feedback.

Key topics

  • Exploring concepts of leadership (and how this differs from management)
  • Understanding the HE and NHS context and environment
  • Managing and leading change, creative management, horizon scanning
  • Managing and leading people
  • Decision making and risk taking
  • Quality and performance, using performance indicators
  • Personal leadership (leadership style, empowering, inspiring etc.)
  • Self-awareness
  • Vision and values
  • Time management and prioritising
  • Communication and interpersonal skills (EQ)
  • Leading and building teams
  • Career planning and management.
  • Accreditation and assessment

Discussions are underway to have the programme accredited by SEDA under the Professional Development Accreditation Framework. It is planned that all participants will maintain a portfolio throughout the programme as a record of their professional development and that those participants who wished to qualify for a Developing Leaders award would be required to submit their portfolios as part of a formal assessment process.

Participants

Through liaison with a network of institutional contacts we have identified twenty- five individuals who would benefit from participating in the programme, these include people from a range of UK medical and dental schools.The programme is intended for people who are seeking a career in educational management and who are either are responsible for a significant component of a health or social care programme or for those who are likely to become managers in the near future.

The programme for the first cohort of 25 participants begins in October 2003 and finishes in August 2004, and a second group (of approximately 50 aspiring leaders) will start the following year. Participants have been consulted about their specific learning needs and these have been incorporated into the programme. Participants will be enabled to:

  • Audit their skills and competencies against an agreed specification
  • Develop a personalised development programme
  • Have a named/trained mentor
  • Participate in a network of Action Learning Sets
  • Access formal training events with expert facilitators
  • Access a virtual learning environment and website.

Mentor programme

We also obtained suggestions from institutions for people who could act as mentors to the participants and are in the process of training 24 mentors. The mentors are mainly senior managers in institutions that deliver high quality health and social care education. Each of the participants has been assigned a mentor from outside their own discipline or subject area.

The main role of mentors is to provide support and assistance for their mentees in achieving tasks including an audit of existing skills and competencies and the completion of personal action plans. All mentors will attend a short training programme designed to enable them to learn more about current challenges facing leaders in health and social care education and develop relevant mentoring skills.

The expert group

An expert group has been established which will provide input into the development phase of the project, particularly in identifying the key skills and competences for leaders in health and social care institutions. The group comprises 22 relatively senior, experienced staff from a range of UK and overseas HE institutions, some of whom will also be mentors. Interviews have been carried out with the group members to ascertain some of the key issues concerning leadership in health and social care education from a practitioner perspective.

Most of the expert group attended a residential event on 21/22 May 2003 and the outcome of the event was to finalise the framework of the leadership development programme and define some of the key activities to be included.

Contact details

Email: Dr Judy McKimm, project manager mckimm@btopenworld.com

Project partners

This project is being led by the University of Leicester in partnership with:

  • Imperial College London
  • The University of Leeds Medical School
  • University College, Northampton
  • Liverpool John Moore University

The project director is Professor Stewart Petersen from Leicester Warwick Medical School. The project is supported by the Council of Heads of Medical Schools and the Deans of Faculties for Nursing, Midwifery and Health Visiting, HESDA and the LTSN-01. HESDA are participating in the design and evaluation of the project.

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Extended summaries of AMEE medical education guides

LTSN-01 has commissioned the writing of extended summaries of a selection of the Association of Medcial Education in Europe (AMEE) Guides series. These comprehensive guides cover key topics in medical education.

Available are guides on the following topics:

All summaries are compiled by AMEE and to obtain full versions please contact: Association for Medical Education in Europe (AMEE) at: amee@dundee.ac.uk or through the AMME website < http://www.amee.org >

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LTSN-01 Miniprojects: 18 proposals awarded shares of £65,000 funding

We had a fantastic response to our call for miniproject applications this year. We received 83 applications, many of an exceptionally high standard, but 18 shone through as deserved winners. So good were they that we stretched our overall miniproject budget from £60,000 to £65,000. Below is a list of those projects awarded an LTSN-01 miniproject grant in 2003.

Medical

  • Why do some medical students fail exams? Dr Alistair Chesser, University of Aberdeen
  • Consulting through an Interpreter, Dr Cathy Jackson, University of Dundee
  • An exploration of the effect of reflection on undergraduate medical students' learning, Dr Andrew Grant, University of Wales College of Medicine
  • Assessment of medical students' attitudes towards professional behaviour, Dr Vikram Jha, University of Leeds
  • Coordinating research activity on Interprofessional Learning involving the Readiness for Interprofessional Learning Scale (RIPLS), Dr Karen Mattick, Peninsula Medical School
  • Communicating with deaf patients. A postal survey of awareness of communication issues. Dr William Murdoch, University of Birmingham
  • An investigation into the learning styles of the University of Southampton Medical School entrants and outcomes of their first year Primary BM exams, Miss Vikki Haley, University of Southampton
  • Development of computer based prepared for practice therapeutics EMQ test, Dr Paul Julian, Barts and the London School of Medicine, Queen Mary, University of London
  • Use of Life Drawing in Undergraduate Clinical Attachments, Dr Sarah Gull, University of Cambridge
  • Developing mental health user input into medical student learning, Penny Morris, University of Leeds

Dental

  • Dental students interacting with dental nurses: an investigation of gender differences in communication and working styles, Professor Ruth Freeman, Queen's University, Belfast
  • An educational package for trainers in dental outreach placements, Dr Peter G Robinson, University of Sheffield
  • A Virtual Learning Environment for Orthodontics, Professor Jonathan Sandy, University of Bristol
  • Evaluation and Dissemination of a Progress File Learning System at Barts and the London Queen Mary's School of Medicine and Dentistry, Dr Elizabeth Davenport, Barts and The London Queen Mary's School of Medicine and Dentistry
  • Chairside teaching and learning: stakeholders' perspectives, Mr Jeffrey Wilson, University of Wales College of Medicine

Veterinary

  • A Bovine Rectal Palpation Simulator for training veterinary undergraduate students, Dr Dominic Mellor, University of Glasgow
  • Does the formal teaching of communication skills improve the ability of veterinary students to communicate with clients in clinical situations?, Mrs Christine Latham, University of Cambridge
  • Objects for OSCEs (Generating Reusable Learning Objects (RLOs) from existing CLIVE courseware to support Day One Competencies), Ms Vicki Dale, University of Glasgow

Further details about these projects are available at http://www.medev.ac.uk/resources/features/miniprojects.

We'd like to thank everyone who submitted a proposal. We've seen some great ideas for improving learning and teaching in the constituency and our only regret is that our budget didn't allow us to fund more of them.

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Miniproject perspective: Disabled students, disabled doctors - time to change?

Dr Kathy Boursicot, Senior Lecturer, Centre for Medical and Dental Education, St Barts and the London

Recent legislation and a high profile legal case have brought into focus the medical profession's struggles with the issue of disability. A miniproject funded by LTSN-01 seeks to establish what current attitudes to disabled people within the medical profession are.

In recent years all institutions of higher education have struggled with the issue of disability.

In 1995 The Disability Discrimination Act (DDA) laid down a marker when it required all such institutions to publish a disability statement. More recently the Special Educational Needs and Disability Act (SENDA) developed the earlier legislation and made it unlawful to discriminate against disabled people or students by treating them less favourably than others.

Initially the institutional response was to focus upon the physical aspects of disability; widening a door or providing managed access to a building. However, it soon became clear that this was inadequate.

Professional challenge

The challenge was particularly acute for those courses that combined academic work with entry rights into a profession such as medicine, nursing, dentistry and veterinary science.

