Download 1.3.1 Human Life Cycle

Faculty of Medicine
Detailed learning outcomes for components of the MBBS/BSc programme
1
Year 1
1.1
Molecules, Cells and Disease
By the end of this theme students are expected to have achieved the
following learning outcomes in relation to the topics indicated.
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1.1.1 Introduction to Cells
Outline the main components of prokaryotic and eukaryotic cells.
Describe the features of the main types of infectious agents.
Describe the constituents, properties and functions of cell membranes.
Describe the constituents of blood and their function.
Classify the main types of diseases and their effect on cells and
tissues.
1.1.2 Nucleic Acids and Gene Expression
Describe the structure of DNA and its packing into human
chromosomes.
Describe the cell cycle, mitosis and DNA replication in prokaryotes and
in eukaryotes.
Describe the organisation of a gene and the mechanism of
transcription.
Describe the main features of protein translation and the role of
ribosomes.
Explain how mutations may result in disease and the role of antibiotics
in protein synthesis.
Explain the main DNA amplification and analysis methods.
1.1.3 Metabolism
Understand the constituents of proteins, explain their assembly and
structure and the forces that contribute to their stability.
Describe the main processes and reactions involved in cellular
energetics.
Contrast glycolytic and oxidative metabolism and describe the
functioning of mitochondria.
Describe membrane constituents in various parts of the cell and the
synthesis and metabolism of fatty acids.
Explain the structure and function of cholesterol, its implication in
disease and possible pharmacological interventions.
Describe the dynamic properties of membranes and vesicles and their
role in excretion and absorption.
Explain how activity affects metabolism in human tissues and describe
the mechanisms which regulate energy utilisation.
1.1.4 Genetics
Describe meiosis and Mendelian inheritance.
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Describe somatic and germline mutations and the types of mutations
that cause common monogenic diseases.
Describe chromosome abnormalities, translocations and the genetics
of Down syndrome, and the role of genetic counselling.
Explain the consequence of mutations and selection on population
genetics.
Explain polymorphism and genetic linkage and their significance.
Describe prenatal diagnostic tests and techniques.
Explain genetic and non-genetic factors in common congenital
childhood diseases.
Describe what is meant by multifactorial inheritance and explain its
role in diseases such as diabetes mellitus and coronary heart disease.
1.1.5 Cellular Organisation of Tissues
Describe the features of epithelial cells and of the extracellular matrix.
Illustrate how epithelial cells have specialised functions, and describe
their different patterns of cell division.
Describe the structure and role of the extracellular matrix, and the
structure and role of collagen in intra and extracellular structures.
Describe the molecules of the extracellular matrix and the regulation of
collagen assembly.
Describe the composition of the main body fluids and the mechanisms
which control their volume.
Describe the mechanisms of signalling along and in between excitable
cells and the factors which control the amount of force exerted by a
muscle.
Explain how signals are transmitted between cells, and between the
cell periphery and the nucleus.
1.1.6 Microbiology
Describe viruses and how they replicate.
Describe how viruses are transmitted and how they cause disease.
Explain how antiviral drugs work, and the difficulties in developing
them.
Describe bacteria and the way in which extracellular bacteria cause
disease.
Describe how intracellular bacteria cause disease.
Describe the mode of action of major antibiotics and argue for and
against their use.
Describe the mechanism of vaccination.
Describe the mechanism of the various types of fungal infections and
their epidemiology.
List protozoal pathogens and describe parasitic infections, including
malaria.
1.1.7 Immunology
Understand the basic concepts in the immunological response.
Describe the cells and organs involved in the immunological response.
Explain clonal selection, CD markers.
Explain innate immunity.
Describe the structure of antibodies and their mode of action.
Understand the difference between primary and secondary immune
response.
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Understand the difference in mode of action of the different classes of
lymphocyte.
Describe the mechanisms of host defence against pathogens.
1.1.8 Cell Pathology
Understand concepts in cell pathology.
Describe the main haemodynamic disorders.
Describe acute and chronic inflammation.
Understand the reasons and benefits of autopsy.
Explain the purpose of forensic medicine and its legal framework.
Describe the relationship between disease symptoms and underlying
cell and tissue changes.
1.2
Life Support Systems
By the end of this theme students are expected to have achieved the
following learning outcomes in relation to the topics indicated.
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1.2.1 Cardiovascular System
Explain how the heart develops and describe the anatomical features
of the mature heart and the morphology of a typical ventricular
myocyte.
