Medicine MBChB

Systems in Practice (SiP) runs from the beginning of Year 1 until the end of Year 3. It is based on the various organ systems of the body and is an integrated course that focuses on normal and abnormal structure, function and behaviour, basic and clinical sciences, and hospital and community perspectives. Problem-oriented learning (where learning is structured around examples of clinical problems) is employed wherever appropriate.

The aims of this phase are to:

• Introduce the biomedical-scientific principles underlying the practice of medicine
• Develop an understanding of normal and abnormal structure, function and behaviour of the various body systems
• Provide an introduction to clinical practice in both hospital and community settings
• Demonstrate how basic and clinical science integrates with clinical practice
• Instil the values of professionalism and enable development of students’ professional identities

Each year is made up of a period of system-based teaching (Principles and three systems are covered in Year 1, seven systems in Year 2, and five in Year 3), Clinical Application of Scientific Principles (CLASP) blocks, examinations, and Student Selected Components (SSCs). The systems programme is integrated so you will learn about the basic science and clinical aspects at the same time. Basic science including anatomy by dissection is taught in all body systems with periods of time to allow you to consolidate your learning in each semester. A transition module at the end of Year 3 will prepare you for your studies on clinical attachments in years 4&5.

The first 8 weeks of first year are the Principles Block, which gives an introduction to the basic principles underlying the practice of medicine. These are:

• Structural Principles
• Functional Principles
• Molecular Principles
• Psychosocial Principles
• Disease Mechanisms
• Defence Mechanisms
• Principles of Drug Therapy
• Safe Medical Practice

The curriculum outcomes from the GMC’s Tomorrow’s Doctors 2009, Basic Emergency Care (BEC), interprofessional learning, the problem-oriented approach to learning and the principles of Medical Ethics are also introduced in this phase. Clinical relevance is emphasised throughout and early patient contact is achieved utilising primary care teaching. You will consider the safe practice of medicine in regular clinical skills sessions. Self-directed learning is well represented in the timetable and established as a significant component of this part of the curriculum. The first year Student Selected Component (SSC) is timetabled and runs parallel to the core from early in semester 1.

Following on from the Principles Block there are teaching blocks covering the various body systems:

• Respiratory
• Reproduction
• Cardiovascular
• Renal
• Gastrointestinal
• Nervous
• Musculoskeletal
• Ageing
• Endocrine
• Haematological
• Child and family
• Special Senses: ENT, Ophthalmology and Dermatology

Teaching in each system is structured around core clinical problems, and is supported by an online study guide. There is a topic for every week of the systems-based courses. For example, in the Cardiovascular system, the topics are:

• Week 1&2: Cardiovascular principles
• Week 3: Cardiovascular risk factors
• Week 4: Vascular and Ischaemic heart disease
• Week 5: Acute MI
• Week 6: Structural cardiac abnormalities

All teaching for a particular week is structured around a clinical example of the week’s topic. Each of these scenarios has a set of learning outcomes which should enable you to identify:

• Which aspects should be revised from Principles Block
• What learning opportunities there are to achieve these learning outcomes
• How this relates to other aspects of the curriculum

Intercalated Degree (BMSc), Between Years 3 and 4

Intercalated courses for the Honours Degree of Bachelor of Medical Science (BMSc) in specified subjects may be open to medical students who successfully complete Year 3 of the MBChB Medicine course or equivalent. Candidates will be accepted for any course only following interview with the specific course leader. The number of places on some courses is strictly limited.

• Anatomy
• Applied Orthopaedic Technology
• Cardiovascular and Diabetes Medicine
• Forensic Medicine
• Healthcare improvement
• Human reproduction, assisted conception and embryonic stem cells
• International Health
• Neuropharmacology and Behaviour
• Medical Education

Preparation in Practice (PiP), Years 4-5

Years 4 and 5 form Preparation in Practice (PiP) which moves towards a task-based learning approach. A series of around 100 ‘core clinical problems’ provide students with a framework for an integrated view of medicine. PiP begins with a transition block, followed by a series of core clinical placements and a final Preparation for Practice block.

The systematic approach to learning about normal and abnormal structure, function and behaviour, and to developing clinical skills in Systems in Practice Phase provides a springboard to take advantage of a wide range of clinical learning opportunities in Preparation in Practice (PiP) Phase.