A degree in medicine, for example, is a confirmation not just of academic achievement but is also an entitlement to provisional registration by the General Medical Council (GMC). This means the graduate is issued with a licence to practice and to engage with the general public in an official professional capacity. As a recent letter from Jenni Knox (Skill: National Bureau for Students with Disabilities) to the Times Higher Education Supplement makes clear:

from October 2004, the General Medical Council, the Nursing and Midwifery Council and other such bodies will be brought under disability discrimination legislation.

High Profile

A recent high profile case (THES May 2002) in which a young, wheel chair bound, student had been refused access to an undergraduate medical course has brought into sharp focus the apparent restrictive attitude of the professional governing body on the admission of disabled students to the study of medicine. After the outcome of the case (which has gone to the European Court of Justice), the Chairman of the Disability Rights Commission commented that;

The GMC should start to look beyond the legal arguments and see how it can welcome disabled people to the medical profession.

In order to explain some of the issues raised by the legislative changes, the LTSN-01 has funded a small, qualitative, study which is being conducted by Dr Alan Butler, myself, Dr Kathy Boursicot, and Professor Trudie E Roberts. The research is essentially a scoping exercise seeking to establish what the current attitudes are to disabled individuals within the medical profession and explore the implications of changes for the future.

Medical schools

To this end a number of medical school admission tutors have been interviewed with regard to their present understanding of the legislation and practice. Medical students and doctors, both disabled and able bodied, have been interviewed to ascertain their experiences and views.

An important element of the study has been to seek the views of the consumers of medical services.

A number of focus groups have been conducted with various sectors of the population; school leavers, age concern groups, general practice patients, hospital patients and disability groups.

Public expectations

These have highlighted the expectations that the general public have of doctors and their thoughts and responses to the notions of more disabled people entering the profession.

So far the indications are that the general public may be more accepting of disability than some of the professional bodies.

Many would welcome greater understanding and tolerance if it led to more doctors being able to empathise with the disabled patients.

Dr Kathy Boursicot, Senior Lecturer, Centre for Medical and Dental Education, St Bartholomew's and the London School of Medicine, k.a.m.boursicot@qmul.ac.uk

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Miniproject perspective: Development, teaching and evaluation of a consultation structure

Dr Alan Radford, Communications Skills Co-ordinator, University of Liverpool

A Guide to the Veterinary Consultation Based on the Calgary-Cambridge Model

The consultation is at the heart of good clinical practice. Experiential learning using simulated patients has become an integral part of the medical curriculum for trainee doctors. The use of these role-plays is frequently based around a consultation structure that allows the consultation to be broken down into its component parts thereby facilitating directed learning and assessment. Recently, similar courses using role-plays have been developed for veterinary curricula. These courses have been well received by educators and undergraduates alike. However, it has been recognised that a lack of structure for the veterinary consultation is the major limitation to developing teaching and learning and will make effective assessment of veterinary undergraduate communication skills difficult.

So why not use the model the doctors have been using I hear you cry. Whilst there are many similarities between the medical and veterinary consultation, some differences are apparent including different types of owners, frequent euthanasia (patients not owners) and fees.

Recognising both the considerable overlap and also the likely differences between the veterinary and medical consultation, a miniproject grant from LTSN was used to fund a two day residential workshop in August 2002 to adapt a widely used medical consultation model to the veterinary context. The workshop was attended by medical and veterinary educators, veterinary practitioners and educationalists. Practioners representing the small animal, equine and farm animal branches of the profession were specifically included to ensure the workshop output would be broadly applicable to the veterinary profession.

On day one of the workshop, clinicians from each branch of the veterinary profession discussed what they felt was important about communicating with their particular clients. In small groups, the veterinary consultation was then broken down into its component parts. Then Dr Sue Kaney explained how she uses such consultation structures in training medical undergraduates at Liverpool University. Dr Jonathan Silverman then introduced the workshop team to one model widely used in medical education - the Calgary-Cambridge model. On day two of the workshop, the delegates deconstructed the Calgary-Cambridge model before rebuilding it, at each stage seeking, where appropriate, to "veterinise" it - to translate it to the veterinary context.

The end product was a model rather snappily entitled A Guide to the Veterinary Consultation Based on the Calgary - Cambridge Model. Although a bit of a mouthful, the name gets over two important points:

  • The model is specifically worded for veterinarians and veterinary education and emphasises key issues in veterinary consultation
  • The model is heavily based on a successful medical model, a testament to the many features shared between the veterinary and medical consultation.

The model breaks the veterinary consultation down into preparation, initiating the consultation, gathering information, physical examination, explanation and planning, and closing the consultation. Throughout the consultation, there is also a requirement to observe, to build the relationship with the client and the patient, and to attend to the flow of the consultation (see figure one).

The whole process is further broken down into 63 specific skills (not presented). Whilst the vast majority of these skills were also already represented in the original Calgary-Cambridge model, there were nine additions including. For example:

  • Creating a professional, safe and effective environment.
  • Ensures facilities / environment are professional and appropriate to anticipated needs.
  • Demonstrates understanding of animal's importance and purpose. Familiarises with past history relating to client and animal(s).

The model is freely available for all to use. The authors hope that it will aid learning, teaching, facilitation and assessment of veterinary communication skills. It has already been used with third years at Liverpool University to introduce them to the veterinary consultation prior to starting the clinical part of their course.The use of the model as an educational tool is currently being evaluated, the results of which will hopefully be published. More details can be obtained by e-mailing alanrad@liv.ac.uk.

The co-authors of this model are Alan Radford, Paula Stockley, Penny Watson, Steve May, Jonathan Silverman, Vicki Dale, Sue Kaney, Mark Glyde, Agnes Winter, Anne Healy, Brian McVey, Ray Sutton, Ian Taylor, Christine Magrath, Rob Turner, John Tandy, Sarah Marshall, Clare Spencer and Lisa Bush.

The authors are grateful to the LTSN-01 and Hills Pet Nutrition for sponsoring the workshop.

References

  • Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning Communication Skills in Medicine. Radcliffe Medical Press (Oxford)
  • Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients. Radcliffe Medical Press (Oxford)
  • AD Radford, P Stockley, G Humphris, S Kaney, R Turner, C McGrath, CJ Gaskell & IR Taylor. (2003). The use of simulated clients in communication skills training for veterinary undergraduates. Veterinary Record 152, 422-427.

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ADVERTISEMENT - University of Dundee: Centre for Medical Education

University qualifications in education for medical educators

The Centre for Medical Education offers postgraduate courses leading to internationally recognised qualifications in Medical Education for health professionals and medical educators. These programmes are designed to develop the skills of participants in their professional roles as medical educators, with emphasis on teaching & learning, facilitation, mentoring, assessment, material design and curriculum development.

  • Postgraduate Certificate in Medical Education (PGCertMedEd)
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Email: c.m.e.courses@dundee.ac.uk

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Fax: +44 (0)1382 645748

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Miniproject perspective: A workshop study pack for gaining consenting skills in dentistry

Dr Jenny King, The Institute of Dentistry Barts and the London, Queen Mary's School of Medicine and Dentistry.

Growing awareness of consumer rights has led to dental patients wanting to know more about the choices of treatment open to them. With LTSN-01 support, four workshops are being developed to raise dental students' awarness of the importance of proper and informed consent.

There is now greater consumer awareness in contemporary society and an increasing emphasis on the importance of respecting other people's rights. For dentistry this means that people want more information and more choice about any treatment that they receive.

This is important ethically because it respects a person's capacity to determine what happens to their own body and helps to build the trust and confidence that is essential in good professional relationships.

