King’s College London School of Medicine

The first two years of MBBS

Despo PapachristodoulouOctober 2011

2

King’s College London School of Medicine and associated District General Hospitals

The standard programme5 Years5 Phases

– Progression from studying medical science – clinical skills – medical practice

In addition:GPEP programme 4 years (graduate/professional entry

programme)EMDP programme 6 years (extended medical degree

programme)

King’s curriculum• 2 years integrated science &

clinical

• 2 years attachments in clinical areas

• 1 year “student house officer” attachments

knowledge

skills

professionalism

How did we get here?

• St Thomas’s • Disciplines

• UMDS 1983 ( St T and Guy’s)• Systems

• King’s 1998• phase 1 and phase 2 (scenarios)

Phase 1 Phase 2

Phase 2

Phase 3 444

Phase 4

Phase 5

336 5 year entrants

28 GPEP

50 EMDP 34 Oxbridge

Phase 1 Phase 2

Phase 2

12 weeks getting started

First 12 scenarios, integrated learning with a clinical context

Next 23 scenarios

The first two yearsYEAR ONE

YEAR TWO

Core and student selected components

• The course consist of • ‘core’ material which is common for all

students• Student selected components which vary in

format

Phase One

Overview: Phase 1 runs over a single term.

It provides a platform of :knowledgeskillsattitudes

that will enable students to progress to the clinical scenario-based part of the course that constitutes the rest of Year 1 and all of Year 2

Summary: Systems covered in phase 1:

Cardiovascular, Respiratory, Nervous, Musculoskeletal, Gastrointestinal, Renal,

Immunology, Statistics, Psychology, Sociology, Ethics.

Early patient contact opportunities in clinical attachments

Development of professional skills and attitudes In a multidisciplinary inte-professional education programme.

Using lectures as a guide:

• Cell biology 21• Anatomy 18• Immunology 6• Biochemistry/ metabolism 8• Microbiology 2• Pathology/histopathology 5• Pharmacology 5• Psychology /sociology/ethics/stats 10

Phase 2 • Phase 2 runs over a year and a half and allows the promotion of understanding between normal structure and function and their interrelationships.

• It also continues to extend training in professionalism: communication skills, attitudes and behaviours as well and teaching basic clinical skills.

Summary: • 35 weekly clinical scenarios

• a variety of learning sessions including:

lectures, small group teaching workshops, student presentations clinical attachments in hospital and community settings

Clinical aspects linked to basic medical science

• The clinical scenarios

• Practical classes e.g. Blood pressure, ECG, lung function tests, nerve conduction velocity, hearing and visual field

• Communication skills with simulated patients

• Self directed learning

• Attachments to primary care centres (general practice)

• Hospital visits

Content of phase 2• Scenarios cover the topics:

• Cardiovascular and respiratory systems• Gastrointestinal and renal systems• Metabolism and Nutrition• Musculoskeletal system• Endocrinology• Fertility and reproduction• Head and Neck Anatomy• Neuroscience• Genetics• Infections

• Scenarios given a patient’s name and condition

Scenario title examples• Sanjay’s malaise; is it influenza?

• Wilma’s woeful wrist

• Diana’s diarrhoea

• Sheila’s sore shoulder

• Harold’s painful hip

• Donna’s diabetes

• Silly? Easy for students to remember

First two years: weekly clinical scenarios

lectures

tutorials

patient contact

Self-directed learning

Clinical scenarios

interprofessional learning communication, ethics

dissection

prosection

Practical skills

= clinical component

Clinical problem: ‘John has chest pain’Professor of Cardiology

Clinical problem debrief /summing upProfessor of Psychology

Example of a clinical scenario in one week

Lectures:The cardiac cycle 2Blood cells, haemopoiesisAtherosclerosisEmbolism and infarctionHeart disease pharmacology 2

Dissection of thoraxIn phase one

Tutorial on CVS physiology

Tutorial on CVS pharmacology

GP or hospital visit

Histology of blood

Problem solving workshopCo-arctation

Problem solving workshopDiseased and healthy heart

Clinical skillsBlood pressureECG

Clinical problem: ‘weight loss and obesityClinician from ITPresentation of Patient with Crohn’s

Clinical problem debrief /summing upIT clinician/ biochemist

Example of a clinical scenario in one week

Lectures: Energy balance and body weightMacronutrients PEMVitamins MineralsLipid synthesis and transport/ hyperlipoproteinaemiasIntegration of metabolismDiabetes mellitusEating disorders Stats: regression and correlation

