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MBChB Medicine and Surgery
|Mode of Study: Full Time||Department: Lancaster Medical School|
|UCAS Code: A100||Duration/Length: 5 Year(s)|
|QAA Subject Benchmark: Medicine||Director of Studies: Dr GS Vince|
|Total Credit Points: 776||Credit Points Year 2: 156|
|Credit Points Year 3: 172||Credit Points Year 4: 172|
|Credit Points Year 5: 152|
- Compulsory Modules
- Educational Aims
- Learning Outcomes
- Learning and Teaching Strategies
- Assessment Strategy and Skills
- External Benchmarks
Syllabus Rules and Pre-requisites
- The student must take the following modules:
- MBCHB101c: Year 1 Paper 3 - Population Health, Health, Culture and Society, Professional Practice, Values and Ethics
- PartII (Year 2)
- The student must take the following modules:
- MBCHB201c: Year 2 Paper 3 - Population Health, Health, Culture and Society, Professional Practice, Values and Ethics
- PartII (Year 3)
- The student must take the following modules:
Educational Aims: Knowledge, Understanding and Skills
Knowledge, Understanding and Skills: What are the General Aims of the Programme?
To enable the student to:
• adopt the principles of lifelong learning
• retrieve, manage and manipulate information by all means, including electronically
• present information clearly in written, electronic and oral forms, and communicate ideas and arguments effectively
• effectively manage time and resources and set priorities
• apply the principles of scientific research and audit
• study topics in depth
• deal with uncertainty and work within a changing environment
• teach effectively and act as a mentor to others
• work effectively within a team
(These are the general aims for graduates as listed in the QAA Benchmarking Statement for Medicine)
Subject Specific Aims of the Programme?
To ensure that students achieve the basic clinical competence, professional skills and attributes which they require to take up posts as Foundation Year junior doctors and proceed to postgraduate training, focused on:
• Knowledge and understanding of the theoretical basis of clinical practice – including biomedical sciences, diagnostic and therapeutic rationales and perspectives on behaviour and populations;
• Professional skills – learning, critical thinking and appraisal, communication, and clinical skills;
• Professional qualities and behaviour – attitudes, conduct, ethics, accountability, teamwork, and responsibility for continuing learning, with due regard for clinical governance.
Learning Outcomes: Knowledge, Understanding and Skills
Medical graduates must be able to demonstrate the outcomes which are laid down by the General Medical Council as essential preparation for clinical practice and for moving on to the Foundation Programme stage of medical education. As well as the categories of knowledge, understanding and skills, the outcomes cover the development of the type of behaviour which must be demonstrated.
The GMC lays out these outcomes in its publication ‘Tomorrow’s Doctors (2009)’:
The doctor as a scholar and scientist
1 The graduate will be able to apply to medical practice biomedical scientific principles, method and knowledge relating to: anatomy, biochemistry, cell biology, genetics, immunology, microbiology, molecular biology, nutrition, pathology, pharmacology and physiology. The graduate will be able to
(a) Explain normal human structure and functions
(b) Explain the scientific bases for common disease presentations.
(c) Justify the selection of appropriate investigations for common clinical cases.
(d) Explain the fundamental principles underlying such investigative techniques.
(e) Select appropriate forms of management for common diseases, and ways of preventing common diseases, and explain their modes of action and their risks from first principles.
(f) Demonstrate knowledge of drug actions: therapeutics and pharmacokinetics; drug side effects and interactions, including for multiple treatments, long-term conditions and non-prescribed medication; and also including effects on the population, such as the spread of antibiotic resistance.
(g) Make accurate observations of clinical phenomena and appropriate critical analysis of clinical data.
2 Apply psychological principles, method and knowledge to medical practice.
(a) Explain normal human behaviour at an individual level
(b) Discuss psychological concepts of health, illness and disease
(c) Apply theoretical frameworks of psychology to explain the varied responses of individuals, groups and societies to disease
(d) Explain psychological factors that contribute to illness, the course of the disease and the success of treatment
(e) Discuss psychological aspects of behavioural change and treatment compliance.
(f) Discuss adaptation to major life changes, such as bereavement. Compare and contrast the abnormal adjustments that might occur in these situations.
(g) Identify appropriate strategies for managing patients with dependence issues and other demonstrations of self-harm.
3 Apply social science principles, method and knowledge to medical practice.
(a) Explain normal human behaviour at a societal level.
(b) Discuss sociological concepts of health, illness and disease.
(c) Apply theoretical frameworks of sociology to explain the varied responses of individuals, groups and societies to disease.
(d) Explain sociological factors that contribute to illness, the course of the disease and the success of treatment including issues relating to health inequalities, the links between occupation and health and the effects of poverty and affluence.
(e) Discuss sociological aspects of behavioural change and treatment compliance.