Furthermore when settling medico-legal disputes or taking any disciplinary action the courts and the professional regulatory bodies are now concerned about whether or not people were appropriately informed and their proper consent obtained.

Social change

Recently there have been new directives from the Department of Health, the BMA, GMC, and also from the GDC and BDA. We live in a new age where consent is being seen as more and more important in human relationships. Dental students should know not only about these theoretical aspects of consent but also be competent to apply them at the chairside.

Negotiating consent is not a single activity. Rather there are a series of tasks that need to be carried out in the consultation that together make up what is best understood as a process of consent.This process ranges from giving information, checking that it has been understood, to reaching consent that is freely given. Obtaining consent is not without difficulty. The cultural diversity of the community means that patients come from many different backgrounds. People may have different expectations and may not always speak the same language as the dentist. Then some of the most difficult moral dilemmas in health care arise in the management of vulnerable patients. People with learning disabilities and children may need extra support in decision making. Deciding with or sometimes on behalf of vulnerable others is never easy.

Workshop programme

Four workshops are being developed to raise dental students' awareness of the importance of consent and to help them to work out a more comprehensive and systematic approach to negotiating a person's informed consent to professional dental care. They are intended as a resource for undergraduate and postgraduate teaching in ethics and law as applied to clinical disciplines and communication skills.

The first of the four workshops considers adult patients and the different component stages in the process of obtaining consent. Three further workshops then explore consent and cultural diversity; decision making for vulnerable adults without the capacity to consent for themselves; and consenting procedures for children and their proxies.

The workshops are designed for small groups of students to work together with a tutor as a facilitator. For each session there is a short video presentation followed by ideas for discussion and role-play. Actors may play simulated patients or students themselves take the role of patients.

Encouraging students

Positive feedback from the actor and the other members of the group is intended to encourage students to recognise helpful behaviours.

This experiential method is a powerful way of learning which helps students to develop their communication skills and to discover for themselves the most helpful ways of obtaining peoples' consent to dental treatment in a variety of different clinical situations. At the end of each workshop there is an opportunity to reflect on what has been discovered, and what works well when obtaining a person's consent.

Obtaining consent is an essential legal, moral and professional requirement in all health care. This requires good communication skills and the development of good relationships between those who provide and those who receive health care. These are skills that can be learnt. The four workshops are designed to promote good consenting practice and the partnership that both dentists and patients work towards. The completed study pack will be made available to dental schools and postgraduate centres.

Contact: Jenny.King@qmul.ac.uk

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Deposit or withdraw: an introduction to the LTSN Bioscience ImageBank

Aurora Levesley, LTSN Bioscience, University of Leeds, and Alison Loftfield, LTSN Communications Manager, LTSN Executive.

Baby squid, mitochondria, human cells, Streptococcus pyogenes, DNA sequence gels - these are just a few of the images available free of charge with rights cleared for educational purposes from the LTSN Bioscience ImageBank. Much of Bioscience research involves the painstaking task of acquiring informative images ranging from scanning electron micrographs to DNA sequence gels to whole plant images. However, few of these images are ever published, due to limited journal space, and many would be a valuable learning and teaching resource. The LTSN Bioscience ImageBank ran a feasibility study, which identified a real need within the community for good quality, annotated, freely available copyright cleared Bioscience images for educational use and also a clear willingness amongst the academic community to share this valuable resource. The LTSN Centre for Bioscience with its 1,500 members, and reaching a further 6,000 through its network, is in a unique position to develop and deliver this shared online image resource.

ImageBank seeks to support the 21 Bioscience subject disciplines covered by the LTSN Centre for Bioscience, including, Genetics, Agriculture, Horticulture, Immunology, Microbiology, Anatomy and Physiology, Biochemistry, Pharmacology, Cellular and Molecular Biology, Plant Sciences, Ecology, Zoology, Forestry. As such it complements image collections such as BioMed Image Archive < http://www.brisbio.ac.uk/ > which have been specifically developed for medical, dental and veterinary teaching.

Since its launch this year the LTSN Bioscience ImageBank collection has reached nearly 1500 images and continues to grow rapidly, through contributions from the Bioscience educational community and industry. ImageBank has been well received and currently supports over 450 image downloads per month. Bioscience research or teaching photographs such as immunology, pharmacology, molecular biology, cell biology images as well as wildlife photographs, biochemical pathway diagrams and computer generated images, are all welcome to build this shared image resource.

Contributions are easy to make online through the LTSN Bioscience ImageBank website. The subject centre assures the quality of images and catalogues them but copyright remains with the contributor. To encourage further contributions, the LTSN Bioscience is currently running a prize draw giving all contributors the chance to win a Nikon Coolpix 2100 digital camera retailed at £200. Further details can be found on the LTSN Bioscience ImageBank website.

The LTSN Bioscience ImageBank collection can be searched using specific words or browsed by subject discipline such as biochemistry or pharmacology or searched by systematic classification or contributor. Each image has descriptive text written by those who have substantial knowledge of the subject matter. Images and text can be downloaded separately or added to a preview folder, allowing multiple images and text to be downloaded as a ZIP file. Images may only be freely downloaded and used for learning and teaching purposes within educational establishments (HE, FE and schools) for non-profit purposes only. Acceptable uses include: academic web pages, lectures, PowerPoint presentations, within computer-aided learning materials, online tutorials, tests, coursework, student presentations or projects and school reports. The user must acknowledge the contributor, copyright holder and the LTSN Bioscience ImageBank on using the image.

ImageBank also provides access to a searchable and browsable database of evaluated bioscience image collections, through a LINKS page. The copyright status of the image collection is provided where possible. Website suggestions are always welcome and can be made online. ImageBank also offers an online facility to request images from the Bioscience educational community.

The LTSN Bioscience ImageBank pilot formed part of a feasibility study which aims to identify the real needs of the bioscience educational community with respect to image use and availability. The LTSN Bioscience ImageBank feasibility study is co-funded by the LTSN (Learning and Teaching Support Network) and the JISC DNER (Joint Information Systems Committee Distributed National Electronic Resource).

The LTSN Bioscience ImageBank can be found at:

For all enquiries contact:

Dr. Aurora Levesley or John Horlock, ImageBank

LTSN Centre for Bioscience

School of Biomedical Sciences

Room 8.49n Worsley Building

University of Leeds, Leeds LS2 9JT

Tel: 0113 343 3001/Fax: 0113 343 5894

Email: imagebank@ltsnbio.leeds.ac.uk

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LTSN in action: X4L Exchange for learning

Susan Eales, Programme Manager, X4L, JISC

The Joint Information Systems Committee (JISC) is a strategic advisory body that provides the infrastructure for learning, teaching and research, offers leadership and guidance in the use of ICT, and acts as a national and international leadership body for collaboration across education and research. In all 25 projects have been funded by JISC as part of the X4L programme with a total value of around £4 million over 3 years.

The X4L Programme aims to add towards our knowledge of whether creating and repurposing learning objects can be a popular, relatively easy and sustainable content-generation method for the future. It will achieve this by developing a learning materials repository, prototype tools and some exemplar learning objects and case studies to highlight and explore the issues around repurposing content. The X4L Programme is also increasing the number of staff in institutions with the skills to repurpose learning objects.

Strand A projects

There are 22 Strand A projects that are developing learning materials. All involve FE/HE partnerships. Some projects are exploring the repurposing and sharing of resources across a range of subject areas. Others are producing learning materials that are specific to a particular course or part of a syllabus.