Describe the main physiological mechanisms determining cardiac
output, the heart sounds and the pressures and volumes in the
chambers of the heart and define commonly-used indices of cardiac
function and state their normal values.
Understand the design of the cardiovascular system and morphology
of blood vessels and describe the major endocrine, neuronal and local
systems involved in regulating systemic blood pressure and blood flow
and how these systems can be altered by certain therapeutic
interventions.
Explain the cardiovascular responses to exercise, blood loss and fluid
overload.
Make accurate measurements of systolic and diastolic blood
pressures using a sphygmomanometer and stethoscope.
Describe how the electrical activity of the heart arises, how this is
modulated, how it changes in different parts of the heart and how it
affects function.
Record an ECG using standard limb leads and measure its standard
intervals, know the normal limits and be able to describe ECG
abnormalities in two diseases of the heart.
Describe the normal haemostatic mechanisms and the causes and
manifestations of bleeding disorders.
Describe the epidemiology of cardiovascular disease including
geographic comparisons and know current theories on the causes of
primary hypertension.
Explain the pathogenesis and clinical consequences of thrombi and
emboli formation in the coronary, systemic and pulmonary vasculature
and understand the rationale for current treatments.
Define heart failure, know its aetiology, symptoms and
pathophysiology and understand the rationale for current treatments.
Understand the effect of cardiac valve dysfunction, its symptoms and
consequences.
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1.2.2 Respiratory System
Outline the basic anatomy and structure of the respiratory system.
Explain the humeral and neural control of the airways.
Describe the structure of the lung epithelium and the function of the
main cells contained within it.
Outline the defence mechanism of the airway mucosa and how these
are changed in airway hypersensitivity, specifically asthma.
Outline the control of breathing and how this changes during sleep.
Describe the delivery of oxygen to the body tissues and the removal of
CO2 from the body.
Outline the principles of ventilation and explain the roles of PO2 and
PCO2 in the pulmonary and alveolar ventilation.
Describe the pulmonary circulation and the basis of pulmonary
hypertension.
Describe the mechanics of breathing, including what is meant by ‘lung
compliance and resistance.
Outline what is meant by the terms restrictive and obstructive lung
disease and how they influence breathing.
Describe the main muscles used in breathing and how these are
utilised to generate different lung volumes. List the lung volumes that
can be measured.
Describe the sensory aspects of respiratory disease with reference to
one example e.g. cough, dyspnoea, chest pain.
Distinguish between chronic and acute lung disease, explain the
defence mechanism to infection in healthy lungs.
Describe the main causes of lung cancer and its basic presentation.
Explain how the lung develops in the foetus, and the changes that
occur in breathing at birth.
1.2.3 Alimentary Systems
Explain the main physiological aspects of the normal alimentary
system including:
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the principles of secretion, absorption, motility and
control within the GI tract.
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distribution and organisation of mucosa.
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cellular mechanisms in digestion and absorption.
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pancreatic structure and secretion.
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hepatic organisation and function.
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the role of the enteric nervous system and gut
hormones.
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Immunological mechanisms within the alimentary tract.
Describe examples of malfunction within the alimentary system
including:
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gastro-oesophageal reflux disease.
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pancreatitis.
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jaundice and liver failure.
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infections of the GI tract.
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inflammatory bowel disease.
1.2.4 Urinary System
Describe the structural organisation of the kidneys and urinary tract at
the system and cellular levels.
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Understand the physiological mechanisms of urinary continence.
Explain the physiological mechanisms by which the various
components of the kidney produce and regulate the composition of
urine.
Understand the principal renal mechanisms responsible for
homeostasis of water, electrolytes, pH, glucose and urea in the
extracellular fluid.
Define Renal Clearance and Glomerular Filtration Rate and explain in
principle how these may be measured in patients.
Understand how renal mechanisms contribute to the control of blood
pressure.
Describe the sites and mechanism of action of the main classes of
diuretics.
1.2.5 Skin
Explain the concept of the skin as a single organ of the body with its
complex intra-relationships with other organ systems of the body.
Describe the basic anatomical structure of the skin and the intrarelationships between the epidermis, dermis and subcutis.
Describe the structure of the epidermis and associated adnexal
structures its foetal development and regulation of growth.
Outline the mechanisms by which the integrity of the dermoepidermal
junction is maintained and the results of failures of these mechanisms.
Describe the migrant cell populations within the epidermis and detail
their origins.
Describe the structure of the dermis including the vascular and nerve
supply to the skin, the development of the dermis, regulation of
collagen formation and events that occur in senescence.
