Major review of healthcare programmes
The Department of Health, in partnership with the Nursing and Midwifery Council, the Health Professions Council and the Strategic Health Authorities have contracted with the Quality Assurance Agency for Higher Education (QAA) to carry out reviews of all NHS-funded healthcare programmes in England during the period 2003-06.
QAA helps to provide public assurance that the quality and standards of higher education are being safeguarded and enhanced by conducting academic reviews of higher education provision.
Major review
Major review is a peer review process. It starts when higher education institutions in partnership with their commissioning Strategic Health Authorities evaluate their provision in a self-evaluation document. This document is submitted to QAA for use by a team of academic and practitioner reviewers who gather evidence to enable them to report their judgements on the academic and practitioner standards and the quality of learning opportunities. Review activities include meeting academic and clinical staff and students, scrutinising students' assessed work, visiting practice learning environments, reading relevant documents, and examining learning resources.
Full details of the process of major review can be found in the Handbook for major review of healthcare programmes, 2003.
Judgements
The range of judgements that reviewers may utilise when they have completed a major review are summarised below.
Academic and practitioner standards
Reviewers make one of the following judgements on standards:
- confidence, which may be expressed as
- limited confidence, or
- no confidence.
To reach this judgement, reviewers look at:
- learning outcomes
- the curriculum
- student assessment
- student achievement.
Confidence in academic and practitioner standards: a judgement that is made if reviewers are satisfied with current standards and with the prospect of those standards being maintained into the future. A judgement of limited confidence is made if standards are being achieved but the reviewers have doubts about the ability of the HEI and partner placement providers to maintain them into the future.
No confidence in academic and practitioner standards: a judgement that is made if arrangements are inadequate to enable standards to be achieved or demonstrated. If a failure to achieve standards has occurred in specific programme/s and/or mode/s and/or level/s only, and there is confidence in standards at other levels, the failing programme/s mode/s level/s will be identified separately.
Quality of learning opportunities
Reviewers make one of the following judgements for each of three elements of learning opportunities:
- commendable
- approved
- failing.
The three elements of quality of learning opportunities are:
- learning and teaching
- student progression
- learning resources and their effective utilisation.
Maintenance and enhancement of standards and quality
Reviewers also report the degree of confidence they have in the providers' ability to maintain and enhance quality and standards in the healthcare programmes under review.
Commendable - the provision contributes substantially to the achievement of the intended outcomes, with most elements demonstrating good practice.
Approved - the provision enables the intended outcomes to be achieved, but improvement is needed to overcome weaknesses. The summary report will normally include a statement containing the phrase 'approved, but...', which will set out the areas where improvement is needed.
Failing - the provision makes a less than adequate contribution to the achievement of the intended outcomes; significant improvement is required urgently if the provision is to become at least adequate.
Summary of the main review outcomes
Subject provision and overall aims
Programmes in midwifery, nursing and operating department practice at the University of East Anglia (the University) in patnership with Norfolk, Suffolk and Cambridgeshire Strategic Health Authority were reviewed in the academic year 2005-06. Judgements were made about the academic and practitioner standards achieved and the quality of the learning opportunities provided.
The review covered the following programmes:
Midwifery
Pre-registration
- Diploma of Higher Education (DipHE)/BSc (Hons) Midwifery (three-year) * **
- BSc (Hons) Midwifery (78 weeks) * **
- Return to Practice Midwifery (delivered within DipHE/BSc (Hons) Midwifery Practice) * **
Post-registration
- DipHE/BSc (Hons) Midwifery Practice
Nursing
Pre-registration
- DipHE/BSc (Hons) in Adult, Mental Health, Child and Learning Disability Nursing branches **
- Return to Practice Nursing (delivered within DipHE/BSc (Hons) Nursing Practice) **
Post-registration
- DipHE/BSc (Hons) Nursing Practice
- BA (Hons) Policy, Planning and Leadership for Health Professionals +
- BSc (Hons) Nurse Practitioner
- DipHE/BSc (Hons) Community Healthcare Practice +
- Postgraduate Diploma in Mental Health +
- MSc Advanced Practitioner-Nursing
- Nurse and Pharmacist Independent/ Supplementary Prescribing (within BSc (Hons) Nurse Practitioner or other awards) ** +
Operating department practice
Pre-registration
- DipHE Operating Department Practice ***.
* These programmes underwent Nursing and Midwifery Council (NMC) annual monitoring as part of the major review of healthcare programmes.
** NMC approved programmes.
*** Health Professions Council approved programme.
+ These programmes are run on an interprofessional basis.
Academic and practitioner standards
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in midwifery, nursing and operating department practice at the University of East Anglia in partnership with Norfolk, Suffolk and Cambridgeshire Strategic Health Authority.
Strengths
- There is a strong partnership between the School, the Strategic Health Authority and placement providers for curricular development in all midwifery programmes (paragraph 6).
- Pre-registration midwifery students benefit from the interprofessional learning opportunities which are provided by the Centre for Interprofessional Practice across the Institute of Health (paragraph 9).
- The School works in close partnership with the supervisors of midwives, practitioners and the midwifery practice facilitator in the development and management of assessments (paragraph 10).
- Formative assessment support for all pre-registration midwifery students is available from academic advisers, with detailed remedial action plans developed for struggling students and an annual review of performance and progression (paragraph 13).
- The School has developed a systematic and effective approach to service-user and carer involvement in development and implementation of the nursing curricula (paragraph 19).
- The School has strong links with placement providers, which have contributed to more integrated curricula for theory and practice in pre-registration nursing (paragraph 21).
- Where practice is graded in some post-registration nursing units, for example, Minor Injuries for Practitioners, the competencies and intended learning outcomes are tested against a comprehensive grading grid, with clear statements on the grid pertinent to the assessment of the developing practitioner (paragraph 29).
- Operating department practice students benefit from the close matching of the curriculum with student placements, including two award-winning surgery units and a range of general and specialist operating theatres (paragraph 36).
- Interprofessional learning is clearly embedded in the operating department practice curriculum, with students able to participate in the School's programme and by joining some planned activities made available on campus with students from a wide range of other healthcare professional groups (paragraph 38).
Weaknesses
- In all midwifery programmes, student work, feedback and grades have not been returned in a sufficiently timely manner to enable students to use assessment feedback to enhance their learning (paragraph 12).
- When the pre-registration DipHE/BSc(Hons) Nursing intended learning outcomes are articulated into practice outcomes, there is a lack of differentiation between levels 2 and 3 in child, adult and learning disability branches (paragraph 18).
- Students on all nursing programmes have identified delays in the return of assignments, including feedback and grades awarded, which means that students are not always able to make use of assignment feedback in their learning (paragraph 24).
- In pre-registration DipHE/BSc(Hons) Nursing programmes, there are still potential difficulties with the grading of practice, especially with respect to the provision of supplementary evidence to confirm the practice grade and the absence of criteria to distinguish between the level of performance, particularly regarding level 3 BSc (Hons) Nursing students (paragraph 29).
- Where operating department practice module intended learning outcomes are articulated into practice outcomes, there is no distinction between levels 1 and 2, although there is evidence of differentiation between levels through specification of the different levels of student engagement in the practice setting (paragraph 33).
- The current operating department practice assessment process does not ensure the achievement of proficiency in drug calculations; for example, the reviewers noted errors by some students in drug calculations in the level 2, unit 4 examination (paragraph 40).
- Operating department practice students expressed concerns that assignments and grades are not returned in a timely manner and they start another assignment before feedback and grades are received from previous assignments (paragraph 40).
- There is a lack of clarity in the assessment process for practice for operating department practice, in particular, a lack of parity in the use and requirements of supplementary evidence (paragraph 42).
Quality of learning opportunities
Learning and teaching
The quality of learning and teaching is commendable.
Strengths
- The enquiry-based learning strategy is well developed, thoroughly reviewed and effective in developing students' learning in pre-registration programmes (paragraph 46).
- Through the work of placement staff and link lecturers, the effective use of the educational audits and matching students' intended learning outcomes with practice, the School is able to ensure that there is parity of learning experiences for students on all programmes (paragraph 50).
- The role of the link lecturer received high praise from students across the nursing pre-registration programmes (paragraph 51).
- During their visits to practice areas, the reviewers noted examples of high-quality learning environments, with positive support for students, an ethos of interprofessional working and a culture of ongoing professional development (paragraph 51).
Good practice
- The pre-registration nursing, midwifery and operating department practice students engage in an interprofessional learning programme provided through the Centre for Interprofessional Practice founded in 2002, which is an effective driver for the development of interprofessional learning (paragraph 47).
Student progression
The quality of student progression is commendable.
Strength
- There is a strong working partnership between the School and the Strategic Health Authority to provide support for the progression of students in all programmes (paragraph 53).