Strand B tools

The JISC learning materials repository - JORUM (latin, a drinking bowl: its contents)

The JORUM has been designed as an advanced tool set, allowing users to locate, preview, access and publish objects. It will also allow for repurposing and sharing content for use in multiple teaching and learning scenarios in a wide variety of educational environments.

Tools for teachers with pedagogic flexibility - RELOAD

RELOAD is developing an open source content packaging tool that can be used online or offline and will be available on CD-ROM if required. This tool will allow users to break down learning materials into objects and reassemble them into new learning materials.

Tools for flexible assessment methods - TOIA

The TOIA Project will develop templates and tools for authoring QTI compliant questions and assessments, a web server based assessment delivery system and a results reporting tool. These tools will become available to the FE and HE community as a whole.

Communities of practice

Communities of practice at all levels are beginning to develop through X4L. Around 120 institutions are involved in the programme - a considerable pool of expertise, collaborating and sharing good practice and content. Regional cluster groups allow further opportunities for project staff to share experiences and ideas.

At institutional level, partnerships and relationships are developing between FE and HE staff and between Learning Resources Managers and teachers. At project level, subject communities of practice are being formed that seek to effect real change.

ACETS

ACETS is investigating the reuse of learning materials covering all areas of healthcare education, from Medicine to Beauty Therapy. Around 30 academics and teachers are being recruited to create exemplars of reusable learning objects. These are then analysed and evaluated in different teaching contexts

ALBEDA

The Albeda Project is repurposing learning objects for a specific part of the A-Level Biology syllabus - Epidemiological Data. The project is incorporating the learning objects in a VLE to make use of the communication tools to promote greater discussion and interaction in a subject area that is difficult to teach in an engaging manner using traditional methods.

Learning for a Healthier Nation

This project aims to promote the use of online learning content and resources to Health Care professionals and enhance the delivery of health care education and vocational training across FE and HE in the UK, particularly in the areas of cancer, coronary heart disease, stroke and mental illness. It intends to achieve this by:

  • Identifying and evaluating a range of health care learning resources
  • Developing and testing approaches to re-purposing learning resources that will meet a range of teaching scenarios
  • Developing guidelines for tutors to enable them to create their own learning/teaching packages using online resources.

Links

Project website at: < http://www.jisc.ac.uk/index.cfm?name=programme_x4l >

Susan Eales, Programme Manager s.eales@jisc.ac.uk, tel 020 7848 2513

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Network News: LTSN - Foundation for the future

Alison Loftfield, Communications Manager, LTSN Executive

During the last three years, the Learning and Teaching Support Network (LTSN) has successfully penetrated each and every discipline, reached thousands of departments, and has worked with nearly 200 higher education (HE) institutions. It has not been an easy task but the LTSN has built a strong foundation in terms of people, profile, relationships and resources. This article examines the next step.

According to the independent evaluation report, the academic community values the LTSN for its subject based approach, the resources offered, the networking opportunities and the fact that it is led by practising academics focusing on educational issues. The report describes the range and quantity of the activities carried out by the LTSN as impressive, the network punches above its weight in terms of the resources available, and represents excellent value for money.

The LTSN has worked hard to earn these plaudits. One of the main strengths of the network is its unique subject focus. No other organisation with the aim of enhancing learning and teaching has this distinctive role yet for many staff in HE it is at this level where most networking and exchange takes place.

High awareness

All 24 subject centres have established links with their discipline communities throughout the UK and research shows that awareness levels are high with 86% of survey respondents having heard of the network, and 80% aware of the subject centre for their discipline. During the last academic year subject centres organised over 650 events with more than 13500 attendees. Furthermore, there is evidence that learning and teaching is being influenced by LTSN activity. Almost half of the respondents reported that their subject centre had already made a contribution to the work of their department.

The LTSN also provides a voice for the learning and teaching community with which to contribute to subject policy and development debates. This voice is being heard as we help to shape some of the developments post White Paper in England.

Academy plans

The LTSN is at the centre of the newly proposed Higher Education Academy whose prime purpose is to improve the quality of the student experience through professional development of all in higher education.

The Academy will do this by:

  • Becoming an authoritative source of strategic advice on policy matters and professional standards
  • Supporting curriculum and pedagogic development across the whole spectrum of higher education activity
  • Facilitating the professional development of all relevant groups in higher education.

The Academy will draw upon and support the work of institutions, individuals and communities of practice, and it will work with a wide range of partner organisations. It will promote relevant research, scholarship, international intelligence, analysis and benchmarking, so that it is recognised as being at the leading edge of development, enhancement and innovation in its field.

New Mission

This mission represents a vision of a new organisation that goes beyond what is currently available in higher education. It will, in due course, provide for all those who support students, a comparable level of professional recognition, strategic advice, influence, support and leadership to that which is available to other professions.

Through the academy, the LTSN will be able to provide increased support for institutions' efforts to deliver high quality teaching. The name may change but the people, profile, relationships and resources will remain the same giving the LTSN a strong foundation on which to build.

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Problem based learning: Special report now available through LTSN-01

A Special report: A pilot systematic review and meta-analysis on the effectiveness of problem based learning, discusses the development and piloting of one such systematic review and meta-analysis on the effectiveness of PBL by an internal group of teachers and researchers convened under the auspices of the Campbell Collaboration. The review manager was Mark Newman, Research Fellow, Middlesex University and Dr Jean Mckendree, Learning Development Officer for LTSN-01 was a member of the review group.

Problem Based Learning (PBL) represents a major development and change in educational practice that continues to have a large impact across subjects and disciplines worldwide. PBL is promoted by professional and funding bodies as an appropriate strategy for professional education and increasingly as the method of choice. PBL is now also now spreading into non-professional subject areas of Higher Education.

An LTSN-01 mini-project grant was awarded to help fund this work and LTSN-01 has published the report in full. To request a hard copy please contact us at enquiries@medev.ac.uk.

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LTSN Projects: Ethics Teaching Highlighted in Contextualised Scenarios

Dr Susan Illingworth, Project Co-ordinator, LTSN-PRS and Mark Brennan, Lecturer, University of Wales College of Medicine

The ETHICS project brings together six subject centres, serving at least 56 seperate disciplines. The project will produce a body of inter-disciplinary ethics teaching and learning resources based round a database of contextualisedscenarios - working examples of ethical problems encountered and used in teaching to highlight relevant principles.

Here Susan Illingworth first sets out the arguments for applied ethics being multi- disciplinary, and describes the basic objectives of the project. Mark Brennan then looks at models for sharing best practice in ethics across disciplines.

Why interdisciplinary?

Ethics is fundamentally concerned with human actions and agency, and as such, it has relevance to all areas of human endeavour. The concepts, principles and theories that over two thousand years of scholarly and systematic investigation into ethics have produced suggest that our moral intuitions are not essentially subject-specific.

An agricultural scientist working in an environmentally sensitive location might have different moral concerns from those of a doctor specialising in children's cancers, but this does not mean that they must appeal to distinct or incommensurable sets of values.

The supradisciplinary nature of ethics is the main reason for supposing that an interdisciplinary approach to ethics teaching might be of mutual benefit. The ETHICS Project's inclusion of six subject centres (Medicine, Dentistry & Veterinary Medicine, Health Sciences & Practice, Philosophy & Religious Studies, Psychology, Law and Bioscience) between them serving the needs of at least 56 separate disciplines, give it a wide base from which to review the effectiveness of existing practice.

What are the project's aims?

Drawing on the extensive combined knowledge and experience of its subject communities, the Project will work to produce a number of ethics learning and teaching resources by the end of 2003. The primary material resource will be a database of Contextualised Scenarios or case studies.

