General Chiropractic Council Report of the GCC’s Panel recognition visit to the Anglo-European College of Chiropractic 21 and 22 February 2007 Panel:

Chris Stephens (Lay member of the GCC) – Chair David Byfield (Chiropractic member of the GCC Education Committee) Margaret Coats (Chief Executive and Registrar, GCC) Kalim Mehrabi (Chiropractic member of the GCC Education Committee) Cliff Hancock (QA in HE consultant to the GCC) – Secretary

Observer:

Carl Lygo (Lay member of the GCC Education Committee) – attended for day 1 only

Background 1. In August 2003, the Privy Council approved the decision of the GCC to recognise the Anglo-European College of Chiropractic’s four year programme for students who would graduate with an M.Chiro by 30 September 2012 (having entered the programme by 2008). At that time, the degree was validated by the University of Portsmouth. In December 2006 the Education Committee of the GCC received comprehensive documentation from the Anglo-European College of Chiropractic (AECC) in support of an application for formal recognition for a further period of its four year M.Chiro degree programme, validated by Bournemouth University. In addition to this documentation AECC had also provided supplementary information in response to questions raised by the GCC following the Education Committee’s consideration of the submitted documentation. 2. The timing of the submission was influenced by AECC’s experience of how long it can take for the Privy Council to approve decisions taken by the GCC, and the need to avoid uncertainty for students entering the programme after 2008. 3. Over the two days of the visit the Panel met groups of academic staff, clinic staff, students, the Pro Vice Chancellor of Bournemouth University and the Chair of the Board of Trustees of the College. There was also an opportunity for the Panel to tour the College, including recently refurbished lecture theatres and the IT server facility. The Panel was also briefed on the plans for the new clinic which is expected to be ready for use by the College from September 2008 onwards. 4. All meetings during the visit were conducted in an open and constructive way and the Panel commended all concerned for promoting a strong sense of academic community. 5.

Dialogue in the meetings centred on:

a. Clinic issues b. Financial management including HEFCE funding c. Recruitment d. The relationship with Bournemouth University e. The rationale for the development of the new programme’s curriculum f. Year 0 issues g. Planning, in particular the business plan for AECC over the next five years h. Research, other postgraduate activity (including CPD) and staff development i. Some detailed matters relating to the content, delivery and assessment of the programme j. Governance issues Clinic issues 6. From its preliminary reading of the AECC documentation the Panel considered that the new programme had been formulated around clinical practice. This was verified by the various teams of academic staff that the Panel met. Of particular interest was the opportunity for further course development offered by the planned new clinic facility. The Panel was shown detailed plans of this facility and it was also brought up to date on progress towards receiving planning permission. The Panel was impressed with the extent of the resource that this would offer to the College. The Panel also noted the intended opening date for the new clinic of September 2008. In response to a question the Panel was told that the existing clinic would be retained but that it would be converted and refurbished as a combination of Student Union space, research facilities, increased technique practice rooms and enhanced IT facilities. 7. It was emphasised to the Panel that, although the primary focus of the clinic would be to provide students with clinical experience, there would also be a push to establish the clinic as a business so that its costs would not be a burden upon the College. The Panel was also told that there would be facilities for a range of practitioners (from professions other than chiropractic) and that this environment would be beneficial to students’ development as potential chiropractic members of multi-disciplinary healthcare teams. 8. The clinic team was asked about mechanisms for covering a downturn in demand for the clinic. The response was that this had never been a problem for the College and any such downturn would probably be relatively small. This would be addressed by considering a revised marketing strategy (the present one being relatively low profile) and reviewing the fee structure. The clinic team also pointed to the satellite clinic facility at Bournemouth University as providing an additional opportunity to increase patient numbers. 9. The College’s principal emphasised to the team that the new appointment to the post of Clinic Director (in place of Dr Thiel, recently promoted to the post of Vice Principal) would have a central focus on the clinic as a mechanism for generating additional income to the College.

