Managing the relationship between medical schools and clinical settings in the UK

1. Managing the relationship between medical schools and clinical settings in the UK Professor Sam Leinster School of Medicine, Health Policy and Practice University of East Anglia East Anglia Joint Venture Medical School

2. From 1st year The role of the clinical placements is to provide experiential learning

3. The requirements for experiential learning

4. Kolb learning cycle Experience Reflection Action Theory

5. Reflective practice Reflection-in-action mentor Reflection-on-action Schon 1990

6. Communities of learning

7. Communities of learning

8. Communities of learning Lave and Wenger Apprenticeship Legitimate peripheral participant

9. A high quality clinical placement Experiential Learning Educational Requirements 1 Experience 2 Reflection Access to adequate numbers of appropriate patients

10. A high quality clinical placement Experiential Learning Educational Requirements 1 Experience • Effective mentoring • Personnel • Time • Ready access to educational resources 2 Reflection 3 Learning community

11. A high quality clinical placement Experiential Learning Educational Requirements Educational Requirements 1 Experience 2 Reflection Active involvement with clinical teams 3 Learning community

12. Pressures on the clinical placements

13. Pressures on resources Commissioned Clinical Service £250M Education & training Other sources £40M Income Streams Financial balance Teaching £10M Payment by Results Government targets Clinical outcomes

14. Pressures on NHS teachers Education & training Appraisal & CPD Administration Government targets National guidelines Clinical outcomes Payment by Results + Choose and Book

15. Pressures on clinical academics Education & training Research Assessment Exercise Appraisal & CPD Administration Government targets National guidelines Clinical outcomes Payment by Results + Choose and Book

16. Pressures on patients Sicker patients IDTC Shorter stays Shift to community settings

17. Management of clinical placements

18. Organisation of medical education in the UK The Queen Central Government Privy Council HEFCE NHS Medical Education Universities Clinical services

19. Organisation of medical education in the UK General Medical Council Healthcare Commission Central Government HEFCE NHS Medical Education Universities Clinical services

20. Funding of medical education in England Central Government Department for Education and Science Department of Health £7,500 £35,000 HEFCE SIFT Medical School Clinical Settings Student fees £3,000

21. Calculations based on overall excess costs Expenditure lost in general accounts Distribution of major fraction historical 20% follows student Bottom up calculation of actual costs Transparent assignment of SIFT to teaching Distribution based on reality 100% follows students Old SIFT v New SIFT NO ACOUNTABILITY ACOUNTABILITY

22. Monitoring placement quality • Educational environment • Learning resources, ethos • Teachers • Qualifications, training, availability • Patients • Type, numbers, accessibility SIFT

23. Accountability • Specify requirements • Audit compliance • Adjust SIFT payments General Medical Council • Inspection visits • Student questionnaires • Student logbooks • Consultant appraisals • Service level agreement for: • Resources • Number and type of sessions for teaching • Job plans for teachers • Type and frequency of patient contacts Regular validation visits

24. The East Anglia Joint Venture NHS Trust Board NHS Trust Board NHS Trust Board NHS Trust Board University Council NHS Trust Board Policy Budgets University Senate Joint Venture Board NHS Trust Executive University Executive Medical School Exec

25. The East Anglia Joint Venture Medical School Exec NHS Trust Executive Overall strategy Research strategy Human Resouces

26. Content of clinical placements

27. Controlling the content Medical School Exec Curriculum Group NHS NHS NHS Academic Unit Team NHS NHS NHS Student Student Other

28. The role of the clinical placements is to provide experiential learning