Describe skin pigmentation, the development, function and control of
melanocytes and the principals of immediate and delayed tanning.
Describe the development and maturation of acquired melanocytic
naevi and the features of carcinogenic change within these lesions.
Describe the development of the hair follicle, its anatomy and
regulation of growth through life including the effect of sex hormones
and age on hair growth.
Describe the principles of barrier function of the skin and its role in
controlling percutaneous water loss and absorption and defence
against microbial invasion.
Explain the control of body temperature and the role of the cutaneous
vasculature in maintaining body temperature.
Explain the importance of the skin as an immunological organ and
describe the role of individual cell types in the cutaneous immune
system.
Describe the consequence of skin organ failure and give examples of
the impact of this on the body and other organ systems.
1.2.6 Anatomy of the Thorax
 Explain the roles of skeleton, muscles, pleural cavities and lungs in
breathing.
 Explain the functions, positions and relations of the structures entering
and leaving the lungs.
 Explain the anatomical principles underlying insertion of chest drains
and relief of tension pneumothorax and cardiac tamponade.
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 Describe the arterial supply and venous drainage of the thoracic
viscera and thoracic walls.
 Define the mediastinum and demonstrate its subdivisions and
contents.
 Explain the principles of X-ray imaging methods and identify the
features of the normal adult chest in conventional X-ray and CT
images.
 Demonstrate using correct terminology the position and relations of
the pericardium and pericardial sac, heart chambers and valves in
anatomical specimens, living subjects and images.
 Explain the origins of heart sounds and demonstrate optimal
auscultation of each valve.
 Describe and recognise normal breath sounds and percussion sounds.
 Explain the pathways through which the heart, lungs, chest wall and
diaphragm obtain their sensory and motor nerve supplies and explain
referred pain of thoracic origin.
 Describe the anatomical organisation and pathways of lymphatic
drainage of the breasts.
 Explain the physiology of lymph formation, the structure and functions
of lymph nodes, the importance of lymphatic drainage in the
dissemination of cancers and infections and the main pathways for
lymphatic drainage of the body.
 Demonstrate the intrathoracic positions and relations of the trachea,
oesophagus, thoracic duct, vagus nerves and phrenic nerves.
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1.2.7 Anatomy of the Abdomen, Pelvis and Perineum
Explain the organisation and functions of the abdominal walls.
Distinguish and explain the anatomical basis for inguinal and femoral
hernias.
Demonstrate the organisation of the peritoneal cavity (including the
lesser sac) and mesenteries and the abdominal viscera in relation to
descriptive planes and landmarks.
Outline the arterial supply and venous drainage of the abdominal walls
and viscera, including the portal venous system and the positions and
importance of the main portal-systemic anastomoses.
Explain the arrangement of the organs in the retroperitoneum.
Explain the patterns of lymphatic drainage of the abdomen, pelvis and
perineum and their importance in the dissemination of cancer.
Outline the motor and sensory nerve supply of the abdominal walls,
abdominal and pelvic viscera and the perineum.
Explain the principle of referred pain and apply it to the abdominopelvic organs.
Demonstrate the anatomical principles underlying palpation of the
liver, kidneys and abdominal aorta.
Identify the features of normal X-ray, CT and MRI images of the
abdomen including contrasts.
Distinguish structurally and functionally between pelvis and perineum,
and identify the landmarks of the pelvis and perineum in a living
subject.
Demonstrate the main components of the female and male
reproductive tracts and external genitalia and explain their roles.
Describe the pelvic floor and pelvic fascia and explain their
importance.
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Explain what can be felt during rectal examination in normal adult men
and women.
Explain the anatomical basis of defaecation, micturition, continence
and sexual function.
Explain the anatomical considerations in catheterisation of the urethra.
1.3
Life Cycle and Regulatory Systems
By the end of this theme students are expected to have achieved the
following learning outcomes in relation to the topics indicated.
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1.3.1 Human Life Cycle
Outline the main physiological mechanisms of sexual arousal and
coitus.
Describe the events of the ovarian and menstrual cycles and their
endocrine basis.
Outline the endocrine background to the establishment and
maintenance of pregnancy.
Outline the initiation and course of labour.
Explain the cellular and chromosomal events of fertilisation, cleavage
and implantation including abnormal implantation sites.
Describe the main events of embryonic development from gastrulation
to completion of body folding.
Describe the main phases and mechanisms of maternal support of the
foetus.
Describe the normal mechanisms of sex determination and
reproductive system development including the role of the Y
chromosome and explain the results of failures in these mechanisms
using specific examples.