Learning resources and their effective utilisation
The quality of learning resources and their effective utilisation is commendable.
Strengths
- Of particular note are the learning resources and the extra skills sessions available to students in some placements, for example, in the Neonatal Intensive Care Unit at the Norfolk and Norwich University Hospital (paragraph 59).
- Students appreciated the learning resources provided by the midwifery programme team's effective use of the virtual learning environment (paragraph 61).
Maintenance and enhancement of standards and quality
Strengths
- Of particular note is the University's requirement to complete programme update forms for each award offered, which build on the updating of programme specifications and unit descriptions (paragraph 62).
- During the review, the reviewers were supplied with concise and highly-informative additional evidence, which enabled the review to progress in an efficient manner (paragraph 65).
Weakness
- The quality of placement audit reports seen by the reviewers was variable in terms of details and evaluation, and many of them did not have action plans (paragraph 64).
Introduction
1 This report presents the findings of a review of the academic and practitioner standards achieved, and the quality of the learning opportunities provided, in midwifery, nursing and operating department practice programmes at the University of East Anglia (UEA) in partnership with Norfolk, Suffolk and Cambridgeshire Strategic Health Authority (NSCSHA). The review was completed during the academic year 2005-06. The NSCSHA oversees health services for a region of mixed urban and rural geography with no major conurbations. Particular features of its needs and services include the high proportion of elderly people, an emphasis on community work within rural areas, low ethnic diversity and pockets of high deprivation. UEA, established in 1962 and based on a campus in Norwich, is a premier research and teaching university dedicated to the advancement of learning and the increase of knowledge both to satisfy the aspirations of individuals and to contribute to economic, social and cultural progress at regional, national and international levels. The Institute of Health (IoH) is one of four faculties at UEA. Its culture is one of planned, steady expansion to meet the educational needs of healthcare providers. Student numbers have increased over the last 15 years from approximately 60 to 3,850 (2,200 full-time equivalent (FTE)). This growth is testimony to the relationships developed between the University and its partners in health and social care. Some 150 FTE academic staff are employed in the IoH and 21 FTEs are seconded; there is also a substantial contribution to activity from the large number of honorary appointments involving NHS personnel, over 190 in total. Within the IoH, provision in midwifery, nursing and operating department practice is delivered in the School of Nursing and Midwifery (NAM). The subjects under review represent only part of the health professional provision at UEA, which also includes clinical psychology, occupational therapy, physiotherapy and speech and language therapy (all considered in an earlier major review). In addition, UEA's provision covers medicine and pharmacy. These, being subjects funded by the Higher Education Funding Council for England (HEFCE), are not part of major review, but they play a significant part in the interprofessional environment and are included in the programme of interprofessional learning for students in the subjects included in this report. The programmes under review are delivered at the Edith Cavell Building in Norwich and at a site in King's Lynn in conjunction with a number of placement providers (predominantly in Norfolk).
A Subject provision and overall aims
2 Midwifery, nursing and operating department practice are currently offered in the following programmes:
Midwifery
Pre-registration
- Diploma of Higher Education (DipHE)/ BSc (Hons) Midwifery (three-year) * **
- BSc (Hons) Midwifery (78 weeks) * **
- Return to Practice Midwifery (within DipHE/BSc (Hons) Midwifery Practice) * **
Post-registration
- DipHE/BSc (Hons) Midwifery Practice
Nursing
Pre-registration
- DipHE/BSc (Hons) in Adult, Mental Health, Child and Learning Disability Nursing branches **
- Return to Practice Nursing (within DipHE/BSc (Hons) Nursing Practice) * **
Post-registration
- DipHE/BSc (Hons) Nursing Practice
- BA (Hons) Policy, Planning and Leadership for Health Professionals +
- BSc (Hons) Nurse Practitioner
- DipHE/BSc (Hons) Community Healthcare Practice +
- Postgraduate Diploma (PgDip) in Mental Health +
- MSc Advanced Practitioner - Nursing
- Nurse and Pharmacist Independent/Supplementary Prescribing (within BSc (Hons) Nurse Practitioner or other awards) ** +
Operating department practice
Pre-registration
- DipHE Operating Department Practice. ***
* These programmes underwent Nursing and Midwifery Council (NMC) annual monitoring as part of the major review of healthcare programmes.
** NMC approved programmes.
*** Health Professions Council (HPC) approved programmes.
+ These programmes are run on an interprofessional basis.
3 The health professional educational programmes in the IoH have been based on four key principles:
- to promote client-centred care and evidence-based practice
- to provide students with experience in a range of practice settings and academic experience that is based on the workforce needs and employment opportunities in the UK
- to maximise opportunities for appropriate interprofessional working
- to deliver education that integrates theory and practice throughout the programmes.
The aims of the healthcare programmes under review are developed and managed jointly with UEA's NHS partners, and are:
- to facilitate the acquisition and application of the knowledge, skills and attributes that will enable the student to manage his or her own practice and that of others in accordance with the relevant statutory body's Code of Professional Conduct and in keeping with the ethical, legal and anti-discriminatory principles
- to enable the students to develop, deliver and manage a high standard of holistic and evidence-based care
- to promote the development of practitioners who are able to adapt their practice to meet the needs of the individual patient/client
- to develop practitioners who are reflective, flexible, responsive to change and able to manage themselves within changing contexts of health and social care
- to enable students to fulfill and promote the role of their own profession within the various multidisciplinary teams to which they contribute
- to develop and maintain a commitment to continuing personal and professional development, effectively selecting and using a range of learning techniques and resources in order to sustain this development.
B Academic and practitioner standards
B1 Midwifery
Intended learning outcomes
4 The intended learning outcomes (ILOs) for pre-registration and post-registration midwifery programmes have been designed to meet the standards of the NMC and the NMC Midwives Rules and Standards. Programme outcomes are clearly mapped to the Subject benchmark statement for midwifery, and meet The framework for higher education qualifications in England, Wales and Northern Ireland (FHEQ), both published by QAA, in terms of the levels of challenge and outcomes expected. Level 1 is equivalent to Certificate, level 2 to Intermediate and level 3 to honours degree. There is effective collaboration between UEA and local National Health Service (NHS) Trusts in the development of the ILOs for both pre-registration and continuing professional development. In post-registration programmes, the ILOs reflect the changing needs of contemporary midwifery practice and enable students to meet the NMC requirements for post-registration education and practice. In the three-year pre-registration midwifery programme, interprofessional learning (IPL) is compulsory and IPL learning objectives are mapped across the ILOs of the provision. Post-registration programmes are aligned with the Knowledge and Skills Framework (KSF) and the National Service Framework.
5 Several mechanisms are in place to ensure effective dissemination of information regarding the ILOs. For example, students, practice staff and external examiners all have access to module handbooks, programme specifications and practice assessment documentation. Students receive oral confirmation regarding how they achieve the ILOs. The use of a virtual learning environment (VLE) provides electronic access to the information. Mentor preparation and updates provide opportunities to explore how to support students in the achievement of the ILOs. Mentors in practice stated that they have a clear understanding of the ILOs and the part they have in ensuring that students meet the requirements of the NMC. Students also confirmed to the reviewers that their mentors were able to support student understanding of the ILOs.
Curricula
6 Midwifery provision consists of well-designed, pre-registration and post-registration programmes, including the Return to Practice Midwifery programme. The two pre-registration midwifery programmes are offered either over three years for direct entrants, or over 78 weeks (shortened programme) to registered adult branch nurses. All curricula are consistent with the NMC regulatory requirements. The midwifery programmes are aligned appropriately against the Subject benchmark statement for midwifery and the FHEQ. External examiner and NMC reports also confirm this. There is a strong partnership between the School, the NSCSHA and placement providers for curricular development in all midwifery programmes. Midwifery curricula are designed in partnership with practice placement providers, current and former students, service users and the supervisors of midwives. The collaborative process is facilitated through formal school processes based on UEA and NMC mechanisms and requirements for programme approval.
7 The pre-registration programmes offer broad-based curricula designed to ensure that midwives are fit for practice and award. External examiners' reports confirm that the design and content of curricula are appropriate for the achievement of the ILOs and meet the NMC requirements. The curricula provide intellectual and clinical progression and offer experiences to ensure that students leave as competent practitioners. Students are encouraged to develop transferable skills, integrate theory and practice, and focus on a woman-centred approach. The feedback from employers and practitioners met by the reviewers during visits to clinical placement environments expresses confidence in the clinical skills of students and the midwifery curricula and confirms that students at the point of registration are proficient practitioners. The Return to Practice Midwifery programme provides an opportunity for practitioners who wish to return to practice and reactivate registration on the professional register.
