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01.5 The newsletter of ltsn-01, June 2004

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

In this issue...

  • FDTL4 updates: Partners in Practice and OCTAVE
  • Postgraduate focus
  • Dental education websites reviewed

Other publication formats..

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

Contents

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

Editorial

The summer is here, and as we focus on exam results and preparing for next years intake of student, we also think of conferences. We are blessed (if a conference attendee) or cursed (if looking after purse strings) to have most of the major medical education conferences in Europe this year. This presents a unique opportunity to visit a large number of events all within easy reach of the UK, giving a chance to catch up with medical educators from all over the world.

As well as the popular topic of assessment, we are told that there are increasing numbers of technical submissions including submissions from those interested in learning technology interoperability standards. The standards and specifications which facilitate the possibility of collaborating with large numbers of collections of electronic learning and teaching resources are becoming increasingly important in medical education as resources get more scarce and the pressure to increase numbers of students on medicine, dentistry and veterinary medicine programmes intensifies.

There are a number of projects in our subject areas already working in this area, and we are sure many of them will be well represented at this year's crop of conferences. There is a conference report in this issue of 01 by Dr David Davies, from the University of Birmingham, on a recent event on eLearning standards and specifications held in Sestri Levante, Italy. The event was popular with UK educators, as there was a strand sponsored by IVIMEDS.

If you have a burning desire to write something on a conference you are attending (it can be on any aspect of any educational event of interest to the LTSN-01 constituency) you might like to enter our competition in which you can win an all expenses paid trip to an ASME Staff development workshop on 13 December. The most original conference report together with the two best runners up will be included in 01.6.

As Susanne Young, our fantastic centre co-ordinator, goes off on maternity leave this month, we take this opportunity to wish her, and her husband, the best of luck for a safe birth. It's the first LTSN-01 baby, so don't be surprised to see a picture of Susanne's babe in the next issue!

Have a good summer!

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

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FDTL4 update: Incorporating disability equality within clinical practice

Caro Howell, PIP Project Co-ordinator

The Partners in Practice project is developing a curriculum framework for teaching disability equality to healthcare professionals. This article reports on progress and the completion of a major consultation.

"Interesting, but what on earth does it have to do with me becoming a doctor?"

This comment was made by third year medical student at the University of Bristol after a day spent learning how to communicate effectively with people who are deaf, visually impaired, have a speech impairment or learning difficulties. To many non-disabled people it might seem an incredible attitude for a would-be doctor to have, however most disabled people routinely experience a lack of disability equality in healthcare.

Students come to medicine and dentistry with varied experiences of disability and to a large extent their attitudes reflect society's general anxiety and assumptions about disabled people. Consequently, disability equality teaching is particularly sensitive and susceptible to cognitive dissonance, while experience has shown that too many students learn only at a superficial level.

The consultation

Partners in Practice is developing a curriculum framework designed to embed disability equality in healthcare education. Last summer we reported the start of a major consultation process involving disabled people, educators and healthcare professionals with the aim of identifying essential learning outcomes for the new curriculum framework (LTSN-01 Newsletter, August 2003; 3:7-8). The consultation has now been completed and initial results are revealing.

Over 150 people took part, of whom almost half identified themselves as disabled. The consultation used the Delphi process, which enables a large number of people to take part at a distance, to express their views in confidence, to change their mind in the light of other people's responses and thereby to reach consensus.

The consultation document consisted of 12 major learning outcomes grouped into 3 overarching categories - attitudes, skills and knowledge.

The learning outcomes were then divided into 39 descriptors that broke each learning outcome down into its constituent parts (the document can be viewed on our website at: http://www.bristol.ac.uk/pip. Participants were asked to score each descriptor on a scale of 0-9, with 0 indicating that it was not an important learning outcome and 9 indicating it to be an essential learning outcome.

We worked closely with disabled people to ensure that the consultation process itself was accessible.

They worked alongside educators and healthcare professionals devising and drafting the consultation document, while information on how to participate was disseminated via disability organisations and support networks, GP's surgeries, email groups and advertising in the disability press. The form itself was available in a range of formats and could be completed online, by email, phone or post. Since three different specialist constituencies were involved in creating the document - disabled people, educators and healthcare workers - banishing jargon entirely proved impossible. Even after the language was simplified, there were still two groups of people for whom the document's structure and language was inaccessible, namely adults with learning difficulties and Deaf British Sign Language (BSL) users. Since both these groups face particular barriers to accessing healthcare, it was essential that their voices were heard.

Recruitment

A series of small, tailor-made workshops were held at the University of Bristol, the University of Glamorgan and the Circles Network in Bristol, recruiting participants via existing community, social and support groups.

The first workshop was for people with learning difficulties and held at Circles Network, a voluntary organisation that supports disabled people and people at risk of social exclusion. We worked with Circles staff and clients to re-format and re-write the document and then during the workshop, a graphic artist supported the discussion by illustrating each point as it was raised. The illustrated version of the consultation document and the revised text was then used to support subsequent workshops and is available on our website at: http://www.bristol.ac.uk/pip.

Two separate workshops were held for deaf BSL users at the University of Bristol, one for older deaf adults and the other for deaf graduates. Working with an interpreter, deaf participants could discuss terminology that was unclear to them with project staff before completing the document.

Results

Data from the consultation is still being analysed, but initial results show a clear consensus of opinion, with issues relating to attitude consistently scoring highly.

Taking those descriptors that scored an 8 or 9 with more than 80% of respondents, the following issues are revealed to be the most important, ranked in order of priority:

  • An understanding that disabled people with long-term conditions are often experts on their medical problems and lifestyle issues.
  • A recognition that different disabled people have different needs, identities and preferences.
  • A recognition that not all problems have a medical solution.
  • A recognition of the danger of excluding other diagnoses based on preconceptions about people with an impairment.
  • An ability to see a disabled person as capable of making rational life decisions.

The challenge now is to ensure that the new curriculum framework is flexible enough to suit the different teaching methods used by the different branches of healthcare education.

We will be running a teaching pilot in September with student doctors and allied health professionals designed to assess the effectiveness of different teaching formats and delivery methods, focussing on the top 15 learning outcomes from the consultation.

For all the obstacles that the project foresees, there are encouraging signs that today's and tomorrow's healthcare professionals are increasingly receptive to disability equality issues. In addition to the negative feedback, other medical students are more positive about the teaching and aware of its importance, as one first year put it: It challenged views I didn't even know I had.

*For more information about the project contact Caro Howell, Project Co-ordinator caro.howell@bristol.ac.uk or access the project website at http://www.bristol.ac.uk/pip.*

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FDTL4 update: Optimising computer-aided and traditional assessment in veterinary education

Dr Stan Head, OCTAVE Project Manager

OCTAVE (Optimising Computer-Aided and Traditional Assessment in Veterinary Education) is a three-year HEFCE funded project, led by the Royal Veterinary College, on behalf of the four English veterinary schools, in collaboration with the two Scottish veterinary schools, designed to rationalise veterinary assessment schemes.

The project has two main aims: to maximise the use of valid computer-aided assessment in formative and summative examinations, and to update traditional practical examinations through the development of a structured, objective approach to assessing practical skills.

The project commenced in earnest in March 2003, with the appointment of Dr Stan Head as the project manager. Early contact with staff at the 4 English veterinary schools showed continued enthusiasm for the project. However, on the CAA side, a major practical hurdle was noted; the requirement to gain software skills for authoring the questions using Questionmark Perception as the database manager and assessment software.

Computer aided assessment

This has been solved in two ways. We have developed a method which allows authoring in MS-Word, using an OCTAVE template, and direct importation into the database. Our template allows all text formatting, and inclusion of a picture. With this method, there is no requirement for the naive author to learn new software skills.

Alternatively, we have developed a web page through which a single question can be written and sent by email to OCTAVE. Without any further processing, these web-authored questions can also be imported into the database.

We are now at the stage where questions are trickling into OCTAVE from individuals. In order to encourage and create a communal atmosphere for question-writing, Focus Group Meetings have been instituted where taught modules are blitzed. Staff meet over a good lunch (provided by OCTAVE) and questions emerge. More of these activities are planned.

In addition, in order to overcome the difficulty of writing educationally instructive feedback, which is essential for the potential of the database to be fully realised by students in formative or self assessment mode, we are piloting sessions where authors talk through questions with a student and the conversation is recorded. The content of this discussion acts as a basis for feedback.

Clinical examination

The second strand of the OCTAVE project is the development of Objective Structured Clinical Examination (OSCE) style assessments for veterinary students. OSCEs have been used for many years in medical assessment andwe have adopted a similar format for veterinary students. A number of five-minute scenarios have been written, and these were used for the first time at the Royal Veterinary College (RVC) in January 2004.

The scenarios are clearly structured so that each student receives exactly the same task, with the same starting situation in terms of instructions and layout of any models and equipment. The assessment is objective; that is, it is a checklist of whether a candidate has performed a task or not, and a scenario comprises between 12 and 23 important steps.

