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
Clinical psychology programmes at Royal Holloway, University of London in partnership with North Central London and North West London Strategic Health Authorities 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:
Pre-registration
- Doctorate in Clinical Psychology (DClinPsy)*
Post-qualification
- Postgraduate Diploma in Cognitive Behavioural Psychotherapy (PgDip CBT).
* Programme approved by the British Psychological Society
Academic and practitioner standards
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Clinical Psychology and Cognitive Behavioural Psychotherapy at Royal Holloway, University of London in partnership with North Central London and North West London Strategic Health Authorities.
Strengths
- The development of two novel roles, associate clinical tutors (employed by the HEI) and liaison tutors (employed by NHS Trusts), has helped establish a well-coordinated team approach to organising clinical placements for the Doctorate in Clinical Psychology programme (paragraph 19).
- The assessment task for Doctorate in Clinical Psychology trainees to produce a journal-ready article based on the student's thesis contributes to the healthy proportion of research publications in peer-reviewed journals produced by trainees on the programme (paragraph 20).
- The best academic work in both programmes showed evidence of sophisticated integration, analysis and reflection. There was evidence of work of the very highest quality (paragraph 29).
Weaknesses
- There is some, although as yet limited, involvement of users and carers in the design and delivery of the Doctorate in Clinical Psychology curriculum (paragraph 16).
- The Postgraduate Diploma in Cognitive Behavioural Psychotherapy programme has not considered ways in which users and carers might contribute to the design and delivery of the curriculum (paragraph 16).
- The return of marked work to Postgraduate Diploma in Cognitive Behavioural Psychotherapy students is sometimes slow (paragraph 23).
- The current learning outcome in the programme specification, which refers to the supervision competence of Postgraduate Diploma in Cognitive Behavioural Psychotherapy graduates, is inappropriate and needs to be brought into line with the information in the programme guide (paragraph 28).
Quality of learning opportunities
Learning and teaching
The quality of learning and teaching is commendable.
Strengths
- All staff members on the Doctorate in Clinical Psychology programme are research-active and have ongoing therapeutic responsibilities. The Postgraduate Diploma in Cognitive Behavioural Psychotherapy staff members also have substantial clinical and teaching experience on which students are able to draw. These role models help trainees develop strong and credible links between research/theory and professional practice (paragraph 31).
- Statistics teaching, in particular, is highly regarded by Doctorate in Clinical Psychology trainees (paragraph 32).
Good practice
- The Audit of Clinical Experience system, designed to help Doctorate in Clinical Psychology tutors and trainees monitor and plan learning on placements, is an innovative and very promising development (paragraph 32).
Student progression
The quality of student progression is commendable.
Strengths
- The quality and detail of the various Doctorate in Clinical Psychology programme handbooks are especially impressive (paragraph 38).
- Doctorate in Clinical Psychology trainees commented on the excellent level of support available from staff in the academic, research and clinical environments (paragraph 38).
Learning resources and their effective utilisation
The quality of learning resources and their effective utilisation is commendable.
Weakness
- Some Docorate in Clinical Psychology trainees reported that resources to support their clinical administration ane practice are very limited, that finding sufficent 'desk space' is problematic and that clinical rooms are scarce (paragraph 44).
Maintenance and enhancement of standards and quality
Strengths
- The Postgraduate Diploma in Cognitive Behavioural Therapy has quickly established a praiseworthy culture of seeking out and acting on feedback from students and supervisors (paragraph 48).
- There is a strong working relationship between the Doctorate in Clinical Psychology programme and the NHS training commissioners in the North Central London Strategic Health Authority (paragraph 49).
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 clinical psychology programmes at Royal Holloway, University of London (RHUL), in partnership with North Central London Strategic Health Authority (NCLSHA) and North West London Strategic Health Authority (NWLSHA). The review was completed during the academic year 2005-06.
2 RHUL provides two healthcare programmes, the pre-registration Doctorate in Clinical Psychology (DClinPsy), which began in September 1997, and the post-qualification, Postgraduate Diploma in Cognitive Behavioural Psychotherapy (PgDip CBT), which began in January 2004. The DClinPsy is delivered in partnership with NCLSHA and the PgDip CBT with NWLSHA.
3 The DClinPsy is a three-year, postgraduate programme based within the Royal Holloway Psychology Department. The programme was accredited by the British Psychological Society (BPS) in 2001 and leads to a qualification that enables trainees to work in the National Health Service (NHS) as clinical psychologists. Trainees hold employment contracts with Camden and Islington Mental Health and Social Care NHS Trust. The NCLSHA commissions training on behalf of the five London SHAs, of which the RHUL doctorate is one of the six commissioned programmes. The DClinPsy Programme Director is a member of the Clinical Psychology Sub-group (CPSG) of the NCLSHA, which has lead responsibility for the strategic development and management of training across London.
4 The PgDip CBT is an 18-month part-time, multidisciplinary programme. It is based at the Psychology Department of the Central and North West London Mental Health Trust, with teaching facilities located close by in Paddington. Students are drawn from different professional groups from within the NHS, including nursing, clinical psychology, psychiatry, and occupational therapy. Places are commissioned mainly by the North West London Strategic Health Authority and students come predominantly, though not exclusively, from Trusts within NWLSHA. The British Association of Behavioural and Cognitive Psychotherapies (BABCP) is currently developing an accreditation process for training programmes.