8 Midwifery curricula are based on the IoH's key principles, namely, they are student-centred and integrate theory and practice. Students follow their respective programme of study with evident progression within the design of the curricula from dependence to independence. The three-year, pre-registration midwifery programme is designed so that the diploma and degree pathways are shared. However, the distinction between the diploma and degree is not apparent in all the unit ILOs. Academic staff confirmed that, while the ILOs for levels 2 and 3 in the three-year, pre-registration midwifery programme are similar, students are enabled to differentiate between levels through the assessment criteria and through interaction with their academic advisers. The pre-registration, enquiry-based learning (EBL) curricula are clearly focused on woman-centred care and promote the close integration of practice and theory. The centrality of service-user needs is a clear focus in the curricula and in the students' learning experience, which supports the development of students' analytical skills. The practice component fosters the progressive development of clinical skills relevant to the practice of midwifery. The reviewers' meetings with mentors confirmed that they generally have a clear insight into the progressive nature of practice learning and are able to link the learning needs of individual students with the curricula. There is extensive and effective liaison between the midwifery staff in the IoH and clinical practitioners to develop the curricula to ensure their relevance and currency. Curricular enhancement is also underpinned by focused staff development and the programme team's involvement in scholarly activities.
9 The post-registration DipHE/BSc (Hons) Midwifery Practice contributes to the continuing professional development portfolio and meets the needs of the NHS workforce. The midwifery team is particularly responsive to the rapidly changing circumstances in which midwives are practising. Midwifery academics and the midwifery managers work closely to ensure that the post-registration midwifery programmes meet the needs of contemporary midwifery services. Meetings with employers confirmed that the School provides appropriate and relevant programmes to meet the learning needs of the qualified practitioners. Pre-registration midwifery students benefit from the IPL opportunities which are provided by the Centre for Interprofessional Practice (CIPP) across the IoH. The reviewers noted a range of IPL opportunities in the practice environment, which student midwives were encouraged to maximise; for example, mandatory multiprofessional skills drills. Ongoing review of the curricula to authenticate their currency takes place through the formal School processes, and external examiners confirm the relevance and currency of all curricula.
Assessment
10 The assessment strategy focuses initially on the testing of the fundamental skills of the midwife and progresses to the testing of critiquing skills, including evaluation of midwifery practice at a holistic level. The NMC (2004) proficiencies for entrance to the register and standards of both an academic and professional discipline at academic levels 2 (intermediate) and 3 (honours degree) are identified and tested. The School works in close partnership with the supervisors of midwives, practitioners and the midwifery practice facilitator in the development and management of assessments; in particular, the scenario-based oral assessment in year three, used to assess management and understanding of midwifery emergencies. A variety of methods is used to test ILOs, including poster presentations, written assignments, objective structured clinical examinations (OSCEs), oral scenario-based examinations, case-style presentations, dissertations, analytical reflections and practice portfolios. The reviewers agree with external examiners that there are appropriate and varied assessments used to measure students' achievements of the ILOs, in particular, to demonstrate progression as students move through the programme.
11 Throughout the programmes, theory and practice are interwoven, allowing for the application and testing of the ILOs in both practice and campus settings. There is joint responsibility between the midwifery education team and placement providers for the assessment of practice. Practice proficiencies are assessed and judged as either Pass or Fail, and a tripartite approach is used in both pre and post-registration midwifery programmes, involving the student, mentor-practitioner and link lecturer. This arrangement demands a high level of commitment, with the link lecturer attending the intermediate and final interview, but it allows for timely remedial action plans to be implemented. Students and mentors spoke positively about the support mechanisms in practice, especially from the clinical placement facilitator (CPF). Where there are problems regarding the sufficiency of mentors available, particularly on labour wards, the collaborative approach between UEA and its NHS partners enables speedy responses.
12 The nature of assessments is clearly communicated to students in their handbooks, with identification of the difference between, and purpose of, formative and summative assessments. The route from the 'participant observer' role to the 'competent practitioner' is made very clear. Students are informed of submission schedules for assignments and results. Although UEA does not specify limits on the length of time for the return of student work, the School is committed to provide feedback as promptly as possible, and a strategy for release of provisional results is being discussed. However, in all midwifery programmes, there is evidence that student work, feedback and grades have not been returned in a sufficiently timely manner to enable students to use assessment feedback to enhance their learning. This is not in line with Precept 12 of the Code of practice for the assurance of academic quality and standards, in higher education (Code of practice), Section 6: Assessment of students, published by QAA. In their scrutiny of samples of student work, the reviewers noted the use of double-marking and internal moderation, and agree with external examiners' comments regarding the fairness and consistency of assessment and the quality of written feedback which supports students' development.
13 Formative assessment support for all pre-registration midwifery students is available from academic advisers, with detailed remedial action plans developed for struggling students and an annual review of performance and progression. Pre-registration and Return to Practice midwifery students are required to maintain a portfolio of learning throughout their programmes, including supporting documentary evidence regarding the attainment of ILOs, for example, skills development, professional awareness, reflection and analysis of critical incidents. Post-registration formative assessments include an effective diagnostic tool designed to meet individual development needs and supplement learning, for example, comprehensive seminar guidelines produced for Neuro-Behavioural Physical Assessment of the Newborn. The reviewers agree with external examiners that there is an effective process for monitoring assessment and student progression.
Student achievement
14 External examiners comment very positively on the high standards achieved by midwifery students and state that the standards are comparable with similar programmes in other higher education institutions (HEIs). They express confidence that students, on qualifying, are confident practitioners who meet the requirements of the NMC. The reviewers scrutinised student work based on longitudinal samples from a range of units and types of assessment. Students demonstrated that, as they progress through the programmes, they achieve the appropriate ILOs for each level and show their development of subject knowledge and skills and an ability to relate theory to practice. In particular, students with higher grades showed an ability to use relevant literature and research to inform the practice of midwifery and to offer a more critical and reflective approach in their written work, especially in portfolios.
15 Final-degree classifications listed in Table 1a show that students are attaining high levels of academic achievement. Of those completing the three-year BSc (Hons) Midwifery pre-registration programme, 45 per cent were awarded a First class honours degree, 22 per cent an Upper Second, 22 per cent a Lower Second and 11 per cent a Third. For the 78-week BSc (Hons) pre-registration programme, 36 per cent were awarded an Upper Second, with 46 per cent gaining a Lower Second and 18 per cent a Third. In post-registration midwifery programmes, 100 per cent of students were awarded the DipHE in Midwifery Practice. In the BSc Midwifery Practice, the two students who completed most recently were awarded a Lower Second class honours degree.
16 Midwifery managers are committed to employing newly-qualified midwives, and the overwhelming majority work for local employers on completion (Table 2a). Student midwives told the reviewers that they felt the programmes prepared them for practice, in particular, for women with different health needs and for practice in different settings. Employers stated they were impressed by the enthusiasm of students and confirmed they were fit for purpose and practice and demonstrated appropriate levels of proficiency.
Table 1a: Completion and achievement statistics for all award-bearing programmes in midwifery
| Programme (Award-bearing only) | Cohort | Diploma programmes Pass |
Diploma programmes Fail |
Degree classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2i | 2ii | 3 | P | F | ||||||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| DipHE Midwifery (3-year programme) | Sep 2002* | 6 | 100 | ||||||||||||||
| BSc (Hons) Midwifery (3-year programme) | Sep 2002* | 4 | 45 | 2 | 22 | 2 | 22 | 1 | 11 | ||||||||
| BSc (Hons) Midwifery (78-weeks programme) | Feb 2004 | 4 | 36 | 5 | 46 | 2 | 18 | ||||||||||
| DipHE Midwifery Practice | 2000-01 | 4 | 100 | ||||||||||||||
| 2001-02 | 1 | 100 | |||||||||||||||
| BSc (Hons) Midwifery Practice | 1999-2000 | 2 | 100 | ||||||||||||||
| 2000-01 | 1 | 25 | 2 | 50 | 1 | 25 | |||||||||||
| 2001-02 | 2 | 100 | |||||||||||||||
* Some students have yet to complete.
Table 2a: Employment statistics for all pre-registration programmes in midwifery
| Programme | Further study | Local employers | Employers elsewhere | Unemployed | Other | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | |
| DipHE Midwifery (3-year programme) Sept 2002* |
6 | 100 | ||||||||
| BSc (Hons) Midwifery (3-year programme) Sept 2002* |
8 | 89 | 1 | 11 | ||||||
| BSc (Hons) Midwifery (78-weeks programme) Feb 2004 |
10 | 91 | 1 | 9 | ||||||
* Some students have yet to complete.
Summary of academic and practitioner standards for midwifery
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Midwifery at the University of East Anglia in partnership with Norfolk, Suffolk and Cambridgeshire SHA.
Strengths
- There is a strong partnership between the School, the Strategic Health Authority and placement providers for curricular development in all midwifery programmes (paragraph 6).