4 Apply to medical practice the principles, method and knowledge of population health and the improvement of health and health care
(a) Discuss basic principles of health improvement, including the wider determinants of health, health inequalities, health risks and disease surveillance
(b) Assess how health behaviours and outcomes are affected by the diversity of the patient population.
(c) Describe measurement methods relevant to the improvement of clinical effectiveness and care.
(d) Discuss the principles underlying the development of health and health service policy, including issues relating to health economics and equity, and clinical guidelines.
(e) Explain and apply the basic principles of communicable disease control in hospital and community settings.
(f) Evaluate and apply epidemiological data in managing healthcare for the individual and the community.
(g) Recognise the role of environmental and occupational hazards in ill-health and discuss ways to mitigate their effects.
(h) Discuss the role of nutrition in health
(i) Discuss the principles and application of primary, secondary and tertiary prevention of disease.
(j) Discuss from a global perspective the determinants of health and disease and variations in health care delivery and medical practice.
5 Apply scientific method and approaches to medical research.
(a) Critically appraise the results of relevant diagnostic, prognostic and treatment trials and other qualitative and quantitative studies as reported in the medical and scientific literature.
(b) Formulate simple relevant research questions in biomedical science, psychosocial science or population science, and design appropriate studies or experiments to address the questions.
(c) Apply findings from the literature to answer questions raised by specific clinical problems.
(d) Understand the ethical and governance issues involved in medical research.
The doctor as a practitioner
6 The graduate will be able to carry out a consultation with a patient:
(a) Take and record a patient's medical history, including family and social history, talking to relatives or other carers where appropriate.
(b) Elicit patients’ questions, their understanding of their condition and treatment options, and their views, concerns, values and preferences.
(c) Perform a full physical examination.
(d) Perform a mental-state examination.
(e) Assess a patient’s capacity to make a particular decision in accordance with legal requirements and the GMC’s guidance (in Consent: Patients and doctors making decisions together).
(f) Determine the extent to which patients want to be involved in decision-making about their care and treatment.
(g) Provide explanation, advice, reassurance and support.
7 Diagnose and manage clinical presentations.
(a) Interpret findings from the history, physical examination and mental-state examination, appreciating the importance of clinical, psychological, spiritual, religious, social and cultural factors.
(b) Make an initial assessment of a patient's problems and a differential diagnosis. Understand the processes by which doctors make and test a differential diagnosis.
(c) Formulate a plan of investigation in partnership with the patient, obtaining informed consent as an essential part of this process.
(d) Interpret the results of investigations, including growth charts, x-rays and the results of the diagnostic procedures in Appendix 1.
(e) Synthesise a full assessment of the patient's problems and define the likely diagnosis or diagnoses.
(f) Make clinical judgements and decisions, based on the available evidence, in conjunction with colleagues and as appropriate for the graduate’s level of training and experience. This may include situations of uncertainty.
(g) Formulate a plan for treatment, management and discharge, according to established principles and best evidence, in partnership with the patient, their carers, and other health professionals as appropriate. Respond to patients’ concerns and preferences, obtain informed consent, and respect the rights of patients to reach decisions with their doctor about their treatment and care and to refuse or limit treatment.
(h) Support patients in caring for themselves.
(i) Identify the signs that suggest children or other vulnerable people may be suffering from abuse or neglect and know what action to take to safeguard their welfare.
(j) Contribute to the care of patients and their families at the end of life, including management of symptoms, practical issues of law and certification, and effective communication and team working.
8 Communicate effectively with patients and colleagues in a medical context.
(a) Communicate clearly, sensitively and effectively with patients, their relatives or other carers, and colleagues from the medical and other professions, by listening, sharing and responding.
(b) Communicate clearly, sensitively and effectively with individuals and groups regardless of their age, social, cultural or ethnic backgrounds or their disabilities, including when English is not the patient’s first language.
(c) Communicate by spoken, written and electronic methods (including medical records), and be aware of other methods of communication used by patients. Appreciate the significance of non-verbal communication in the medical consultation.
(d) Communicate appropriately in difficult circumstances, such as breaking bad news, and when discussing sensitive issues, such as alcohol consumption, smoking or obesity.
(e) Communicate appropriately with difficult or violent patients.
(f) Communicate appropriately with people with mental illness.
(g) Communicate appropriately with vulnerable patients.
(h) Communicate effectively in various roles, for example as patient advocate, teacher, manager or improvement leader.
9 Provide immediate care in medical emergencies.
(a) Assess and recognise the severity of a clinical presentation and a need for immediate emergency care.
(b) Diagnose and manage acute medical emergencies.
(c) Provide basic first aid.
(d) Provide immediate life support.
(e) Provide cardio-pulmonary resuscitation or direct other team members to carry out resuscitation.