Assessment in practice

With training, naive assessors can be used for many stations, although some stations do require specialist knowledge in order to assess the student fairly and competently. In order to distinguish veterinary OSCEs from steeplechase-style spot tests, which are essentially paper-based, short answer questions, the scenarios have been designed to assess the candidate's ability to perform real practical tasks.

A graduate from veterinary school, unlike many other professional graduates, has, on their first day after graduation, to have mastered a number of practical competences, named euphemistically Day One skills. These have been determined, and published by the professional statutory body, the Royal College of Veterinary Surgeons (RCVS (2001) Veterinary Education and Training: A Framework for 2010 and Beyond). The OSCEs that we have developed and used in a formative manner at RVC test at least some of these Day One skills.

Members of all the UK veterinary schools were invited to attend the OSCE assessment in January 2004 and the representative from Liverpool veterinary school both attended and acted as assessor for a number of stations. A number of workshops on writing successful OSCEs have been held and more are planned at the RVC. The workshops are hosted by Dr Katharine Boursicot, who has run training workshops for OSCE examiners at Barts and the London School of Medicine. The focus of the workshop is to write OSCEs and, in the same session, trial what has been written.

As the scenarios are for practical skills, a comprehensive and rapid system for collecting the required equipment has been built up. Even a cow's pelvis and calving snares were sourced and moved to the workshop classroom within 20 minutes. A representative from Cambridge Veterinary School contributed to the last workshop.

Standard setting

Methods of setting the pass/fail level for OSCE stations have been investigated; these include those that use norm referencing and those based on criterion referencing.

As a consequence of our results and the practical skills format of the assessment, we have found it necessary to develop an approach to standard-setting based on the borderline group method. The results of those students who have just failed, together with the results of those students who have just passed, are used to set a pass/fail level. Our modification answers some of the criticisms of the borderline group method as originally described.

The future of OSCEs at the RVC

The final examination in March 2005 will have OSCE spot tests components, in addition to traditional written papers. In order to allow the students experience of this form of assessment, OSCE's are being arranged at the end of the monthly rotations for the fourth year students and will occur every fourth Friday, commencing in August 2004.

Initial student feedback on OSCEs shows considerable enthusiasm, and recognition of the validity of this type of test.

We look forward to a busy and rewarding period at the RVC and the other English veterinary schools as OSCEs become a valued additional assessment resource.

*For more information about the project contact Stan Head at shead@rvc.ac.uk.*

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Summer competition: Write an original conference report and win an all expenses paid trip to an ASME staff development workshop

The prize

An all expenses paid trip to the ASME/LTSN-01 workshop Education healthcare educators: Models for delivering effective staff development on 13 December 2004.

Who can enter

All staff teaching pre-registration students in UK medicine, dentistry or veterinary medicine programmes.

How to enter

Write up your favourite educational conference experience in the style of Japanese haiku, a limerick, a Shakespearean sonnet, a short script for a comedy sketch, or a scene from a soap opera. You might prefer to make something more visual such as a photomontage, a drawing, a pictorial storyboard, cartoon or anything other form of representation that takes your fancy.

You could even write a song.....

Entries can be in any format, should be no longer than 500 words if in written form (electronic or paper based), no larger than A3 if pictorial and paper based, or no larger than 5MB if in electronic format.

Please make sure you include your name, Higher Education Institution, email address and a daytime telephone number.

The winners will be judged by a panel of experts including colleagues from the subject centre for the performing arts, PALATINE, see http://www.lancs.ac.uk/palatine/.

Deadline for submissions:

Friday 3 September 2004. The winner will be notified by email on Friday 10 September 2004. The winning entry and two runners up will be published in 01.6. Entries can be submitted by post or by email. If you would like your entry back, please include a stamped addressed envelope with postal submissions. Send them to: Summer competition, LTSN-01, 16/17 Framlington Place, University of Newcastle, Newcastle upon Tyne, NE2 4AB Email: newsletter@medev.ac.uk with the subject line: Summer competition.

The judges decision is final and no correspondence will be entered into. Entries will be disqualified if they are defamatory or likely to cause offence.

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LTSN-01 miniproject update: An educational package for trainers in dental outreach placements

Mike Smith, Outreach Programme Evaluator, University of Sheffield

The University of Sheffield's School of Clinical Dentistry is increasing its outreach placements in primary care settings for undergraduates and professions complementary to dentistry.

This has necessitated the development and deployment of a transferable training package to support dental staff hosting students on placement.

Students are supervised by local dentists during their six-week block placements. A three-year National Dental Development Unit funded project first placed a pilot group of twenty students in ten Community Dental Service and Dental Access Centres in areas of high need across northern England in 2003.

Students provided treatment for of a greater number and wider range of patients than they would normally encounter in the dental hospital.

Evaluation

Qualitative evaluation of this pilot involved all twenty students, thirty staff in the placements and some of the students' university tutors.

It identified the following key points:

  • Students profited from the experience and improved in both confidence and competence.
  • Besides their anticipated increase in clinical experience and wider range of patient types, students found unexpected benefits from teamwork and opportunities to consider the influence of the patients' backgrounds and communities on their treatment.
  • Placement staff enjoyed the break from routine and opportunities to take on new roles.
  • Students especially valued the support, guidance and feedback from their hosts but the supervisors were not confident this met the School's requirements.

Building confidence

This last point, supervisors' lack of confidence in their role, was a concern as a consistent approach to supervision across on-site and outreach placements should reduce the time needed for students to adapt to the new learning environment, increase School tutors' confidence in supervising dentists' assessments of students and reduce the stress on those supervisors.

Two principle resources were available to be harnessed in the development of a solution. First, the experience and expertise of existing staff at this other schools could be shared more fully with the trainers.

Secondly, disseminating the best practice identified during the pilot stage of the development would provide a foundation for further development. Training supervisors has been shown to develop their approach and increase their confidence in the role (Hobson, 2004). Consequently, together with the dental service managers involved, programme manager, Professor Michael Lennon, proposed two training events for dental staff based on these resources. The events would also address the quality assurance of supervision through considering educational, clinical and future aspects of outreach supervision.

LTSN-01 support

An LTSN-01 miniproject supported development and delivery of a resulting training package delivered to all supervising dentists and many of the dental nurses involved. It was timed for the spring of 2004; shortly before the next cohort of 35 students were ready to start their outreach placements.

The programme outline is shown in the boxed inset but also gave ample opportunities for placement staff from different centres to meet in groups so that they could discuss their experiences and raise queries for the panels of experts to round off each session.

The combined experiences of supervising dentists from the pilot and several staff from dental schools' outreach programmes in Manchester, Liverpool and Sheffield, provided a sufficient mass of experience to generate examples, pitfalls and best practice to keep the whole event grounded in practice.

Judging by the hum of discussion and occasional raucous outbursts there was plenty of participation. This judgement is supported by the formal evaluation by the thirty plus attending each of the two events. Around 70% rated the sessions very worthwhile. As a follow up some staff are to visit the dental hospital in Sheffield to see students working and being assessed in their normal environment.

Success

The intended outcomes were improved quality assurance of learning experiences that are integrated and consistent across the school of dentistry and the host clinics and an increased confidence among both placement and school staff that their teaching is being reinforced elsewhere and, finally, that staff at the host clinics will be more confident that they are better prepared to supervise students.

As I write the first batch of students have recently returned from the 2004 round of outreach. They report that excellent working relationships with their supervisors were quickly established and supervision was sensitively provided.

They felt they made significant strides towards becoming effective members of dental teams. No doubt the LTSN-01 supported training had some part to play in ensuring that.

This time the undergraduate students have agreed on their return to participate in some research which compares their competence in treatment planning and confidence in practicing dentistry with similar students who have not attended an outreach placement. But that's another story for another time.

References

Hobson, R.S. (2004) Does training the teachers change teaching practice? Presentation at IADR Conference, Hawaii, USA, 12 March 2004

*For more information about the project contact Peter G Robinson, peter.g.robinson@sheffield.ac.uk or Michael Smith, michael.smith@sheffield.ac.uk.*

Training event programme

Educational aspects, chaired by Prof Michael Lennon

  • Clinical assessment procedures within the School: Dr Phillip Benson
  • Clinical supervision and feedback: Mr Phil Young, SDO, Liverpool PCT - Workshop followed by questions to panel
  • Clinical aspects, chaired by Professor Trevor Walsh

Expected levels of clinical competence in:

  • Paediatric Dentistry, Dr Helen Rodd
  • Oral Surgery, Dr Alison Loescher
  • Dental Therapy, Ms Judy Hinchliffe

Workshop followed by questions to panel

Future aspects Future Developments, Prof Peter G Robinson and Mr Peter Bateman, Director of Dental Services, Sheffield

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LTSN-01 miniproject update: Objects for OSCEs - repurposing CLIVE courseware

Gill McConnell, Educational Development Manager, University of Edinburgh

Over the last 12 years the CLIVE consortium (http://www.clive.ed.ac.uk) has produced a large bank of learning resources, supporting many subject areas in veterinary undergraduate education and reaching into continuing professional development. These resources, delivered principally over Local Area Networks, vary from focussed 15 minute tutorials and quizzes to interactive courses with multiple learning objectives and many hours of interactive study.

