“Tomorrow’s Doctors” Implementation Workshop University of Edinburgh Medical School Professor Allan Cumming

MANY CHALLENGES Focus on two Outcome-based education and assessment The Student Assistantship

GMC QABME, University of Edinburgh 2008/9 “Review and simplify the curriculum structure …….” “Rationalise the vertical themes running through the curriculum……”

Outcome-based education and assessment

Curriculum model (Edinburgh) Spiral ***** Core and options ***** Integrated **** Systems-based ***** Discipline-based **** Problem-based ** Case-based *** Task-based ** Outcome-based ** Student-centred **** Self-directed **** Multi-professional ** Community-centred **** Curriculum model (Edinburgh)

Curriculum outcomes = preparedness for practice What to learn - content How to learn – educational strategy teaching and learning tools Assessment Educational environment Student

What are we doing? Edinburgh curriculum is being structured and described in terms of twelve Curriculum Outcomes The assessment strategy is being aligned with these outcomes “Tomorrow’s Doctors 2009” outcomes are the primary basis of the new structure - with appropriate additions to reflect the character of the Edinburgh graduate

EDINBURGH MBChB OUTCOMES OVERARCHING OUTCOME GMC TOMORROW’S DOCTORS 2009 OVERARCHING OUTCOME An Edinburgh medical graduate will be a caring, competent, confident, ethical and reflective practitioner, equipped for high personal and professional achievement, able to provide leadership and to analyse complex and uncertain situations. GMC 7. Medical graduates are tomorrow’s doctors. In accordance with Good Medical Practice, graduates will make the care of patients their first concern, applying their knowledge and skills in a competent and ethical manner and using their ability to provide leadership and to analyse complex and uncertain situations. THE DOCTOR AS SCHOLAR AND SCIENTIST Ability to apply to medical practice: 1. BIOMEDICAL AND CLINICAL SCIENCES GMC 8. Apply to medical practice the biomedical scientific principles, method and knowledge relating to: anatomy, biochemistry, cell biology, genetics, immunology, microbiology, molecular biology, nutrition, pathology, pharmacology and physiology. 2. PSYCHOLOGICAL ASPECTS OF MEDICINE GMC 9. Apply psychological principles, method and knowledge to medical practice. 3. SOCIAL SCIENCES AND PUBLIC HEALTH GMC 10. Apply psychological principles, method and knowledge to medical practice. GMC 11. Apply to medical practice the principles, method and knowledge of population health and the improvement of health and health care. 4. EVIDENCE-BASED MEDICINE AND RESEARCH GMC 12. Apply scientific method and approaches to medical research.

THE DOCTOR AS PRACTITIONER Ability to: 5. Carry out a CONSULTATION WITH A PATIENT GMC 13. Carry out a consultation with a patient. 6. DIAGNOSE AND MANAGE CLINICAL PRESENTATIONS GMC 14. Diagnose and manage clinical presentations. 7. Undertake CLINICAL COMMUNICATION GMC 15. Communicate effectively with patients and colleagues in a medical context. 8. Carry out EMERGENCY CARE, FIRST AID, RESUSCITATION AND PRACTICAL PROCEDURES GMC 16. Provide immediate care in medical emergencies. GMC 18. Carry out practical procedures safely and effectively. 9. Apply principles and knowledge of PHARMACOLOGY AND THERAPEUTICS, including prescribing. GMC 17. Prescribe drugs safely, effectively and economically. 10. Apply principles and knowledge of MEDICAL INFORMATICS GMC 19. Use information effectively in a medical context. THE DOCTOR AS PROFESSIONAL 11. Apply principles and knowledge of MEDICAL ETHICS, LEGAL AND PROFESSIONAL RESPONSIBILITIES GMC 20. Behave according to ethical and legal principles. 12. Demonstrate PERSONAL AND PROFESSIONAL DEVELOPMENT GMC 21. Reflect, learn and teach others. GMC 22. Learn and work effectively within a multi-professional team. GMC 23. Protect patients and improve care.

OUTCOMES – END PRODUCT OF THEMES Each Outcome supported by an Outcome Theme (OT) Each OT has a Theme Head and team Curriculum content and assessments related to each OT planned and tracked electronically

The Edinburgh MBChB curriculum “a caring, competent, confident, ethical and reflective practitioner, equipped for high achievement, able to provide leadership and analyse complex and uncertain situations” 12 CURRICULUM OUTCOMES 12 THEMES The Edinburgh MBChB curriculum PRIOR LEARNING

OUTCOMES PLUS equipped for high personal and professional achievement RESEARCH RECOGNITION OF EXCELLENCE STUDENT CHOICE MOBILITY caring, competent, confident, ethical and reflective practitioner EXTRA-CURRICULAR HUMANITIES 12 CURRICULUM OUTCOMES 12 THEMES SAFE PATIENT CARE SAFE PATIENT CARE PRIOR LEARNING

Examples “the Edinburgh graduate will be…” “Scientist/scholar; Practitioner; Professional “Ability to apply principles and knowledge of pharmacology and therapeutics, including prescribing” “Provide a safe and legal prescription” “Describe the adverse effects of warfarin” Levels of outcome in the Edinburgh MBChB degree programme. “Course” refers to any subdivision of the curriculum such as a module or clinical attachment.

Outcome-base assessment and compensation Tomorrow’s Doctors 2009, Para 117 “Medical schools must have appropriate methods for setting standards in assessments to decide whether students have achieved the ‘outcomes for graduates’. There must be no compensatory mechanism which would allow students to graduate without having demonstrated competence in all the outcomes.” Most ‘integrated’ assessment systems have some degree of compensation as an integral feature of their design. Ensuring that each of the outcomes has been passed by every student will require investment in resources and time to alter systems of assessment, data gathering and remediation.

BLUEPRINTING Tracking Assessment of Outcomes

Student Assistantship (StA) – some questions Could the StA be considered an approach to teaching and learning lasting throughout final year? If the StA is a discrete period of time within final year, how long should it last? Even within a StA, students may not undertake activities that require provisional registration. This is interpreted in a variety of ways by clinical staff and NHS management. ? Is there guidance on how students should gain real-life experience in, for example: Prescribing drugs and fluids Injecting drugs into patients Injecting drugs into bags of fluids for IV infusion Accessing IT systems in hospitals and practices