These are working examples of applied ethical problems used in teaching to highlight relevant ethical principles. The Project aims to offer scenarios which are:

  • Defined in relation to stated learning and teaching objectives.
  • Of proven effectiveness in meeting those learning and teaching objectives.
  • Drawn from a wide range of disciplines but presented so as to facilitate translation into other subject areas.

It is hoped that the database will provide a useful resource not only for new teachers of ethics looking for ideas on course development, but also for experienced ethicists for whom it will provide a snapshot of current teaching and learning priorities.

We are now inviting teachers who use contextualised scenarios to contribute an item for this database.

If you are interested, please check out the ETHICS website for furthern information:

The Project's objectives with regard to the development of human resources are potentially the more significant in the long term.

Despite the supradisciplinarity of ethics, ethics communities remain largely subject-specific. It is therefore a key aim of the Project to promote a network of ethicists drawn from all participating disciplines, by providing a forum for the exchange of ideas on their shared subject.

Multiprofessional Frameworks

Many graduates will work within teams drawn from a range of different professions when they leave university. Accordingly, they will need to be able to discuss moral issues competently and constructively with a diverse range of people. In some cases they will be asked to address the concerns not only of fellow professionals but of members of the public. One of the primary motives behind the drive towards a greater ethical awareness among graduates is an appreciation of the consequences for any profession of a loss of public confidence. It will therefore be increasingly important for teachers of ethics to produce learning and teaching outcomes on three levels:

  • Subject-specific: students will need to understand:
  • The moral issues that arise most frequently within their subject area.
  • The perspectives of students and professionals within this subject area.
  • The perspectives of key stakeholders/service users in the professions served by that subject area.
  • Interprofessional: students will need to understand the perspectives of people from professionally related subject areas on issues of shared moral significance.
  • Public: students will need to understand the perspectives of private individuals and relevant social groups on moral issues arising within their subject area.

The key to public confidence

Conflicting professional values can only serve to undermine public faith in professional standards, so an effective learning and teaching strategy must seek to present moral issues in a way that anticipates and fosters dialogue between different professions and between professions and the public. The ETHICS Project exists to help teachers meet this difficult but vital challenge.

Dr Susan Illingworth

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Sharing best practice in teaching ethics - learning from each other

As an arts and humanities graduate who has spent nearly 15 years working as an academic in science, medicine and dentistry, this project is dear to my heart bringing together as it does teachers and learners from a wide range of disciplines. The ETHICS project provides a exciting opportunity for teachers to share with one another our diverse knowledge, experience and approaches to teaching and learning of ethics.

Education is often at its best when academics and students leave their cosy ghettos and interact with colleagues outwith their own discipline. This has obviously happened informally for many years, but the focus and co-ordinating nature of the project are to be welcomed.

I believe there may be several key benefits that will accrue from this project, not least the development of a new professional network with organised opportunities for teachers to meet and discuss their academic interests and activities. Other benefits include:

Scenarios - So what is this a case of?

Ethics taught out of context and without application loses much of its flavour; the development of an ETHICS Project database of scenarios from across the disciplines is a very valuable initiative.

Medical teaching has always involved the use of cases; how often have you heard a colleague use the phrase, "I had this patient..."?.

Many of us also use scenarios and cases to illustrate key ethical principles and to present ethical dilemmas.

Having taught aspects of business, management and engineering ethics, as well as bio-ethics, medical and dental ethics, I have found that cases and scenarios from one discipline can often be customised to suit another. Having authored a case-based book and two teaching packs myself, user feedback has suggested academics appreciate having a ready resource and fresh cases to add to their own repertoire.

As teachers in medicine, dentistry and veterinary science, we are constantly being pulled in all directions - clinical work, research, teaching, and administration - and under pressure to deliver high quality teaching and publications; anything which helps us to teach well but also saves time and effort is likely to be applauded. LTSN-01 is currently inviting teachers to contribute their own cases to form part of the database.

Curricular approach - How do we teach ethics?

The ETHICS project is already obtaining information about how ethics is taught across the disciplines; this includes the type of curricula in operation. In the medical disciplines, these will vary from traditional curricula delivering information via didactic lectures and seminars (which still have an important part to play in the educational process) to the new system-based, problem-based, self-directed and open learning curricula. The latter are likely to make much more use of small group work where cases and scenarios are widely used. All of these approaches can be innovative and progressive, and thus of interest to other teachers and students.

The curriculum in use will obviously affect the role of both teachers and students, but there is a major shift in medical, dental and veterinary education involving change for both parties. The traditional role where teachers were seen as imparters of wisdom has evolved to include our role as facilitators of learning.

More emphasis on student-centred learning and teaching mean that our students have had to become active rather than merely passive recipients of knowledge; they are expected to engage with us and each other as much as with patients.

Integration - How do we integrate the teaching of ethics?

Many teachers of ethics feel unhappy if their subject is presented as something peripheral or separate to the main degree course (e.g. even the title medical ethics can be perceived as less involved than ethics in medicine).

In medicine, dentistry and veterinary science, ethics should be an integral component of the overall curriculum, not presented as an optional extra; after all, ethics is about behaviour and professional practice rather than just rules and regulations.

The project is likely to deliver information on how ethics has been integrated with other subjects in the curriculum. Ethics as a subject cries out for an inter- disciplinary approach, but also frequently requires integration within a broader curriculum.

This integration is not always easy to achieve; it requires diplomacy, communication, and the ability to convince others of the need for ethical discussion and study. Teachers' experiences in this area are likely to interest colleagues in other disciplines. This experience might well be shared when colleagues participate in the forthcoming ETHICS Project workshops.

Educational resources - Where do we go to find out more?

Sometimes teachers and students fail to think laterally when seeking learning resources. The project may help teachers in guiding students towards a more eclectic range of resources than the traditional reading list. This range might include academic textbooks and journals, daily newspapers, CD-Roms, DVDs, videos and websites. The LTSN-01 website is just one such example.

Dedicated support - Keeping us on track.

Perhaps the major benefit of the project is having a specialist project officer to support and promote the project. Susan Illingworth, the ETHICS Project Coordinator, is to be congratulated on all her hard work. Sarah Marshall and Suzanne Hardy, LTSN-01 Learning Development Officer and Information Officer and their team also deserve praise for their active support of the ETHICS project in medicine, dentistry and veterinary science.

Mark G Brennan, Subject Specialist Adviser to the LTSN ETHICS Project, Lecturer in Medical and Dental Education, University of Wales College of Medicine, Visiting Senior Lecturer in Medical Ethics, Royal College of Surgeons in Ireland, Honorary Research Fellow, Centre for Ethics in Medicine, Bristol University

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ADVERTISEMENT - NEW AND IMPROVED RESOURCE GUIDE FOR HEALTH AND LIFE SCIENCES

How do you find what you want on the web?

Finding quality resources relevant to your subject area can be both time consuming and frustrating.

The JISC Resource Guide for Health and Life Sciences can guide you to the essential resources for learning and teaching in your subject area.

Order FREE copies of the NEW EDITION immediately for September/October delivery and view the web-based guide at:

< http://www.jisc.ac.uk/resourceguides/hls/ >

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Workshop programme 2003

LTSN-01 workshops are free and open to anyone involved in learning and teaching in medicine, dentistry and veterinary medicine and cover a wide range of topics. All participants of medical and dental workshops are eligible for CPD credits. Forthcoming workshops include:

Professional Practice programs in Professional Education:It ain't what you do, it's the way that you do it!