Within this bank are thousands of potential Reusable Learning Objects (RLOs). Most of these resources were written using Macromedia Authorware. Recent versions of Authorware allow content to be packaged as SCORM 1.2 compliant RLOs, which could, in theory, be imported into VLEs (Virtual Learning Environments).

Although this is likely to be the quickest route for producing RLOs, technically it is not necessarily the best. We have already experienced significant difficulties in configuring our computer labs with the upgraded web player to deliver all recent versions of Authorware. The requirement for this special Internet-browser plug-in is likely to make these objects less attractive for uptake by others.

For this pilot study, we are making several versions of a limited number of objects to assess the effort required to adopt differing approaches - Authorware, Flash, web pages. We are using the JISC project RELOAD editor to package the results. The resultant objects are targeted at the Day 1 competencies identified in the QAA benchmarks for veterinary science ( http://www.qaa.ac.uk/crntwork/benchmark/phase2/vet_sci.pdf).

CLIVE is in the fortunate position of having in place a collaborative agreement between the six UK vet schools. However, it is still essential to contact authors for permission to re-purpose their work. We began by mapping 43 CLIVE learning packages against Day 1 competencies, concentrating initially on those originating in Edinburgh and Glasgow. We have been delighted with the response of authors - no-one has refused, and some have identified a need to update their work. This we regard as an added benefit.

Our first RLOs describe basic procedures in dermatology, with videos. Other topics are likely to include anaesthetics, pathology and anatomy. Decisions about the best level of granularity have to be made and this varies with the resource. Some videos will stand alone, as will some images. There is the added problem, widely discussed (for example Littlejohn, A. (2003)), of whether context should be included. The concept of context-free content is almost a non-sequitur, except for the finest-grain object such as an image. The time-constraint of cataloguing the most granular elements, so that they may be used by others outside the discipline, is one that we do not aim to overcome. However, we do aim to make full descriptions, which may still enable those from other disciplines to find useful resources.

The approach we are taking is to make a best guess at this, then send results to authors and reviewers so that there is something concrete to view and discuss. Annotations (by others) provide a route for additional uses to accrue to an object.

Questions extend beyond the level of granularity. Glasgow is using the Universitas 21 repository, Edinburgh is trialling IntraLibrary. For this pilot project, to ensure access for both schools, we shall upload to both repositories, with possibly varying metadata, depending on preferred profiles. We hope this will be a temporary problem while institutions sort out access for collaborative projects.

Cataloguing requires collaboration with librarians to agree classification and discipline-specific vocabularies and to check that cataloguing is good - accurate and of sufficient depth to enable discovery. This is all challenging but, perhaps, the biggest challenge lies ahead - to encourage others to use the re-usable.

*For further details of the project, contact:Vicki H Dale, Educational Technologist (Glasgow) V.Dale@vet.gla.ac.uk or Gill McConnell, Educational Development Manager (Edinburgh): G.McConnell@ed.ac.uk*

References

Littlejohn, A. (2003). Issues in Reusing Online Resources. Journal of Interactive Media in Education, 2003 (1) Special Issue on Reusing Online Resources. ISSN:1365-893X

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Miniproject update: Assessing undergraduate interprofessional learning

Professor Maurice Savage, Queens University Belfast

Interprofessional education (IPE) is currently a high priority for government, professional bodies and higher education providers.

This article describes a mini-project in which sought to develop a clinical case-study approach for ward-based learning, setting medical and nursing students the task of working together to prepare a case history and assessing their response.

According to Barr (1) the aims of IPE are to promote collaborative practice, prepare students for effective teamworking and ultimately to improve patient care.

Although the provision of interprofessional learning opportunities is now a requirement of the curricula of many healthcare professions, appropriate methods to assess the skills and knowledge gained during these events have yet to be developed (2).

Current debate has indicated that the clinical area might be an appropriate environment to facilitate interprofessional learning (3) and this project focused on developing assessment appropriate for IPE delivered in this setting.

It also built upon work already undertaken in the schools of medicine and nursing at QUB, where an IPE programme in Child Health and Children's Nursing has been delivered to fourth year medical and third year nursing students since 2000 (3).

Project description

During a shared clinical placement medical and nursing students worked together in teams of four to six students.

The project was delivered in three hospitals and one nurse and one medical consultant co-ordinated the project at each site.

Each team of students was required to take a history from a patient recently admitted to a paediatric ward. Students were instructed that the clinical condition they were to focus on was respiratory disease and hence they must select a patient who had a previously diagnosed respiratory condition.

One student from each profession took a history, and the other students observed. The purpose of this task was to provide students with an opportunity to learn about the history taking techniques used by members of the healthcare team.

After taking the history each team worked together to prepare an interprofessional care plan for the patient. On completion of the programme students were required to complete two assessments. Each team had to prepare a 15-minute oral presentation describing the care plan they had developed.

Each student was also required to prepare a 1,000 word reflective commentary outlining the knowledge and skills they had acquired during this learning experience. The resulting presentations and reflective commentaries were assessed by an interprofessional team of teachers at each clinical site.

The following resources were prepared to support the project:

  1. A student information pack, which included:
    • Aims and learning outcomes for the IPE programme
    • Assessment criteria and marking schedules
    • Guidelines for preparation of oral presentation and reflective commentary
  2. Guidelines for teachers, which included information about the philosophy underpinning the programme and details about the assessment procedures.

Project evaluation

Each cohort of students participated in a focus group on completion of the programme. Most students evaluated the project positively, and acknowledged the importance of assessing learning on completion of IPE.

This is demonstrated by the following quotation from one medical student: Having an assessment in IPE made me take this part of the course seriously. If there was no assessment I would not have made the effort to ensure that I met with the nursing student to complete the care plan.

Lessons learned

The guidelines provided by curriculum planners about the categories of patients selected for interview should be flexible.

The first cohort of students was instructed to take a history from an asthmatic child. However, there were no asthmatic patients on some wards. Subsequent cohorts of students were advised to take a history from a child with a respiratory condition.

An oral presentation and reflective portfolio were identified as the most appropriate assessment tools for this project. They were selected because they encouraged students to continue to work collaboratively following completion of the clinical task. In addition both forms of assessment provided students with an opportunity to reflect on the learning experience. Reflecting on this experience enabled students to enhance their understanding of the function of the multiprofessional team in healthcare delivery and increased their awareness of the roles and responsibilities of individual team members.

Benefits of project

This project has demonstrated that it is possible to devise an assessment strategy that is acceptable to staff and students from different professions and meets some of the educational requirements of healthcare regulatory bodies and HEFCE.

For example, in addition to participating in IPE students were encouraged to engage in reflective practice and were provided with opportunities to enhance key transferable skills including teamworking and presentation skills.

Feedback from students

The following quotations from the reflective commentaries prepared by students demonstrate some of the educational benefits of the project:

  • We based the care plan on a problem management approach and I was surprised to learn that this was also how the student nurse approached her management. (Medical student)
  • Having completed this exercise I realise how important it is to communicate with nursing staff when forming a plan of care for a patient. (Medical student)
  • Medical students were very motivated and willing to take advice...very knowledgeable and I learnt from them also. (Nursing student)
  • IPE should become available in all hospitals and should be integrated into medical training, pre-registration and post registration nurse education. (Nursing student)

*For further details of the project, contact: Maurice Savage, m.savage@qub.ac.uk or Mairead Boohan, m.boohan@qub.ac.uk.*

References

  1. Barr H. Interprofessional education: 1997-2000. A review for the UKCC. London: UKCC, 2000.
  2. Ross F, & Southgate L. Learning together in medical and nursing training. Medical Education, 2001. 34, 739-743.
  3. Morison S, Boohan M, Jenkins J, Moutray M. Facilitating undergraduate interprofessional learning in healthcare: comparing classroom and clinical learning for nursing and medical students. Learning in Health and Social Care 2003. 92-104.

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Meet LTSN01: Megan Quentin-Baxter

Describe your job in LTSN-01

I am Deputy Director of LTSN-01 and responsible for all the day to day operations of the Subject Centre. I am supported by Office Administration, Educational Development, Information and Technical, and about a dozen specialist subject advisors. I report to Reg and our Advisory Board/the Executive. Do? As little as possible.

What is your professional background?