A Subject provision and overall aims
5 The provision currently offers the following programmes:
Pre-registration
- Doctorate in Clinical Psychology*
Post-qualification
- Postgraduate Diploma in Cognitive Behavioural Psychotherapy.
* BPS-approved programme
6 RHUL's mission statement makes clear its commitment to facilitating high-quality research, learning and teaching to enhance the public good. The overall aim of the subject provision is to equip students with the skills and knowledge to be effective practitioners within the NHS in their chosen areas of practice. To this end, RHUL and its partner NHS Trusts aim to deliver high-quality programmes of study and placement experience that meet the requirements of the relevant professional and/or regulatory bodies.
7 The stated aims of the DClinPsy demonstrate a commitment to producing graduates who are eligible to practise as clinical psychologists within the NHS and to attain chartered status as clinical psychologists under BPS regulations. The programme aims to contribute to the NHS increased workforce requirements for clinical psychologists locally and nationally, having increased the annual intake from 12 in 1997 to a current one of 26.
8 The PgDip CBT provides professional development at the postgraduate level for individuals who are employed in mental health service provision and have the need to use cognitive behavioural therapy (CBT) in their everyday work. Building upon students' previous experience, the taught component of the programme aims to develop a comprehensive and critical understanding of the theoretical basis of CBT and the research evidence for its effectiveness for different types of client. The programme also includes a practical component involving supervision and guidance in CBT practice, the ultimate aim of which is to ensure that all programme graduates meet the recognised minimum level of clinical competence in the application of CBT, as defined by the BABCP.
B Academic and practitioner standards
Intended learning outcomes
9 The intended learning outcomes (ILOs) of the programmes are comprehensive and clearly stated in the programme specifications. The ILOs fully support the aims of the programmes to train psychology graduates to qualify as clinical psychologists, and a variety of mental health clinicians to become CBT-competent practitioners within the NHS. The ILOs of both programmes support trainees and students in becoming fit for practice, purpose and award.
10 The DClinPsy ILOs reflect the Subject benchmark statement for clinical psychology, published by QAA, and are consistent with the criteria for the Accreditation of Postgraduate Training Courses in Clinical Psychology, published by the BPS. They are being further developed, although no specific reference has so far been made to the emerging health professions framework. The ILOs of the PgDip have been developed in accordance with the requirements of the BABCP. There are mechanisms in place, including representative committee structures, to ensure that the ILOs are monitored and developed to meet the changing needs of stakeholders. There is also discussion with, and some shared ownership of the ILOs by, clinicians, supervisors, DClinPsy trainees and PgDip students. Indeed, for both programmes, the level of ownership and commitment to delivering the ILOs across a broad range of stakeholders is impressive, although this is more evident on the DClinPsy, where partnership arrangements are longer established.
11 The move toward a nationwide, competence-based learning framework in clinical psychology requires that programmes revisit and redevelop their ILOs, particularly in relation to practice-based learning. At RHUL, the DClinPsy programme is, for the most part, working in partnership with local placement providers to ensure the appropriateness and feasibility of any agreed placement learning objectives.
12 For both programmes, the ILOs listed in the programme specifications are consistent with, but not entirely the same as, those disseminated to staff and students. This inconsistency is most evident in the DClinPsy, where an abridged version of the programme's ILOs is disseminated through the student and supervisor handbooks. Trainees and supervisors on the DClinPsy indicate that both handbooks are easily available and accessible and confirm that the ILOs, as stated, are clear and sufficient. Staff have also recently finalised individualised outcomes for specific modules and pieces of assessed work.
13 PgDip CBT students and supervisors consider themselves well informed of the programme's ILOs. The Cognitive Therapy Scale (CTS-R), used in support of practice-based learning, is consistent with the programme's stated ILOs and provides clear guidance for students and supervisors about learning objectives on placement. All supervisors are given a copy of the programme guide, which contains the ILOs and a manual of the CTS-R that provides more specific information about CBT skills. A handbook for PgDip CBT supervisors is currently being developed.
Curricula
14 The DClinPsy programme espouses the values of evidence-based practice. It has combined a competence-based framework with its established research strengths to produce a curriculum that meets the professional standards stipulated in the Subject benchmark statement for clinical psychology training. Overall, the curricular content is balanced and comprehensive. The PgDip CBT encourages its students to take a critical and informed approach to both the theory and practice of CBT. The programme has been designed to be consistent with the professional standards under development by the BABCP.
15 The DClinPsy programme prepares trainees well in applied research skills, using both quantitative and qualitative methodologies. All staff on the programme are university employees and expected to be research-active. This contributes to the good quality and range of research supervision on offer. Students on the PgDip CBT are encouraged to develop a sophisticated appreciation of the current status of the evidence base in their field.
16 There is some, although as yet limited, involvement of users and carers in the design and delivery of the DClinPsy curriculum. This is recognised as an area for development by the programme. The programme provides teaching and supervised clinical experience that cover a range of psychotherapeutic approaches, although trainees tend to choose to write up their reports of clinical activity using a cognitive-behavioural framework. The PgDip CBT curriculum benefits from contributions from external lecturers who are recognised authorities in their subjects. The PgDip programme has not considered ways in which users and carers might contribute to the design and delivery of the curriculum.