Date: 17 September, 2003. Facilitator: Henry Collins, University of Sydney

Venue: Veterinary Teaching Hospital, University of Liverpool

This is a workshop for veterinary educators in professional courses who are introducing, or are interested in introducing, a Professional Practice program. This workshop will be led by Henry Collins who has taught Veterinary Parasitology for 33 years in both New Zealand and Australia. He has promoted the reform of veterinary education for many years and is responsible for the planning and implementation of the innovative Professional Practice program in the new BVSc course at Sydney. He is currently on study leave in the UK and will be working in the Learning Assistance Centre at the University of Bristol. This is the first of two workshops Henry will be facilitating for LTSN-01. The second will be in December, Improving Professional Education and meeting the needs of the Professional Student. Further details about this will be made available on the LTSN-01 website.

Further details: < http://www.medev.ac.uk/resources/meetings/workshops/professional_practice >

Developing good quality assessments in dentistry

Date: 14 November, 2003. Facilitator: Paul O'Neill, University of Manchester

Venue: The Wolfson Room, West Scotland Centre for Postgraduate Dental Education, Glasgow

This workshop is for dental school staff who are involved in designing, delivering or evaluating assessments in dental schools. It will be led by Professor Paul O'Neill from the University of Manchester and Director of the FDTL-4 project funded to set up a question bank shared between 5 medical schools and based on learning outcomes. It will provide participants with the opportunity to devise possible assessments for learning outcomes derived from GDC guidance and to devise a blueprint. The workshop will be highly interactive and be based on small group activities.

This workshop is only bookable via the following LTSN-01 Nominated Primary Contacts: Professor Stirrups (Dundee), Dr Bissell (Glasgow), Dr Hobson (Newcastle), Dr Ibbetson (Edinburgh) and Dr Morison (Belfast).

Further details:

< http://www.medev.ac.uk/resources/meetings/workshops/assessment_glasgow >

Booking forms and details of the full workshop programme are available on the LTSN-01 website at

< http://www.medev.ac.uk/resources/meetings/workshops >

If you can't attend a workshop but are interested in the topics being covered you can download resources from all our events at the following webpage:

< http://www.medev.ac.uk/resources/meetings/workshops >

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Newly-funded LTSN workshops

We are pleased to announce that the recent call for proposals to facilitate future LTSN-01 workshops resulted in the commissioning of four new workshops. Keep an eye on the LTSN-01 website for further details on dates and venues. Or email us at enquiries@medev.ac.uk with a request to be added to our mailing list and you'll receive an email alert when booking comes on line.

  • MEDICAL: Exploring Key Elements of Supervising Undergraduate Research Projects in Medicine and Biological Sciences; Dr Caroline Beardsmore, Senior Lecturer, University of Leicester.
  • DENTISTRY: Student Centred Learning and Debriefing; John Sweet, Lecturer, University of Wales College of Medicine
  • VETERINARY: Teaching Evidence Based Veterinary Medicine, Dr Mark Holmes, Senior Lecturer in Preventive Veterinary Medicine, University of Cambridge.
  • GENERIC: Scholarship of Learning and Teaching; John Sweet, Lecturer, University of Wales College of Medicine.

LTSN-01 has also recently agreed to co-fund the following three events. For more information about these events email enquiries@medev.ac.uk.

  • MEDICAL: Selecting the Right People to be Tomorrow's Doctors; Dr Jane McHarg, Peninsula Medical School
  • MEDICAL: Ethnicity, Communication and Student Assessment, 8th October 2003; Dr Rhian Loudon, Clinical Lecturer in Behavioural Science, University of Birmingham
  • VETERINARY: Novel assessment Methods for a lecture-free final year course in Veterinary Medicine, 8th September 2003; Dr Anne Healy, College Lecturer in Large Animal Clinical Studies, University College Dublin

We are always looking for workshop topics you would like us to cover. Please feel free to send your ideas to LTSN-01 at enquiries@medev.ac.uk. Alternatively, if you would like to facilitate a workshop yourself, please complete an application form under our call for workshop proposals:

< http://www.medev.ac.uk/resources/proposals/workshops3/workshop_application_form >

The next deadline for applications is 31st October 2003.

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Postgraduate education at the RCVS

Freda Andrews, Head of Education, RCVS

The Royal College of Veterinary Surgeons has statutory duties under the 1966 Veterinary Surgeons Act to regulate undergraduate veterinary education, professional conduct, and to maintain the Register of those qualified to practise as veterinary surgeons in the UK. Under its Royal Charter powers, it also runs examinations leading to postgraduate certificates and diplomas in 19 different subject areas relating to the various veterinary disciplines and species. The longest established qualification awarded by the RCVS is the Fellowship which can be achieved following examination of a thesis or, for those who have been qualified for at least 20 years, by submitting evidence of their meritorious contributions to learning. Possession of the RCVS Diploma, or the Fellowship, entitles an individual to apply for recognition as an RCVS Specialist.

The RCVS Certificate is the first level postgraduate qualification, and candidates are required to have had around 2-3 years of post-qualification experience in the subject area concerned before attempting the examination. No set courses are provided as the qualifications are achieved on a self-study basis, although candidates do normally attend various CPD courses provided by the universities and private sector. The Diploma is the next level up from the Certificate, requiring a total of around 5 years experience in the chosen subject area. Both the Certificate and the Diploma examinations are run on the basis of the candidate submitting a body of work (eg. case books for the Certificate, dissertation or published papers for the Diploma), together with traditional written examinations, and clinical, oral and practical exams. The exams are held annually, and three attempts are allowed.

The first Diploma exams in Veterinary Anaesthesia and Veterinary Radiology were held in the 60s, with Certificates and Diplomas in a range of other specialist areas becoming available throughout the 1980s and 1990s. Since their inception, RCVS has awarded 1575 Certificates and 354 Diplomas. Although this represents a relatively small proportion of the total number of veterinary surgeons on the RCVS Register (currently standing at around 21,000), indications are that pursuit of a postgraduate certificate is increasingly becoming the norm among younger members of the profession, with 310 enrolling on various RCVS Certificates last year. (To put this into perspective, 493 students graduated from the six UK schools in 2002.)

Even though these figures represent an encouraging trend in the pursuit of postgraduate qualifications, we would like to see the take-up increase further. Our completion statistics show that the certificate is significantly more difficult to achieve for those working in practice, compared to those holding residency or intern positions in universities. This raises the question as to whether the qualification is meeting the professional development needs of veterinary surgeons in general practice. A steering group at RCVS has been undertaking a strategic level review of veterinary education and training, and its recommendations published in July 2002 included the proposal that RCVS Certificates should be modularised to make them more accessible to those working in practice.

The latest proposals (subject to further discussion) suggest that there should be a new certificate-level qualification representing around 600 notional learning hours, made up of six modules, any of which could be taken as a stand-alone short programme. Those wishing to achieve the full qualification would be required to take key skills modules covering communication, practice management, welfare, and clinical diagnostic skills, together with a combination of species-based and/or discipline based modules. The level of the qualification would be comparable to the current Certificate.

An important difference, however, is that the modular structure could attract a wider range of practising veterinary surgeons to work towards individual modules, who would not otherwise be interested in committing themselves to the longer programme of study required by the current certificates. The challenge will be to find an assessment scheme that will be both valid and cost effective to deliver, given an increased take-up and a more flexible qualification structure. Certificate examinations have, to date, assessed theoretical knowledge and practical clinical skills via the traditional, unseen examination, but paid less attention to whether the performance of the individual in practice has actually changed. There is scope with the proposed new qualification to place a greater emphasis on developing reflective practice, and to encourage individuals to work together within learning sets to improve their professional and clinical skills. We are interested in exploring the use of reflective learning diaries and case diaries for some of the modules, although some of the discipline-based modules, may still need a more traditional approach through a combination of case-book assessment, practicals and vivas.