I did my first degree in Zoology at Otago in New Zealand, and was initially employed to develop some (primitive) CAL material alongside working as a research assistant and laboratory demonstrator. After travelling for a year I took a Research Associate post and did my PhD in developing and evaluating interactive video learning resources (see http://www.medev.ac.uk/resources/features/rats/). I joined Newcastle in 1994, teaching, supporting the curriculum and managing funded projects, and in 2000 joined the subject centre. More recently I spent 13 months 60% with UKeU as a Learning Technologist (Education and Health). I have been back full time since January 04.

And your professional interests?

My favorite research interest is in hypermedia - collection and mathematical analysis of log data in interactive learning systems for the purpose of informing software development. I am fascinated by curriculum design and implementation, problem led approaches in teaching, and support for students and staff.

Tell us about your personal interests?

Well, I'm a cat person.

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Review: Dental educational websites

Damien Walmsley, Professor of Restorative Dentistry, University of Birmingham

What dental educational sites are available to the dentist? A good starting point is Omni (http://omni.ac.uk/) which helps the beginner browse through the available sites in dentistry. OMNI (Organising Medical Networked Information) is designed as a portal to assist the teachers, researchers and students in the health and medical sciences.

There are precious few collections available for accessing clinical images but the Bristol BioMed Image Archive (http://www.brisbio.ac.uk) does have a good collection for downloading.

Another simple but effective database of images is the Iowa image database (http://www.uiowa.edu/~oprm/AtlasWIN/AtlasFrame.html). These examples are large collections that are readily available. It is possible to find small collections of material but this is an area that needs redeveloping.

Finding learning materials

Finding learning materials is rather uneven as the learning materials may vary enormously from downloadable stand alone CAL programs to Web based courseware. As the use of the Web has expanded so has the amount of material but most institutions will now for different reasons password protect their material.

This is due to copyright problems linked to either ownership of the material or whether the patient has given permission for it to be used. All schools have some form of intranet but unless one is a teacher at the institution it is often not possible to evaluate them. However there are schools developing their own web based courseware and some have examples available.

In Birmingham there is a fully interactive web site that encompasses blended learning by offering fully interactive material with conventional lecture notes and other handouts (http://www.dentistry.bham.ac.uk/fordentists/caldownloads.asp). This approach has also been championed by Liverpool who also uses their web to deliver material with their administration of the course (http://www.liv.ac.uk/luds). Both institutions have developed their own Virtual Learning Environments.

Whilst GKT is large institution it also sees the advantage of placing course material such as notes and administration on it own internal server using WebCT (http://www.kcl.ac.uk/teares/gktvc/). Sheffield is a dental school who is also developing a communication environment called iCT.

Whilst all these schools run a virtual campus but it is difficult to go past the first few pages or see a few examples as much of the material is hidden behind

Organisations

It is always good to talk and the following sites are a good springboard to contacting other teachers both within the UK or abroad. The Association for Dental Education in Europe site is particularly useful as their annual conference in Cardiff is taking place in September. The LTSN-01 site is kept up to date with useful nuggets of information. Go to http://www.adee.dental.tcd.ie/ or http://www.adea.org/ or http://www.medev.ac.uk/.

Clinical guidelines

There are always trends and areas of interest and the big topic at the moment is evidence based dentistry and there are several useful sites to get you started on this expanding subject. Try http://www.nelh.nhs.uk/oralhealth or http://www.ihs.ox.ac.uk/cebd/.

Summary

The strength of the Web is its continuous development and access. Whilst there is material present it is not often freely available and with the copyright of materials becoming more important this is starting to restrict the free use of the Web. However, there are examples of good practice available which is able to assist the teacher, researcher and student.

*For further information contact Damien Walmsley, Professor of Restorative Dentistry, a.d.walmsley@birmingham.ac.uk*

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Postgraduate focus: new website and services

Professor Shelly Heard, Postgraduate Dean for the London Deanery

E-learning can deliver knowledge based programmes, clinical case study programmes and diagnostic support systems which offer learners in the NHS access to educational material when and how they want to use it. Learning opportunities are also now available to support development in some of the professional skills which are required to deliver good patient care. http://www.HealthcareSkills.nhs.uk is a new web site developed by the London Postgraduate Medical and Dental Education Deanery in conjunction with Ash/Binary Vision.

The Website http://www.HealthcareSkills.nhs.uk supports 4 learning programmes in directed at a multiprofessional audience in communication skills, team-working, patient safety and ethics and law. A senior steering group acted as an editorial board, shaping the objectives, developing and reviewing the content and ensuring overall coherence to the educational material. The programmes are available to all healthcare professionals at no cost.

Each programme is introduced by its own learning objectives. Navigation is simple, moving the learner from section to section, with book-marking enabling return when required. There are videos, real-time voting enabling the learner to share views on a range of issues with other learners, interactive formative learning opportunities through multiple choice questions and pre and post learning assessments, as well as reflective notes to support a learning portfolio. The key components of each programme are indicated below:

http://www.communicationskills.nhs.uk

This programme covers the essential issues leading to an understanding how good communication contributes to effective care patient care. It explores, for example, how diversity can potentially create misunderstandings which can be addressed by the healthcare professional, how risk can best be communicated to patients/carers, the techniques of good listening and responsiveness, the necessity for open questions in exploring issues with patients and carers and the potential for patient-professional partnerships in producing better health outcomes.

http://www.teamworking.nhs.uk

Written by Professor Jenny Firth-Cozens, a leading UK expert in team-working and patient safety, this programme explores the key elements how teams function in delivering healthcare. It describes the characteristics of a good healthcare team, encourages reflection about the learner's own participation in teams and demonstrates the contribution to patient care and safety made by effective team working. Both Communication Skills and Teams and Leadership have now been procured by the NHSU for adaptation, piloting and dissemination to support learning in the Foundation Programmes of Modernising Medical Careers (MMC).

http://www.ethicsandlaw.nhs.uk

This programme (pictured above) aims to provide an understanding of the principles of medical ethics and to create an awareness in the learner of the difference between moral judgments and those made in a court of law. It encourages healthcare professional to explore issues around human and patient rights in relation to professional behaviour.

http://www.patientsafety.nhs.uk

Supported by input from the National Patient Safety Agency (NPSA) and the NHS Litigation Authority, this programme explores key aspects of patient safety. It considers how safe organisational systems should be developed to support the healthcare professionals working within them, and the responsibility of healthcare professionals, particularly within the context of clinical governance. The HealthcareSkills site also has three other programmes that support healthcare professionals in their important responsibilities in educating the healthcare workforce:

http://www.appraisal-skills.nhs.uk

This site explores with learners how to participate in the formative process of educational appraisal which underpins effective learning.

http://www.clinicalteaching.nhs.uk

This site takes the learner through key elements in understanding issues in clinical education issues such as curriculum development and assessment as well as exploring appropriate teaching methods in a range of clinical settings.

http://www.liberatinglearning.nhs.uk

This is an interactive programme which supports learning in the context of the European Working Time Directive and was developed from the document written by the Conference of Postgraduate Deans' Ad hoc Working Group. The educational programmes on www.healthcareskills.nhs.uk have been designed to support the professional development of clinicians working in the NHS. It is free for all users and seeks to address important educational needs of healthcare professionals.

*For further details contact:Shelly Heard, Postgraduate Dean, London Deanery sheard@londondeanery.ac.uk*

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LTSN-01 Conference report: Twenty Twenty Vision - External clinical placements

Nigel Purcell, LTSN-01

In dentistry they're called Outreach. In veterinary medicine they're called Extra Mural Studies and in medicine they're simply called Clinical Placements. Whatever their name, LTSN-01 recognised external clinical placements as a key issue facing its constituency. And so the conference Twenty Twenty Vision was born to provide a forum for an exchange of ideas about supporting innovation and sharing good practice in the management and support of external clinical placements.

Twenty Twenty Vision started life as a small, invitation only event but grew to be something much larger. Prompted by interest from the whole LTSN-01 constituency the event was opened up to all and also widened to encourage those working in the health sciences and practice arena to attend. The venue was the Atlantic Suite at Manchester Airport and it took place on 6th May 2004.

External clinical placements

The day was chaired by Professor Reg Jordan, the Director of LTSN-01, and the initial keynote address was given by Professor Amanda Howe from the University of East Anglia School of Medicine, Health Policy and Practice, on the topic of External clinical placements: Why do we do it?

Attendees were asked imagine what the curriculum would be like without placements. She then went on to contrast the typical current approach which tends to be based on the apprenticeship model and emphasises an opportunistic and somewhat unstructured approach with a more systematic, structured, externally controlled form which has the potential to be more effective and productive.

But, given the practical difficulties arising from organising placements, why do we do it? There are all kinds of benefits available from placements but key ones include the opportunity to integrate theory with practice and to set learning in the context of the patient. Placements enable the student to develop clinical skills, to see the full development of disease processes in a real setting and to learn at first hand about the doctor/patient relationship. They can also experience how services are delivered in multi-disciplinary teams and crucially can undergo attitude changes as they encounter powerful learning experiences.