PiP aims to provide the medical student at graduation with:

• The knowledge and skills necessary to fulfil the responsibilities of a Foundation Doctor
• Sound professional attitudes towards patients and colleagues
• An understanding of the obligations of the medical profession
• The ability to take responsibility for self-directed continuing medical education and lifelong learning.

The Transition Block takes place in the first eight weeks of year 4 and is designed to enable you to recognise the need to integrate the knowledge, skills and attitudes learned in the systems-based context of the previous three years to the setting of managing a patient presenting with a core clinical problem. This should prepare you for learning in the clinical environment by enabling you to elaborate, reorganise and refine their learning.

Following on from the Transition block there are five clinical attachments, each of eight weeks duration. Development towards the Curriculum Outcomes takes place within the framework of roughly 100 core clinical problems. You will be expected to organise your learning around these common problems / concerns with which patients present, each problem being supported by an online study guide.

You are encouraged to develop a wealth of clinical experience of patients and their problems, to master the competencies relating to the core clinical problems outlined in the study guides, and to learn to look at the patient as a whole rather than from the perspective of a disease entity. This strategy is aimed at enabling you to pursue a career in medicine where patients’ concerns and problems are central to your practice.

There are five clinical attachments, each of eight weeks in duration.

Medicine: General Medicine and Medical Specialties (Neurology, Oncology and Infectious Diseases)

Surgery: General Surgery and Surgical Specialties (ENT, Ophthalomology and Urology)

Integrated Specialties: Old-age medicine, Dermatology, Orthopaedics, Rheumatology, Emergency Medicine and Anaesthetics

Obstetrics and Gynaecology & Child Health

General Practice & Psychiatry

A number of these blocks can be undertaken either within Tayside or elsewhere in Scotland (Fife, Forth Valley etc).

All students have the exciting opportunity of an 8 week elective during PiP. This is a period of clinical practice organised by the student anywhere in the world and focused on their own objectives. Most go overseas and around half to developing countries. Dundee has been leading the development of a ‘Responsible Elective’ program which has includes some opportunities for extended attachments, presently in Malawi.

There is a change of emphasis towards the end of Year 5 to the development of experience provided by a particular specialty, and final preparation for practice as a Foundation doctor. Students maintain and further develop their achievements in relationship to the curriculum outcomes. These developments now take place within a framework of Student Selected Components and Pre-registration (Foundation) Apprenticeship blocks: the former provide an opportunity for in-depth study in selected areas and the latter for integrating theory and practice in preparation for the Foundation appointments the following year.

Student-selected components have been part of the undergraduate medical curriculum in the UK for nearly twenty years. One of the key innovations of Tomorrow’s Doctors (1993) was the provision of student choice on a scale that had never been seen before. It was seen as essential if students were to engage with the process of reform

In the original Tomorrow’s Doctors (1993) document it was identified that:

“...the greatest educational opportunities will be afforded by that part of the course which goes beyond the limits of the core, this allows students to study in depth in areas of particular interest to them, that provides them with insights into scientific method and discipline of research, and that engenders an approach to medicine that is constantly questioning and self-critical. This part of the course we refer to in terms of ‘special study modules.”

Not all student-chosen elements are modular. In recognition of this, the term ‘special study module’ was replaced some years ago by the more generic ‘student-selected component’ or SSC.

SSCs provide the opportunity to study areas of your own choice in depth; indeed this remains the explicit purpose. They also allow you to develop generic skills that are essential to your professional development. In addition, students can, through SSCs, achieve core learning outcomes not related to specific fields of knowledge, but concerned with transferable skills, like information handling, computer literacy, critical thinking and independent learning. SSCs aren’t an ‘optional extra’ – they’re a very important part of the curriculum.

The relation between core and SSC varies in different parts of the Dundee curriculum. In Year 1 the SSC is a longitudinal exercise running throughout the year. In Years 2 and 3 (Systems in Practice), SSCs are delivered as modules interspersed with other elements of the curriculum. In Years 4 and 5 (Preparation in Practice), SSCs are delivered in both ways: longitudinal (fourth year project) and modular (elective and clinical SSC).

Currently the GMC stipulates that SSCs must occupy at least 10% of curriculum time, compared with one-third originally. This represents an attempt to shift the emphasis from quantity to quality, i.e. to ensure that genuine student choice achieves its fullest expression. In Dundee, the proportion of curriculum time devoted to SSCs varies from one year to the next, but is on average about 25%.

