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

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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
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From 1st year
The role of the clinical placements is to
provide experiential learning
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The requirements for experiential learning
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Kolb learning cycle
Experience
Reflection
Action
Theory
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Reflective practice
Reflection-in-action
mentor
Reflection-on-action
Schon 1990
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Communities of learning
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Communities of learning
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Communities of learning
Lave and Wenger
Apprenticeship
Legitimate peripheral participant
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A high quality clinical placement
Experiential Learning
Educational Requirements
1 Experience
2 Reflection
Access to adequate numbers of appropriate patients
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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
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A high quality clinical placement
Experiential Learning
Educational Requirements
Educational Requirements
1 Experience
2 Reflection
Active involvement with clinical teams
3 Learning community
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Pressures on the clinical placements
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Pressures on resources
Commissioned Clinical Service 250M
Education training
Other sources 40M
Financial balance
Income Streams
Teaching 10M
Payment by Results
Government targets
Clinical outcomes
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Pressures on NHS teachers
Education training
Appraisal CPD
Administration
National guidelines
Government targets
Clinical outcomes
Payment by Results Choose and Book
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Pressures on clinical academics
Education training
Research Assessment Exercise
Appraisal CPD
Administration
National guidelines
Government targets
Clinical outcomes
Payment by Results Choose and Book
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Pressures on patients
Sicker patients
IDTC
Shorter stays
Shift to community settings
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Management of clinical placements
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Organisation of medical education in the UK
The Queen
Central Government
Privy Council
HEFCE
NHS
Medical Education
Clinical services
Universities
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Organisation of medical education in the UK
General Medical Council
Healthcare Commission
Central Government
HEFCE
NHS
Medical Education
Clinical services
Universities
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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
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Old SIFT v New SIFT

• 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

NO ACOUNTABILITY
ACOUNTABILITY
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Monitoring placement quality

• Educational environment
• Learning resources, ethos
• Teachers
• Qualifications, training, availability
• Patients
• Type, numbers, accessibility

SIFT
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Accountability
General Medical Council

• Inspection visits
• Student questionnaires
• Student logbooks
• Consultant appraisals

1. Specify requirements
2. Audit compliance
3. Adjust SIFT payments

• 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
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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
NHS Trust Executive
Joint Venture Board
University Executive
Medical School Exec
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The East Anglia Joint Venture
Medical School Exec
NHS Trust Executive
Overall strategy
Research strategy
Human Resouces
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Content of clinical placements
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Controlling the content
Medical School Exec
Curriculum Group
NHS
NHS
NHS
Unit Team
Academic
NHS
NHS
NHS
Student
Student
Other
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The role of the clinical placements is to
provide experiential learning