However there are real problems associated with clinical attachments. It is very difficult to ensure a consistent learning experience across differing sites and there is an ever increasing mismatch between demand and supply as the service pressures are increased.

The variations in quality create a strong case for developing standards for clinical placements, whilst the pressures on supply lead to hard choices as to what we will prioritise within the available time and resources. They also lead us to consider how else we can achieve the purposes of attachments within the faculty.

There are a variety of possibilities but none can be a complete substitute for a high quality learning experience grounded in the real world of clinical care.

Breakout sessions

During the day, delegates were the opportunity to discuss particular issues in breakout groups. Issues addressed were:

  • Portfolios - How can portfolios support learning on external clinical placements? Led by Janet Strivens, Lecturer in Education, University of Liverpool.
  • eLearning - How can e-learning support learning on external clinical placements. Led by Pat Reynolds, Deputy Director of Education for Distance Learning, Kings College London
  • Student support - What is an ideal support framework for students on placements? Led by Professor Stephen May, Vice Principal for Teaching, Royal Veterinary College

Conclusions

To close the day Professor Richard Halliwell, President of the Royal College of Veterinary Surgeons summed up the key messages he had gathered during the day. He set the context and then listed some of the key benefits while also mentioning the supplementary strategies that are available.

A key question was whether it is reasonable to expect busy practitioners to give time to teaching students and the unequivocal answer is that they have a professional duty do so.

Portfolios are potentially a very useful tool to support placements but barriers to their use still exist and elearning has great potential but again needs careful thought and planning if it is to be of real use.

Prof Halliwell acknowledged that making effective use of clinical placements has never been easy and is probably harder than ever in the current intensely service focused situation but he concluded on an upbeat note by saying: We don't have problems, we have challenges!

What you said...

"I found the e-learning session very good. I valued most hearing about the common challenges and solutions; I particularly valued the mixed participants from the LTSN constituency."

"I really liked the attitude and approach of the speakers, and valued Megan and Reg's friendly but authoritative handling of the day. Thanks for organising it and giving me the chance of attending."

Find out more....

A full report and downloads of the presentations and breakout group feedback are available from http://www.medev.ac.uk/resources/meetings/twentytwenty_vision.

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The Northern Deanery: Modernising Medical Careers

Peter Hill, Postgraduate Dean and Director of the Northern Deanery

Modernising Medical Careers (MMC) is a new UK policy likely to be at least as profound in its effects as the Calman reforms were for higher specialist training when introduced in 1996. Whilst these much needed reforms started life as proposed changes to the Senior House Officer grade, they will actually influence the whole training system, impinging both on undergraduate as well as on specialty training.

Key elements: Acute care, Communication skills, Clinical governance, Audit, Evidence based practice and academic work, Opportunities to access shortage or difficult to recruit-to specialities, The wider NHS, Team working.

The whole purpose of this approach is to enhance the education of doctors and dentists in order to provide for the needs of a modernised National Health Service (NHS) that puts patients at the centre of its focus. The NHS has a fundamental responsibility to not only provide service today but also ensure the provision of a quality service for tomorrow.

Key concepts

At the heart of these changes is the idea of a structured two-year Foundation Programme (FP) for newly-qualified doctors and dentists. During these two years, doctors will hone their skills to be able to care for a range of patients from the young to the very old, including the acutely ill, and in a variety of settings - primary and community, as well as in hospital. In addition trainees will get the opportunity to sample a wider range of possible career opportunities. Pilot programmes will be introduced in 2004 and all newly qualifying doctors will be expected to embark on a Foundation Programme by August 2005.

The Department of Health describes seven pillars for Foundation Programmes: quality assured, flexible, trainee centered, competency assessed, service based, coached, structured and streamlined.

What we are doing

The Northern Deanery is approaching MMC by prioritising quality whilst understanding the need to meet longer term NHS aims. Each Foundation Programme will enable the trainee to access the full curriculum. Each placement in the programme has to fit with others to support increasing experience and development.

Various models will allow trainees to access training that meets their needs and career aspirations, elective opportunities, timely choice of their FP 2nd year programme and innovative use of study leave. With our FP Learning Portfolio we hope to encourage trainees to understand their own learning needs, and manage them according to programme requirements and their own aspirations.

Moving from experience-based to an outcome-based training puts competency assessment at the core of MMC. We will introduce a coaching model whereby the coach will support the trainee in their learning for the duration of the programme and will not be a member of the assessment committee.

The development of our faculty of trainers will be a key issue. We need to support the development of our coaches in providing careers information, guidance and counselling; improve the skills of our assessors (who will be from a range of professions); and skill up everybody (trainees and trainers) to support training and on the job learning.

Embedding the principles of assessment and the need for trainees to prepare for revalidation at this stage of training will enhance their effectiveness in the speciality training that follows.

From August 2007 all FP graduates should enter speciality training. The aim is for one competitive entry point from which to progress to a Certificate of Completion of Training. This will allow independent practice in their chosen speciality, whether it be general practice or urology, as long as the competencies are met. The duration of training will differ from specialty to speciality. Bottlenecks should be reduced; opportunities to move between specialities should be increased. Flexibility may be as important for speciality training as it is for FPs.

Conclusion

We need sufficient numbers of the right kind of doctor in the right place to meet the needs of the modern NHS. MMC aims to ensure that all doctors and dentists in their early postgraduate years have the necessary core skills and wider experience of clinical practice. This should improve career choice for the trainee, and enhance uptake of training, even for those specialities that have difficulty recruiting.

*For more information contact Peter Hill, Postgraduate Dean and Director of the Northern Deanery, peter.hill@ncl.ac.uk*

Useful addresses:

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News: Higher Education Academy, Review and Centres for Excellence in Teaching and Learning

Dr Megan Quentin-Baxter, Deputy Director, LTSN-01, presents an update on the new Higher Education Academy, which came into existence earlier this year.

"The Higher Education Academy is concerned with every aspect of the student experience. It will provide coherence, added value, inclusivity and a powerful emphasis on the needs of stakeholders."

"The Academy will work co-operatively with colleges and universities, as well as the Leadership Foundation, and the new Centres for Excellence in Teaching and Learning, to help establish management and leadership structures which provide higher quality experiences for students and more transparent recognition and reward for good teaching." Paul Ramsden, May 2004 (1)

On 30th April 2004 LTSN-01 formally became part of the new Higher Education Academy. The Academy is made up of the Institute for Learning and Teaching (including the National Teaching Fellowship Scheme ), the Learning and Teaching Support Network and the National Coordinating Team.

The new Chief Executive, Paul Ramsden, will take up post in August 2004. The Higher Education Academy is a company limited by guarantee and owned by UUK and SCOP, thus operates independent on behalf of higher education. A Board is responsible for its strategy, policy, finances and employment, and a Council will oversee professional matters, such as setting professional standards and criteria for admission to the register, and for advising on quality enhancement. Both have representation from practitioners and other stakeholders.

The major part of the Academy's funding will come from the Funding Councils, with other funding coming from institutional subscriptions from HEIs, individual subscriptions from registered practitioners and income from contracts for services provided by the Academy.

Paul Ramsden has been Pro-Vice-Chancellor (Teaching and Learning) at the University of Sydney since 1999 and is author of many well-known books in learning and teaching in higher education (2), and is a very welcome addition to the staff of the Academy.

Paul is committed to establishing a solid, easily-accessible evidence base that will enable all staff who teach and support student learning to choose the course of action that will best achieve their goals, and to set this in a wider policy context.

Cliff Allan has been appointed Director of Programmes (and Acting CEO until August), Victoria Eaton as Director of Registration and Accreditation, and Jane Pither is Director of Finance.

The Leadership Foundation

In parallel, the Leadership Foundation for Higher Education (incorporating the Higher Education Staff Development Agency (HESDA) ) also launched recently (3). These agencies are all committed to consolidating support for education and a common agenda towards enhancement of the student learning experience, and recognise a shared interest with agencies representing staff such as AUT, NATFHE and UNISON:

Academy review

As part of the integration into the Academy a review is taking place of all LTSN subject centres over the next five months, led by a committee chaired by Professor Bob Burgess (University of Leicester), to consider the optimal configuration and focus of subject centres in the new structure.

Those with a role in health and social work (LTSN-01, LTSN Health Sciences and Practice, and LTSN Social Work and Social Policy) are undergoing a special review by a sub-committee chaired by Professor Janet Finch (University of Keele), which will look at the needs of the disciplines presently covered, their relationships within the Academy and elsewhere in the sector (e.g. professional bodies), the potential impact and opportunities arising from policy changes in health and social work education, practice, staff development and funding in England, Scotland, Wales and Northern Ireland.

It is possible that you will be contacted by evaluators seeking comment in these areas, and we greatly appreciate any advice and guidance that you can offer to us or to the Finch committee.