17 Interprofessional learning (IPL) opportunities on the DClinPsy programme arise predominantly on clinical placements. Supervisors across all specialties reported that trainees get frequent experience of co-working with colleagues from a variety of other healthcare disciplines. In the future, the Audit of Clinical Experience (ACE) computer system for recording learning experiences on placement will be able to provide a cumulative record of IPL for each trainee. The PgDip CBT has a multidisciplinary intake of students from a range of healthcare professions such as nursing, psychiatry and clinical psychology. Joint teaching therefore offers regular opportunities for IPL. However, supervision groups have sometimes been organised on a unidisciplinary basis to accommodate differing levels of students' prior experience of CBT.
18 The DClinPsy curriculum is appropriately pitched at doctoral level and in line with the guidance provided by The framework for higher education qualifications in England, Wales and Northern Ireland (FHEQ), published by QAA. There is also evidence of a definite developmental strategy in the design of the curriculum, especially evident in the research thread of the programme and the therapeutic 'master classes' in which year-three trainees present cases for analysis from a multitheoretical perspective. The PgDip CBT programme is designed to accommodate the learning needs of students with differing prior educational experiences. Hence, the curriculum commences with teaching the fundamental principles of CBT and moves in an appropriately developmental fashion to consider specialist application of the approach to particular clinical problems. The curriculum is appropriately pitched at postgraduate diploma level, in line with the FHEQ.
19 Allocation of DClinPsy clinical placements is managed jointly with the clinical psychology training programmes at the University of East London (UEL) and University College London (UCL). These collaborative arrangements allow allocating tutors to ensure that all trainees gain the full range of experiences necessary to develop the competences prescribed by the BPS. The development of two novel roles, associate clinical tutors (employed by the HEI) and liaison tutors (employed by NHS Trusts), has helped establish a well-coordinated team approach to organising clinical placements for the DClinPsy programme. The placement contract specifies both the core competences to be developed and the individual learning outcomes expected of the trainee.
Assessment
20 DClinPsy trainee achievement of the ILOs is assessed by a variety of appropriate methods. Academic skills are assessed through written work, including essays and unseen examinations, while research competence is assessed by a substantial thesis. The assessment task for DClinPsy trainees to produce a journal-ready article based on the trainee's thesis contributes to the healthy proportion of research publications in peer-reviewed journals produced by trainees on the programme. PgDip CBT ILOs are also assessed using a variety of different assignments, including direct sampling of 'live' therapy, case-studies promoting theory/practice integration and academic essays designed to evaluate students' capacity to demonstrate a critical understanding of the evidence base.
21 Feedback for DClinPsy trainees on their clinical performance on placements is structured using the same competence framework that informs the taught component of the programme. Supervisors can attend well-designed training events, organised in line with BPS requirements, that prepare them for their role as assessors and include specific guidance on programme procedures relating to placement failure. The clinical skills of students on the PgDip CBT are carefully assessed through the evaluation of audiotape recordings of therapeutic conversations using a well-established specialist scale. Students on the programme reported that this explicit framework helps them appraise their evolving competence in CBT.
22 All academic work on the DClinPsy programme is double-marked, and clinical supervisors can also use a referral system to seek a second opinion from programme tutors when they have concerns about the adequacy of a trainee's performance on placement. External examiners' reports indicate confidence in the rigour, fairness and quality of the marking of assessed work. The initial PgDip CBT external examiner's report confirms that the marking process is rigorous and that appropriate qualitative feedback is provided to students on their work.
23 Assessment strategies on the DClinPsy programme bridge both the University and NHS components of the programme. They are in accord with the Code of practice for the assurance of academic quality and standards in higher education (Code of practice), Section 6: Assessment of learning, published by QAA. Video feedback on basic interviewing skills is provided by programme staff at the end of the introductory teaching block, and some clinical supervisors act as second-markers on the reports of clinical activity. The programme is seeking to improve its methods for inducting supervisors into this assessment role so as to increase their level of involvement. Staff recognise that the return of marked work to PgDip CBT students is sometimes slow. Staff have set in motion measures intended to remedy this deficiency.
24 Both programmes have established systems for identifying and supporting students with special educational needs, and can employ the resources of the Educational Support Office of RHUL to ensure that the work of any such students is fairly and appropriately assessed.
Student achievement
25 Tables 1a and 1b show the Pass rates for graduates of both programmes and the employment destinations of graduates of the DClinPsy programme. Overall, the degree and diploma results demonstrate the high quality of student achievement across both programmes.
26 The DCIinPsy programme has a very high success rate and is producing trainees who are fit for practice, purpose and award. External examiners' reports are complimentary about the standard of trainee achievement. A 100 per cent Pass rate has been achieved for all cohorts over the past three years, with between 88 and 100 per cent of each cohort taking up appointments in the NHS, about one-third of these with local employers. Feedback from employers and past trainees confirms the quality and employability of graduates of the programme.
27 The results for the first completing cohort of the PgDip CBT show that nearly half the students exit with Merit or Distinction. PgDip CBT students are, generally, already employed in the local NHS. However, there was a clear indication from recent graduates, supervisors and employers that the programme equips graduates with a range of competences to enhance their existing roles and, subject to acquiring BABCP accreditation, prepares them to become specialist cognitive behavioural psychotherapists within the NHS. There is, necessarily as yet, a paucity of data on graduates of the PgDip CBT, but the programme intends to follow up graduates, to research their experience after qualifying, and to monitor their career development.