10. In a meeting with the year 4 (clinic) tutors it was emphasised to the panel that the enhancement of clinical skills had been a major focus in re-writing the course. Early (soft) indicators have shown that students entering the clinic were working at a greater level of fluency (both in terms of communication and clinical skills) than had been the case previously. This has also flowed from the students’ exposure to patients at a much earlier stage of the programme. The previous course had a separation (in time) of pre-clinical knowledge and clinical skills. The present one was much more integrated in nature with the acquisition of clinical skills as paramount. 11. The clinic team also set out their mechanisms for monitoring and supporting weaker students. These were various and appropriate, commencing with identification by monitoring student performance on a weekly basis, followed by a weekly supervisors’ meeting where problems are discussed and then setting in place appropriate mentoring facilities. It was emphasised to the Panel that student support could come from a range of members of the clinic team. 12. In the meeting with students a possible problem was highlighted to the Panel. It was stated that if a student were to see a new patient at relatively short notice then it was not always possible for the case to be presented to a member of clinic staff in the required time period. The clinic staff emphasised that there would always be someone on hand to provide such support and that this difficulty, although perhaps perceived by the student, would not be a real one. Staff would always be available to deal with acute cases, for example. 13. The students also indicated that enhanced marketing to obtain more patients would be appreciated by the student body. The course team told the Panel that there had been no real difficulties with students meeting the 400/40 GCC patient criterion. 14. The process of transition into clinic was discussed fully. AECC has a system of third year students shadowing their fourth year counterparts in the period immediately before the clinic entrance examination in addition to a clinic induction programme. The students commented very favourably on the support that they receive leading up to the clinic entrance examination and in all of their subsequent work in the clinic. The Panel was impressed by the level of commitment of both staff and students in developing clinical skills. Funding, financial management and the relationship with Bournemouth University 15. The Panel asked the senior staff of the College about the relationship with Bournemouth University in respect of HEFCE funding. The response set out that all Home and EU students were funded at the HEFCE Band B rate and that this resource (subject to a reduction set out in the confidential financial agreement between the two institutions) then accrued to the College. At present HEFCE funding is only available in respect of students in years 1 and 2. Years 3 and 4 students are all self-funded. Students funded under HEFCE funding support are also subject to paying the recently (September 2006) instigated £3000 variable fee. 16. Based on very detailed confidential information provided by AECC to the Chief Executive & Registrar, the panel was satisfied that AECC’s financial affairs are very

well managed and that it has significant financial reserves. No issues arose, therefore, in respect of the financial viability of the programme. 17. The academic relationship with Bournemouth University is also strong. The course structure had, to some extent, been dictated by the needs of the University for a modular structure. However, this had not compromised the College’s ability to deliver the academic programme in the way that it felt best suited the needs of chiropractic students. It was emphasised to the Panel that the basic building blocks of the programme are the units of study and these are agglomerated coherently to form modules. 18. The meeting of the Panel with the Bournemouth University PVC and the Chairman of the Trustees of College (together with the Principal) demonstrated to the Panel the synergy of the relationship between College and University. The current contract between the two organisations runs to 2009. Both sides saw it as a strong and developing relationship. The provision at AECC was complementary to that of the health courses at the University. A recent QAA visit to the University had taken in AECC as an associate college and, whilst the report of the visit is yet to be finalised, it demonstrated broad confidence (the highest category) in the provision at AECC. It is expected that the final report will be live on the QAA website in May 2007. The Chairman of the Board of Trustees also spoke positively about the relationship with the University. 19. Both the College and the University officials also pointed to the synergetic relationship in respect of research. AECC’s strengths in this area had helped bolster the University’s profile and the University’s support and facilities had helped to enhance the College’s research capability. Recruitment, admissions policy and practice 20. The Panel explored AECC’s admissions policies and processes and its recruitment strategies. For 2007 entry the College will have a full listing with UCAS having had a restricted arrangement for 2006 entry. Nevertheless the College had recorded between 4 and 5 applications for each place available. In terms of marketing the College saw Norway (which is not a member state of the EU) as a particularly strong market and there have been some preliminary discussions with HEIs in Norway about the possible establishment of a new facility there. In addition the College has targeted Canada, Israel, Hong Kong and South Korea as possible sources of increased numbers of students. It was remarked that marketing was much wider in the pre-HEFCE funding days. Although these changes to recruitment and admission had resulted in a changed student demographic profile (there now being a greater proportion of younger students on entry) this had not led to a change in withdrawal or failure rates. 21. The student group that the Panel met were complimentary of the College’s recruitment processes. They spoke of the very good service given by support staff throughout the process. They felt themselves to be part of the College early on and any enquiry made was answered promptly and accurately with the impression given that each applicant was important as a person to the College.