CETLs

Over the same period, and of strategic importance, institutions may be preparing Stage 2 bids for Centres for Excellence in Teaching and Learning (England) which are due by midday on 29th October 2004. Summaries of the short-listed Stage 1 bids should be available on the Hefce website by the time we go to print. It appears that institutions were very strategic in how they responded to the call as Hefce has received about half the potential number of bids that institutions could return.

Approximately 100-110 bids will be invited to submit Stage 2 proposals, and the funding council is holding a briefing meeting at Olympia on 22nd July, where bidders can raise questions, meet each other and various support agencies, including members of the Academy. Institutions in Northern Ireland responded to a separate CETL call with bids closing on 28th May 2004.

We would like to extend our congratulations to all those who made a case for excellence under these calls, and wish you every success with your bids. Please don't hesitate to get in touch if we can be of assistance (bidders, those who were disappointed, and non-bidders), or if we can help with any questions about the Academy or review, as outlined above.

References:

  1. Exchange Magazine: http://www.exchange.ac.uk/ Issue 6, p7.
  2. such as Ramsden, P. (2003). Learning to teach in higher education, RoutledgeFalmer, 288p; and Ramsden, P. (1998). Learning to lead in higher education, RoutledgeFalmer, 304p. Both available from Amazon
  3. March 2004: http://www.leadership-he.com/

Further information:

Dr Megan Quentin-Baxter megan@medev.ac.uk.

Useful addresses:

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Book Review: Ethically Speaking

Helen Cooper, Fourth Year Medical Student,University of Newcastle Upon Tyne

Ethics are the morals that govern our actions. Awareness of ethics is vital to function in today's society, whatever your walk of life. Therefore, there is an increasing need to educate students about ethics as they embark on their professional lives. Ethics teaching has many hurdles to cross with the subject being notoriously difficult for students to comprehend and often labelled as boring. This is a brief review of case material used in ethics teaching at various UK institutions to investigate how ethics is being brought to the students.

Four cases produced by Bristol University, University of West England and North Bristol NHS Trust perfectly illustrate the embedded approach to ethics teaching instilling internal values in students. The scenarios look at the issue of ethics at the end of life including advanced statements, consent, withholding/withdrawing treatment and duty of care.

These are all common issues, met often in working life, and developing a self-identity is essential. They are taught in a small group setting, encouraging students to reflect on their practice. Medical and nursing students participate together, promoting interprofessional learning and developing students' presentation skills as they present their views to the group. Professional codes of conduct are introduced by the facilitator but they are not central which would distract attention. In contrast, material from University of Newcastle Upon Tyne focusing on ethics in genetics takes a more pragmatic approach.

Students work through scenarios including carrier identification, pre-implantation diagnosis, prenatal diagnosis, gene therapy and embryonic stem cell research with reference to relevant legislation. The pragmatic approach is reflected in the knowledge-based summative assessment. The case material is very detailed with a lot of scientific principles to digest. This may be difficult for some groups of students. The session is designed to be in a small group which aids participation and sharing views. The material may be more accessible if the emphasis was shifted from the legislation towards the implications of genetics ethics for the health professionals, which is somewhat neglected.

The embedded and pragmatic approaches are successfully combined in a scenario used at University of Liverpool School of Veterinary Science. The ethics of renal transplantation in cats is discussed using a mixture of role-play and teaching on Royal College guidelines. This encourages students to consider the autonomy of all involved within the legal and ethical constraints. The only concern is that it is a large group session which often discourages full participation as well as students feeling daunted at the prospect of playing the role of the ethics committee.

Finally, another successful combination of embedded and pragmatic approaches is a case used with medical students at University of Newcastle Upon Tyne. The case looks at suicide and refusal of treatment in a patient with a long history of multiple sclerosis. Students are asked to decide whether the patient should receive treatment on arrival at casualty. Considering both sides of the story is encouraged by different groups presenting arguments for and against treatment. This is a useful and unique technique although some students find playing devil's advocate difficult. Participation is maximised by the competitive atmosphere between the groups but safety of the students is highlighted from the start to maintain a supportive learning environment.

The development of technology and knowledge brings challenges to ethics teaching. As more dilemmas arise, there is a need to further raise awareness and develop innovative teaching for use in higher education. The most important considerations for ethics teaching are to tailor the material to the student group and to furnish the students with the personal autonomy and reasoning skills they will need in the future http://www.medev.ac.uk/resources/ethics_teaching.

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The Welsh Baccalaureate

Pam Clark, Assistant Registrar (Recruitment & Admissions), University of Wales College of Medicine

A presentation on the Welsh Baccalaureate Qualification was made earlier this year to medical school admissions tutors attending a Forum 'Selecting the Right People to be Tomorrow's Doctors' held at Exeter and hosted by Peninsula Medical School.

The Welsh Baccalaureate is a new post-16 over-arching diploma qualification, nationally recognised, evaluated by the University of Bath Department of Education and assessed by the Welsh Joint Education Committee.

It is being piloted in 30 centres across Wales between 2003-7 with a decision by the Welsh Assembly Government in 2006 on roll-out to other centres in Wales. Approximately 700 students may be applying through UCAS for entry in 2005 offering the WBQ.

The WBQ was designed to widen participation in, and encourage completion of, post-16 education; to raise achievement and promote parity of esteem for vocational and academic courses; to encourage progression to further and higher education, training/employment and to encourage active and responsible citizenship.

Assessment of the Core includes portfolios of evidence, tests, component diaries, records of curriculum activities and experiences, verification and evaluation statements from employers, community offices and enterprise activity organisers. The Core comprises 640 guided learning hours (64 credits) or (seven units), includes regular one-to-one tutoring and mentoring support and it has been awarded 120 UCAS Tariff points.

The WBQ can be achieved at either Intermediate (Level two) or Advanced (Level three) level. At Intermediate Level the academic options include a minimum of five GCSE or NVQ Level two or BTEC First at pass level or equivalent while the Advanced Diploma requires a minimum of two GCE Advanced or NVQ Level three or BTEC National Certificate at pass level or equivalent.

Offers from HEI's should include achievement of the Welsh Baccalaureate Advanced Diploma, using UCAS Tariff points and stipulating - where appropriate - the number of units, subjects and grades required in the optional qualifications.

Students taking the WBQ will

  • have the ability to use and apply key skills
  • be more effective, independent individual learners
  • improve their investigative, analytical, evaluation and ICT skills
  • have a greater awareness of a range of issues affecting both contemporary society and them as individuals
  • have a greater appreciation of the world of work and business

The University of Wales College of Medicine has warmly welcomed the breadth of education and diversity of learning experiences afforded by the over-arching Welsh Baccalaureate Diploma. Offers will be based on achievement of the Advanced Diploma with 390 Tariff points, including 15 units in optional qualifications, AB grades being required in two science GCE A level subjects.

Two-part structure for the WBQ

  • Options - students' existing programmes of study such as GCSE, AS/AL, AVCE, NVQ, etc.
  • Compulsory core - made up of four 4 components

Key skills

  • Communication: application of number,
  • Information technology,
  • Problem solving,
  • Working with others,
  • Improving own learning and performance

Wales, Europe and World

  • Eight key issues; political, social, economic and cultural
  • Individual Investigation; Written/oral presentation based on one of the above issues
  • Language module; developing new or existing modern foreign language skills

Work-related education

  • Working with employers
  • Team enterprise activity

Personal and social education

  • Four key issues: family, health, relationships, aspects of citizenship
  • Community participation

Information on this new qualification is currently being made available to HE institutions by the WBQ Project Team and also by UCAS. Further details can be found on the website: http://www.wbq.org.uk.

A conference for HE admissions tutors will be held at St. David's Hotel, Cardiff Bay on Thursday 23 September 2004 when teachers and students will share their experiences and enthusiasm for this new qualification.

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Special focus: The BBC streams flow from Lifesign

William Garrison, Producer, Learning Media Development, University of Portsmouth

Lifesign is one of the first projects to offer a subject-specific range of moving-image resources. JISC funding ended in 2003 but, now hosted by the University of Portsmouth, it continues its commitment to provide streaming video for life science students of UK Higher and Further education.

Existing licences for the BBC series The Private Lives of Plants and The Human Body will continue until 2006. Portsmouth has also partnered with the Educational Broadcasting Services Trust to extend licences for programmes from its Shotlist collection, on clinical biochemistry and techniques in cell biology. Portsmouth is also seeking new sources of funding to continue the service beyond 2006 and to expand the catalogue with new programmes.

Innovation

Lifesign is an innovative project delivering rights-cleared videostreams for online learning. It is the first site to offer programmes from BBC Worldwide and it is the first to provide sophisticated tools that allow users to create segments and create playlists. The Lifesign Browser and Playlist Creation Tool makes it very easy for students and lecturers to create custom web pages.

Anyone can create an account and begin searching, viewing, and selecting clips from programmes. Anyone can organise clips into a playlist incorporating additional text and even hyperlinks to other web pages.

