Tuesday, 9 November 2004. A Discussion was held in the Senate-House of the following Reports:
Report of the Faculty Board of Biology, dated 28 June 2004, on the abolition of Part II of the Medical and Veterinary Sciences Tripos (p. 53).
Dr D. MACDONALD:
Deputy Vice-Chancellor, I wish to speak mainly about the proposal to abolish Part II of the Medical and Veterinary Sciences Tripos (MVST), which follows on from the proposal from the Faculty Board of Biology recommending that MVST Part II be replaced by a new Part II course in the Natural Sciences Tripos (NST) called Biological and Biomedical Sciences (BBS), which will be introduced by my colleague, Dr Johnstone. This new course would be open to students reading Natural Sciences, Medicine, or Veterinary Medicine.
These proposals for the introduction of BBS and the abolition of MVST Part II are related and I would like to begin by filling in some of the background to these proposals. One of the great strengths of the Cambridge medical course is the emphasis it places on the study of the scientific basis of medicine in the first three years, and as such it is very important for Cambridge to be able to demonstrate to external bodies such as the GMC and the Royal College of Veterinary Surgeons that our medical and veterinary students graduate with a scientific degree. All our medics and vets obtain their professional qualifications (2nd M.B. and 2nd Vet M.B.) by the end of their second year, and our third year is the equivalent of the intercalated B.Sc. Degrees offered in other medical and veterinary schools.
Between 60 and 65% of medical and veterinary students currently study either a single NST Part II science subject in their third year, with 30% reading MVST Part II, and the remaining 5% taking a Part II from another Tripos such as Archaeology and Anthropology or, perhaps, Social and Political Sciences.
These two elements, the professional qualification, and the specialist study of science or another Tripos in the third year would be further differentiated, and the scientific nature of Part II study emphasized, if the MVST were to contain only Parts IA and IB, and all students progressed to their B.A. via another Tripos. This would usually be the NST, but there is nothing in these proposals to preclude medical students reading a third-year subject from another Tripos, for example, Archaeology and Anthropology, as at present.
You may ask why it is necessary to remove the MVST Part II component of this provision, and there are several reasons.
Part II of the Medical and Veterinary Sciences Tripos was introduced in October 1976. After nearly thirty years, following changes to the medical and veterinary curricula, and increasing pressure on resources, the Faculty Board of Biology has been reviewing all of its Part II provisions.
Biology Departments are moving towards a more modular approach to teaching at Part II, and the sharing of these courses between NST and MVST is now the norm. As a result MVST Part II now has few courses designed exclusively for medics and vets, and has a structure where all the four-paper subjects, and a majority of the other papers are borrowed from single subject biological sciences in the Natural Sciences Tripos. Students reading MVST Part II are mostly taking NST biology courses, under the MVST banner.
This arrangement can and has led to inequalities because two students who take essentially the same papers, may be assessed under different sets of rules, depending on whether they are examined under NST or MVST rules. With the introduction of the new course of Part II BBS, it is not sensible either on academic or on resource grounds for there to be two groups of students taking the same courses and exams, but being classed by different sets of examiners. Under these new proposals, such inequalities should disappear, as all students, whether medics, vets, or natural scientists, will be assessed under NST rules.
A further benefit of the change is that the new BBS course will offer a greater potential choice of papers to medical, veterinary, and science students.
Although MVST Part II has always been open to Natural Scientists, many have been deterred by the name. The new NST Part II BBS course is academically challenging and rigorous, and will be a clear and attractive option for all students wishing to study biological and/or biomedical science in their third year.
Finally, placing all Part II provision in the Faculty of Biology under the single umbrella of the Natural Science Tripos will simplify course management, examination, and reporting, and allow resources to be focused on delivery.
It should also lead to a much more straightforward and transparent process for allocating Part II places, because students and Directors of Studies will have a simple choice of two alternative course formats, depending on student inclination and requirements.
These proposals have the full support of the Faculty Board of Biology, the Strategic and Management Committees of the NST, and the Senior Tutors' Committee, and I commend them to the Regent House.
Report of the Strategic Committee for the Natural Sciences Tripos, dated 14 September 2004, on the abolition of Part II (General) and revision of Part II of the Natural Sciences Tripos (p. 54).
Dr K. JOHNSTONE:
Mr Deputy Vice-Chancellor, there are very strong reasons for the abolition of NST Part II (General) and the introduction of Part II Biological and Biomedical Sciences, and Part II Physical Sciences. I will confine my comments to Part II Biological and Biomedical Sciences.