- Pre-registration midwifery students benefit from the interprofessional learning opportunities which are provided by the Centre for Interprofessional Practice across the Institute of Health (paragraph 9).
- The School works in close partnership with the supervisors of midwives, practitioners and the midwifery practice facilitator in the development and management of assessments (paragraph 10).
- Formative assessment support for all pre-registration midwifery students is available from academic advisers, with detailed remedial action plans developed for struggling students and an annual review of performance and progression (paragraph 13).
Weakness
- In all midwifery programmes, student work, feedback and grades have not been returned in a sufficiently timely manner to enable students to use assessment feedback to enhance their learning (paragraph 12).
B2 Nursing
Intended learning outcomes
17 The ILOs are clearly stated in the programme specifications and validation documents for all four branches of pre-registration nursing and for post-registration programmes of study. The reviewers confirm that programmes meet the FHEQ. Pre-registration branch learning outcomes were derived from the NMC Standards of Proficiency statements and the Subject benchmark statement for nursing. Post-registration programmes were mapped against the KSF and, for the Return to Practice nursing programme, the ILOs met the NMC Standards of Proficiency statements. Partnership working and collaborative development of ILOs were evident, with practice staff stating that the ILOs reflected contemporary practice. In developing the ILOs, the programme team demonstrated a commitment to embrace new requirements and directions from the NMC and changes to service delivery.
18 External examiners and practice staff corroborate the appropriateness of the ILOs, and the reviewers' scrutiny of work confirms that ILOs have clearly differentiated outcomes between levels and programmes. ILOs for nursing programmes are clearly articulated in the module handbooks. However, when the pre-registration DipHE/BSc(Hons) Nursing ILOs are articulated into practice outcomes, there is a lack of differentiation between levels 2 and 3 in child, adult and learning disability branches. The ILOs for the IPL units are clearly stated and are integral to the pre-registration programme. The reviewers agree with practice staff, external examiners and students that the ILOs reflect the aims of the provision and meet NMC requirements for registration, thus ensuring that students are fit for practice, purpose and award. Effective communication of the ILOs is achieved through dissemination of the handbooks, oral preparation of the students and through the VLE. The communication and discussion of ILOs is integral to the mentor preparation programmes and also the mentor updates. Practice staff seen by the reviewers had a clear understanding of the ILOs for the units and how to support students to achieve these.
Curricula
19 The School adopts a collaborative approach in developing and offering practice-centred, pre-registration and post-registration nursing programmes to meet the NSCSHA's workforce needs. The reviewers, external examiners and the NMC Visitors confirm that all pre-registration and NMC recordable post-registration nursing programmes reflect the requirements for 'fitness for practice' curricula. External examiners' and NMC monitoring reports confirm that the pre-registration nursing programmes are designed to meet NMC regulatory requirements, the Subject benchmark statement and the University's regulations. The Return to Practice Nursing curriculum, within DipHE/BSc (Hons) Nursing Practice, and the Nurse and Pharmacist Independent/Supplementary Prescribing curriculum, a unit within the BSc (Hons) Nurse Practitioner, degree also meet the NMC requirements. Where relevant, the Subject benchmark statement is addressed in post-registration programmes, for example, in the BSc (Hons) Nurse Practitioner. Where benchmarks are not available, the programme teams focus on the national agenda; for example, the MSc Advanced Practitioner programme incorporates the National Primary and Care Trust Competency Framework and the NMC draft standards for the advanced practitioner. There are effective systems enabling students, service users and carers, clinical mentors, placement providers, SHA and nursing educationalists to be involved at all stages of programme development, including planning, development, delivery and evaluation. In addition, the School has developed a systematic and effective approach to service-user and carer involvement in development and implementation of the nursing curricula. There are well-developed processes to facilitate a responsive approach to curricular development and review, which enable minor changes to reflect practice development; for example, to take account of the implementation of the National Service Frameworks, modification of placement learning, improved theory and practice links and parity across placement sites.
20 The design and structure of the curricula for all the pre-registration and NMC-recordable nursing programmes meet NMC requirements, enabling standards of proficiency and safe practice to be progressively developed. Pre-registration nursing programmes are well structured, incorporating campus-based clinical skills learning, providing all pre-registration students with essential skills prior to entering clinical practice and timetabled opportunities to develop their clinical skills throughout the three-year programme. The units in all curricula are clearly aligned with the programme ILOs and are appropriately sequenced to enable students to progress between levels. The learning disability branch units clearly reflect the Valuing People principles. Branch programmes have recently been reviewed to facilitate clearer theory and practice links, especially for the child branch and the Common Foundation Programme (CFP). The CFP in pre-registration nursing is arranged so that students work in mixed-branch study groups. From September 2004, students have a week of branch-specific skills before their clinical placements. Opportunities for IPL are provided in the curricula and are available in post-registration programmes. Specifically, IPL through CIPP is compulsory for the first two years of the pre-registration programmes and is voluntary in year three.
21 Curricular content and structure are suitably arranged to ensure that students have the opportunity to relate theory and practice and develop their abilities to use evidence-based practice. Practice hours meet EU requirements in pre-registration programmes where students spend 50 per cent of their learning in practice placements. During some placement visits, a minority of students reported that the theoretical content did not always relate to practice-based learning, but the programme team is keenly aware of these incidents and takes appropriate action to ensure that students are able to achieve the ILOs. The School has strong links with placement providers, which have contributed to more integrated curricula for theory and practice in pre-registration nursing. Placement learning is an integral component of the curricula and there are clear, shared responsibilities between the School and practice staff, with CPFs acting as conduits between the School and placement providers to ensure integration of theory and practice.
22 The design and the delivery of the pre-registration curricula is based on the use of EBL. Such initiatives encourage the development of teamworking and problem-solving skills required of a registered practitioner. Clinical scenarios in EBL are developed in collaboration with clinical practitioners and, in the mental health branch, service users are involved in developing the scenarios. EBL promotes client-centred as well as student-centred learning, ensuring that practitioners are fit for practice.
23 Both pre and post-registration nursing programmes are flexible. Pre-registration programmes are sufficiently flexible to enable students to step off and return later to gain exit awards of certificate, diploma and honours degree. A variety of post-registration programmes at undergraduate and postgraduate levels is available, responding to the continuing learning needs of the qualified nurses. Recent additions to the portfolio include Practitioner Acute Care Skills, an endoscopy programme, Non-medical prescribing and the MSc Advanced Practitioner programme. The nursing programmes meet the evolving needs of practice and encourage lifelong learning. The School reports plans to develop postgraduate provision, including developing an MSc in Clinical Education and a professional doctorate.
Assessment
24 A variety of methods is used to assess pre and post-registration programme ILOs, including project work, essays, OSCEs, written and oral examinations, portfolios and portfolio-based assignments. The range used is commended by external examiners for the opportunities provided to demonstrate achievement of ILOs, as well as the students' ability to relate theory to practice. Effective use is made of a portfolio to access BSc post-qualifying programmes through accreditation of prior learning, with clear demonstration of evidence needed to assess the requirement to meet level 2 ILOs. In all programmes, students are required to maintain a portfolio of evidence of achievement, with development and progress of the proficiencies specified for each unit. External examiners also commend the feedback given to students, and the reviewers would concur with this, especially with respect to the post-registration programmes, where feedback is clear in terms of strengths and weakness and is often word-processed for easier reading. In 2005, UEA, in line with other HEIs, increased the pass mark from 35 per cent to 40 per cent. Students on all nursing programmes have identified delays in the return of assignments, including feedback and grades awarded, which means that students are not always able to make use of assignment feedback in their learning. Although UEA does not specify limits on the length of time for the return of student work, the School is committed to provide feedback as promptly as possible and a strategy for release of provisional results is being discussed.
25 Students' work is marked using generic marking criteria supplemented by unit-specific criteria, with assessment methods and learning outcomes identified clearly in pre and post-registration student handbooks. There are detailed, directional, generic marking criteria grids for levels 1, 2 and 3. M-level descriptors have the required higher levels of knowledge and conceptualisation. Use of the marking criteria grids in providing feedback to pre-registration students is not always maximised, and the reviewers concur with an external examiner that feedback does not always match the grade awarded. Acquisition and assessment of clinical skills are emphasised in both pre and post-registration programmes. In pre-registration programmes, there is a skills profile in the assessment of practice documents and a formal assessment through OSCEs. The School has been responsive to external examiners' comments and now uses an OSCE to test skills and ILOs for unit 3 in the CFP rather than unit 6, a branch unit. There is regular dialogue with NHS partners regarding the nature of skills to test within both the pre and post-registration programmes.