28 Across the two programmes, the reviewers scrutinised more than 30 pieces of assessed work, including reports of clinical activity, essays, small-scale research projects and dissertations, and were satisfied that this demonstrated assessment and achievement of the ILOs. However, PgDip CBT students' expectation of gaining supervision competence is not being met as this is insufficiently taught or assessed. The current learning outcome in the programme specification, which refers to the supervision competence of PgDip CBT graduates, is inappropriate and needs to be brought into line with the information in the programme guide.
29 The reviewers found that the level of student achievement was commensurate with the awards of doctorate and postgraduate diploma and that the best academic work in both programmes showed evidence of sophisticated integration, analysis and reflection. There was evidence of work of the very highest quality in essays and, in clinical casework, theory and practice were expertly integrated and critically scrutinised, although the reviewers note the relative paucity of casework written outside the cognitive behavioural paradigm on the DClinPsy. The quality of the research submissions of trainees on the DClinPsy programme is notable, and the record of third-year dissertation publication in refereed journals is impressive. A praiseworthy eight (47 per cent) of the first completing PgDip CBT cohort achieved Distinction or Merit awards, with a further 47 per cent achieving a Pass grade.
30 The reviewers visited a variety of placement settings within North and North-West London, meeting with trainees, recent graduates of both programmes, supervisors and employers. Recent graduates from the DClinPsy reported that the programme had provided them with the knowledge and skills necessary to undertake their first appointment as clinical psychologists. Graduates of the PgDip CBT spoke positively about the programme in terms of equipping them with knowledge and skills of benefit to their existing work settings, but also spoke of it as a good foundation for practising as cognitive behavioural psychotherapists. The programme team also provides some informal support to graduates of the programme who are in pursuit of BABCP accreditation. Supervisors working with a range of clinical client groups commented on the impressive quality of graduates from both programmes. They complimented them on the high standard of their clinical skills, while employers expressed satisfaction with the way in which the competences and skills of those who had completed either programme met their service requirements.
Table 1a: Completion and achievement statistics for all award-bearing programmes in clinical psychology
| Programme | Cohort | Doctorate and Diploma programmes Pass |
Doctorate and Diploma programmes Fail |
||
|---|---|---|---|---|---|
| No. | % | No. | % | ||
Doctorate in Clinical Psychology |
Sept 2000 | 16 | 100 | ||
| Sept 2001* | 18 | 90 | |||
| Sept 2002** | 6 | 25 | |||
| PgDip in Cognitive Behavioural Psychotherapy | Jan 2004*** | 16 | 94 | ||
* Two trainees (10 per cent) not yet completed
** 18 (75 per cent) not yet completed
*** One student yet to complete
Table 1b: Employment statistics for all pre-registration programmes and exception reporting only for post-registration/post-qualification programmes in clinical psychology
| Programme | Further study | Local employers | Employers elsewhere | Unemployed | Other | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | %1 | No. | % | |
| Doctorate in Clinical Psychology Sept 1999 Sept 2000 Sept 2001 | ||||||||||
| 0 | 9 | 56 | 5 | 32 | 0 | 2* | 13 | |||
| 0 | 10 | 63 | 6 | 38 | 0 | 0 | ||||
| 0 | 12 | 60 | 5 | 25 | 0 | 3** | 15 | |||
| PgDip in Cognitive Behavioural Psychotherapy Jan 2004 | ||||||||||
| 17*** | 100 | |||||||||
* Unknown
** Two unknown; one extending training
***First graduating cohort in PgDip CBT Sept 2005
Summary of academic and practitioner standards for clinical psychology
Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Clinical Psychology at Royal Holloway, University of London in partnership with the North Central London and North West London Strategic Health Authorities.
Strengths
- The development of two novel roles, associate clinical tutors (employed by the HEI) and liaison tutors (employed by NHS Trusts), has helped establish a well-coordinated team approach to organising clinical placements for the Doctorate in Clinical Psychology programme (paragraph 19).
- The assessment task for Doctorate in Clinical Psychology trainees to produce a journal-ready article based on the trainee's thesis contributes to the healthy proportion of research publications in peer-reviewed journals produced by trainees on the programme (paragraph 20).
- The best academic work in both programmes showed evidence of sophisticated integration, analysis and reflection. There was evidence of work of the very highest quality (paragraph 29).
Weaknesses
- There is some, although as yet limited, involvement of users and carers in the design and delivery of the Doctorate in Clinical Psychology curriculum (paragraph 16).
- The Postgraduate Diploma in Cognitive Behavioural Psychotherapy programme has not considered ways in which users and carers might contribute to the design and delivery of the curriculum (paragraph 16).
- The return of marked work to Postgraduate Diploma in Cognitive Behavioural Psychotherapy students is sometimes slow (paragraph 23).
- The current learning outcome in the programme specification, which refers to the supervision competence of Postgraduate Diploma in Cognitive Behavioural Psychotherapy graduates, is inappropriate and needs to be brought into line with the information in the programme guide (paragraph 28).
C Quality of learning opportunities
Learning and teaching
31 All staff members on the DClinPsy programme are research-active and have ongoing therapeutic responsibilities. The PgDip CBT staff members also have substantial clinical and teaching experience on which students are able to draw. Clinical supervisors provide a significant proportion of the teaching on the DClinPsy curriculum. These role models help trainees develop strong and credible links between research/theory and professional practice.
