Pharmacists in Scotland - five-year integrated education programme: scoping report

Advisory Group: Meeting Two

The Advisory Group received presentations on nursing and medical models for workforce planning, placements and experiential learning.

• Nursing: Dr Colette Ferguson and Dr Peter Ward

The presentation described the nursing and midwifery performance management system used by NES. The Nursing and Midwifery Council ( NMC) are the regulatory body who set the education standards which shape the content and design of programmes and state the competences of a nurse and midwife. They also approve education institutions and programmes and maintain a database of approved programmes, including quality assurance. The standards for learning and assessment in practice are implemented as a collaboration between the universities and the service. There are a regulated number of hours, and nursing students spend approximately 50% of their time in practice orientated placements. The degree programmes can be three of four years in length.

Student intake targets are set annually through a collaborative process involving Scottish Government, the Executive Nursing Director, the Universities, the SFC, NES, the Care Home sector and associated partnerships. Decision making is based on demand, supply, recruiter's net data, workforce profiling and professional judgment. The majority of students in a nursing degree programme are home students and the number of overseas students is very small. Performance management is conducted by NES on behalf of Scottish Government by monitoring the progression and completion data for all providers. This includes monitoring the performance within and between universities and advising on likely future outputs and optimum intake targets.

The data sources used in the performance management system were described. They included: recruitment and retention data and annual students and mentor surveys. Surveys include an annual final year survey and take into account overall satisfaction, clinical decision making and clinical practice. Quality Management of the Practice Learning Environment ( QMPLE) is an online database that has been developed by NES in partnership with colleagues from both practice and universities. It manages information relating to the quality of the practice learning experience through student feedback, educational audits, quality standards for practice placement ( QSPP) audits and mentorship data. QMPLE is a tool designed for and used in practice but it also is available to universities and provides accessible and meaningful feedback on areas including placement information.

Mentorship is a very important element to the programme as is partnership and the NMC look for evidence of partnership. There are service level agreements ( SLAs) in place for the number and quality of placements. Overall there was agreement that the focus on practice educators, mentorship and the underpinning infrastructure seemed critical to the success of the programme.

• Medicine: Professor Gary Mires

The presentation described the move to outcomes based education at the School of Medicine at the University of Dundee; the use of technology and small group learning in teaching; assessment processes tailored to the curriculum needs; and the student selection process.

With regards the outcomes based approach the aim was to define the product and then design the curriculum. The Dundee graduate is expected to be able to practice as a safe and reflective doctor and have the capability to enter postgraduate training. The focus of teaching and learning throughout all five years of the Dundee undergraduate medical degree is based on over 100 core clinical problems, with students building on defining the diseases that can contribute to these core problems. Years one to three are based around (body) systems in practice and years four and five on preparation in practice. In other words, students start in the early years with basic practice linked to body systems-based learning and there is a transition to clinical practice in the later years with increasing clinical attachments. Students learn to identify normal and abnormal. There is a strong emphasis on integrating science and specialties, with a focus on the patient rather than the system. Years four and five are focused on the transition into clinical practice with all the systems based teaching pulled together. There are a number of core clinical placements: medicine, surgery, obstetrics and gynaecology, child health, psychiatry and general practice along with a student selected clinical component ( SSC). The fifth year is basically providing a probation period for practice (Dundee call it a foundation apprenticeship).

Technology is used to enhance student learning. Strategies include an interactive virtual learning environment ( VLE), simulation, eLearning, team based learning and virtual patients. Technology underpins all teaching activities. In addition, the timetable links to learning resources. Medical students see patients from week two of year one of the programme. They undertake most of their learning in years one to three in small group problem-orientated teaching activities. Integration is the key: the basic science runs throughout the medical undergraduate programme; it is the emphasis that changes. In years four and five the blocks link to specific disciplines with students moving around the clinical environment however core clinical problem solving remains a key part of the learning. Students also build a portfolio of evidence using the NES portfolio which links to post-graduate training. In year five the emphasis changes and students are prepared for practice as a Foundation Year ( FY) doctor: Foundation Apprenticeship with the FY doctors providing supervision. They are embedded in the ward environment and undertake shadowing of FY doctors. They are expected to develop a learning plan and are actively engaged in case load management (working with FY doctors). Students work in interprofessional teams. There is a mid-point review in the fifth year, followed by developing a reflective diary, formative work placed based assessment and a final review.

Reflecting on the presentations the group noted the access to patients for students provided through the approaches in medicine and nursing and the relative paucity of clinical placements in the pharmacy undergraduate course compared to the nursing and medical courses which can be a matter of days in pharmacy compared to weeks and months for the other professions. There was discussion on the Additional Cost of Teaching ( ACT) funding provided by the Scottish Government to cover the additional costs of teaching medical undergraduate students within the NHS. NES distributes ACT fund to all NHS Boards and GPs in Scotland who are engaged in undergraduate teaching. NHS Boards are responsible for delivery of clinical teaching to undergraduate medical students and for ensuring appropriate quality standards are met within local education providers. A performance management framework supports the management of Medical ACT and all Boards have to meet the requirements to receive Medical ACT funding. ACT funding was seen as a great success story due to the fact that it allows for investment at NHS Board level to support the use of NHS staff to teach medical students as part of their under-graduate education.