There will be scope for universities to work with RCVS to develop their veterinary CPD provision in line with the new proposals, and there is considerable potential for these new developments to increase the take-up both of university short courses, and postgraduate qualifications in general. We would be interested to hear from universities and other CPD providers, who might be interested in seeking RCVS accreditation of their courses as modules within the new qualification, or who would be interested in developing new courses to cater for the needs of veterinarians in practice.

The consultation paper and recommendations of the RCVS Education Strategy Steering Group can be downloaded from the RCVS website:

< http://www.rcvs.org.uk/vet_surgeons/index.html >

f.andrews@rcvs.ac.uk

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Conference Report - GKT Summer Fayre Innovations in Education, 16th July 2003

Dr Pat Reynolds, Deputy Director of Education for Distance Learning, King's College London

To celebrate and disseminate the conclusion of the EU Educational Social Fund Project "Distance Learning for Healthcare in Small to Medium Size Enterprises" a Summer Fayre Innovations in Education was held in a large marquee at King's College London on 16th July 2003.

Three LTSNs were integrally involved in providing expertise for the project, LTSN-01, Health Sciences and Practice and the Generic Centre. During the two years of the EUESF Project webcasting of Continuing Professional Development (CPD) to 50 dental practices and 50 pharmacies was evaluated:

The Fayre also exhibited the latest innovations in learning, teaching and educational technology within the HE sector. Nairn Wilson, Dean and Head of the GKT Dental Institute invited over 30 exhibitors to demonstrate their expertise and Hew Mathewson, President of the General Dental Council formally opened the occasion.

Professor Diana Laurillard, Head of the E-learning Strategy Group of the Department for Education and Skills (DfES) gave a keynote presentation entitled "Towards a Unified E-Learning Strategy" and Dr Larry Goodyer, currently Head of School, Leicester School of Pharmacy, presented the work of the EU ESF project to a packed audience.

Other features included multinational videoconferencing over three continental time zones, thanks to the sponsorship of Review Video Ltd. A closing keynote speech from The Executive Producer of BBC E-learning External, David Dawson-Pick amused the audience with clips from well known BBC productions, highlighting important pedagogical aspects behind the BBC's e-learning programmes.

A real and virtual balloon race was launched for charity, sponsored by KaVo Ltd and the BBC.

Over 600 people attended this innovative showcase which presented the work of the EUESF Project and gave insight into new approaches for professionals undertaking CPD.

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ADVERTISEMENT

LTSN Health Sciences and Practice and LTSN-01, in collaboration with the UK CENTRE FOR THE ADVANCEMENT OF INTERPROFESSIONAL EDUCATION (CAIPE) are hosting two 2-day Interprofessional Workshops for educators and practitioners who are involved in facilitating interprofessional learning.**

LTSN Health Sciences and Practice, King's College, London September 26th and November 11th 2003

LTSN-01, The University of Newcastle upon Tyne September 30th and November 14th 2003

These workshops take into consideration the complexity of issues involved in working across professional boundaries to achieve change; the need to consider potential barriers to change, the importance of having an evaluation process in place from the beginning of any interprofessional learning initiative, and the importance of patient-client involvement and focus in all interprofessional learning.

The workshops will be valuable to teachers and practitioners with educational, clinical and/or education development, training or management roles across health and social care, who have a responsibility to facilitate the learning of others. Ideally, you would come with one or more colleagues representing contrasting disciplines or education bases. You should be able to come to both days.

The Workshop Aims

  • To develop skills in facilitating interprofessional learning
  • To promote understanding of the underpinning concepts of interprofessional work and learning
  • To build on experience and expertise of participants
  • To focus on the experience of students of IPL
  • To focus on the experience of service users

Learning Outcomes

  • Apply the underpinning concepts of Interprofessional Learning (IPL) to interprofessional initiative(s)
  • Identify and develop the skills needed to facilitate IPL in mixed professional groups
  • Plan and implement effective IPL from the students' perspective
  • Involve service users in IPL
  • Consider approaches to evaluation of IPL

Cost

There will be a small cost to cover some of the expenses involved. Since we encourage people to come with colleagues from other professions and backgrounds there is a sliding scale. 1 person £100; 2 people in group ?150 (?75 per person); 3 people in group £200 (£66.66 per person)

Closing date for booking for both workshops is Tuesday 23rd September 2003.

Numbers are limited to approximately 24 and will be allocated on a first come first served basis. For a booking form contact Helena Low at CAIPE, admin@caipe.org.uk

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Sharing good practice

For this edition of the newsletter the focus of sharing good practice is on special study modules. Tomorrow's Doctors recommended that the curriculum must have both a core and student-selected components (SSCs) and that in a standard five-year curriculum between 25% and 33% would normally be available for SSCs.

SSCs must allow students to do the following:

  • Learn about and begin to develop and use research skills.
  • Have greater control over their own learning and develop their self-directed learning skills.
  • Study, in depth, topics of particular interest outside the core curriculum.
  • Develop greater confidence in their own skills and abilities.
  • Present the results of their work verbally, visually or in writing.
  • Consider potential career paths.

Highlighted in this article are an innovative SSC in place at Queens University Belfast and the approach being adopted at Peninsula Medical School.

For more examples please see the LTSN-01 good practice database

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Medics in primary schools: an innovative special study module

Mairead Boohan, Lecturer, Medical Education Unit, Queens University, Belfast

Medics in Primary Schools is a Special Study Module offered to second year medical students at Queen's University Belfast. The students taking this module spend one afternoon each week in a primary school and provide instruction to P6 pupils on each of the following topics: healthy eating, heat energy and healthy skin.

The schools that participate in the module are selected to represent the demographic and cultural diversity of the Greater Belfast Area. Medical students are provided with a teaching pack prepared by experienced teachers. However, students can formulate their own lesson plans and identify appropriate pedagogic techniques to deliver each lesson.

Qualitative and quantitative evaluation of the module indicates that pupils, teachers and medical students find this a valuable and rewarding learning experience. As well as acquiring knowledge about topics related to health, pupils have an opportunity to interact with health care professionals in a familiar environment.

This contrasts with the clinical setting where pupils normally encounter health care professionals. Indeed this experience may help to overcome any anxieties that pupils may have about visiting the doctor in the future. In addition pupils and in particular those from less affluent backgrounds have an opportunity to meet and interact with a role model that may influence their future career choices. Teachers value the knowledge and expertise that medical students bring to the classroom. Finally, medical students have an opportunity to practice and refine several key transferable skills including oral and written communication. Students also gain a lot of experience in the presentation of concise jargon free information to young children.

An unanticipated positive outcome of the module is the amount of teamwork that students engage in.

As each medical student is placed in a different primary school it was anticipated that students would work independently when preparing lesson plans however, they provide a lot of support for each other and exchange information freely. The module provides an opportunity for medical schools to offer a valuable and worthwhile educational experience to both medical students and the wider community.

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A special studies programme

Dr John McLachlan, Director of phase one, Peninsula Medical School

Special Study opportunities are now an established part of virtually all Undergraduate medical curricula in the UK following the recommendations of Tomorrow's Doctors (General Medical Council, 1993), which were re-affirmed in the follow-up document (General Medical Council, 2001).