32 Both programmes employ an appropriate range of teaching methods that are well matched to their stated ILOs. Statistics teaching, in particular, is highly regarded by DClinPsy trainees. On the DClinPsy programme, preparation for the initial placement is sound. The thorough university-based training in psychometrics is valued by both trainees and supervisors. The ACE system, designed to help tutors and trainees monitor and plan learning on placements, is an innovative and very promising development. PgDip CBT students report that theory/practice links are helpfully strengthened by the timetabling of group supervision discussions that immediately follow formal teaching sessions.
33 Not all DClinPsy trainees are able to gain access to specialist placements in services for older adults and people with learning difficulties. However, the placement planning system, coordinated across the three North London DClinPsy training programmes, allows allocating tutors to ensure that all trainees gain the experience necessary to develop the competences required for independent professional practice. Not all PgDip CBT students find it easy to take on appropriate training cases within their own agencies. In these circumstances, programme tutors have helpfully used their network of local NHS contacts to arrange access to suitable patients. Both programmes place a high priority on the development of safe and ethical professional practice.
34 DClinPsy programme documentation is comprehensive and detailed. Hard copies of this material are provided for supervisors, and trainees can access a web-based version on a password-protected intranet. However, as yet, only limited information on either the DClinPsy or PgDip CBT is posted on RHUL's Department of Psychology website for access by external users.
35 Clinical supervisors on the DClinPsy can attend what they consider to be well-regarded training workshops organised jointly by the RHUL, UCL and UEL programmes. Supervisors report that these events are considered relevant and appropriately pitched to their learning needs. However, although supervisor workshops are designed around explicit learning objectives, individual learning outcomes are not systematically assessed. PgDip CBT staff are in the process of producing a handbook for supervisors to clarify programme expectations of their role. This initiative should fill an important gap in existing programme documentation. It is likely to trigger further developments in training opportunities for PgDip CBT supervisors to parallel the peer review system used as a quality assurance strategy for the taught component of the programme.
The quality of learning and teaching is commendable.
Strengths
- All staff members on the Doctorate in Clinical Psychology programme are research-active and have ongoing therapeutic responsibilities. The Postgraduate Diploma in Cognitive Behavioural Psychotherapy staff members also have substantial clinical and teaching experience on which students are able to draw. These role models help trainees develop strong and credible links between research/theory and professional practice (paragraph 31).
- Statistics teaching, in particular, is highly regarded by Doctorate in Clinical Psychology trainees (paragraph 32).
Good practice
- The Audit of Clinical Experience system, designed to help Doctorate in Clinical Psychology tutors and trainees monitor and plan learning on placements, is an innovative and very promising development (paragraph 32).
Student progression
36 Admission policies and procedures for the DClinPsy are clearly stated and appropriate. As with other UK clinical psychology programmes, application is through a central clearing-house. The programme recognises that the limited number of applicants from black and minority ethnic (BME) groups is a problem. The programme has implemented a number of initiatives focused on raising the profile and accessibility of clinical psychology training to undergraduate BME populations but has yet to benefit from these initiatives. Recruitment to the DCIinPsy programme is buoyant. In 2005, there were 440 applicants and a shortlist of 90 was interviewed for the total of 26 places. The PgDip CBT takes applications from a wide range of clinicians working in the local health economy. NHS clinicians from the region are involved in selection and recruitment across both programmes, although the reviewers note the lack of involvement of service users in selection. The DClinPsy programme is currently considering how it might involve service users in its admissions process.
37 Both programmes provide students with induction teaching and work to ensure that they are adequately prepared for their first placement, in line with the Code of practice, Section 9: Placement learning. As part of the induction on the DClinPsy, trainees participate in a 'pass out' intended to ensure that they are fit to start their first placement. However, some placement supervisors questioned the preparedness of DClinPsy trainees in relation to their clinical assessment and report-writing skills, although others reported that the programme's induction procedures are comprehensive and sufficient. Similar discrepancies were noted in the accounts offered by several trainees.
38 At induction, students on both programmes are allocated a personal tutor (DClinPsy) or personal adviser (PgDip CBT) and are provided with sufficient written information about their programme, including information about how to access appropriate support. The quality and detail of the various DClinPsy programme handbooks are especially impressive. The DClinPsy trainees commented on the excellent level of support available from staff in the academic, research and clinical environments.
39 Trainee withdrawal from the DClinPsy is a rare event (Table 3). The last two trainees to do so were from the 2000 entry cohort. So far, only one student in each of the two cohorts has withdrawn from the PgDip CBT. These favourable statistics underline sound admissions processes and the consistently high quality of support given to students throughout these programmes.
Table 3: Recruitment and attrition statistics
| Award title | Recruited number | Withdrawal | Transfer in | Transfer out | Discontinuation | ||||
|---|---|---|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | No. | % | ||
| Doctorate in Clinical Psychology | |||||||||
| Sept 2000 | 18 | 2 | 11 | 0 | 0 | 0 | 0 | 0 | |
| Sept 2001 | 20 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| Sept 2002 | 24 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| Postgraduate Diploma in Cognitive Behavioural Psychotherapy | |||||||||
| Jan 2004 | 18 | 1 | 5 | 0 | 0 | 0 | 0 | 0 | |
| Jan 2005 | 21 | 1 | 5 | 0 | 0 | 0 | 0 | 0 | |
The quality of student progression is commendable.
