Wednesday, 6 March 2013

#Ukmeded : National Finals

Another #Ukmeded introduction to a chat post from me. This week's topic is to be National Finals, and I'm hoping to focus a little more on the more moral question of: are they something we should consider, rather than on the practicalities of implementing any such scheme.

The medical schools up and down the country each have their own style of teaching medicine, from Glasgow's PBL based system to Imperial's old school core science and clinical years. They have control over how they select their intake of students and what emphasis different elements of medicine are given within their courses and how they assess their students. Ultimately however, their aims must be broadly similar: to produce medical graduates who can work alongside each other across the country performing the same basic job with confidence, skill and safety. And in the more long term, medical graduates with the skills and knowledge to prepare them to progress through the various stages of post graduate training.

 The GMC's Tomorrow's Doctors "sets the knowledge, skills and behaviours that medical students learn at UK medical schools: these are the outcomes that new UK graduates must be able to demonstrate" (  The GMC uses a Quality Assurance of Basic Medical Education (QABME) to assess that this minimum standard has been met. However, many foundation doctors do not feel adequately prepared for their first job and there are worries about the consistency in competency of foundation doctors. (

But the ability to be a good doctor is about more than just basic competencies, and I personally believe it is important to be able to compare the quality of medical education between medical schools more formally. It would allow the public, the profession and students ourselves to be reassured that there is not an appreciable difference in the quality of junior doctor produced by different universities. 

I have met medical students from up and down the country and am lucky enough to count many of these amazing people my friends. I am sure that we would all like the chance to be judged on our own merits rather than our intelligence and ability misrepresented based on assumptions about the universities which we attend. Many people will say, "It's all right for you, you go to Cambridge, you'd do really well. I go to ... university and we couldn't compete". But that attitude is precisely the one I would love to have the data to challenge. I would personally like the opportunity to test myself against my whole cohort of medical students and be given the chance to compare my strengths and weaknesses and how well prepared I have been by my medical school.

If all medical schools are aiming to produce the best doctors possible from their intake then surely they too should be keen for the chance to prove the excellence of their students and teaching methods?

I am going to leave it there on my own opinions for just now, and suggest a few questions to consider and a few resources for thinking about the issue of national finals in more depth. Resources include current student attitudes to the quality of their education, comparison of the graduates of different medical schools pass rates in post graduate exams, and discussion by the GMC and MSC.

Questions to discuss (I can think of loads!): 

Should we have a national exit exam?

Should a national exit exam examine only basic competencies?

Should a national exit exam discriminate the quality of medical graduates?

Would such an exam give reassurance that the quality of medical graduates from medical schools is comparable?

Would such an exam give reassurance that the quality of medical education at different medical schools is comparable?

Could such an exam be used for ranking applicants to the Foundation Programme?

Would such an exam cause a "teach to the exam" attitude?

Would such an exam cause an increase in the average quality of medical graduates?

Would such an exam cause an increase in the average quality of medical education?

Would such an exam allow for variety of styles to remain across medical schools?

Would such an exam improve the preparation of students to later take post graduate exams?

Would such an exam reduce the current level of disparity seen between graduates of different medical schools first time pass rates in post graduate exams?

Are groups opposed to such proposals because they wish not to be compared in case that comparison is unfavourable?

Would differences between medical schools be down to selection procedure or teaching or both?

Could the comparisons made as a result of such an exam impact on current efforts to widen access to medicine?

Resources in no particular order:

Massive thanks to my friends @RoseTintdScrubs and Christopher King (who sadly isn't on twitter!) for all their help with collecting the resources and for all the discussion about this issue already!

Friday, 1 February 2013

Making progress on the VLE

A little update from the last blog post.  Turns out after our excellent and productive #ukmeded chat my blog was passed to someone involved with the VLE at Cambridge. There has been some behind the scenes work going on about redesigning the VLE and a workshop style meeting was set up for yesterday afternoon and having been sent the blog and worked out who I am emailed and invited me specifically.  I'll give a full run down on what went on in a sec, but in brief I am very positive about the whole thing now and the engagement by all concerned was great.