26 In post-registration programmes, OSCEs and portfolios with skills profiles are strong features, with skills linked to the KSF and other specific proficiencies dependent on the particular unit within the programme, for example, the First Contact unit in MSc Advanced Practitioner and the Nurse and Pharmacist Independent/ Supplementary Prescribing unit in BSc (Hons) Nurse Practitioner. In the Emergency Care Practitioner Programme, tested at levels 2 and 3, OSCE scenarios are used as a means to test all unit ILOs and there is clear differentiation between levels 2 and 3 in the examination. External examiners acknowledge the appropriateness and rigour of the OSCE process, particularly for Non-medical Prescribing and Neuro-behavioural Physiological Assessment of the Newborn. The role of the academic adviser in respect of formative work is made clear to students. The individualised nature of formative assessment makes it immensely valuable; for example, where students have failed a first submission, they are required to negotiate and document a remedial action plan with their academic adviser. Post-registration, formative assessments are a diagnostic tool designed to meet individual development needs and supplement learning; for example, the Action Learning Set in the Mentorship Preparation Programme provides a forum for students to bring real life examples or 'cases' which then become the 'content' for the sessions.
27 In pre-registration DipHE/BSc (Hons) programmes, the assessments of theory and practice are given separate credit value. The grading of practice is not new to UEA, and at validation there was a strong commitment to the principle of awarding academic credit for achievement in practice and the principle that students undertaking a degree in nursing should be able to demonstrate a higher level of cognitive engagement in their practice commensurate with the notion of the graduate practitioner. The distribution of the credit rating in the final year of the BSc Nursing pre-registration programme is a 40 level-3 credit for a dissertation, 20 level-3 credits for a theoretical, portfolio-based assignment (implemented in 2004 prior to completion of the programme by the first cohort undertaking the 2001 curriculum), and 60 level-3 credits based on the assessment of practice. Assessment of practice is based on direct observation, discussion and documentary evidence. Students are required to provide supplementary documentary evidence to support clinical performance and to provide a link between theory and practice. The supplementary evidence is not marked, but it informs and influences the summative assessment of practice. The final grade is agreed, following negotiation between the student and mentor, the grade being based on achievement of the unit's ILOs, which are also matched against the NMC proficiency statements. ILOs differ between diploma and degree students with more critical debate expected of the latter.
28 The grading of practice influences the BSc (Hons) Nursing degree classification. The NMC reports noted that some students and mentors reported dissatisfaction with applying a grading system to practice assessment and identified that the interpretation of practice proficiencies is variable and that there are mixed views about the grading of practice, particularly in relation to the subjectivity of terminology that guides the grades awarded. The self-evaluation document (SED) notes that, in 2004-05, 'external examiners indicate general satisfaction with our procedure for assessment of practice and the work we are undertaking to enhance reliability'. However, external examiners have also commented on possible grade inflation arising from grading of practice assessment. Some students and mentors reported differing experiences in the assessment of practice, identifying the grading of practice as subjective, with a lack of consistency in the rationale given for decision of grades, uncertainty regarding mentors' expectations of their supplementary evidence and differences in volume and type of evidence to provide. The reviewers heard from some students that there was capping of marks by mentors. There was no further evidence to show that this was systematic across all programmes. Mentors and students differ on whether supplementary evidence is used as a means to inform the grade, some mentors not using it at all. Students spoke of differences in their self-assessment and their mentors' understanding of this form of assessment, a point confirmed by mentors, but most agreed that the final grade was agreed following negotiation. Students considered that there was little difference in expected performance between level 2 and 3 students, but mentors identified that they would expect more critical analysis from degree students, and there are clear differences between the ILOs of level 2 and level 3 students, without compromising professional proficiency standards.
29 The reviewers note the rigour of the School's responsiveness to criticism concerning the grading of practice and the efforts to increase reliability, including the refining of the descriptors, the clarification of the nature of supplementary evidence that students are required to present as part of the assessment process, revision of the grading criteria for assessing clinical practice, and the development of a tripartite process of moderation in practice. In addition, academic advisers check the grades awarded against the supplementary evidence. In 2005, the NMC acknowledged the implementation of moderation in practice as a positive step forward. Moderation in practice is a process valued by mentors, especially the involvement of link lecturers in the process. Some mentors are now more positive about grading, stating that the grading of practice is a critical part in the development of students, and they felt well prepared for grading through link teacher support and the mentor updates. A School survey of feedback from moderators indicates that there is often considerable discussion between the mentor and student before the final agreement of practice grades, with moderators being impressed by the conduct of the mentors in agreeing grades, which are appropriate and realistic. The School has highlighted its commitment to continue to work with NHS partners and mentors to further refine and standardise the process. The SED states that external examiners continue to engage the School staff in dialogue about grading assessment of practice in pre-registration nursing programmes. External examiners have identified that further work needs to be undertaken with the grading of practice and some would prefer that practice was replaced with pass/fail criteria. In pre-registration DipHE/BSc(Hons) Nursing programmes, there are still potential difficulties with the grading of practice, especially with respect to the provision of supplementary evidence to confirm the practice grade and the absence of criteria to distinguish between the level of performance, particularly regarding level 3 BSc (Hons) Nursing students. Where practice is graded in some post-registration nursing units, for example, Minor Injuries for Practitioners, the competencies and ILOs are tested against a comprehensive grading grid, with clear statements on the grid pertinent to the assessment of the developing practitioner. Units for post-registration programmes identify the attainment of specified competencies as proficiencies achieved or not achieved with a Pass/Fail and a percentage grade awarded. With reference to the Code of practice, Section 6: Assessment of students, the assessment strategy in pre-registration DipHE/BSc (Hons) Nursing, is not aligned with Precepts 7 and 12.
Student achievement
30 External examiners confirm that students are achieving the ILOs and that student work is of a high standard and at least of a standard comparable with provision elsewhere. The level of students' work is consistent with NMC requirements and the Subject benchmark statement. Students are considered by examiners to be fit for practice, purpose and award. Students' work showed evidence of practice that was current and evidence-based. Generally, work indicated the development of reflective practice and that students are able to make links between theory and practice. Higher achieving students showed skills of analysis and critical appraisal, while weaker students tended to have a poor written style and failed to follow guidelines, despite considerable support from the School staff. The use of EBL has encouraged the development of students' skills in teamworking, problem-solving and clinical reasoning. In their scrutiny of longitudinal samples of student work, the reviewers also noted the high level of achievement of some students, in particular, with reference to relating theory and practice, using evidence from current research and making use of the scientific knowledge relevant to the discipline.
31 Table 1b shows that 100 per cent of the DipHE Nursing students pass the programme. For the BSc (Hons) Nursing programme over the last three cohorts, 43 per cent of students achieved a First class honours degree, (an achievement which peaked at 58 per cent in 2004), 50 per cent achieved an Upper Second, 6 per cent a Lower Second and 1 per cent a Third. Data for the post-registration programmes show a 100 per cent pass rate for the DipHE in Nursing Practice and the PgDip in Mental Health. Awards for the post-registration BSc (Hons) in Nursing Practice show that 65 per cent of students in the last year gained a First or Upper Second class award. The BSc (Hons) Nurse Practitioner award has increasing numbers of students, all of whom achieved First or Upper Second class awards in the last qualifying cohort.
32 The majority of newly-qualified nurses are employed locally on completion of their programmes (Table 2b). Local Trusts are committed to supporting them with a period of preceptorship, which is highly valued by students. Students stated they are confident to practise on completion of the programmes. Employers regard students as mature, self-assured and able to meet the challenge of difficult and changing situations.
Table 1b: Completion and achievement statistics for all award-bearing programmes in nursing
| Programme (Award-bearing only) | Cohort | Diploma programmes Pass |
Diploma programmes Fail |
Degree classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2i | 2ii | 3 | P | F | ||||||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| DipHE Nursing | Sep 2001 | 101 | 100 | ||||||||||||||
| Apr 2002* | 55 | 100 | |||||||||||||||
| Sep 2002** | 78 | 100 | |||||||||||||||
| BSc (Hons) Nursing | Sep 2001 | 19 | 58 | 12 | 36 | 2 | 6 | ||||||||||
| Apr 2002 | 5 | 38 | 7 | 54 | 1 | 8 | |||||||||||
| Sep 2002*** | 11 | 31 | 22 | 61 | 2 | 6 | 1 | 3 | |||||||||
| DipHE Nursing Practice | 1999-2000 | 33 | 100 | ||||||||||||||
| 2000-01 | 30 | 100 | |||||||||||||||
| 2001-02 | 28 | 100 | |||||||||||||||
| BSc (Hons) Nursing Practice | 1999-2000 | 4 | 7 | 28 | 52 | 15 | 28 | 7 | 13 | ||||||||
| 2000-01 | 2 | 5 | 22 | 50 | 15 | 34 | 5 | 11 | |||||||||
| 2001-02 | 7 | 21 | 15 | 44 | 10 | 29 | 2 | 6 | |||||||||
| BSc (Hons) Nurse Practitioner | 1999-2000 | 1 | 33 | 2 | 67 | ||||||||||||
| 2000-01 | 4 | 100 | |||||||||||||||
| 2001-02 | 3 | 27 | 8 | 73 | |||||||||||||
| BA (Hons) Policy, Planning and Leadership for Health Professionals | 2000-01 | 2 | 22 | 5 | 56 | 1 | 11 | 1 | 11 | ||||||||
| 2001-02 | 1 | 9 | 6 | 55 | 4 | 36 | |||||||||||
| PgDip Mental Health | 2003-04 | 6 | 100 | ||||||||||||||
* Plus five intercalations - students yet to complete.