10 Prescribe drugs safely, effectively and economically.
(a) Establish an accurate drug history, covering both prescribed and other medication.
(b) Plan appropriate drug therapy for common indications, including pain and distress.
(c) Provide a safe and legal prescription.
(d) Calculate appropriate drug doses and record the outcome accurately.
(e) Provide patients with appropriate information about their medicines.
(f) Access reliable information about medicines.
(g) Detect and report adverse drug reactions.
(h) Demonstrate awareness that many patients use complementary and alternative therapies, and awareness of the existence and range of these therapies, why patients use them, and how this might affect other types of treatment that patients are receiving.
11 Carry out practical procedures safely and effectively
(a) Be able to perform a range of diagnostic procedures, and measure and record the findings.
(b) Be able to perform a range of therapeutic procedures
(c) Be able to demonstrate correct practice in general aspects of practical procedures.
12 Use information effectively in a medical context.
(a) Keep accurate, legible and complete clinical records.
(b) Make effective use of computers and other information systems, including storing and retrieving information.
(c) Keep to the requirements of confidentiality and data protection legislation and codes of practice in all dealings with information.
(d) Access information sources and use the information in relation to patient care, health promotion, advice and information to patients, and research and education.
(e) Apply the principles, method and knowledge of health informatics to medical practice.
The doctor as a professional
13 The graduate will be able to behave according to ethical and legal principles. The graduate will be able to:
(a) Know about and keep to the GMC’s ethical guidance and standards including Good Medical Practice, the ‘Duties of a doctor registered with the GMC’ [see Appendix 2] and supplementary ethical guidance which describe what is expected of all doctors registered with the GMC.
(b) Demonstrate awareness of the clinical responsibilities and role of the doctor, making the care of the patient the first concern. Recognise the principles of patient-centred care, including self-care, and deal with patients’ healthcare needs in consultation with them and, where appropriate, their relatives or carers.
(c) Be polite, considerate, trustworthy and honest, act with integrity, maintain confidentiality, respect patients’ dignity and privacy, and understand the importance of appropriate consent.
(d) Respect all patients, colleagues and others regardless of their age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status. Respect patients’ right to hold religious or other beliefs, and take these into account when relevant to treatment options.
(e) Recognise the rights and the equal value of all people and how opportunities for some people may be restricted by others’ perceptions.
(f) Understand and accept the legal, moral and ethical responsibilities involved in protecting and promoting the health of individual patients, their dependants and the public including vulnerable groups such as children, older people, people with learning disabilities and people with mental illnesses.
(g) Demonstrate knowledge of laws, and systems of professional regulation through the GMC and others, relevant to medical practice, including the ability to complete relevant certificates and legal documents and liaise with the coroner or procurator fiscal where appropriate.
14 Reflect, learn and teach others.
(a) Acquire, assess, apply and integrate new knowledge, learn to adapt to changing circumstances and ensure that patients receive the highest level of professional care.
(b) Establish the foundations for lifelong learning and continuing professional development, including a professional development portfolio containing reflections, achievements and learning needs.
(c) Continually and systematically reflect on practice and, whenever necessary, translate that reflection into action, using improvement techniques and audit appropriately for example, by critically appraising the prescribing of others.
(d) Manage time and prioritise tasks, and work autonomously when necessary and appropriate.
(e) Recognise own personal and professional limits and seek help from colleagues and supervisors when necessary.
(f) Function effectively as a mentor and teacher including contributing to the appraisal, assessment and review of colleagues, giving effective feedback, and taking advantage of opportunities to develop these skills
15 Learn and work effectively within a multi-professional team.
(a) Understand and respect the roles and expertise of health and social care professionals in the context of working and learning as a multi-professional team.
(b) Understand the contribution that effective interdisciplinary teamwork makes to the delivery of safe and high quality care.
(c) Work with colleagues in ways that best serve the interests of patients, passing on information and handing over care, demonstrating flexibility, adaptability and a problem-solving approach.
(d) Demonstrate ability to build team capacity and positive working relationships and undertake various team roles including leadership and the ability to accept leadership by others.
16 Protect patients and improve care.
(a) Place patients’ needs and safety at the centre of the care process.
(b) Deal effectively with uncertainty and change.
(c) Understand the framework in which medicine is practised in the UK, including: the organisation, management and regulation of healthcare provision; the structures, functions and priorities of the NHS; and the roles of, and relationships between, the agencies and services involved in protecting and promoting individual and population health.
(d) Promote, monitor and maintain health and safety in the clinical setting, understanding how errors can happen in practice, applying the principles of quality assurance, clinical governance and risk management to medical practice, and understanding responsibilities within the current systems for raising concerns about safety and quality.
