An Coiste FeabhaisAcadil The Committee on Academic Quality Improvement

The Academic Quality Assurance Programme 2002 2003

REVIEW OF THE DEPARTMENT OF OTORHINOLARYNGOLOGY

Final Report

3rd September 2003

Department of Otorhinolaryngology: Review Group Report

This report arises from a visit by a review team to the Department of Otorhinolaryngology on 11th- 12th February, 2003. The Department had already prepared and submitted a 'Self Assessment Report' that, with other documentation, was made available to the review team well in advance of the visit. The review team consisted of: Professor Brian Kavangh, Dept. of Critical Care Medicine, Hospital for Sick Children, Toronto (Chairperson); Professor Helen Carty, Department of Radiology, Royal Liverpool Childrens Hospital, Professor John Reynolds, Department of Surgery, Trinity Centre, St. Jamess Hospital, Dublin, Dr. Geraldine Gaffney, Department of Obstetrics & Gynaecology, NUI, Galway; and Dr. Iain Mac Labhrainn, (Centre for Excellence in Learning & Teaching) of the CFA acting as rapporteur. The report is structured to cover the following main topics : 1. Aims and Objectives 2. Organization and management 3. Programmes and Instruction 4. Scholarship and Research 5. The Wider Context 6. Summary and Concluding Remarks 7. Generic Issues 1. Aims and Objectives The Departmental aims as stated in the Self Assessment report are fairly generic in nature. Although they were developed in 1987 and they do not appear to have been updated since that time, they are appropriate with respect to the departments role. In regards teaching the aims appear to have been operationalised, but with regards research they may not be realistic in the current context.

2. Organisation & Management The Department provides an extensive clinical service as well as delivering undergraduate and postgraduate teaching and training. There are three consultants and a clinical tutor. No research strategy exists. The relationship between the Department and the Department of Surgery is confused. There is apparently no administrative or infrastructural support from the university specifically for the department, and Western Health Board staff are being used, unofficially, to deliver secretarial support. There was a stated request to be considered as a separate entity from the Department of Surgery.

OtorhinolaryngologyFinalReport03

Department of Otorhinolaryngology: Review Group Report

3. Programmes & Instruction 3.1 General There is a traditional approach to teaching in the Department of Otorhinolaryngology, with the focus on didactic lectures and tutorials. This is apparently also the norm across other courses in the Faculty. Curricular reform, in which the Faculty is currently engaged, should look at teaching methods, the use of a variety of resources and the potential development and use of self-study materials. A Faculty teaching and learning strategy should be considered with specific recommendations regarding student feedback (to ensure consistency and comparability) and support for staff to develop their teaching skills. Teaching booklets containing relevant course materials, references, etc as produced by a number of departments in the Faculty were felt to be examples of good practice and their production should be encouraged across all departments. The teaching timetable requires clarification and adjustment to match assessment and attachments with the teaching blocks in a more satisfactory way and some attention needs to be paid to the fact that the lecture/teaching programme isnt always able to be fulfilled given the inevitable tension between clinical and academic responsibilities. There is an evident need for an adequately equipped clinical skills laboratory that could be shared with the other small departments to ensure that the students have ample opportunity for self-study and supervised practical sessions outside the busy health board accommodation. 3.2 Specific Issues We have summarised our findings and comments in the form of a SWOT analysis for the department. Strengths: teaching objectives are clear and relevant; provision of clinical tutor is an example of good practice that resolves tension between clinical and academic and is a model that might suit other areas in the curriculum; assessment methods are focussed on practical clinical skills, which is appropriate for the subject; good sense of perspective regarding the requirements of undergraduate teaching in ENT and the course is appropriately tailored to suit; student feedback identified the clinical tutor as being an excellent teacher; good library facilities Weaknesses: non-relevance of timing of the lecture course to attachments; inappropriateness of space being used to deliver student teaching. The review group regards the teaching conditions within the hospital as being archaic.

OtorhinolaryngologyFinalReport03

Department of Otorhinolaryngology: Review Group Report

o This space is severely overcrowded and inadequate for the student numbers currently being taught. This will be exacerbated with any increase in student numbers. o Clinical space is shared between teaching and clinical needs, causing disruption of tutorials; poor communication and management within department of surgery, which possibly affects the use of space and resources; the timing of attachments and examinations sometimes leads to impact on attendance - students identified overall timetable as being chaotic; over-reliance on patients for teaching as opposed to using other approaches/resources e.g. clinical skills laboratory tutorial groups are too large

Opportunities: These should be properly reviewed on appointment of new staff. The students specifically requested that there should be a short exam/assessment at the end of the placement period. Review timing and place of end of year examination in relation to final degree; Consider the use of outlying clinics as suitable for basic clinical experience

Threats: Lack of protected teaching time. The department had recommended, preferably, an 8/3 split. If this is deemed appropriate, it requires to be formally acted upon by the university. A new appointee needs a clear remit and job description regarding teaching. If not, the program will founder.