** Plus five intercalations and three permitted extensions - students yet to complete.
*** Plus one intercalation - student yet to complete.
Table 2b: Employment statistics for all pre-registration programmes in nursing
| Programme | Further study | Local employers | Employers elsewhere | Unemployed | Other | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | |
| DipHE Nursing | ||||||||||
| Sep 2001 | 94 | 93 | 5 | 5 | 1 | 1 | 1 | 1 | ||
| Apr 2002* | 1 | 2 | 51 | 93 | 1 | 2 | 2 | 4 | ||
| Sep 2002** | 68 | 87 | 7 | 9 | 1 | 1 | 2 | 3 | ||
| BSc (Hons) Nursing | ||||||||||
| Sep 2001 | 1 | 3 | 29 | 88 | 3 | 9 | ||||
| Apr 2002 | 12 | 92 | 1 | 8 | ||||||
| Sep 2002*** | 31 | 86 | 3 | 8 | 2 | 6 | ||||
* Plus five intercalations - students yet to complete.
** Plus five intercalations and three permitted extensions - students yet to complete.
*** Plus one intercalation - student yet to complete.
Summary of academic and practitioner standards for nursing
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Nursing at the University of East Anglia in partnership with Norfolk, Suffolk and Cambridgeshire SHA.
Strengths
- The School has developed a systematic and effective approach to service-user and carer involvement in development and implementation of the nursing curricula (paragraph 19).
- The School has strong links with placement providers, which have contributed to more integrated curricula for theory and practice in pre-registration nursing (paragraph 21).
- Where practice is graded in some post-registration nursing units, for example, Minor Injuries for Practitioners, the competencies and intended learning outcomes are tested against a comprehensive grading grid, with clear statements on the grid pertinent to the assessment of the developing practitioner (paragraph 29).
Weaknesses
- When the pre-registration DipHE/BSc(Hons) Nursing intended learning outcomes are articulated into practice outcomes, there is a lack of differentiation between levels 2 and 3 in child, adult and learning disability branches (paragraph 18).
- Students on all nursing programmes have identified delays in the return of assignments, including feedback and grades awarded, which means that students are not always able to make use of assignment feedback in their learning (paragraph 24).
- In pre-registration DipHE/BSc(Hons) Nursing programmes, there are still potential difficulties with the grading of practice, especially with respect to the provision of supplementary evidence to confirm the practice grade and the absence of criteria to distinguish between the level of performance, particularly regarding level 3 BSc (Hons) Nursing students (paragraph 29).
B3 Operating department practice
Intended learning outcomes
33 The ILOs for the pre-registration operating department practice (ODP) programme are clearly informed by the Association of Operating Department Practitioners' (AODP) Curriculum Document and more recently by the Subject benchmark statement. The programme outcomes have also considered the Standards of Proficiency published by the HPC. The module ILOs are set appropriately for certificate and intermediary levels in line with the FHEQ. Where ODP module ILOs are articulated into practice outcomes, there is no distinction levels 1 and 2, although there is evidence of differentiation between levels through specification of the different levels of student engagement in the practice setting. A skills practice grid for confirming skills acquisition complements the ILOs. The ILOs include reference to knowledge and understanding, practical outcomes, and transferable skills. Trust staff and the School work collaboratively in developing the ILOs, and practice staff were able to articulate how they translate the ILOs to ensure achievement that reflects contemporary operating department practice.
34 Module and programme handbooks and the programme specification state ILOs clearly and students confirmed that they generally understood what was expected of them, although some students expressed some confusion over how to match practice outcomes to the unit outcomes. The reviewers' scrutiny of student work did confirm that there are clearly differentiated levels of ILOs. External examiners corroborate the appropriateness of the ILOs in students achieving the requirements for registration. Unit outcomes are discussed with students at the start of each module. They are also available in an electronic format through the VLE. Link lecturers and lecturer practitioners work closely with students to ensure they are familiar with the ILOs for placements. Mentors stated that it took some time to understand ILOs fully in relation to practice and assessment, but they received further guidance from the link lecturers and lecturer practitioners.
Curriculum
35 The pre-registration curriculum in ODP enables the ILOs to be achieved and is comparable to those of other ODP providers. The ODP programme is offered over two years, with equal emphasis on theory and practice. Theory and practice are clearly linked in the curriculum, which enhances students' abilities to integrate campus, and practice-based learning. The curriculum content reflects the emerging Health Professions Framework and prepares students for safe practice and to be competent healthcare professionals who are fit for purpose, practice and award. The curriculum content contains the appropriate emphasis on knowledge and understanding, cognitive skills, subject-specific skills, practice and professional skills, transferable skills and progression to employment. The ODP curriculum enables students to demonstrate over the two-year duration of the programme a gradually increasing depth and breadth of knowledge to ensure their fitness for practice.
36 ODP students benefit from the close matching of the curriculum with student placements, including two award-winning surgery units and a range of general and specialist operating theatres. The School and the local Trusts, involving other managers from placement provider units and clinical practitioners, have worked closely to develop the curriculum. The NSCSHA and partner placement providers have reflected the AODP requirements in the curriculum, which are consistent with current HPC requirements as well as the Subject benchmark statement, the FHEQ and the University's regulations. The curriculum comprises units that are sequenced to ensure students progress from being observers of practice to competent practitioners. The curriculum content, which is clearly aligned with the ILOs, indicates progression and increasing challenges through levels (certificate and intermediary) of study. The curriculum design is flexible and offers an interim award of Certificate to those students who have successfully completed year one and do not wish to complete the programme.
37 Placement learning is structured to support achievement of learning outcomes and includes two day-surgery units, which are nationally recognised for their excellence. Appropriate emphasis is placed on skills acquisition throughout the programme, which are recorded in a Skills Development Profile (SDP). Students are exposed to clinical placements with numerous learning opportunities in local placement areas. The curriculum offers work-based learning (WBL) during which students attend sessions at local Trusts. There is emphasis in the curriculum on holistic, patient-focused care, including exposure to the breadth of knowledge necessary for safe operating department practice. The programme team has kept the WBL focus under review to ensure it retains its skills-based focus. Lecturer practitioners, clinically competent lecturers and subject experts contribute to the currency of the curriculum to ensure currency of learning and teaching and its relevance to the current NHS environment.
38 The curriculum provides a clear framework for the development of reflective practice skills, promoting the development of lifelong learning and transferable skills, including time-management, working with others and accessing information. IPL is clearly embedded in the ODP curriculum, with students able to participate in the School's programme and by joining some planned activities with other professional groups made available on campus. Students are also able to exploit additional IPL opportunities during placement settings, for example, working alongside students of medicine, nursing and midwifery.
Assessment
39 The overall aim of the assessment strategy is to use assessments that progressively test the knowledge, skills and attitudes required from an operating department practitioner in order to be fit for the award of the DipHE. The programme is assessed at level 1 (certificate) and level 2 (diploma), with each unit having an equal proportion of assessments and credits. The reviewers considered that there is a clear assessment strategy in place for progression in practice from 'participant observer', a student who is closely supervised, through to 'competent practitioner', a student who is more independent. Not all students follow the same pattern of clinical placements; therefore, the practice-based unit ILOs can be assessed and achieved by the end of each year, rather than at the end of each unit. Students, with guidance from their placement mentor, select six ILOs to be tested at the end of any unit. The reviewers confirm the external examiner's comments that assessments are closely aligned with, and are appropriate to, the measurement of students' achievements of the ILOs, including those for practice.