Explain the principles of how genes control the unfolding of
development giving important examples.
Distinguish and give examples of chromosomal, genetic and
developmental abnormalities and outline how these may arise.
1.3.2 Neuroscience and Mental Health
Categorise the major causes of neurological disorders and outline the
main components of a neurological examination.
List the characteristics of neurones which suit them to their role and
outline their organisation at the tissue level.
Define the roles of neuroglia in the nervous system.
Explain the ionic basis of neuronal potentials, how they are
propagated and the factors which affect them.
Explain the basic process of synaptic neurotransmission, indicating the
diversity of function of the basic types of transmitters.
Explain the mechanisms underlying epilepsy in terms of abnormal
transmitter function and outline the common methods of drug
treatment.
Define the structure and function of the main components of the
central nervous system.
Explain the flow and functions of cerebrospinal fluid through the brain
and meninges and relate it to the development of hydrocephalus.
Describe the organisation of peripheral nerves and their relationship to
the central nervous system.
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Differentiate the effects of common nerve lesions and list the
techniques used in diagnosis.
Define the organisation of the autonomic nervous system in terms of
its physiology, neurochemistry and gross anatomy, including the
sympathetic and parasympathetic influences on the principal systems
of the body.
Describe the main abnormalities in autonomic failure and the main
methods by which autonomic activity may be estimated clinically.
1.3.3 Endocrine System
Understand the basic principles underlying the endocrine system,
individual hormones, their regulatory function and relevance to clinical
medicine.
Identify the pivotal role of the hypothalamo-hypophysial axis in
regulating other endocrine glands and to relate the actions of the
adenohypophysial hormones to clinical diseases.
Explain the role of the neurohypophysial system and its hormones.
Understand how intermediary metabolism is influenced by hormones,
in particular what happens to in the absence of insulin, in diabetes
mellitus.
Understand how thyroid hormones affect metabolism and function in
normal and disease states.
Describe adrenal hormones function and comprehend how
disturbances in adrenal steroid production are associated with
Addison’s disease and Cushing’s syndrome.
Describe the actions of the gonadal steroids and understand the
regulation of their production, and role in gametogenesis.
Explain how hormones from the parathyroid glands, the thyroidal
parafollicular cells and a vitamin D metabolite all contribute to
regulating the blood calcium concentration.
1.3.4 Musculoskeletal System
List and briefly describe the structure and function of some of the
motor proteins.
Outline the main features of the crossbridge cycle as it occurs in
skeletal muscle.
Describe the processes involved in the control of contraction of
skeletal muscle by intracellular calcium.
Define the term “motor unit” and explain how it is relevant to in vivo
muscle function.
Briefly explain the processes involved in matching muscle contractile
force to the task required.
Outline the major similarities and major differences between the
contraction of skeletal, cardiac and smooth muscle.
Describe the electromyography and what information can be gained
with it.
1.4
Foundations of Clinical Practice
By the end of this theme students are expected to have achieved the
following learning outcomes in relation to the topics indicated.
1.4.1
Sociology
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Understand those sociological concepts which are relevant to the
practice of medicine.
Understand the relationship between disease and social contexts of
the life course, psychosocial environment and socio-economic
circumstances.
Understand cultural influences on the experience of disease as
manifest in illness behaviour, the sick role and stigma.
Understand social influences on the practice of medicine, including its
limitations and the relationship between, and communication between,
doctors and patients.
1.4.2 Communication Skills
Describe the features of patient-centred communication.
Describe the role of verbal communication skills in the doctor-patient
relationship.
Describe the role of non-verbal communication skills in the doctorpatient relationship.
Make effective presentations.
Identify their own strengths and weaknesses in communicating with
patients.
1.4.3 Information Technology
Understand that graphic presentation of numerical information
improves understanding of the data set.
Understand that different types of data require different forms of
graphical display.
Understand that coding data types in a seemingly logical manner can
sometime lead to anomalous results when data is analysed and
presented.
Illustrate numerical data in a variety of graphical styles according to
the nature of the data.
Import data from one software package into another and to manipulate
it into a desired structure for creating the illustration.
Utilise whatever graphic display systems are available to achieve the
objectives of the study.
Include a trendline on the plotted data, as appropriate.
Customise plots by altering axes and scales, applying labels, etc.
Import the graphical presentations into a Research Report and
describe briefly each illustration created.
Submit the Research report as an email attachment.
1.4.4 Patient Contact Course
Listen and talk to patients and to establish what is important to people
who use health care services.
Understand why people come and see a health professional.