Special study opportunities are aimed to ensure development of life-long learning skills (transferable or generic skills) associated with opportunities to explore topics outside the core of the undergraduate medical curriculum (Macnaughton, 1997; Murdoch-Eaton and Jolly 2000). A credit rated Special Studies Module runs in Phase 1 (Years 1 and 2) and Phase 2 (Years 3 and 4). Each carries 60 credits (the Phase total is 240 credits). Each Module is made up of a number of Special Study Units (SSUs).

Each student will take 7 SSUs in Phase 1 and 6 in Phase 2. SSUs are related to Core through their objectives, not through their content. Phase 1 SSUs are 2 weeks long and Phase 2 SSUs are 3 weeks long. SSUs represent 29.6% of the course as a whole. SSUs are interspersed throughout the Core (Harden and Davis 1995).

Means of supervison

The Phase Directors supervise the Special Studies Modules. There is a full time SSU Administrator. SSUs are designed to promote critical thinking and communication skills, explicitly report writing in the scientific style. The format of many short SSUs was chosen to (a) increase the range of student experiences and (b) to ensure reliability by having many assessors. Validity and comparability is ensured by the SSU Steering Group which reviews each SSU proposal.

Each SSU is assessed by two means. The provider completes a standardised judgement form on student engagement (e.g. enthusiasm, co-operation etc.). This is modelled on forms used extensively in the assessment of health professionals (Prescott et al, 2002).

Making judgements

Judgements made by providers are low stakes - that is, a student cannot fail the Module on the basis of a single adverse judgement. Providers are given training by PMS in assessment principles.

The student submits an SSU Report in the scientific format which is assessed by PMS staff using a structured standardised format and the student is given detailed individual feedback.

Each student has an Academic Mentor who monitors their performance on SSUs and provides further guidance. Students evaluate each SSU, and this information goes to the SSU Steering Group.

The student must pass each Special Studies Module in order to progress. Each student completes an evaluation form on each SSU they undertake. This form is completed and submitted via Blackboard, which logs the time and date of submission and indicates which students have not yet completed their forms. Report summaries are produce by Blackboard and are incorporated into the SSU Access Database. On this basis, each SSU can be reviewed at any point, but not less than once a year, by the SSU Steering Group.

Feedback to students

Students are informed in writing that they can also contact the SSU Administrator, their Academic Mentor or the relevant Phase Director at any point with comments or concerns, and these will receive immediate attention. SSUs can be offered by (a) our University of Exeter or Plymouth Partners (b) Primary or Acute Care Trusts in the locality (c) members of the wider health care community, including lay people, in the South West.

Students must do one SSU from each of these sources in each Phase, but can choose the others without restriction. Students select their SSUs by transferable votes at the beginning of each academic year.

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ADVERTISEMENT - Association for Medical Education in Europe

AMEE 2004 CONFERENCE - Access to Education in Health Care

5-8 September 2004 Edinburgh International Conference Centre Edinburgh, UK

The exciting programme is designed to interest a wide range of health care professionals including doctors, nurses, dentists, vets, pharmacists physiotherapists, etc.

Plenary sessions include:

  • New models for curriculum delivery
  • Competency-based education and assessment
  • Interprofessional education

Pre-conference workshops and symposia will take place on 5 September.

Online registration will start in October and the abstract deadline is 4 April 2004. The provisional programme and call for papers will be available in early October. To receive your copy, and for information on AMEE's other activities including the journal Medical Teacher and AMEE Guides, please contact:

Tracey Martin, AMEE, Tay Park House, 484 Perth Road, Dundee DD2 1LR, UK

Tel: +44 (0)1382 631953; Fax: +44 (0)1382 645748; AMEE@dundee.ac.uk

< http://www.amee.org >

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Towards a federated learning environment

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

The DEVIL project is investigating practical ways to provide dynamic library resources from within a range of virtual learning environments, particularly important within devolved LTSN-01 subjects.

The different components of the university learning environment, such as courses, the library, registry, finance etc, have traditionally proved to constitute a fairly fragmented and mutually-independent mix. In the last few years however, the widespread adoption of virtual learning environments (VLEs) has led course delivery and administration to become increasingly integrated.Much of the broader learning environment however remains unintegrated. Some joins, such as between VLEs and registry, have been achieved, although these are usually based on exchanging data rather sharing it live.

The DEVIL project, found at < http://srv1.mvm.ed.ac.uk/devilweb/ >, as part of the JISC-funded DiVLE programme, has been investigating practical ways of providing dynamic access to library resources from within a range of VLEs. The result has been the development of a DEVIL middleware layer that acts as a broker between any number of subscribing VLEs and library-controlled catalogues.

Levels of functionality

There are two levels of functionality. The first level is for those VLEs with limited facility to integrate new services. In this situation the broker can render search results as HTML or PDF pages for uploading into the VLE, with the service itself running external to the VLE. The second and more advanced level employs generic and standard protocols, providing a full brokerage service in which search results are returned to the VLE in a specification-compliant format.

This allows tools and services within the VLE to process and use this information in a fashion appropriate to its specific educational contexts. The practical result is that dynamically-linked information on library resources can be directly embedded and processed within the VLE.

Part of the library

Extending this model, the generic search and retrieve functionality could be enabled in both directions, allowing not only the library to become part of the VLE but the VLE to become part of the library. Indeed this concept could be extended to any system or group of systems in the learning environment, thus creating a federated learning environment or FLE. In the FLE any component or system can participate as long as it is sufficiently standards- and specifications- compliant.

A key component in the FLE is the concept of authentication and authorisation. While an institution-wide common authentication system is still under discussion at Edinburgh, the medical (EEMeC) and veterinary (EEVeC) VLEs have adopted ATHENS devolved authentication (DA) as a way of providing users with direct and targeted access to secured teaching and learning materials.

The DA method means that a user is automatically ATHENS authenticated when authenticating to a local service such as a VLE. Resulting from information presented at the LTSN-01 Breaking Boundaries conference, the Edinburgh instantiation of ATHENS DA is proving invaluable, not only for accessing services such as Medline but also as a way of authenticating those VLE users outside the university to services that are otherwise restricted to the university domain. This is particularly important in LTSN-01 subjects where much of a course is delivered in hospitals, clinics and in the community, far from the university centre.

See the web page < http://www.athensams.net/development/devolved_authentication/ for more information.

Opportunities now exist for otherwise discrete and independent services to integrate and share information and functionality across institutions and indeed between institutions.

By sharing common protocols and standards the online learning environment can be rich and dynamic, and far more adaptable to student and staff needs than has previously been possible.

Rachel Ellaway, eLearning Manager, College of Medicine and Veterinary Medicine, The University of Edinburgh Rachel.ellaway@ed.ac.uk

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Upcoming educational events and conferences

More information on forthcoming non LTSN-01 events and conferences is available from our events page.

You will find LTSN-01 workshops listed here:

< http://www.medev.ac.uk/resources/meetings/workshops >

It is worth noting that many of the major educational conferences in our subject areas are talking place in Europe in 2004. They will appear in these pages as soon as dates are confirmed publicly.

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ANNOUNCEMENT - BioMed Image Archive one day conference: Using Images of Patients for Learning and Teaching Tuesday 6th January 2004

Major changes in the use of images containing patients need to be embraced by the teaching profession in order to avoid the pitfalls associated with getting things wrong: prosecution, media attention and undermining of established patient trust. This one-day conference aims to engage the education community in examining the issues surrounding this complex area.

The even is supported by LTSN-01, with speakers from the Institute of Medical Illustrators, the Open University Rights Department, the British University Film and Video Council, as well as other experts in law and ethics, as well as data protection.

For more details visit the BioMed Image Archive Web site < http://www.brisbio.ac.uk/ >

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