4. Scholarship & Research The Department has no specific research background, focus or strategy. This is reflected in the absence of significant published research work, contribution to textbooks, higher degrees, and research funding. The retired Head of Department was quite explicit about the predominant teaching interest of himself and other lecturers, and the students are clearly satisfied with the teaching course. The replacement Head of Department will have significant research opportunities in the hospital and University campus. The primacy in the sessional arrangements of the new appointment, whether at Senior Lecturer or Professorial level, will be on delivering on the established curriculum course. The research dimension should reflect priorities developed through the Department of Surgery and the Faculty of Medicine and Health Science. The possibility of intercollegiate or multicentre research might be an appropriate model for a small department. 5. The Wider Context The clinical workload of staff in the department is enormous and places pressure on all other activities. A formal, contractual structure for time allocation will ease

OtorhinolaryngologyFinalReport03

Department of Otorhinolaryngology: Review Group Report

management of the Departments responsibilities and may facilitate other developments. 6. Summary & Concluding Remarks The Department presented clear and concise undergraduate aims, which the reviewers felt were appropriate to an undergraduate course. The appointment of a clinical tutor was felt to be beneficial to the department. Research activity within the department has been minimal but the appointment of a successor to the retired Head of Department could address this. Although part of the Department of Surgery, the Department appears to function in isolation both from an administrative and academic perspective. The review group have recommended that 1. The academic head of department should have Senior Lecturer status with protected academic time. 2. The relationship with the Department of Surgery should be clarified. A suggested approach would be that Otorhinolaryngology would function as a sub-department of the Department of Surgery with its own administrative and budgetary arrangements. 3. Formal or external assessment of the undergraduate course and examination should be encouraged. 4. The timetable and scheduling of examinations, teaching and attachments in Otorhinolaryngology and Ophthalmology need to be better coordinated.

7. Generic issues pertaining to Departments within the Department of Surgery Throughout the review process, several generic issues became apparent to the review panel, who were responsible for reviewing the Departments of Otorhinolaryngology, Anaesthesia and Radiology and Ophthalomology. 1. Full-time Dean. The Dean of the Faculty is a part-time position. The external members of the panel believe that a full-time Dean is required at NUI (Galway), and indeed this common need in all Irish Universities at this time is widely recognised. 2. Departmental Budgets The system of linking departmental credit and budget to the curriculum-linked student FTE is inappropriate for rewarding departments that are unable to achieve representation in the final medical examination. It may discriminate against such departments, and provide unfair advantage to departments whose curriculum is in part taught by non-credited departments. 3. Curriculum Review Committee The structure of the curriculum review committee is small and does not represent many departments (e.g. anaesthesia, radiology) that are not featured as distinct elements in the traditional curriculum. This is inappropriate, and reflects (apart

OtorhinolaryngologyFinalReport03

Department of Otorhinolaryngology: Review Group Report

from medical informatics) a binding of undergraduate teaching to a traditional medical degree construct (Bachelor of Medicine, Bachelor of Surgery, etc). 4. Faculty Research Strategy All departments should be welcomed as members of the faculty research committee 5. Skills Teaching and Facilities The teaching facilities that we visited were uniformly archaic; the space facilities for teaching need to be developed along modern lines. There particular opportunities for all Departments involved in this review process this theme should be driven through cross-Departmental strategy within Faculty and curriculum review group.

and are and the

6. Communication, Transparency, & Concordance in Perceptions The panel was struck by some discordance in perspective as portrayed by the Dean compared with that portrayed by some of the consultant staff. 7. Student Numbers The panel was concerned that the plans for increased student enrolment were not accompanied by adequately developed plans for teaching space and resources 8. Academic Contracts There were serious staff contract issues in two of the four departments reviewed. 9. Arrangement with Department of Surgery The nature of the affiliation between the department of surgery and the Departments of Otorhinolaryngology, Ophthalmology, Radiology and Anaesthesia is unclear, and has been that way for a considerable time. There is an urgent need to revisit this problem and establish an actionable and measurable agreement between Surgery, for those departments that would remain within the department of surgery. The expected appointment of the Chair in Surgery in the near future may assist in establishing such arrangements. 10. Stipend for Clinical Lecturers - potential for creative development An approach to financial issues, suggested by Dr Flynn (Anaesthesia), was that departmental clinical lecturers stipends be pooled and directed to the departments for academic purposes. The panel viewed this as imaginative and creative. 11. Training the Teachers The consultant staff need to be offered, and to engage in, formal processes designed to learn and maintain teaching skills. 12. Academic Promotion The consultant staff need to be offered a process of academic promotion for teaching and or research, based on validated and accepted criteria. There is no incentive (aside from a stipend that is essentially negligible relative to overall income) for consultants to teach medical students, and from what the panel can discern, many consultants do not teach.

OtorhinolaryngologyFinalReport03

Department of Otorhinolaryngology: Review Group Report

Comments on the Methodology of the Review Process 1. Staff from the departments and the Quality Office were considerate and efficient. 2. By and large, the documentation submitted was good, well structured and clear. 3. It was felt by the review group that the number of departments under consideration on this single visit was too large and future reviews of these units should be organized differently. 4. It was felt that the absence of input from the Department of Surgery provided the review group with a number of difficulties. Furthermore, the rationale presented that a review was inappropriate in the absence of a Head of Department was not an opinion shared by the review group, insofar as a review may be a critical source of information for a new appointment. 5. Given the number of departments and the amount of documentation required, the group would have benefited from a dedicated administrative assistant. 6. The lack of adequate modern facilities for the review group was also problematic and the provision of networked computer access, printer, telephone etc, would have aided the process.

Professor B. Kavanagh (Chair) Professor H. Carty Professor J. Reynolds Dr. G. Gaffney Dr I. Mac Labhrainn (Rapporteur)

(3rd September 2003)

OtorhinolaryngologyFinalReport03