40 The range of assessment tasks becomes more complex as the student progresses through the programme. Assessment methods include essays, case studies, OSCEs, written examination and a portfolio of evidence, all set at an appropriate level for a DipHE. Assessment methods aim to enhance the student experience and are based around developing practice. External examiners have praised the assessment process for its transparency, clarity of guidelines for students, equitable and fair marking, high level of feedback and a moderation process that ensures that appropriate standards are maintained. However, some students in their meetings with the reviewers identified some variability in the quality of written feedback, with uncertainly regarding where they needed improvement. The current ODP assessment process does not ensure the achievement of proficiency in drug calculations; for example, the reviewers noted errors by some students in drug calculations in the level 2, unit 4 examination. The programme team is responding to the issue by exploring with the external examiner ways in which the testing of drug calculation skills can be strengthened and student performance improved. The OSCEs aim to assess the extent to which the student can perform under pressure and are marked by practitioners and academic staff. The OSCE process involves the external examiner at an early stage, but the School considers conducting the OSCE across three NHS Trusts to be challenging with regard to reliability. ODP students expressed concerns that assignments and grades are not returned in a timely manner and they start another assignment before feedback and grades are received from previous assignments. This is not aligned with Precept 12 of the Code of practice, Section 6: Assessment of students. UEA does not specify limits on the length of time for the return of student work, but the School is committed to providing feedback as promptly as possible and a strategy for release of provisional results is being discussed.
41 The summative assessment of practice is based on continuous assessment with agreed progress interviews during the placement. During the final interview, the student and mentor independently judge the grade of the student's performance and discuss their rationale before the mentor makes the final assessment. The final assessment is informed by evidence based on the agreed six practice outcomes being tested. In addition to direct observation from the mentor on the students' performances, the evidence includes skills acquisition as documented in the SDP, reflective accounts and written evidence of integration of theory and practice. The SDP is also reviewed at the start of the placement and used as a basis of a contract between student and mentor, a situation confirmed by mentors. The SDP itemises and provides a means of testing those skills, which are deemed to be fundamental to the role of the operating department practitioner. Some skills within the profile are 'compulsory' and programme regulations state the skills must be completed up to the level of a 'competent practitioner' by the end of the programme.
42 In their discussions with the reviewers, students considered that the grading of practice is subjective, with a wide variation in mentor expectations and the amount of supplementary evidence needed to inform the final grade. Students also said that some mentors based the grade on performance and supplementary evidence, while others decided the grade with little reference to this evidence. There is a lack of clarity in the assessment process for practice for ODP, in particular, a lack of parity in the use of and requirements of supplementary evidence. This is not aligned with Precept 7 of the Code of practice, Section 6: Assessment of students, published by QAA. In their discussions with some mentors, the reviewers noted that the mentors did not have a consistent approach, leading to variability in students' experiences of assessment. In their meetings with students and from the scrutiny of student work, the reviewers concluded that there is a disparity in the amount of effort required by students regarding the supplementary evidence. This is particularly significant as practice is graded. Students and mentors identify the availability and helpfulness of the link lecturer in resolving any practice assessment issues. The School has implemented moderation in practice, which involves the link lecturer attending the intermediate and final assessment, advising the students and mentors on the process of practice assessment, the nature of supporting evidence and interpretation of grading criteria. The reviewers agree with the external examiner who has expressed concerns regarding the inter-assessor reliability of the grading of the practice assessment. The School is addressing these challenges by constantly reviewing and revising the criteria used for grading practice. The introduction of a Lead Placement Mentor, an experienced Trust-based operating department practitioner or nurse who is also an experienced mentor, seeks to ensure greater consistency, reliability and parity in the assessment process.
Student achievement
43 The external examiner stated that the ILOs are achieved and that standards of achievement are comparable with other ODP programmes. Students' abilities to link theory and practice are praised. The reviewers concur with the external examiner that the standards achieved are consistent with the level of academic award and that students' work demonstrates added value, given the student profile recruited through the widened entry gate. Students with higher grades demonstrate a range of skills and knowledge with reference to evidence-based practice and making effective use of research and scientific knowledge. Some students find tasks relating to drug calculations difficult and are not always passing the tests.
44 All students who completed the programme in 2005 achieved the diploma award and were employed locally (Table 1c). Practice staff stated that they had confidence that students achieving the ILOs of the programme were appropriately fit for purpose, practice and award. Students stated that they regarded themselves confident to practice effectively on completion.
Table 1c: Completion and achievement statistics for all award-bearing programmes in operating department practice
| Programme (Award-bearing only) | Cohort | Diploma programmes Pass |
Diploma programmes Fail |
Degree classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2i | 2ii | 3 | P | F | ||||||||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| DipHE Operating Department Practice | Sep 2003* | 13 | 100 | ||||||||||||||
* Plus one permitted extension - student yet to complete.
Table 2c: Employment statistics for all pre-registration programmes in operating department practice
| Programme | Further study | Local employers | Employers elsewhere | Unemployed | Other | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | No. | % | |
| DipHE Operating Department Practice Sep 2003* |
13 | 100 | ||||||||
* Plus one permitted extension - student yet to complete
Summary of academic and practitioner standards for operating department practice
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Operating Department Practice at the University of East Anglia in partnership with Norfolk, Suffolk and Cambridgeshire SHA.
Strengths
- Operating department practice students benefit from the close matching of the curriculum with student placements, including two award-winning surgery units and a range of general and specialist operating theatres (paragraph 36).
- Interprofessional learning is clearly embedded in the operating department practice curriculum, with students able to participate in the School's programme and by joining some planned activities made available on campus with students from a wide range of other healthcare professional groups (paragraph 38).
Weaknesses
- Where operating department practice module intended learning outcomes are articulated into practice outcomes, there is no distinction evident between levels 1 and 2, although there is evidence of differentiation between levels through specification of the different levels of student engagement in the practice setting (paragraph 33).
- The current operating department practice assessment process does not ensure the achievement of proficiency in drug calculations; for example, the reviewers noted errors by some students in drug calculations in the level 2, unit 4 examination (paragraph 40).
- Operating department practice students expressed concerns that assignments and grades are not returned in a timely manner and they start another assignment before feedback and grades are received from previous assignments (paragraph 40).
- There is a lack of clarity in the assessment process for practice for operating department practice, in particular, a lack of parity in the use and requirements of supplementary evidence (paragraph 42).
C Quality of learning opportunities
Learning and teaching
45 The UEA Corporate Plan (2003-08) identifies three strategic learning and teaching aims: research-led teaching and learning, enhancing quality and equality of opportunity, and widening participation. The IoH's Learning and Teaching Operational Plans are aligned with this strategy and include a list of objectives to be met, with clear responsibility for actions identified for programme teams. The curriculum framework documents include the learning and teaching strategy. There is some variance in the strategies presented across the frameworks, reflecting different stages of learning and teaching development evolving at the time of each validation. Commonly, all frameworks refer to the use of EBL that supports the philosophy of developing personal learning autonomy and structures learning within a clinical context. Following the inception of the CIPP in 2002, IPL is included in all pre-registration programmes except, currently, the 78-week midwifery programme. Although excellent in many respects, the student handbook for pre-registration nursing, midwifery and ODP limits information on the overall learning and teaching strategy to glossary details and responses given to hypothetical questions. Handbooks for post-registration programmes also omit detailed accounts of this overall strategy. However, students have access to a booklet on EBL on joining programmes and the IPL handbook for each year produced by the CIPP. Unit handbooks for pre-registration programmes make reference to the use of EBL. The 18-month midwifery programme identifies the use of e-learning through the VLE and a web-based package. The ODP programme refers to a skills development profile and the use of work-based learning days. Students at pre and post-registration levels were able to confirm understanding of the learning and teaching strategy. The IoH has a service-user strategy and provides examples of service-user involvement in the development of teaching and learning. These are seen across the pre-registration nursing and midwifery programmes and in the clinical studies post-registration unit. Recently, the School reorganised the learning and teaching timetable to enable students to spend their time more profitably when on the main campus.
46 The NMC has described the EBL strategy as innovative, although it wanted a greater balance of teaching methods in the programmes. The SED reports that modifications to EBL were made in response to student evaluations, increasing the variety of teaching methods used and the provision of branch-specific skills. The EBL programme was formally evaluated using two questionnaires and interviews. The results suggested that students were satisfied with mixed-branch groups and that the balance of teaching and learning methods was right. The programme update reports for 2004-05 generally suggest that students in the branches are fairly positive about EBL, though the child branch in unit 6 still had some reservations about the value of EBL. Pre-registration nursing and ODP students gave mixed, though fairly favourable, comments. Students recognised that the approach encouraged independent learning and the development of lifelong skills in information retrieval. One student on the new MSc Advanced Practitioner programme, however, had not yet encountered EBL (although some units in the programme do use it) and felt that it would be beneficial. The School has responded to the feedback received from the NMC and students, and continues to work to achieve a balance of teaching and learning, identifying that further work is needed to develop the nursing branch programmes. The EBL strategy is well developed, thoroughly reviewed and effective in developing students' learning in pre-registration programmes.
