In 2018, the Irish Medical Council gave Trinity’s School of Medicine two years to fix a ream of problems facing students on badly planned placements – in which students faced high stress in an under-supervised environment – before the council’s assessors returned to decide whether or not College should keep its accreditation.
College has said that since the report, the School “has worked hard to implement the various recommendations made in the report and address any issues that were identified”. However, the 2018 report described a clinical placement programme in disarray and an apathetic School that was “dismissive of stress, mental health issues and wellbeing of the students”.
In total, Trinity only managed to fully pass two of the nine levels of compliance that the Medicine Council sets out as the yardstick for its reports, with the council recommending that Trinity only keep its accreditation for two more years. This was in stark contrast to College’s 2011 report when it was given just 10 recommendations – compared to the 24 recommendations in the 2019 report – and a five-year extension to its accreditation.
The report focused on the School’s sub-par clinical placements, and “strongly recommended” that the School carry out a full review of its clinical training sites and improve the supports provided to struggling students.
Third and fifth-year students appeared to bear the brunt of the shortcomings, with other years emerging relatively unscathed.
The recommendations followed complaints from students that placement was often “undermined by poor organisation and communication from the School of Medicine administration”.
Students described a clinical environment in which they were overlooked: the educational roles of staff were hazy with students describing a “fend for yourself” approach to placement, tutorials were often cancelled at short notice and not rescheduled and the students complained that hospitals didn’t cover the whole curriculum with doctors sometimes being unaware of what students had been previously taught.
Third-year students on placement at Tallaght University Hospital, for example, said that they felt that they were “considered a burden on the teams to which they were allocated”.
Furthermore, the council felt that the clinical training sites needed to “clearly define key educational roles and the required training for such rules” and to make sure that sites had someone on hand who would deal with the “oversight of the delivery of the curriculum and assessment”.
The School relied heavily on junior doctors to teach students and, often, students were expected to pursue “self-directed learning” while on placement.
Students also complained of the financial burden of the course which requires certain travel expenses and a number of compulsory courses, “some of which were self-funded and expensive”, it said.
Fifth-year students stated that they received €150 in funding for either travel or accommodation for placements that generally cost “around €500”.
The report said that third years described “an intense curriculum”, which was inhibited by “poor administration and placement planning and a reliance on self-directed learning”.
The report also found that third and fifth-year students said that they were experiencing a high level of stress and that the supports provided by the School and the College were “not effective”.
In an email statement to The University Times, Catherine O’Mahony, a Trinity media relations officer, said that “Trinity College Dublin welcomes the fact that there is a demanding accreditation process in place for the School of Medicine, as run by the Irish Medical Council (IMC), and values the opportunities for improvement and action that arise from such processes. The IMC’s approach underpins the fact that Ireland’s medical training is of so high a standard”.
O’Mahony added that the School worked “extremely hard to benchmark its activities against those of other high-quality medical schools worldwide”. It has also “engaged fully with the IMC in this instance”, O’Mahony said, adding: “We wish to make clear that the Irish Medical Council’s visit referred to in the report took place in 2018 and refers to a period before then.”
“In the intervening period the School of Medicine has worked hard to implement the various recommendations made in the report and address any issues that were identified”, she said. “Most of the recommendations have now been implemented while some remain a work in progress, due to the COVID-19 pandemic.”
“At a meeting with the School on October 1, the Medical Council congratulated the School on the work done thus far and said they hoped to continue to work positively with it in the next months.”
“The School of Medicine is also working with its healthcare partners and with other units in Trinity on those aspects noted in the report that are not directly under the School’s control.”
While changes may have been made now, in 2018, when students did speak up regarding issues experienced on placement, they were “told to take responsibility themselves for issues”.
“The majority of the students interviewed felt they were not being heard”, the report added.
Indeed, students complained that the School was not providing an “adequate level of care”. According to the report, the School “was critical and unsupportive” when students expressed their concerns. “Some students appeared upset describing their experiences”, it said.
On this front, the report’s assessment of the School was damning, stating that there was “a consistent theme at every meeting” with third-years: “They stated that the School of Medicine was dismissive of stress, mental health issues and wellbeing of the students.”
Moreover, the report noted that although some class representatives brought students’ issues to the School, they were rarely acted upon, leaving class representatives reluctant to “raise their heads above the parapet”.
The School also came under fire for its handling of exams – a trend that has continued this year. In March, for example, final-year medicine students in Trinity were told that crucial clinical assessments – worth 25 per cent of their marks for the year – would be moved forward five weeks.
The Medical Council recommended that the School “puts pressure” on College “to introduce and disseminate a fixed timetable of assessments and exam dates at the beginning of each academic year”.
The recommendation came off the back of complaints made by students who said that they were given “extremely tardy information” about exam dates – with as little as one week’s notice – making preparation for exams “extremely challenging” for them.
The report found that the lack of clarity surrounding exams “caused a lot of difficulty and anxiety for students”.
Finally, the Medical Council strongly recommended “that Trinity College Dublin fill all vacant posts within the School of Medicine as a matter of urgency”.
In its report on the Institute of Population Health and Primary Care in Tallaght, the Medical Council said that the “current vacancy for the position of Chair of General Practice has led to poor representation and advocacy”.
Since the report was published, the School said that it has introduced a number of changes to improve the running of the undergraduate medicine programme, including extra counselling services for students on placement and a “fundamental review and renewal” of third-year placements – which it says has received positive feedback. The School said that it has also improved communication with students, introducing weekly meetings with class reps and senior members of staff, and that the School has “worked hard to fill all vacancies in the School”.
Students have also been made aware of the Medical Council report and the “work that the School has been doing to address the recommendations”.