Strengths
- The quality and detail of the various Doctorate in Clinical Psychology programme handbooks are especially impressive (paragraph 38).
- Doctorate in Clinical Psychology trainees commented on the excellent level of support available from staff in the academic, research and clinical environments (paragraph 38).
Learning resources and their effective utilisation
40 The taught component of the DClinPsy curriculum is delivered by an appropriately experienced staff team, supplemented with significant contributions from both local clinical supervisors and invited 'expert' speakers from outside the programme community. Both programmes are well staffed and have good administrative support. All the academic staff are active practitioners in the NHS and so possess up-to-date, practice-based expertise in their field. Between them, the staff team covers a wide range of subject areas and approaches relevant to clinical psychology in general and cognitive behavioural psychotherapy in particular.
41 The programmes are supported by the Camden and Islington NHS Trust which employs all the trainees. The DClinPsy Programme Director holds the programme budget, while human resource and financial support are reported by the programme team to be effectively managed for the staff by RHUL and for the trainees by the employing Trust.
42 The DClinPsy programme has the use of large, dedicated, fit-for-purpose teaching rooms, which include PowerPoint, OHP, VCR and other teaching resources. There are also some rooms available for small-group work. The teaching rooms also serve as common rooms for trainees. PgDip CBT students have access to suitable teaching space and other resources based at the Woodfield Road Centre for Mental Health, the administrative base for the PgDip CBT.
43 There is an appropriate level of information technology (IT) resourcing across both programmes, with a sufficient number of accessible, networked PC terminals and good access to CD-ROM resources, research and statistical analysis packages and electronic journals, although some trainees have commented on the limited access to electronic journals. Many of the IT resources are dedicated for trainees on the DClinPsy, but there are additional facilities available as part of the wider psychology subject group provision. There are well-resourced library facilities at RHUL for DClinPsy trainees, and PgDip CBT students have access to facilities at St Mary's Hospital library as well as some resources on site at the Woodfield Road Centre for Mental Health. There is also an impressive library of psychometric tests held at RHUL for use by DClinPsy trainees.
44 Resources on placement are variable. Some DClinPsy trainees reported that resources to support their clinical administration and practice are very limited, that finding sufficient 'desk space' is problematic and that clinical rooms are scarce. However, others reported good access to networked PCs and library resources and sufficient space. In terms of resourcing, fewer problems were reported by PgDip students. This is probably due to the fact that, for many, their routine place of work provides their clinical placement.
45 The challenge of securing sufficient resources to support clinical psychology trainees on placement is a national issue. The programme staff team is aware of it and, in partnership with the other North London programmes and the various placement providers, is seeking to make the best of limited resources. Initiatives have included the move to a competence-based framework, close cooperation and the rationalisation of placements across the three regional programmes. However, some placement supervisors commented that insufficient planning and notification of placements sometimes hampered their ability to safeguard and effectively utilise resources.
The quality of learning resources and their effective utilisation is commendable.
Weakness
- Some Doctorate in Clinical Psychology trainees reported that resources to support their clinical administration and practice are very limited, that finding sufficient 'desk space' is problematic and that clinical rooms are scarce (paragraph 44).
D Maintenance and enhancement of standards and quality
46 The DClinPsy programme forms part of the wider provision of RHUL's Department of Psychology, which was highly rated in the 2001 subject review. The programme is also subject to the extensive and appropriate internal quality assurance mechanisms employed by RHUL. The programme staff and partners have taken care to ensure that practices are in accordance with the Code of practice, published by QAA. The validation of the PgDip CBT in 2003 was conducted in accordance with RHUL guidelines that included external representation on the validation panel.
47 The DClinPsy programme was accredited by the BPS in 2001 and was commended for its research and academic standards. The specific suggestions for improvements to the programme made in that accreditation report have been acted upon. The appropriate external accrediting body for the PgDip CBT is the BABCP. At present, the BABCP is developing processes for programme accreditation. It is anticipated that this programme will be submitted for accreditation in 2006.
48 There is established consultative machinery on the DClinPsy programme that supervisors and students can use to provide feedback to programme staff. Both trainees and NHS-based supervisors express confidence in their ability to raise any matters of concern with programme staff who have the reputation for responding respectfully and promptly to any such feedback. The PgDip CBT has also quickly established a praiseworthy culture of seeking out and acting on feedback from students and supervisors.
49 There is a strong working relationship between the DClinPsy programme and the NHS training commissioners in the NCLSHA. Contract review meetings are held regularly and the Programme Director is a member of the CPSG that develops common policy initiatives across the three clinical psychology training programmes in North Central London, North-East London and North-West London. An important example of this collaboration is the Diversity Working Group that is responding to evidence that clinical psychology training programmes in the UK, including this one, do not currently attract applications from all sections of the community the NHS serves. The RHUL programme's commitment to this principle is unambiguously expressed in the advice to applicants contained in its 2006 entry in the Clearing House for Postgraduate Courses in Clinical Psychology handbook.
50 Day-to-day liaison between the DClinPsy programme staff, who manage clinical psychology trainees, and representatives of the Camden and Islington NHS Trust that employs them is described as working in a mutually satisfactory manner. The NCLSHA carries out a contract review every five to seven years when the contract comes up for renewal. In addition, the DClinPsy programme team produces an annual report for the NCLSHA, as well as dealing in an informal manner with any matters of mutual concern as and when they arise.