47 The pre-registration nursing, midwifery and ODP students engage in an IPL provided through the CIPP founded in 2002, which is an effective driver for the development of IPL. The programme is in the early stages of implementation, following a pilot project. The provision is now compulsory at year one for pre-registration nursing, ODP and midwifery (except for the 78-week programme). Students are allocated to mixed professional groups which address clinical scenarios. The groups reflect professions from across the IoH and include pharmacy from the Faculty of Science. The provision is repeated three times a year to allow students an opportunity to take part. Year two of pre-registration programmes also includes compulsory IPL provision (again with the exception of the 78-week midwifery programme), with students working in cross-professional groups across the year, meeting up to five times, with facilitation on three occasions. Students produce two reflective statements related to themes of communication with the team and patient. For students in the final year of the three-year nursing and midwifery pre-registration programmes and of the two-year ODP programme, there is a CIPP interprofessional conference day which likewise involves students at an advanced stage in their programmes from across IoH and from pharmacy. Currently, attendance is voluntary and is part of a pilot project. The conference includes guest presenters, practitioners and patients. Pre-registration nursing students from across branches reported that they are allowed to leave placement settings, where necessary, to complete the interprofessional programme, although the total nursing practice hours (2300 hours) required for registration were not compromised by this. The timing of delivery of some of the sessions is being changed to avoid students being absent from placement. The CIPP team evaluates the student learning experience and CIPP analysis relating to 2005-06 includes positive written feedback from students. In contrast to this, some nursing students gave positive views, but others gave a poor evaluation of IPL in discussions. They considered that they learned more from IPL while in practice settings and were concerned that their efforts were not recognised through summative grading. IPL is continuing to be actively developed.
48 The SED reports a strategy for increasing the use of e-learning opportunities. There is an expectation that all staff will engage in the use of the VLE, and UEA is developing an institution-wide e-learning strategy. The use of the VLE was piloted in 2002-03 and there are ongoing developments in the implementation of e-learning, although engagement varies across the School. The majority of staff has had some form of VLE training and there is recognition that this needs supplementation through the continuation of other staff development opportunities. Student information technology (IT) skills are surveyed on commencement, and training in the use of the VLE is provided. Sixty-four units report using the VLE, with the majority of staff providing material on-line. Other initiatives include the development of an interactive package for midwifery programmes funded through a UEA Teaching Fellowship that received a national RCM award and the provision of an Infection Control package on-line in clinical placement areas.
49 The post-registration programmes are based on key principles, one of which is to promote evidence-based care. The SED identifies a number of staff engaged in higher degrees and research activity that contributes to curriculum development. Additionally, a Nursing and Midwifery Research Unit is engaged in funded research. The staff development database and staff CVs show that staff are attending a range of one-day programmes on a number of educational aspects, such as IT skills and resuscitation skills, and a number are engaged in higher degree study. Research activity supports evidence-based learning and teaching through the implementation of findings from individual study and funded projects. A programme is also in place to meet the educational needs of staff without a teaching qualification.
50 Through the work of placement staff and link lecturers, the effective use of the educational audits and matching students' ILOs with practice, the School is able to ensure that there is parity of learning experiences for students on all programmes. The Code of practice, Section 9: Placement learning, informs the placement provision. Formalised teaching and skills sessions are available in some placements for pre-registration students and, in ODP, those sessions (designated as WBL) are managed through lesson plans to ensure parity across placements. The SED identifies increasing pressure on placements for mental health and learning disability nursing. A strategic development plan is in place with ongoing monitoring to ensure that placements are available. Health and safety issues are provided for in mandatory training, with evidence of placement areas operating to maintain safe practice. The release of practitioners to attend mentor updates is recognised as being problematic, although the School and the NSCSHA are seeking to overcome these issues. The monitoring of mentor up-dating is assisted through audit processes and there is a database which includes 'resting' staff.
51 The role of the link lecturer received high praise from students across the nursing pre-registration programmes. Most teaching staff have link lecturer roles, but there is no fixed expectation of the time spent in practice by link lecturers. A recent survey has identified variation in attended time from 10 to 27 per cent being spent in practice each week. The role operates with a contract between the link lecturer and the placement area, in which the negotiated level of support is identified. During their visits to practice areas, the reviewers noted examples of high-quality learning environments, with positive support for students, an ethos of interprofessional working and a culture of ongoing professional development.
The quality of learning and teaching is commendable.
Strengths
- The enquiry-based learning strategy is well developed, thoroughly reviewed and effective in developing students' learning in pre-registration programmes (paragraph 46).
- Through the work of placement staff and link lecturers, the effective use of the educational audits and matching students' intended learning outcomes with practice, the School is able to ensure that there is parity of learning experiences for students on all programmes (paragraph 50).
- The role of the link lecturer received high praise from students across the nursing pre-registration programmes (paragraph 51).
- During their visits to practice areas, the reviewers noted examples of high-quality learning environments, with positive support for students, an ethos of interprofessional working and a culture of ongoing professional development (paragraph 51).
Good practice
- The pre-registration nursing, midwifery and operating department practice students engage in an interprofessional learning programme provided through the Centre for Interprofessional Practice founded in 2002, which is an effective driver for the development of interprofessional learning (paragraph 47).
Student progression
52 UEA has a well-developed strategy for widening access initiatives and is engaged in the 'Aim Higher' initiative to encourage applications from students who are under-represented in higher education. The School is committed to developing this strategy in recruitment to its programmes. For example, in partnership with the NSCSHA and local Trusts, the School engages in a secondment scheme for Health Care Assistants to access undergraduate training across the spectrum of health provision at UEA. There are clear and well-managed accreditation of prior learning procedures and, through links with local further education colleges, students can access shortened diploma programmes through cadet schemes. No prospective student is admitted to a pre-registration programme unless interviewed, normally by school and practice staff. The School and practice staff interview all prospective pre-registration students. Some post-registration students are interviewed and, where agreed, practice staff participate. The prospectus and the School's programme-specific information are informative about the awards and set out admission requirements in a clear, accurate and helpful style for applicants.
53 Students spoke positively about their induction programmes, which provide them with comprehensive information on their experiences as healthcare students. All students are allocated an academic adviser to offer support and, in particular, monitor their progress, a process that is effective and appreciated by students. There is a clear policy for students to access academic advisers and for the annual progress review of students. Students have access to a wide range of other academic support, including link lecturer and CPF roles, which are highly valued by students. The preparation of students for clinical placement is outlined in the student handbooks. However, there are some variations in supporting the transition of students from the campus learning to the clinical environment, because adequate placement induction programmes do not always take place, with students reporting varying experiences. The reviewers were impressed by the strength of the partnership between practice personnel and the link lecturer role that facilitates the monitoring of student progression in placements. There was some concern expressed by the School regarding the security of the future of CPFs, but the reviewers were reassured that an action plan led by the NSCSHA is being actively promoted. There is a strong working partnership between the School and the NSCSHA to provide support for the progression of students in all programmes in campus and clinical settings.
54 The School has a commitment to supporting students with additional educational needs, and works in close collaboration with the office of the University's Dean of Students. There is a clear policy and support system in place to assess and offer ongoing support to the additional educational needs of students in line with the Code of practice, Section 3: Students with disabilities. Students expressed concern that additional educational support is only available from the Norwich campus. The School has responded by training two members of staff in the assessment of dyslexia and is now in a stronger position to offer additional support in practice settings.
55 Support for students from mentors is well developed. The mentor programme is centred on the key elements of assessment in practice and the requirements of professional and regulatory statutory bodies. There is a specific place on the VLE for the mentor programme for students to discuss their progress, placement assessment and the grading of practice. This discussion is reinforced in the Action Learning Sets. The mentor support for students often exceeds the minimum level required by the NMC.
56 In some programmes, there is a large amount of transfer activity which makes it more reliable to analyse withdrawals as a percentage of the total cohort derived from recruited numbers plus the net effect of transfers in and out. On this basis, the withdrawals for the midwifery programmes are 18 per cent, and 8 per cent for the DipHE and BSc (Hons). For the DipHE Nursing, the rate averages 20 per cent over the last three cohorts and 10 per cent for the degree programme over the same period. For the ODP programme, the withdrawal rate was 17 per cent, which is regarded as being mainly due to the relatively small gap between validation and recruitment and commencement of the programme (Table 3). The School is attentive to monitoring the reasons for withdrawals through exit interviews and noting trends in the annual reports. The School is looking to address problems with attrition rates and has responded to the issue with some vigour and responsibility.
Table 3: Recruitment and attrition statistics for pre-registration and NMC recordable qualifications
| Award title | Recruited number | Withdrawal | Transfer in | Transfer out | Discontinuation | ||||
|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | ||
| DipHE Midwifery (3-year programme) | |||||||||
| Sep 2002 | 16 | 2 | 13 | 3 | 19 | 8 | |||