Understand what people expect from health care professionals.
Understand what it is like for a person to live with a chronic illness or
disability.
Work with a group of other students and a group leader.
1.4.5
Evidence Based Medicine
1.4.5.1 Epidemiology and Public Health
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Interpret data from epidemiological studies.
Describe health and disease in population terms.
Read a scientific paper critically.
Appreciate the importance of population factors in individual
health/disease processes.
Appreciate the dangers of false inference from naïve interpretation of
data.
Appreciate the variability of biological data.
Appreciate the importance of statistics to medicine.
Appreciate the role of mathematical models in investigating disease,
epidemiology and natural history terms.
Understand the basic methods of epidemiological measurement and
study design.
Understand the scale and population patterns of infectious diseases
and key approaches to their study.
Understand the importance of nutrition in health and disease.
Understand the role and principles of descriptive statistics.
1.4.5.2 Statistics
Understand the importance of probability and statistics in evidencebased medicine.
Know the difference between various types of data, and how they can
be summarized.
Understand the principles behind statistical inference using statistical
tests and confidence intervals.
Read a scientific medical article confidently and critically.
Use a computer package (SPSS) for data exploration and summary.
Perform basic statistical analysis 'by hand' (on a calculator) and using
SPSS.
Understand the statistical issues involved in analysing and interpreting
a clinical trial.
Year 2
2.1
Molecules, Cells and Disease
By the end of this theme students are expected to have achieved the
following learning outcomes in relation to the topics indicated.
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2.1.1 Haematology
Describe blood cell types, their origin and life cycle.
State the normal ranges for blood cell counts. Understand the
nomenclature used to describe blood cell abnormalities
Understand the difference between the various categories of
anaemias and their possible causes.
Describe the role of iron in blood cell development and the role of diet
and absorption on the development of specific anaemias.
Understand molecular the roles of vitamin B12 and folic acid in the cell
cycle, particularly blood cells and describe clinical features and the
management of deficiencies in these vitamins.
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Understand the molecular and cellular basis of coagulation and the
genetic and clinical features of haemostatic disorders.
Understand blood groups, blood components and problems
associated with blood donation and transfusion.
Describe the causes and consequences of abnormal levels of the
main white blood cell categories.
Understand the structural and functional properties of the haemoglobin
molecule and the effect of the most common defects in the
haemoglobin genes on health.
Describe the genetics, clinical features and management of sickle cell
anaemia.
2.1.2 Laboratory Diagnostic methods
Describe the use of antibodies in diagnostics.
Describe the use of histopathology and cytopathology for diagnostics.
Understand the role of screening in patient care.
Understand chemical pathology procedures, their purpose and their
implementation in a clinical setting.
Understand how bacteriological cultures help define clinical conditions
and describe how the bacteriological laboratory functions and how it
can be used to confirm clinical diagnosis.
Describe the use of the virology laboratory to diagnose and confirm
infections.
2.1.3 Microbiology
Explain the increased risk of infection associated with hospital
admissions and the increasing risks since the Second World War.
Describe the relationship between hygiene, antibiotics usage and
infections in a hospital setting and modern hospital infection control
measures.
Describe outbreaks of infectious diseases and the steps taken to
identify and manage them.
2.1.4 Carcinogenesis
Understand the involvement of cellular processes in cancer, and
describe the range of expertise required to develop treatments.
Describe the main features of cancers from their epidemiological
perspective in adults and children.
Explain the relationship between radiation, carcinogens and DNA
damage as well as the natural mechanisms of DNA repair.
Describe the relationship between mutations, cancer and genetics and
what distinguishes hereditable predisposition to cancer.
Understand how disruption of the cell cycle leads to cancer and what
the role of protooncogenes, oncogenes and tumour suppressor genes
are.
Describe how our understanding of the causes of cancer has led to the
development of therapies, and their shortcomings.
2.1.5 The Cell Cycle
Describe the cell cycle, with reference to DNA and protein synthesis
and control mechanisms and highlight the main differences between
various tissues.
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Describe the mechanism of apoptosis and differentiate it from
necrosis.
Understand the role of apoptosis in development.
Describe the main signalling pathways that regulate gene activation
and protein synthesis. Understand the role of oscillating signals.
Understand the concepts of tumour suppressors, proto-oncogenes
and cytoprotective pathways.
2.1.6 Cell Behaviour
Describe the roles of growth factors, cell contacts and tissue
boundaries in the control of division of normal and transformed cells.
Describe the mechanisms of cell locomotion, with reference to the
three filament systems that define the cytoskeleton.