51 Although neither the DClinPsy or PgDip CBT programmes have made major moves towards incorporating users and carers in the design and delivery of their programmes, a number of the NHS Trusts with whom they have established partnerships have extensive experience that will inform future initiatives in this important area of development.
52 The self-evaluation document produced for the review, although not fully conforming to the structure laid down by QAA, was evaluative, contained self-critical analysis and provided the reviewers with a sound basis for their enquiries.
Strengths
- The Postgraduate Diploma in Cognitive Behavioural Therapy has quickly established a praiseworthy culture of seeking out and acting on feedback from students and supervisors (paragraph 48).
- There is a strong working relationship between the Doctorate in Clinical Psychology programme and the NHS training commissioners in the North Central London Strategic Health Authority (paragraph 49).
Action plan
Major Review of healthcare programmes
DECEMBER 2005
Royal Holloway, University of London in partnership with
North Central London and North West London Strategic Health Authority
We have discussed and agreed the following action plan:
Title of organisation (Lead SHA/WDC): North Central London and Strategic Health Authority
Signature: Mr Alan Davies
Position: Acting Director of Workforce Development
Title of organisation (HEI): Royal Holloway, University of London
Signature: Professor Andrew Wathey
Position: Senior Vice-Principal
| Component | Strengths/Weaknesses | Actions to be taken | Target completion date/s | Constraints preventing delivering the action required | Impact of not delivering the action required | Lead responsibility (organisation/s and person/s)Name and title of organisation | Evidence of quality enhancement |
|---|---|---|---|---|---|---|---|
Academic and practitioner standards |
Strengths The development of two novel roles, associate clinical tutors (employed by the HEI) and liaison tutors (employed by NHS Trusts), has helped establish a well-coordinated team approach to organising clinical placements for the Doctorate in Clinical Psychology programme (paragraph 19). |
Associate clinical tutor contracts will be maintained. Further funding will be sought for the maintenance of the liaison tutor roles. |
Ongoing annual review for associate clinical tutors. June, 2006 for applying for further funding for liaison tutors. |
Lack of continued funding for liaison tutors. |
Responsibility for sourcing, monitoring and development of placements would fall more on to the programme team and NHS clinicians. |
Clinical Psychology Subgroup of the SHA for further funding for liaison tutors. |
Increase in number of available placements. |
The assessment task for Doctorate in Clinical Psychology trainees to produce a journal-ready article based on the student's thesis contributes to the healthy proportion of research publications in peer-reviewed journals produced by trainees on the programme (paragraph 20). |
The requirement for trainees to produce a journal-ready article will be continued. |
Ongoing review and Annual Programme Review (Feb 2007). |
None foreseen. |
Reduced publication rate and reduced public domain access to outcomes of research. |
DClinPsy Programme Director and Research Director. |
New peer-reviewed publications based on trainee research. |
|
The best academic work in both programmes showed evidence of sophisticated integration, analysis and reflection. There was evidence of work of the very highest quality (paragraph 29). |
Maintain and, where possible, enhance the quality of work through the current mechanisms of teaching and evaluation. |
Ongoing. |
None foreseen. |
Reduction in standard of student work. |
DClinPsy Programme Director and Academic Director. Post Grad Diploma Programme Director. |
Visiting Examiner reports. Examination Sub-board minutes. |
|
Weaknesses There is some, though as yet, limited involvement of users and carers in the design and delivery of the Doctorate in Clinical Psychology curriculum (paragraph 16). |
Discuss with users and carers alternative methods for obtaining their feedback to inform developments in curriculum design and delivery, then implement the agreed method and consider findings in annual review. |
September, 2006. |
Need to ensure a sufficient level of user and carer participation so that feedback is representative. |
Limitation of students' training experience. |
DClinPsy Programme Director and Academic Director. Programme Management Committee. |
Annual review reports. Visiting examiner reports. Student feedback on relevant sessions. Notes of meetings with service-users. |
|
The Postgraduate Diploma in Cognitive Behavioural Psychotherapy programme has not considered ways in which users and carers might contribute to the design and delivery of the curriculum (paragraph 16). |
Discuss with users and carers alternative methods for obtaining their feedback to inform developments in curriculum design and delivery, then implement the agreed method and consider findings in annual review. |
December, 2006 |
Need to ensure a sufficient level of user and carer participation so that feedback is representative. |
Limitation of students training experience. |
Post Grad Diploma Programme Director. Programme Management Committee. |
Annual review reports. Visiting examiner reports. Student feedback on relevant sessions. Notes of meetings with service-users. |
|
The return of marked work to PgDip CBT students is sometimes slow (paragraph 23). |
Speed of return of marked work to be improved. Target dates for return of each piece of work to be set and monitored. |
April 2006 and thereafter |
None foreseen |
Students not receiving timely feedback on work, which would reducing the quality of their learning experience and affect their academic development. |
Post Grad Diploma Programme Director. Deputy Programme Director. |
Monitoring of work submission and return dates as regular aspect of programme audit. |
|
The current learning outcome in the programme specification which refers to the supervision competence of Postgraduate Diploma in Cognitive Behavioural Psychotherapy students is inappropriate and needs to be brought into line with the information in the programme guide (paragraph 28). |