To publish this custom page on the web, all that is required is the click of a button. Each custom page has a unique URL that can be shared by email, in word documents, or as links in WebCT, Blackboard, or other HTML documents.

Lifesign has gone far beyond the scope of the original proposal. It has become an ongoing, service with enormous potential. One important area of development at Portsmouth is the application of Digital Rights Management. Using DRM, they will offer programme makers flexible licensing systems to make new content accessible for use in teaching and learning. DRM will help us greatly expand the catalogue of programmes. Janice Gardner from EBS Trust is very interested to see how students are accessing the site.

She said: "Lifesign has made our programmes accessible to many more students than is possible using videotape. We are very excited that Shotlist programmes are among the most popular that Lifesign has to offer and we are keen to continue to support their efforts with new content. Maths for biologists could be next."

The future

As Lifesign grows, it is likely to go beyond the Life Sciences into other disciplines. Using Digital Rights Management, they hope to offer many programmes from Shotlist and from the BBC Learning collection. Lifesign was created to demonstrate the feasibility of delivering streaming video for learning. Now it is poised to become an essential ongoing and evolving service to higher and further education.

For more information about the Lifesign contact William Garrison at william.garrison@port.ac.uk.

Key websites

  • Project Website: http://www.lifesign.ac.uk
  • Portsmouth Streaming Site: http://stream.port.ac.uk
  • EBS Trust: http://www.ebst.co.uk

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Mental Health in Higher Education: Taking stock and moving forward

Jill Anderson, Senior Project Development Officer

Mental Health in Higher Education (mhhe), a collaborative project of the Learning and Teaching Support Network, set out to increase networking and the sharing of good practice between the disciplines involved in learning and teaching about mental health in higher education. Outputs have included three national workshops; scoping reports on the teaching of mental health in difference disciplines; two forthcoming practice guides (on user involvement and the use of self in learning and teaching about mental health); and a set of case studies of learning and teaching. A web site has been established www.mhhe.ltsn.ac.uk which is linked to a jiscmail discussion group: ltsn mental health in higher education.

"There is more that unites than separates us" (nurse academic)

It was clear from responses to an initial mhhe questionnaire that educators across the disciplines are grappling with similar challenges:

  • How to determine what all students, on generic programmes, need to understand about mental health problems and wellbeing
  • The constraints of increasing student numbers, and insufficient time to devote to learning and teaching about mental health.
  • How best to ensure that students are helped to learn about the range of perspectives which exist, whilst developing a sense of their own professional identity and the particular contribution they can make
  • How to combat stigma and ensure that mental health is perceived as an attractive option at the point of specialisation.
  • How to involve service users and carers in education and training in constructive ways of benefit to all concerned.
  • How to address the needs of students with mental health problems and their implications for support structures and curriculum development.

"There is much to be gained from talking to each other" (medical educator)

The project has provided a range of opportunities for exchange between educators from different disciplines. The chance to meet face to face, at workshops and events, has had an important role to play.

The project has disseminated information about other initiatives in mental health teaching, such as the development of a module on psychosis, drawing on the results of the BPS report Recent Advances in Understanding Mental Illness and Psychotic Experiences; as well as guidance being developed nationally, such as the recent work by the joint NIMHE/Sainsbury Centre Workforce Unit on developing Essential Shared Capabilities for Mental Health. For further information about both see below.

"Increased knowledge about how things work in different disciplines can only help understanding" (medical educator)

Becher's work on Academic Tribes and Territories (2001), draws attention to the differences that exist between disciplines in higher education. We know, too, that the area of mental health is characterized by a diverse range of understandings and perspectives.

Unsurprisingly, given this context, there have also been differences of opinion and challenges over the year.

At a practical level, it took time to become familiar with the differences between the subject communities. Whilst the majority of medical and psychology educators remain clinically active, many of those involved in social work or occupational therapy do not (as evidenced in the recent report on the Clinical Activity of Mental Health Lecturers, available on the mhhe website). Different cultures about CPD credits and charging, for example, surround the organisation of events in different disciplines. Educators, in common with students and practitioners, may also have preconceptions about their peers from other disciplines, sometimes based on outdated notions about how mental health is taught.

Brian Lunn, in the above mentioned case study notes how "nursing students had anticipated a cold... clinical approach from psychiatrists and were surprised to see a broad approach which differed from the medical model they had been taught on". Educators, given the opportunity to find out about recent changes in education in fields other than their own, can similarly be surprised and develop their understanding.

"It's may be important that as psychiatric educators, we start to speak to each other, before beginning to speak to everyone else as well!" (medical educator)

Feedback from the workshops, via the website and in other ways, underlines the gains to be made from increasing networking between disciplines. A key message has also been the desire for educators to talk within each. Far-reaching change to the curriculum within a subject area can place significant demands on educators' time and energy, reducing that available for inter-disciplinary initiatives and exchange. The mhhe project has both engaged with, and linked educators to single discipline organizations, including the Association of University Teachers in Psychiatry.

In the face of a raft of recent policy and practice developments in mental health, it is timely to consider how the learning of students and practitioners can be enhanced. The experience of the mhhe project has shown that inter-disciplinary exchange can bolster and disseminate effective practice and support change.

Given limitations as to what can be achieved in a one year project, identification of ongoing funding was a key priority in the latter stages of this work.

The mhhe project has been welcomed by many external regional and national bodies (e.g. the National Institute for Mental Health in England, Workforce Development Confederations, Sainsbury Centre for Mental Health etc) providing, for the first time, a means for policy makers and others to dialogue with mental health educators in other than an ad hoc way. The context for this is of course the increasing imperative for MH services to be integrated and provided collaboratively in practice across health and social care.

We enter the next phase of the project's work with three year funding from the Department of Health to develop a more systematic network of mental health educators in England. Further development work in Wales, Scotland and Northern Ireland is anticipated to ensure that the UK focus of this work is maintained. A regular e-bulletin will be produced and a series of regional networking events is planned. Links with developments around e-learning initiatives in mental health are anticipated. We are keen to increase the involvement of medical educators in this next phase. Please contact the Senior Project Development Officer if you would like to be added to the project's mailing list or to suggest priority areas for future work.

Workshop one: Paying more than lip service

The importance of user and carer involvement in mental health education is acknowledged across all disciplines (for interesting examples from undergraduate medical education, see the recent article by Livingston & Cooper in Advances in Psychiatric Treatment). This event, attended by 60 participants, provided an opportunity for the cross-fertilisation of ideas. The use of service users trained as role players in medical training was, for example, of particular interest to educators from other disciplines (an idea being worked through in a current ltsn-01 funded mini-project - see below).

A good practice guide on this topic, co-sponsored by NIMHE, will be published in the autumn.

Workshop Two: Nobody knows as much as everybody

Fifty people met in Edinburgh for the second mhhe workshop in November 2003.

The focus of this event was to share perspectives on how we learn and teach about mental health. It was co-sponsored by the National Resource Centre for Ethnic Minority Health, part of NHS Scotland.

Examples were given of how students can be helped to develop a broad and holistic understanding of mental health problems and wellbeing.

Workshop Three: Starting small and thinking big

The final mhhe workshop, on interprofessional education about mental health, took place in Bristol in January 2004, attended by 85 people.

Findings were presented from the TRIPLE project, a parallel collaborative project on interprofessional education in which ltsn-01 has been an active partner.

A key note presentation by Bill Fulford introduced the concept of "values-based practice" which has important implications for the training of medical students and those from other disciplines (see www.scmh.org.uk for details of a forthcoming event in this area). Brian Lunn's case study, on the mhhe website www.mhhe.ltsn.ac.uk/casestudies/casestudy2.asp is an interesting example of an interprofessional initiative involving medical and nursing students at pre-registration level.

For further information visit http://www.mhhe.ltsn.ac.uk or to get involved contact Jill Anderson, jill.anderson@nottingham.ac.uk.

References

  1. Becher, T. & Trowler, B. (2001) Academic Tribes and Territories: Intellectual Enquiry and the Cultures of Discipline, Maidenhead: Open University Press
  2. Ferguson, K., Owen, S. & Baguley, I. (2003) The clinical activity of mental health lecturers in higher education, London:DOH
  3. Livingston, G. & Cooper, C. (2004) User and carer involvement in mental health training, Advances in Psychiatric Treatment, 10, 85-92.

Useful links

  1. The Association of University Teachers of Psychiatry. http://www.rcpsych.ac.uk
  2. Psychosis revisited - a module on psychosis http://www.salomonscentre.org.uk/caspd/consultancy/psychosis.htm
  3. Essential Shared Capabilities for Mental Health. An update on this work available in Workforce 3, downloadable from the workforce stream section of the NIMHE website: http://www.nimhe.org.uk
  4. Developing mental health user input into medical student learning: an ltsn-01 funded mini project. http://www.medev.ac.uk/resources/funded_projects/show_project?reference_number=394

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Workshop report: Fishing for e-learning standards in Sestri Levante

Dr David Davies, University of Birmingham

At the beginning of May around 500 delegates gathered in Sestri Levante, a quiet fishing town on the beautiful Portofino coast, Northern Italy for the 2004 eLearning Results1 meeting.