Describe the various types of molecular motors and polymerisation
engines that are responsible for biological movement at the cellular
level.
Understand the molecular basis of muscle contraction.
Describe the mechanisms that control cell locomotion.
Describe the mechanisms that control cytoskeletal processes
occurring during cell locomotion, with reference to phosphorylation,
second messengers and G-proteins.
Understand the role of metastasis in the development of cancer.
2.1.7 Cancer as a Disease
Understand the nomenclature that differentiates malignant and benign
cancers and their differentiation and development stage.
Describe the microscopical features of carcinomas.
Describe the mechanisms of invasion and metastasis and the factors
that affect sites of metastases.
Explain the terms 'grading' and 'staging', the effect of tumours on hosts
and host defence mechanisms against tumours.
Describe epidemiological, genetic and clinical features of breast
cancer and the main therapeutic avenues.
Describe the epidemiology of skin cancer and the role of sunlight and
of the papilloma virus in the development of disease.
Differentiate the different types of leukaemias and their presentation.
2.1.8 Immunology
Explain the mechanisms of hypersensitivity and its clinical
presentations.
Describe the mechanisms of atopic diseases, and their management.
Outline the genetic and environmental factors leading to autoimmunity
and the biological basis of immunological tolerance.
Describe the immunological aspects of the various categories of
transplantation, and the immunological management of transplant
recipients.
Outline current theories of why the foetus is not rejected by the
mother.
Describe the mechanisms that control cytoskeletal processes
occurring during cell locomotion, with reference to phosphorylation,
second messengers and G-proteins.
Understand the role of metastasis in the development of cancer.
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2.2
Life Cycle and Regulatory Systems
By the end of this theme students are expected to have achieved the
following learning outcomes in relation to the topics indicated.
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2.2.1 Human Life Cycle
Define and discuss the nature and principles of management of major
issues in women’s health, including manipulation of fertility, menstrual
and endometrial problems, cervical cellular abnormality and the use of
hormone replacement therapy.
Describe the normal patterns and regulation of prenatal and postnatal
growth, including the origins and principles of management of
intrauterine growth retardation and the assessment of growth in
children.
Explain the initiation and nature of the endocrine changes of puberty;
analyse the main features of psychological and social development
during puberty and adolescence and how common and serious
problems may arise.
Describe the main physiological, psychological and social changes
associated with ageing and how the health of ageing people can be
supported.
Explain the main structural and physiological features of the foetal
circulation and how these change at and after birth.
2.2.2 Neuroscience and Mental Health
Outline briefly the main events in the development of the nervous
system from the neural tube to the formation of cortical layers.
Describe the organisation and functions of the normal spinal cord and
explain the pattern of neurological deficits which follow injury at
different levels.
List the main components of the brain and demonstrate how they
relate to each other by identifying them in MRIs and 3-dimensional
models.
Describe the blood supply of the brain, outline the factors important for
regulating cerebral blood flow and distinguish the main features and
causes of common cerebrovascular accidents.
Define the main somatosensory systems in terms of their receptors,
pathways and clinical significance.
Outline how pain is classified clinically, how it may be modified by
psychological factors and how it may be treated.
Describe the organisation and function of the motor system and
distinguish the main neurological disorders arising from dysfunction of
different parts of the motor system.
Explain the main events in the process of conduction, transduction and
analysis of sound by the ear and auditory pathways, indicating the
most common causes of deafness and how they may be distinguished
initially.
Describe how the vestibular apparatus and pathways provide
information for maintaining balance and outline how dysfunction leads
to dizziness.
Describe the organization and function of the visual system and
indicate the effects of dysfunction at different levels within the
pathway.
Outline the neural mechanisms which underlie the control of eye
movements and posture, giving examples of disruption by lesions.
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Outline the involvement of the limbic system in the maintenance of
emotional states and goal-oriented behaviour and describe the effects
of dysfunction on behaviour.
Describe the role of the cerebral cortex in cognitive function and
behaviour and outline the more common forms of dementia.
Outline the distinguishing features of depression and anxiety and how
it may be treated.
Outline the neural mechanisms underlying consciousness and sleep.
2.2.3 Endocrine System
Describe the clinical features of hypo- and hyper-pituitary states,
differentially diagnose particular conditions and suggest appropriate
treatments.
Understand the actions of the neurohypophysial hormones and their
receptors and relate this knowledge to the diagnosis and treatment of
conditions such as diabetes insipidus and syndrome of inappropriate
ADH.
