King’s College London School of Medicine The first two years of MBBS Despo Papachristodoulou October 2011

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

The standard programme 5 Years 5 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 Phase 4 Phase year entrants 28 GPEP 50 EMDP 34 Oxbridge

Phase 1Phase 2 12 weeks getting started First 12 scenarios, integrated learning with a clinical context Next 23 scenarios The first two years YEAR 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 : knowledge skills attitudes 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 Immunology6 Biochemistry/ metabolism 8 Microbiology2 Pathology/histopathology5 Pharmacology 5 Psychology /sociology/ethics/stats10

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 up Professor of Psychology Example of a clinical scenario in one week Lectures: The cardiac cycle 2 Blood cells, haemopoiesis Atherosclerosis Embolism and infarction Heart disease pharmacology 2 Dissection of thorax In phase one Tutorial on CVS physiology Tutorial on CVS pharmacology GP or hospital visit Histology of blood Problem solving workshop Co-arctation Problem solving workshop Diseased and healthy heart Clinical skills Blood pressure ECG

Clinical problem: ‘weight loss and obesity Clinician from IT Presentation of Patient with Crohn’s Clinical problem debrief /summing up IT clinician/ biochemist Example of a clinical scenario in one week Lectures: Energy balance and body weight Macronutrients PEM Vitamins Minerals Lipid synthesis and transport/ hyperlipoproteinaemias Integration of metabolism Diabetes mellitus Eating disorders Stats: regression and correlation Problem solving workshop Regression 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 Diabetology Lectures: Diagnosis and classification Insulin secretion Insulin action and insulin resistance Therapeutic use of insulin Pathogenesis of type 1 diabetes Pathophysiology of symptoms of diabetes Randomised control trials Monitoring control in diabetes Hyperglycaemic emergencies Pharmacology of type 2 diabetes Metabolic syndrome and obesity Diabetic complications Scenario debrief: What is new in diabetes Professor of Diabetology Clinical epidemiology tutorial randomised control trials Clinical skills communication skills Explaining and exploring CAL session Case history and management PSW insulin therapy PSW hypoglycaemia Living with Diabetes Hospital visit Diabetic 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 Scenarios Scenarios total cardiovascular and respiratory 8-13 gastrointestinal, renal, nutrition and metabolism Students must pass all three written examinations One 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 Scenarios Scenarios OSCE 12 total musculoskeletal, endocrinology head and neck, neuroscience genetics, infections Students must pass all three written papers and the OSCE One 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 ( ) Presenting the basic science material in scenario format made it interesting Strongly agree60% Agree33% Neutral6% Disagree1% Strongly disagree0%

Student evaluation from end of year questionnaires ( ) Presenting the basic science material in scenario format made it interesting Strongly agree60% Agree33% Neutral6% Disagree1% Strongly disagree0%

Student evaluation Presenting the basic science material in scenario format helped learning Strongly agree53% Agree43% Neutral2% Disagree1% Strongly disagree1%

Student evaluation Presenting the basic science material in scenario format helped learning Strongly agree55% Agree33% Neutral8% Disagree3% Strongly disagree1%

Student evaluation I found the clinical sessions in hospital and general practice interesting Strongly agree28% Agree49% Neutral17% Disagree4% Strongly disagree1%

Evaluation The end of year examinations were : Too difficult36% About the right level of difficulty 64% Too easy1%

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