This is a very intense course with a large amount of knowledge and skills to acquire in a relatively short time. You will need to dedicate at least 50 hours each week to learning, much of it by yourself and with your learning set.
At the University of Birmingham we believe in very close integration between the theory learning (‘the hip is a ball and socket joints and the femur anatomy is as follows’ and clinical learning (‘when people fracture their hips it happens like this, they present like this, and your understanding of the hip anatomy enables you to understand why and how hips fracture’). You will also link theory and practice by learning, say, how to examine a hip on each other, on a simulated patient and (often) on a real patient before you see such a patient in a clinical environment.
Video: Working with ACEs
We also place great emphasis on the acquisition of clinical competencies. The learning trajectory for clinical procedures such as taking blood is as follows:
- practice on ‘plastic arm’
- practice on each other
- supervised practice on real patients
- sign-off as competent to perform independently.
A similar process is followed for clinical examination skills:
- theory e.g. anatomy of the female breast including pictures, models
- examining manikins
- examining simulated patients (i.e. real people who give you feedback on your examination skills)
- placements for all students in relevant specific outpatient or inpatient environments (e.g. breast cancer clinic to acquire skills of examining the female breast).
Case Based Learning (also known as Problem Based Learning) is the main way in which you will learn the anatomy, physiology, biochemistry, behavioural science, ethics, law and pharmacology you will need to understand what is happening in the clinical environment. Each week your small teaching group will be given a problem or case to work with. This is not a diagnostic problem but an understanding problem. A case might be:
A 55 year-old single obese man of Irish background who works as a bus driver has poorly controlled diabetes and seems unable to give up smoking. His vision has deteriorated significantly due to the diabetes.
The group's task would be to identify the key learning issues:
• What is diabetes? Including for example the anatomy and physiology of pancreas (endocrine system), pathophysiology etc.
• How does it develop?
• How is it managed?
• Why is smoking important?
• How does the man’s gender, age, occupation, family situation and ethnic background fit in, it if at all?
• Are there any legal issues?
These cases/problems are supported by the following:
• Traditional lectures, to provide some background (eg on the basic principles of pharmacology)
• Clinical skills sessions with simulation (eg working with role players on mental illness scenarios; Inter-professional learning scenarios with nursing and medical students on a cardiac arrest)
• Anatomy seminars using each other and life models for surface anatomy
• Up to five days will be spent in General Practices specially selected for teaching, where you will see patients with relevant histories and physical signs (eg patients with asthma when studying respiratory medicine)
Immediately prior to Term 2 is an intensive simulation period to ensure your clinical examination and communication skills are sufficient (note: we will offer particularly intensive teaching to those who have found it more difficult to acquire these skills).
During Term 2, you will spend most of the time in one hospital Trust seeing general and adult medicine, such as strokes, heart attacks, asthma, abdominal pain and bleeding, pneumonia. You will be practicing your clinical skills on a daily basis and will be mentored (and monitored) to ensure you are progressing. You will return to the medical school for 5 days during these weeks to review relevant theory, report back and present cases you have seen and, together, you will apply principles acquired in term 1 to the cases you are seeing.
Seven weeks of term 3 are theory weeks similar to term 1, but using the many cases you will have seen in term 2. You will be expected to have acquired a very substantial portfolio of cases across general medicine (at least 50 cases in detail and many more in outline, you will have seen these patients, taken histories and examined them personally). Additional days within General Practice may also take place, along with progress examinations.
Terms 4 and 5
Starting during the last few weeks of the first year and continuing into the second year for a total of thirty-two teaching weeks, terms 4 & 5 consist of 6-week rotations in core specialties (GP, mental health, obstetrics, surgery, paediatrics). Each 6 week block will consist of 3 weeks of theory twinned with 3 weeks of practice (for example in paediatrics the 3 weeks of theory will cover child development, immunisations, common diseases, relevant anatomy, communication issues and child safety, followed by 3 weeks on a general paediatric unit seeing patients with common paediatric problems). Additional cross-rotation teaching will also take place during two additional Academic Activities weeks.
This term begins with four weeks of acute and front door medicine theory, revisiting areas of weakness, and including more sophisticated theory, for example how to avoid common diagnostic mistakes. Some simulation will be used to challenge students with more difficult scenarios and diagnostic challenges and get you ready for the final part of the course.
This will be followed by seven weeks spent in acute and front door medicine.
Progress examinations, required for entry into the National Assessment, will take place at this point. After this, some flexibility will allow students, after discussion with core faculty, to arrange attachments of interest, not usually in their base hospital, for example in cardiology or oncology. We will also encourage students who wish to try areas not included within the course, such as palliative care, again after discussion.
The formal teaching and learning curriculum finishes at the end of 6 terms. However, a further four week period is allocated to preparation for and taking the national examinations, which are currently 200 multiple choice knowledge questions and 12 Objective Structured Clinical Examination stations.