The number of students taking NST Part II (General) has fallen to less than 20 in recent years and this must be attributed at least in part to the perception that this course was taken by weaker students. During this time there has been an increasing pressure on Departments in the Biological Sciences to create places on single-subject NST Part II courses, due to a year on year increase in the numbers of students wishing to take the NST Part II in biological subjects. In these courses the main factor which limits the number of students is the ability to supervise experimental projects. There is therefore an urgent need to establish an alternative course structure which has the same intellectual rigour as an NST Part II single subject, but which does not include an experimental laboratory project. I believe that Part II Biological and Biomedical Sciences will fulfil this role by providing an intellectually challenging alternative for those NST Part II biological students who do not wish to perform an experimental project as part of their Part II course.
In making arrangements for Part II Biological and Biomedical Sciences, the Faculty Board of Biology has taken great care to ensure that the course will be as attractive as possible and has modelled it on MVST Part II, which of course has been very successful over the past few years. The abolition of MVST Part II is part of the arrangements to present study within the Faculty of Biology as a cohesive whole.
Further arrangements to support students in their learning and to ensure equity of treatment include making students members of the Department in which they take their Major subject, thus providing the same support and infrastructure as for NST Part II single subject students. In addition, the examination procedures will parallel those of the NST Part II single subject. The Minor subjects will allow students to access other courses such as those in Education, which are not available as part of the NST. I believe that this will be particularly attractive to those students who are considering teaching as a career.
Importantly, Part II Biological and Biomedical Sciences and Part II Physical Sciences both have course structures which allow the utilization of modules from each other. Such exchange of material has not been planned at the outset, but the structures allow such exchange in the long term. As Part II NST subjects become further modularized, other combinations of courses are likely to become possible.
Part II Biological and Biomedical Sciences has the support of the Faculty Board of Biology, the NST Management Committee, the NST Strategic Committee, and the NST Biological Directors of Studies. I commend its adoption to the Members of Regent House.
Dr J. H. KEELER:
Mr Deputy Vice-Chancellor, I would like to make a few brief remarks about how these proposals for the abolition of Part II (General) affect the Physical Sciences. I speak as the Chairman of the Management Committee for the Natural Sciences Tripos, which as has already been mentioned supports these proposals, and also, as a College Director of Studies in Natural Sciences.
Historically, the take-up of physical science subjects in Part II (General) has been rather low - rarely more than a handful of students per year. In recent years, the subjects available as Special Subjects within Part II (General) have been limited to Physics and Chemistry, thereby further reducing the number of students taking this option.
However, despite the low take-up, Part II (General) was a very useful option, as it provided a way for students to continue the study of a range of subjects into their third year, something which is very much in the spirit of the Natural Sciences course. Speaking from our recent experience in my own Department, Chemistry, the students who have taken Part II (General) are often heading for teaching in the secondary sector; clearly, an area where breadth would be very useful. To be even more anecdotal, one of my colleagues also took Part II (General) some years ago in order to combine the study of Advanced Physics with Theoretical Chemistry. So, over the years, Part II (General) has provided a useful facility.
It was therefore concluded that something like Part II (General) needed to be retained in the Physical Sciences - hence the proposals for a new Part II in Physical Sciences in the Report before us. The new scheme for the Physical Sciences is, in my view, a considerable improvement on the old Part II (General). The structure is simpler, does not increase the burden of examining and, most importantly, more subjects are offered as 'half subjects' based on existing Part II courses. I think therefore it would be more attractive to students and provide them with a useful set of options.
Students have the option of taking two 'half subjects', or combining a Part IB subject with a 'half subject'. This latter option is particularly useful at it will make it possible for students to study both physical and biological subjects in their final year - again something which is very much in the spirit of the NST.
In summary, I commend these proposals for a Part II Physical Sciences to the Regent House, and hope that, along with the proposals for Part II Biological and Biomedical Sciences, they will meet with the House's approval.
Joint Report of the Council and the General Board, dated 25 October 2004, on procedures for dealing with questions of fitness to practise medicine of medical students (p. 115).
THE SENIOR PROCTOR:
Deputy Vice-Chancellor, as Senior Proctor, I speak not only to voice the concern of the current Proctors, but also that of our likely successors and of certain former Proctors who have been consulted during the preparation of these remarks.
It is no particular business of the Proctors to assess a medical student's mental or physical health or grasp of medical ethics and we accept the purpose of these regulations in that respect. If, however, a student is suspected of a simple offence against University discipline, it has usually been regarded as a legitimate and principal concern of the Proctors acting on behalf of the Regent House.
The proposed Rules of Procedure 2(b), 10, and 11 seem to take no specific account of this. We suspect that this apparent omission is inadvertent, but it is nevertheless one that should not pass without some comment. Furthermore, Rule 2(b) and Rule 10 are to some degree contradictory, as the former seems to expect the Chairman to refer matters to the Advocate immediately upon discovery, while the latter requires appropriate consultation and evidence of a prima facie case.