“The purpose of SSCs is the intellectual development of students through exploring in depth a subject of their choice.”

Student assessment is based on the “Tomorrows’ Doctors” learning outcomes and the core clinical problems. The core curriculum, Student Selected Components (SSCs) and electives are all assessed in relation to the outcomes. As far as possible, assessment is integrated like the teaching and learning, and oriented towards clinical relevance rather than theoretical aspects.

Assessment informs staff and students, with the aim that students will be fit to practise as Foundation doctors. A range of appropriate assessment instruments are used to enable assessment of the outcomes at the level required at each stage of the curriculum. These are selected to allow assessment of knowledge, its application, competence, performance and professionalism.

Dundee has been at the forefront of new approaches to assessment in medical education, meeting the challenges posed by an integrated, outcome-based curriculum. A range of assessment methods are used including:

• online progress tests, allowing you to identify areas on which to focus
• online assessments of knowledge, understanding and application
• clinical examinations (OSCEs and Workplace-Based Assessments)
• portfolios of learning.

These are designed to assess your mastery of the curriculum outcomes, and test skills and attitudes as well as knowledge.

You will gain experience of the summative examinations by undertaking formative assessments. During systems in practice, for example, these include the online exam and the anatomy practical exam. Questions included in these formative assessments are representative of the style of question found in the summative examination and are done under examination conditions. You will receive feedback on your performance in these exams.

You may be asked to complete a reflective essay, case report or other piece of written work as part of either formative or summative assessment. This assessment method is particularly likely to be used in SSCs or clinical attachments and may form a component of your portfolio.

You may be assessed either formatively or summatively on a verbal report or presentation, for example of a patient case or research findings. As with written assignments this method frequently forms part of assessment of SSCs or clinical attachments.

Online examinations include Multiple Choice Questions, Extended Matching Item (EMI) questions, Numerical Questions and Drag and Drop Graphical Questions.

EMI questions generally consist of a lead-in question setting the topic (e.g. management of stroke patients), followed by series of clinical scenarios (each with a single best answer) and a range of answers to select from (in this case a selection of management options). This type of assesses not only knowledge but its application.

The Cumulative Assessment Programme (CAP) is an online formative test for medical students which is performed annually, a few months prior to summative examinations. The test is compulsory and uses multiple choice and extended matching questions.

You will receive results with feedback on answers, marks relative to your peers, systems of teaching and curriculum outcomes. If you have performed poorly a meeting with a pastoral tutor can be arranged to discuss and identify potential learning difficulties and support requirements.

The results are also used to allow the medical school to plan appropriate revision teaching depending on individual cohorts of students’ needs. In addition they allow phase conveners to assess quality of teaching in their teaching block and so initiate improvement in teaching in any future redesign of course curriculum.

The Objective Structured Clinical Examination (OSCE) is used each year to measure competence in skills such as communication, clinical examination, practical procedures / prescribing, clinical reasoning and interpretation of results. Students rotate through a series of stations at which they are required to undertake a variety of tasks. The OSCE in the early years consists of shorter task-based stations, and in the later years of longer, integrated stations.

A portfolio is a collection of work that can be used to demonstrate progress and learning. Whilst the written and practical exams can measure what the student knows, these tools do not easily assess professional behaviours. The Dundee portfolio enables assessment of higher order skills such as self- reflection, critical thinking and clinical reasoning. By accumulating evidence of experiences and accomplishments a final assessment of students’ strengths and weaknesses, across all competences, can be made.

With the growing use of the portfolio as a summative assessment, there is a need for more objective ways to measure student performance in clinical placements. A range of tools have been developed for use in postgraduate medical education and these are now being incorporated into undergraduate assessment. They include Direct Observation of Procedural Skills (DOPS; a measure of competence in practical procedures), mini-Clinical Evaluation Exercise (mini-CEX; can be used for observations of patient interactions) and case-based discussions (CBD; used to assess clinical reasoning and judgement). Many of these tools are used in year 4 and 5 clinical attachments.

The Ward Simulation Exercise is an innovative assessment undertaken in the Dow Simulation Suite. Students complete this during Preparation for Practice (PfP) block. Students adopt the role of a Foundation doctor in a ward with simulated patients and nursing staff in order to experience coping in this situation, and are given feedback on their performance. The exercise is recorded and students are able to view this in order to reflect on their performance