Compare and contrast type I and type II diabetes mellitus, describe the
micro and macro-vascular complications of diabetes mellitus and the
importance of insulin resistance.
Understand the functioning of the hypothalamic-pituitary-thyroid axis
and be able to differentiate between hypo- and hyper-thyroidism in
terms of clinical symptoms, causes, and treatments.
Describe how the adrenal steroids influence body function and be able
to differentiate between conditions of adrenal excess and deficiency
and suggest appropriate treatments.
Outline the physiological and pharmacological actions of
glucocorticoids in acute and chronic inflammation, their clinical pros
and cons.
Differentiate between the combined oral and progesterone only
contraceptives, in terms of their clinical applications and
pharmacology.
Understand the endocrine aspects of the menopause, list common
symptoms, describe principle treatments and be able to discuss the
pros and cons of the treatments currently available.
Comprehend the variety of drugs that act on the HPG axis and their
clinical application and in particular be able to describe the clinical
usefulness of androgen-related drugs in terms of their physiological
actions, pharmacology and administration.
Demonstrate an understanding of the endocrine aspects of fertility and
apply this understanding to the appropriate treatments available to
patients with common disturbances in endocrine fertility such as PCO.
State and explain the signs and symptoms of commonly occurring
bone abnormalities such as osteoporosis, Paget’s disease and Vitamin
D disturbances.
2.2.4 Musculoskeletal System
2.2.4.1 Muscle
Define the term “motor unit”.
Describe the distinguishing properties of the different “types” of muscle
fibres that exist in human skeletal muscle.
Describe human skeletal response to disuse, exercise and damage.
14
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Describe the main clinical features of peripheral neuropathies and
muscular dystrophies that result in muscle weakness.
Briefly describe the molecular basis of the muscular dystrophies.
2.2.4.2 Rheumatology
Describe the anatomical structures and macromolecular components
affected my rheumatic diseases.
Identify the 4 most common rheumatic diseases and be able to
distinguish between them on the basis of aetiology, demography,
pathogenesis, history, examination, blood investigations, radiology and
treatment.
2.2.4.3 Metabolic Bone Disease
Describe the general features of bone structure and function.
Describe the major features of osteoporosis, osteomalacia, Paget’s
disease and hyperparathyroidism and basics of treatment.
Explain how these diseases are distinguished on bone biopsy, their
biochemical markers, and radiological features.
Described Bone Densitometry and its use in relation to osteoporosis.
2.2.4.4 Orthopedics
Describe the tissues of the musculoskeletal system.
Describe how each may be involved in injury and repair.
Describe the basic clinical features of injuries of the cervical spine,
upper limb and of the lumbar spine, pelvis and lower limbs.
Name the major pathogenic organisms causing bone and joint
infection.
Describe the epidemiology and pathophysiology, elements of
prevention and management of joint infection.
Describe the incidence and demography of musculoskeletal neoplasia.
Describe the histological and radiological features of benign and
malignant tumours using correct terminology.
Describe the physiology and anatomy of the growing skeleton.
Explain the pathological elements and orthopedic problems in children
and how these relate to diagnosis.
Describe the principles of management of paediatric orthopedic
problems.
2.2.5 Anatomy of Head, Neck & Spine
Explain the functions and regional differences of the vertebral column
and relate to common causes of back pain.
Describe the relationships of the spinal cord, meninges and spinal
roots to the vertebral column and explain the importance of this in
spinal injury and in lumbar puncture.
Demonstrate and name the major bones and important landmarks of
the skull.
Explain the organization and clinically important features of the arterial
supply and venous drainage of the head, neck and spine.
Explain the formation, flow and reabsorption of cerebrospinal fluid and
the significance of raised intracranial pressure.
Identify the pathways by which cranial nerves and blood vessels leave
or enter the skull.
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Demonstrate the compartmental organization of the structures of the
neck.
Describe the distribution of the main branches of the external carotid
and subclavian arteries including the carotid pulse.
Describe the pattern of lymphatic drainage of the head and neck.
Explain the uses and the anatomical basis for safe insertion of central
venous lines.
Outline the main neuromuscular and skeletal systems involved in
biting, chewing, swallowing, salivation and speech including
mechanisms preventing aspiration of liquids and solids.
Demonstrate simple clinical tests for functional integrity of the cranial
nerves.
Demonstrate the main features of the oral and oropharyngeal regions
on a living subject.
Describe how function of the airway may be compromised and outline
the principles of protection of the airway.
Demonstrate the position and connections of the paranasal sinuses
and the mastoid air cells and explain their clinical importance.