Problem solving workshopRegression and correlation

Problem solving workshop: metabolic syndrome

Another example of a clinical scenario in one week (YEAR TWO)Clinical problem: ‘Donna and Tony have diabetes’Introduction by Professor of DiabetologyLectures:Diagnosis and classificationInsulin secretionInsulin action and insulin resistanceTherapeutic use of insulinPathogenesis of type 1 diabetesPathophysiology of symptoms of diabetesRandomised control trialsMonitoring control in diabetesHyperglycaemic emergenciesPharmacology of type 2 diabetesMetabolic syndrome and obesityDiabetic complications

Scenario debrief: What is new in diabetesProfessor of Diabetology

Clinical epidemiology tutorial randomised control trials

Clinical skills communication skillsExplaining and exploring

CAL sessionCase history and management

PSW insulin therapy

PSW hypoglycaemia

Living with DiabetesHospital visitDiabetic Centre

Self directed learning

The clinical skills centre allows students to practise their practical skills

Medicine in the community: year 1 aims

• Orientate students in clinical environment

• Direct experience of working with patients

• Set context for basic science

• Encourage reflection

• Encourage self-directed learning

• Develop professionalism

Community: year 2 aims

• To be able to take a patient history

• To understand issues involved in access to healthcare

Assessment : Year one

MB BS Part 1 is a Module consisting of two main components, which are weighted as follows:

• End of Year Examinations 80 %• In-Course Assessment (ICA) 20 %

The end of year examination component consists of three units, which are weighted as follows:

Examination Assessment Duration(hours) % of final mark

1 Phase 1 3 342 Scenarios 1-7 2 233 Scenarios 8-13 2 23

total 80

1-7 cardiovascular and respiratory8-13 gastrointestinal, renal , nutrition and metabolismStudents must pass all three written examinationsOne further attempt is possible

Assessment Year 2

• MB BS Part 2 is a Module consisting of two main components, which are weighted as follows:

• End of Year Examinations 82 %• In-Course Assessment (ICA) 18 %

The end of year examination component consists of four units, which are weighted as follows:

• Examination Duration(hours) % of final mark

• Scenarios 14-23 3 28• Scenarios 24-32 3 28• Scenarios 33-36 1.5 14• OSCE 12

total 82

14-23 musculoskeletal, endocrinology24-32 head and neck, neuroscience33-36 genetics, infectionsStudents must pass all three written papers and the OSCEOne further attempt is possible

• Objective Structured Clinical Examination

• Examines skills, knowledge and understanding in clinical situations

• It is a minimum competence exam

OSCE

• History taking

• Practical skills

• Communication skills including sensory awareness

• Living Anatomy

Each OSCE has a mix of:

Evaluation: looking at

• Scenario format

• Clinical experience

• examinations

Student evaluation from end of year questionnaires (2010-11)

• Presenting the basic science material in scenario format made it interesting

• Strongly agree 60%• Agree 33%• Neutral 6%• Disagree 1%• Strongly disagree 0%

Student evaluation from end of year questionnaires (2010-11)

• Presenting the basic science material in scenario format made it interesting

• Strongly agree 60%• Agree 33%• Neutral 6%• Disagree 1%• Strongly disagree 0%

Student evaluation 09-10

• Presenting the basic science material in scenario format helped learning

• Strongly agree 53%• Agree 43%• Neutral 2%• Disagree 1%• Strongly disagree 1%

Student evaluation 10-11

• Presenting the basic science material in scenario format helped learning

• Strongly agree 55%• Agree 33%• Neutral 8%• Disagree 3%• Strongly disagree 1%

Student evaluation 10-11

• I found the clinical sessions in hospital and general practice interesting

• Strongly agree 28%• Agree 49%• Neutral 17%• Disagree 4%• Strongly disagree 1%

Evaluation 10-11

• The end of year examinations were :

• Too difficult 36%• About the right level of difficulty 64%• Too easy 1%

Strengths of our course

• Scenario format of teaching. (strong student feedback, frequently cited as one of the best features )

• Learning in the community

• The relevance of basic science to clinical medicine is made obvious.

Weaknesses

• Huge amount of organisation needed to allocate 850 students in 3 hospitals and primary care centres

• Too many lectures.

• Timetable loses flexibility

If you are using specialist teachers (clinical)

• make sure they appear on the day

• If the member of staff changes, ensure that any new presentation follows the aims of the session. Any ‘innovation’ should be agreed by the MEC

• Make sure that the specialist does not teach his specialty but uses it to demonstrate the importance and relevance of basic science in medicine

Tips

• Do not start a scenario on a Monday