Although any member or employee of the University may make a disciplinary complaint to the Advocate, if specific regulations are to be enacted to govern this particular situation, then we do not believe that it should be at the discretion of the Chairman whether or not to consult the Proctors before taking action. Rather, we suggest that he or she should initially be required to inform the Proctors of the alleged offence. If the Chairman is dissatisfied with the actions or advice of the Proctors, he or she is still free to approach the Advocate or the Police directly, but the Proctors will have had the opportunity to fulfil their proper functions on behalf of the Regent House.
It is the Proctors who patrol exam rooms, brief invigilators, and are summoned to police disorder involving students. The Proctors normally act as the channel through which complaints by examiners or invigilators are further investigated and referred to the Advocate if necessary. The Proctors are not, of necessity, possessed of any particular personal wisdom, but we are well placed to be 'the Regents on the Clapham Omnibus' in disciplinary matters. During our time as Pro-Proctors, Proctors, and Deputy Proctors, we have the opportunity to acquire a broad range of experience in this area and we also have the benefit of the confidential advice and experience of our predecessors.
Just as we would not expect to express a medical opinion about fitness to practise, we would not expect the career of a medical student to be terminated over a question of University discipline without some involvement by the Proctors at an early stage.
Professor G. R. EVANS (read by MS A. CHAPMAN):
Mr Deputy Vice-Chancellor, 'a heavy responsibility falls therefore on UK universities with medical schools to ensure that any conduct, behaviour, or other matters that could bear on a student's suitability or fitness to practise medicine or deal with patients that comes to light during the student's course must be properly handled by the university, which could not confine its responsibility to academic issues alone.'
A similar expectation of good and professionally appropriate behaviour is a requirement for solicitors and barristers, too, and the teaching profession is increasingly under ethical scrutiny. So perhaps we should be giving thought to the wider question whether the University's responsibility towards its students and theirs towards the University extends beyond 'academic issues alone'. I doubt whether anyone would wish to disrupt the now longstanding tradition of pastoral care of students by Colleges. (Though that goes back nowhere near 800 years, ye intending flag-wavers for the celebration of our alleged eighth centenary.) But the idea is apparently to add to the duties of students as they enter into their contract with the University obligations of good conduct which go beyond the ordinary maintenance of good order described in the Statutes and Ordinances and watched over by the Proctors.
This has already happened without anyone apparently raising the question whether it should, when the old division between the academic and the clinical stages moved and it began to be the practice to place medical students on the register from the beginning of their course. Removal from the register, unless there is an avenue of appeal, presumably means the end of the hope of a medical career, certainly of the right to take one's degree examinations.
I am not clear how the proposed changes to the Medical and Veterinary Studies Tripos and the Natural Sciences Tripos Part II discussed today will affect this assertion that the academic and clinical stages of medical training are no longer distinguishable. Perhaps not at all, but it does seem to place medical students and natural scientists doing the same courses under different requirements, with only the former at risk of not being allowed to take their examinations if they misbehave.
I read the proposed procedure with some suspicion, for are our student complaint and discipline procedures in general not in serious need of overhaul and is this not merely a sticking-plaster upon their general unsatisfactoriness? The role of the College, not covered in the University procedures, and leading to great difficulties for students who may not know whether a matter of complaint or discipline is technically under the jurisdiction of the College or the University, is even more blurry here, for the student's Tutor and Senior Tutor appear on the stage with no clear role.
'Where there is a question', the process begins. Who is allowed to raise this question? We are told that it has to be done in writing with a name and address, but apparently the accuser's standing is irrelevant. There is no provision to outlaw malicious or vexatious complaints. If 'it should become apparent or it is suspected that the medical student's alleged problems are caused by ill health or disability …'. Apparent to whom? And the detailed procedures designed to cover such cases move uneasily between ill-health, serious ill-health, disability, the welfare of patients, and the capacity of the student thus affected to practise medicine. Procedures under which 'the Chairman of the Board shall have [a mere] discretion to allow reciprocal questioning by all parties,' but the student apparently does not have an automatic right to question witnesses surely do not satisfy the audi alteram partem rule?
Heaven help the medical student who is deemed not to be 'reasonably conventional' in appearance or, suffering from a heavy cold, cannot decide whether it is proper to attend a patient who 'suddenly collapses' in the street while he is passing.
I am not for a moment suggesting that it is not important to ensure that new doctors are fit to practise medicine. But I do not trust the system here and I foresee injustices and inequalities about allowing the students we admit to complete the academic elements of their courses and get their degrees, if some of the above points are not attended to.