Course design, integration and assessment 22. In several meetings with different groups of staff it was made clear to the Panel the extent of the whole staff involvement with the design of the new curriculum and the development of the programme of study. The emphasis within all of the early planning had been the desire to make the course more clinically driven than its predecessor. The course team had considered what would be required as output from the programme and then worked back from that goal. A significant emphasis had also been placed on a problem based approach in order to foster reflective practitioners able to take on sometimes contradictory evidence but still to be able to formulate an efficacious schedule of treatment. To that end basic sciences had been integrated into clinical practice. 23. As the programme is reaching the end of its first full cycle a large review is planned for the end of the academic year 2006 – 07. This will be in addition to the usual annual course review that has always taken place. 24. In order to promote integration and assimilation of students into clinical practice Year 3 of the programme is designated the ‘pre-clinic’ (or junior clinic) year. A more structured mentoring programme has been set in place that allows for students’ clinical development and also to ensure continuity of patient care across cohorts. 25. The course is more resource intensive than its predecessor and the Panel was pleased to record that additional resources had been put in place to deliver the curriculum effectively. Both staff and student workload is monitored on a regular basis. Student contact time is limited to 22 hours per week and staff loading is a maximum of 28 hours including preparation time. 26. Assessment processes have also been developed to be consonant with the programme of study and these include: topic papers, clinic based problem paper and the requirement for critical analysis of a research paper. 27. In response to a question about the pattern of assessment the Panel was informed that there were now no end of year examinations in year 1 but rather termly assessments. Years 2 and 3 also have these termly assessments but they also have end of year examinations, including the clinic entrance exam. Year 4 is the clinic year and the focus there is on the clinic exit examination and the research project. All OSCE assessments throughout the programme are pass/fail. 28. In several meetings the Panel discussed the various mechanisms that exist for redeeming partial failure and also for the moderation and standard setting for assessment. Compensation between modules is allowable only for marginal failure (48% or 49% - the pass park being 50%); a mark any lower would trigger a resit opportunity. Standard setting across the year and between modules is carried out by the whole teaching team. In setting all of the minimum pass standards the safety of student as clinician is the threshold. Feedback to students is on the basis of grade – although the actual mark is also available. 29. The Panel raised the College’s strategy for developing students’ fitness to practise. This was currently under development with a discussion document having

been circulated. Issues addressed include: inappropriate behaviour, professional impropriety, non-attendance at both clinical and academic sessions, attitude and enhanced CRB checks on entry. Consideration is also being given to a declaration to be made by on-going students at the beginning of each academic year. The Panel was pleased to note the development of the strategy and encouraged the College to continue with the work to fruition. Of particular use would be reinforcement of the GCC regulations on registration on a regular basis. 30. The development of the revised curriculum had been well received by the students and this increased satisfaction has been reflected in student feedback about the quality of their experience. The students also gave positive feedback to the Panel on the quality of student handbooks produced for each year of the programme. The students also indicated that some parts of the assessment schedule had been changed from termly to twice yearly. They felt that this had not been a positive move and they would like to see the previous schedule re-instated. 31. The Panel raised the matter of resources needed to manage student projects and also the criteria used to determine the acceptability of a project proposal. Staff members indicated that around four to six students are allocated to each staff member so that does mean that the indicative workload of 120 projects can be handled effectively. In assessing the suitability of a project proposal it is the process of being able to demonstrate critical thinking that is key. 32. The development of the student as practitioner was also discussed; the emphasis from the team here was on the students’ adoption of an approach based on the use of integrated techniques rather than the utilisation of a cookbook of techniques. Staff reported that students tend to have a fascination for techniques but it is the aim of the course to create a chiropractic problem solver rather than purely a technician. To that end a particular technique (Gonstead) is taught in an elective module although it also forms part of the mainstream programme. Research and staff development 33. The Panel indicated that the level of involvement of AECC staff in professional activities, especially research, was high. 34. Staff development activities were also strong. The relationship with Bournemouth University has enhanced such opportunities with AECC staff able to join staff induction programmes and other courses set up for Bournemouth staff. There are also opportunities for collaborative research and teaching with Bournemouth colleagues. Board of Governors vacancies 35. The Panel’s concerns in this area were around the skills gap that seemed apparent caused by the resignation or retirement of a number of governors. The senior staff were able to bring the Panel up to date. Two Board vacancies had recently been filled and, although these were not like for like replacements, the gaps that the College has also perceived were now filled. For example, the Panel was told that Tim Wheeler (Vice Chancellor of Chester University) had recently joined the Board and

his comprehensive background in higher education had meant that the Board was now able to discharge its responsibility in a number of areas including quality assurance. 36. The senior staff also stated that it remained the College’s intention that the Board of Governors reflects the international nature of both the student and staff population. It was acknowledged that this sometimes made identification and recruitment of the right people difficult. Conclusion 37. In conclusion the Chair of the Panel thanked the College for its hospitality and openness. He commended the College for     

the high standard of the documentation produced for the visit the patient centred curriculum the evidence of team working in the development of the curriculum the commitment of academic, administrative and support staff the extent and quality of the learning resources and plans for the new clinic.

38. The Panel was satisfied that the programme meets in full the GCC’s current Criteria for the Recognition of Degrees in Chiropractic. 39. The Panel concluded that they would recommend to the Education Committee recognition without conditions of the AECC M.Chiro programme for awards achieved between 1 June 2013 and 30 September 2017 ie for a period of five years commencing with the student intake of 2009. 40.

All programmes recognised by the GCC are subject to annual monitoring.

The Panel made the following recommendations: a. The College should continue its work in developing a strategy for ensuring students’ fitness to practise. b. The requirements for GCC registration should be made clear in the College’s information provided to applicants prior to entry to the programme and also that these requirements should be reinforced at registration for the start of each academic year.