We had a whole afternoon 2-5pm, refreshments and lunch galore, and we had 6 students and 4 staff members to really get to the bottom of how to make the whole VLE better and more user friendly. In the discussion we covered a huge number of issues linked to the VLE, learning, course organisation and even student welfare, and it was so refreshing to feel listened to as an equal about my learning.

The students were:
Me a final year (aka stage 3),
Two 5th years (stage 2's) one of whom is the ex clinical society pres and one the current,
Two 4th years (stage 1's) one of whom is the academic and welfare officer for clinsoc
One of the level 2 (a year before graduating) grad entry students who has worked in software development before coming to medicine

The staff were:
One of the Associate Deans, A GP who is in charge of the GP parts of our course and who has taken on the VLE
Two of the curriculum office staff who are involved in administrating the course and specifically content on the VLE
One of the IT staff

We started with a quick presentation about the plan for the afternoon which largely broke into two big sections, sorting out the structure of the VLE and coming up with a better looking front page and by extension a more functional website. But first we did a quick brainstorm on what we didn't like about the current incarnation and came up with a huge list which covered everything from the last blog post and a good few littler niggles as well.

The biggest dislike was that the site with its very flat and illogical hierarchies make the site near impossible to navigate. And that means things get hidden and put in the wrong place and generally lead to my previous ranting. So we needed to work out structure that could address that, and focus on some logical hierarchies. We began with an idea proposed by the Associate Dean that focused on a placement based model as opposed to the placement and speciality confused split we have at the moment. A lot of discussion went into refining the initial idea but we were all very pleased to get rid of the placement/ speciality split and to form some real hierarchies. The students also pushed for  the inclusion of what we're calling Longitudinal Learning maps, as we chose to split the provision of that material by placement we wanted somewhere with an overview without duplicating material. We chose to have pages which linked to the material elsewhere and showed as a kind of "map" for the learning for the year. In the end we worked out something that looks like the below:

One of each tab has been expanded to show the principles. What I really like is the hierarchy reflects how our course works and should help to integrate some of the overarching learning into every placement. It might even force some of the placement and speciality directors into thinking about how their things integrate with each placement!

We spent a long time on the structure but once we had worked it out we turned our attention to a functional and attractive front page. We decided to ditch a lot of the elements currently on there, including the calendar, messages and upcoming events as they all have very little functionality currently. It was felt that we wanted a very streamlined front page with simply a button for each stage which would take you into the start of the above hierarchy alongside a couple of other buttons such as  to the longitudinal learning maps, to the student welfare info and to some "General" Clinical school official information (we couldn't come up with a good name for that one). We also spoke about having a tool bar at the top of every page which let you return to the stage home and to the general home as well as a menu to the above "general info". We also wanted some indication of where we were in each hierarchy either by the web address or a bar on screen which said something like Stage3> Medicine> Learning resources.

We spent some time at the end discussing some other niggles (including the terrible picture they insist on showing us of ourselves) and a bookmarks tool which is being introduced as a bit of a fix until the big changes come in. It was just going to be rolled out to us but we have persuaded them that for all changes big or small they need to get a group of students to Beta test the new features as the VLE is cluttered with things that could work but just don't. There were things we suggested that can't be done in Moodle's current set up and there were things we suggested that the team had explored if other medical schools were doing.

All in all we came up with some very positive changes for the VLE but the fantastic thing about the whole process was that it was real grass roots development of a system that the student interact with all of the time. I can't help thinking how nice it was to sit down with such a responsive group of staff and I wonder how many of our other med school niggles might be solved if such engagement was the norm, I came away buzzing. Thanks to everyone on the #ukmeded chat for sparking some great discussion and ideas and for passing on the blog and getting me involved!