(e) Understand and have experience of the principles and methods of improvement, including audit, adverse incident reporting and quality improvement, and how to use the results of audit to improve practice.
(f) Respond constructively to the outcomes of appraisals, performance reviews and assessments.
(g) Demonstrate awareness of the role of doctors as managers, including seeking ways to continually improve the use and prioritisation of resources.
(h) Understand the importance of, and the need to keep to, measures to prevent the spread of infection, and apply the principles of infection prevention and control.
(i) Recognise own personal health needs, consult and follow the advice of a suitably qualified professional, and protect patients from any risk posed by own health.
(j) Recognise the duty to take action if a colleague’s health, performance or conduct is putting patients at risk.
What are the General Learning Outcomes?
See General Aims above.
Learning and Teaching Strategies and Methods: Knowledge, Understanding, Skills
The learning and teaching strategies and methods used in the MBChB programme are as follows:
• Problem-Based Learning (PBL) (years 1-4) – this is a method used extensively in medical education to encourage students to participate actively in their own learning, and to develop skills in self-directed learning which they will need for lifelong learning in the medical profession.
• Supporting lectures given by a wide range of academic and clinical staff – linked to the PBL topic for that fortnight
• Anatomy teaching sessions again linked to the PBL topic
• Small group teaching of communication skills led by GPs (years 1-2) and integrated into rotations in the later years
• Practical teaching sessions on clinical skills (year 1) and clinical skills teaching in later years integrated into hospital placements – taught by NHS clinical skills tutors
• Special Study Modules – 4-mini-projects, each lasting four weeks (during which time the students are not doing anything else). Students study a topic of their choice offered by convenors including LMS staff, staff from other LU departments, staff from UCumbria and UCLan, clinicians, GPs – and write a report, usually a literature review)
• Workshops and small group teaching on population health, critical appraisal, medical ethics
• Small group teaching (by GPs) to support the community placements.
The learning is supported by clinical placements:
• Hospital placements (years 2-5) with integrated clinical skills and communication skills teaching.
• Community placements (years 1-5) – with the Health Visitor Service in year 1 and with GP practices in years 2-5.
• A short placement (year 2) with a non-NHS organisation providing resources to patients in the community (charities and voluntary organisations).
• A 5-week elective period spent in a healthcare setting outside of the North West of England.
There are three distinct phases of the programme:
- Foundations of medicine Year 1
- Learning to diagnose and manage illness Years 2-4
- Intensive clinical experience Year 5
The course content falls into four curricular themes:
• Medical Sciences
• Population Health
• Health, Culture and Society
• Professional Practice, Values and Ethics
Each PBL scenario will generate learning objectives for each of the four themes and topics are revisited throughout the course in a ‘spiral’ manner.
Subject Specific: Knowledge, Understanding and Skills?
General Knowledge Understanding and Skills?:
Assessment Strategy and Methods: Knowledge, Understanding and Skills
The Medical School Assessment Policy (available on request) sets out the approach adopted to ensure that students achieve the outcomes described above. The document also aligns LMS policy with the overarching assessment policy of Lancaster University.
The Assessment Policy describes all of the assessment methods to be used, when and why. It explains some of the particular issues for assessment of medical education, e.g.
• The use of formative assessment (to allow students to assess their progress, learning and understanding)
• Use of the assessment ‘blueprint’ in setting the written papers
• The use of practical exams for clinical skills (the OSCE)
• The assessment methods for SSMs, the ethics case analysis and the Health, Culture and Society coursework
• The year 5 portfolio assessment process (Professional Education and Training Appraisal or ‘PETA’)
• The use of logbooks to record satisfactory work on placements
• The standard setting process and how each pass mark is arrived at
• The building up of a bank of exam questions, and the use of questions from the central question bank of the Medical Schools Council Assessment Alliance
• The number of external examiners required and when they will be appointed
• Reasonable adjustments to written exams e.g. 25% extra time/use of computer for dyslexic students (NB there is no extra time in clinical exams as they have to convey the ‘real life’ situation of clinical work).
An Assessment Handbook (available on request) is produced annually which pulls together for the students all of the information on assessment – together with the Assessment Policy, this is a full description of assessment strategy and methods.
All assessments comply with Lancaster University’s Assessment Policy, but a number of programme-specific caveats are required to deal with the particular requirements of medical education, for example the fact that no condonation of failed elements is allowed.
Assessment of General Knowledge Understanding and Skills?
The general aims of the course are developed and assessed in many different areas of the course, for example:
• Adopt the principles of lifelong learning – the PBL process, the clinical placements, the year 5 PETA process
• Study topics in depth - the elements where there is student choice i.e. the Special Study Modules and the year 5 Selectives in Advanced Medical Practice
- covered under 'Evaluation and Improvement of Quality Standards'.
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