Now in its second year, the conference organised by Giunti Interactive Labs brings together industry leaders, academics and government agencies to share case studies and discuss good practice in the field of e-learning standards.

The meeting offered a refreshing change from the usual navel-gazing often associated with e-learning standards meetings and instead focussed on success stories of standards adoption.

The standards bodies themselves were well represented with delegates from IMS, SCORM, AICC and the UK's own CETIS in attendance. Medicine and health sciences were well-represented as this year as AMEE2 was a co-sponsor.

The medical and health strand featured presentations that discussed learning outcomes, e-portfolios, assessment, training and collaboration, all subjects familiar to regular AMEE goers but in Sestri Levante the issues took a more technical twist with talk of interoperability standards, both present and emerging.

It became clear to this conference delegate that the present crop of e-learning standards only address some of the issues of interest to medical educators, and even then perhaps only the more technical aspects of content exchange.

For standards to really take root in medical education the areas of reflective learning, electronic portfolios and professional competency need the standards touch. New standards, as yet to be defined, that govern the creation and operation of multimedia learning tools such as virtual patients and how these communicate with electronic patient record systems are also needed.

This view of information management that starts with the classroom and ends with the consulting room is as yet unexplored by the standards bodies.

A major presence in Sestri Levante were IVIMEDS3 and Medbiquitous4, two consortia that aim to bring together much of the debate about e-learning standards in medical education, training and practice by bringing together like-minded institutions, both professional and academic.

IVIMEDS in particular is positioning itself to act as a focal point for e-learning standards in medical education. As a paid-up member of IMS, IVIMEDS will give a voice to the seldom heard medical expert on the standards-making bodies.

For those poor souls who were left at home on May exams duty and were unable to spend time in the lovely fishing town of Sestri Levante the conference web site is well worth a visit.

Streaming video of all presentations as well as PowerPoint slides are now online. It's just like being there in person. Well, Ok, maybe not, but it's the next best thing until eLearning Results 2005.

Dr David A Davies (d.a.davies@bham.ac.uk), Medical Education Unit, The University of Birmingham.

References

  1. http://www.elearningresults.com/
  2. http://www.amee.org/
  3. http://www.ivimeds.org/
  4. http://www.medbiq.org/

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Slice of Life: From shared educational resource to international meeting

Suzanne Stensaas, University of Utah

In the beginning

In 1986 Slice of Life began as a faculty project based in the Health Sciences Library at the University of Utah.

"Slice of Life" was the name given to the shared Videodisc (NTSC format of stored, still images in video format. Over ten years the disc went through 7 editions, as new material brought the total to 44,000 images, from 240 contributors at 65 institutions.

The goal was to have freely available most of the still images needed for basic science education. The focus was health sciences education. Subjects like histology, pathology, anatomy, and radiology were very well represented. In 1993 a new Disc, Slice of Brain focused on the neurosciences with many of the original images, plus many more. From 1989-1993 contributors and people interested in medical multimedia gathered annually to share educational materials they had created using the disc. The meeting was a logical outgrowth of the project. Some faculty wanted their software distributed, so a non-profit, library-based distribution office was established as commercial publishers were often not willing to distribute software in an affordable manner to a small market. Distribution of software by the Eccles Health Sciences Library ended in 1998 as many projects were moved to the Web or lacked resources for conversion.

Serendipity

Since the original contributors wanted to share their teaching materials we had a like-minded group of individuals. We have added many "Slicers" along the way. This has provided the foundation for successful collaboration. Meetings and hands-on pre-workshops became places to share ideas and teach techniques. Social events turned into collaborative projects or grant proposals. The HEAL project is one such project. (http://www.healcentral.org)

An international network

A group of health science educators and software developers mixing practical technology with education has emerged. The 16th annual workshop focuses on Medical Multimedia with presentations and pre-workshops on evaluation, new technology, and demonstrations in health sciences. It will be held in Amsterdam and Leiden, June 28-July 3, 2004 and is limited to 250 registrants. The diverse program and abstracts can be seen at http://www.slice.gsm.com. Programs and Abstracts of the past 6 meetings can be reviewed at http://slice.gsm.com/2004/past_meetings.htm

Student software prize

The annual $1000 medical student software prize acknowledges the help many faculty have received from creative medical students over the years. (This year's deadline is June 11, 2004 with guidelines and form at http://slice.gsm.com/2004/student_software.htm). The prize is open to students in any country and projects in any language.

Future evolution?

This will certainly occur and will depend on individuals who want to take this informal group in a particular direction or undertake specific projects. Of particular interest is the creation of shared resources, tools, and materials that can be used in a variety of ways in any language.

For further information about Slice of Life contact Suzanne Stensaas at suzanne.stensaas@hsc.utah

Current projects free to be used or downloaded:

  • Digital Brain Atlas that can be downloaded for free. It was created with Flash and has graphics that can be zoomed. http://medstat.med.utah.edu/eccles/slice/brain.html
  • A Neurological Examination site with Videos of normal and abnormal patients. http://medstat.med.utah.edu/neurologicexam/home_exam.html
  • A companion Pediatric Neurological Examination site went on line this year. Movies can be freely used on other non-profit educational sites. http://medstat.med.utah.edu/pedineurologicexam/home_exam.html

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Organisation focus: The Staff and Educational Development Association (SEDA)

Nigel Purcell, Senior Educational Advisor, LTSN-01

A look at the different resources available from the Staff and Educational Development Association, particularly useful for those involved in staff development.

The Staff and Educational Development Association (SEDA) produces a wide range of useful resources for those involved in staff development. SEDA papers are comparatively compact publications, typically about one hundred to one hundred and fifty pages long, which explore aspects of good practice in relation to the staff development process, and to learning and teaching.

There are SEDA papers on personal development planning, student induction, active learning strategies in seminars and good practice in working with international students.

The Active Learning in Seminars: Humanities paper consists of a pack of 12 resource cards for teachers and tutors suggesting a variety of ways in which seminars can be made more interesting. Ideas covered include games, group work suggestions, role play etc.

Student support

There are also several papers on the very interesting possibilities of using students to support students.

These include a review of the practical implications of introducing peer assessment, a do-it-yourself guide to promoting peer assisted learning designed for students and an outline and an evaluation of the different types of peer tutoring systems. Not surprisingly SEDA also produces papers directly focused on the staff development process itself. For example, Staff Development in Action is a collection of workshops designed in a very practical style and including photo-copiable OHTs for use in staff training and development.

Leading Academic Programmes and Courses: developments in roles, practices and in-house training is another useful staff development resource. Its main focus is on 'definitions and suggested good practices for the work of a variety of leaders in HE.

Monographs

In addition to their papers SEDA also produce a series of somewhat shorter monographs - typically less than fifty pages - designed for wide circulation amongst teaching staff. These address a variety of very practical issues for teachers.

There are monographs on teaching large groups and small groups, on assessment, using educational media, developing reflection skills, equal opportunities and on how to enhance student learning.

They are also available collected together in several packs, combining a number or related monographs and available at discounted rates for buying larger numbers. For example the Lecturers Pack 1 contains five of the monograph and is available with a significant discount if more than ten packs are purchased.

Journals

SEDA also publish two quarterly journals. The Educational Developments Magazine (ISSN: 1469-3297) aims to explore key issues in depth. Recent articles have looked at embedding learning and technologies, the idea of scholarship and constructivist principles and conditions for learning.

The other journal is Innovations in Education and Teaching International (ISSN: 1470-3297), which is a refereed journal covering a range of teaching and learning issues.

Books

Finally, SEDA publish a series of books through Routledge Falmer. These include A Guide to Staff and Educational Development, edited by Peter Kahn from the University of Manchester and David Baume from the Open University.

Another interesting title is Managing Educational Development Projects which is edited by Paul Martin, Carole Baume from the Open University and Mantze York from Liverpool John Moores University.

Although most of the SEDA resources are generic they include a substantial range of materials which can be adapted to the medical, dentistry and veterinary context.

They are definitely worth a look if you have a staff development role within your institution and/or if you are seeking to deepen your own understanding of educational theory and practice.

For further information visit the website at http://www.seda.ac.uk

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Workshop programme 2004

Forthcoming workshops

LTSN-01 workshops are free and open to anyone involved in learning and teaching in undergraduate medicine, dentistry and veterinary medicine. All participants of medical and dental workshops are eligible for CPD credits.

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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Don't miss the next issue of 01, available May 2004 from: http://www.medev.ac.uk/resources/newsletter

Register for LTSN-01 bulletins at: http://www.jiscmail.ac.uk/lists/ltsn-01.html

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