The current learning outcome on supervision to be amended to indicate that students will receive some teaching on supervision but that attainment of competence as a supervisor is not a learning outcome of the programme. |
Programme ammendment to be submitted to ammendments committee September 2006. |
None foreseen |
Students gaining misleading impression of gaining supervision competence from their diploma programme. |
Post Grad Diploma Programme Director |
Revised learning outcomes in the programme specification. |
|
Quality of learning opportunities Learning and teaching |
Strengths All staff members on the Doctorate in Clinical Psychology programme are research-active and have ongoing therapeutic responsibilities. The Postgraduate Diploma in Cognitive Behavioural Psychotherapy staff members also have substantial clinical and teaching experience on which students are able to draw. These role models help trainees develop strong and credible links between research/theory and professional practice (paragraph 31). |
DClinPsy staff will continue to have clinical responsibilities and be research active. Post Grad Diploma Staff will continue to be active in clinical work and attend relevant clinically focused CPD training. |
Ongoing. |
Teaching/supervision and administrative demands limit time available for research and clinical work. |
Limitations to the quality of research supervision if staff who supervise student research are not research active. Limitations to the quality of clinical supervision if supervisors do not maintain their own clinical skills. |
DClinPsy Programme Director. Post Graduate Diploma Programme Director. |
Description of staff research and clinical responsibilities in programme handbooks. Annual SHA report in December. |
Statistics teaching, in particular, is highly regarded by Doctorate in Clinical Psychology trainees (paragraph 32). |
Standard of statistics teaching will be maintained. |
Ongoing. |
None foreseen. |
Students being limited in their ability to conduct quantitative research. |
DClinPsy Programme Director and Research Director. |
Student feedback. Student research dissertations. |
|
Good practice The Audit of Clinical Experience system, designed to help Doctorate in Clinical Psychology tutors and trainees monitor and plan learning on placements, is an innovative and very promising development (paragraph 32). |
The system will be consolidated by implementing across all years of the DClinPsy and disseminated to other programmes. |
September, 2006. |
None foreseen. |
Limitations in the ability of the programme team to take an overview of trainees' clinical experience. |
DClinPsy Programme Director and Clinical Director. Programme Management Committee. |
DClinPsy records indicating full use of the system and responses from other programmes. |
|
Student progression |
Strengths The quality and detail of the various Doctorate in Clinical Psychology programme handbooks are especially impressive (paragraph 38). |
The quality of information provided in the handbooks will be maintained and, where possible, enhanced in future versions. |
September, 2006 and annually thereafter. |
None foreseen. |
Student understanding of programme content and requirements would be impaired. |
DClinPsy Programme Director. |
2006-2007 Handbooks. |
Doctorate in Clinical Psychology trainees commented on the excellent level of support available from staff in the academic, research and clinical environments (paragraph 38). |
Every effort will be made to maintain the existing level of support, through the programme monitoring and quality assurance mechanisms. |
Ongoing. |
None foreseen. |
Trainees' performance would be likely to suffer if support was not maintained. |
DClinPsy Programme Director. Programme Management Committee. |
Trainee feedback. Visiting Examiner reports. |
|
Learning resources and their effective utilisation |
Weakness Some Doctorate in Clinical Psychology trainees reported that resources to support their clinical administration and practice are very limited, that finding sufficient 'desk space' is problematic and that clinical rooms are scarce (paragraph 44). |
Discussion between the North London courses (UCL, Royal Holloway, and UEL) and NCL SHA has led to the setting up of a placement group whose role is to meet with senior NHS managers to discuss placement resources. |
May, 2006. |
None foreseen. |
Ongoing difficulties in the provision of some placement resources. |
DClinPsy Programme Director along with other North London Programme Directors and the Clinical Psychology Subgroup of NCL SHA. |
Notes of Placement Group meetings, including agreed terms of reference. Student feedback. Annual SHA report in December. |
Maintenance and enhancement of standards and quality |
Strengths The Postgraduate Diploma in Cognitive Behavioural Therapy has quickly established a praiseworthy culture of seeking out and acting on feedback from students and supervisors (paragraph 48). |
Current practice of regularly seeking student and supervisor feedback is to be maintained with regular feedback to the Programme Management Committee. |
Ongoing. |
None foreseen. |
Reduction of quality of training if programme is not responsive to student feedback on quality of teaching and supervision. |
Post Grad Diploma Programme Director and Deputy Programme Director. |
Ongoing monitoring and presentation of student feedback. Annual review reports. Programme Management Committee minutes. |
There is a strong working relationship between the Doctorate in Clinical Psychology programme and the NHS training commissioners in the North Central London Strategic Health Authority (paragraph 49). |
Relationship to continue mainly through the DClinPsy Programme Director being an active member of the NCL SHA Clinical Psychology subgroup. |
Ongoing. |
None foreseen. |
Any weakening of the relationship would adversely affect the commissioning arrangements, the quality of training provided and the overall quality of the programme. |
DClinPsy Programme Director, Education Deputy Director NCL SHA, and Chair of the Clinical Psychology Subgroup. |
Programme Director attendance at meetings of the NCL SHA Clinical Psychology subgroup; notes of meetings; special arrangements being put in place to facilitate training (e.g., extension of trainee contracts due to circumstances impacting upon training). Annual SHA report in December. |
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