Describe the structure and functions of the extra-cerebral components
of the visual and auditory systems and outline simple methods for
examination of these systems.
2.2.6 Anatomy of Limbs
Describe the organisation and relationships between cells and matrix
in bone, and explain how bones grow, repair and remodel.
Demonstrate the palpable landmarks of the upper and lower limbs.
Describe the patterns of muscle groups and motor nerves controlling
the main movements at the joints of the upper and lower limbs.
Explain the principles of organisation and main relations of the brachial
plexus.
Distinguish in functional and neuromuscular terms between power
grips and precision grips.
Describe the main sensory and motor disabilities associated with
injuries of the roots of the brachial plexus and the main nerves of
upper and lower limbs; explain the importance of the carpal tunnel.
Demonstrate the patterns of segmental motor and sensory supply in
the upper and lower limbs.
Explain the organisation of a typical synovial joint and the relationship
between joint geometry, and available movements and stability; apply
these principles to the major limb joints.
Explain the reasons for current practice in management of fractures of
the femoral neck.
Outline the fractures or dislocations likely to be produced by a fall onto
an outstretched hand and explain any special neurological or vascular
risks associated with them.
Outline the roles of the main muscle groups of the lower limb and trunk
in standing and walking.
Demonstrate the main pulses of upper and lower limbs and to explain
their uses.
Explain the anatomical basis and importance of compartment
syndromes.
Demonstrate the superficial veins of the upper and lower limbs and
explain their function and clinical significance
16
2.2.7
Pharmacology & Therapeutics
 Understand the process of new drug development, with particular
emphasis on clinical trials.
 Understand the principles of pharmacokinetics and its core concepts
(clearance, half-life, volume of distribution, bioavailability, therapeutic
drug monitoring).
 Understand the principle of drug metabolism and excretion.
 Understand the basic mechanisms and clinical importance of drug
interactions.
 Understand the influence of age (babies, children and the elderly) and
of pregnancy and lactation on prescribing.
 Understand the effects of disease, especially hepatic and renal, on
responses to drugs and the way drugs are handled in these
circumstances.
 Understand the clinical importance of adverse drug reactions and
approaches to detecting and quantifying them.
 Understand the principles of the management of poisoning and
overdose.
 Understand the principle therapeutic approaches to the management
of common clinical problems in:
 Cardiovascular
 Respiratory
 Gastrointestinal
 Rheumatological
 Endocrine
 Neurological diseases
 Infections (bacterial, viral and fungal including sexually
transmitted diseases)
 Oncology
 Manage common medical emergencies.
2.2.8 Psychology
 Explain psycho-physiological theories of emotion, and individual
differences.
 Identify cognitive determinants of emotion.
 Define stress and provide evidence for the relationship between stress
and illness and how to measure stress.
 Understand the stress models of Selye and Lazarus appraisal model
of stress and methods for coping with stress.
 Explain models of learning, habituation and sensitisation, classical
conditioning, instrumental learning and vicarious learning.
 Understand learning theory explanation of phobias and depression
and treatment methods.
 Understand the role of individual behaviour in the aetiology of major
diseases.
 Define health behaviour and describe behavioural strategies for the
prevention of disease and injury.
 Review evidence of effectiveness of health education approaches.
 Understand major theoretical approaches to personality and the role of
personality in health.
 Explain how personality tests are created and assessed.
 Explain how IQ is measured and its clinical uses.
17
 Understand the influences of heredity and environment on IQ.
 Understand EEG and ERP measures, how they are measured and
their clinical uses.
 Understand that vision is an active process of interpreting the available
cues to see what is out there, not a passive representation of the
retinal image.
 Understand the process and theories of attention.
 Understand memory processes and amnesic conditions
 Appreciate that patients forget much of what doctors say to them and
how to improve what patients remember.
 Appreciate that people are poor at making probability judgments about
their health and know the most common types of error made.
 Appreciate that diagnosis and decisions to treat are examples of
problem solving and understand how use of heuristics and probability
judgments may result in errors being made.
2.3
Foundations of Clinical Practice
By the end of this theme students are expected to have achieved the
following learning outcomes in relation to the topics indicated.
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2.3.1. Communication Skills
List key features of the content of a medical history.
Identify the skills necessary for an effective assessment of drug,
alcohol and tobacco use.
Describe how to meet both the patient’s and doctor’s agenda in a
consultation.
Use the skills associated with patient-centred interviewing while taking
a medical history.
Describe ways in which written communications are used in health
care.
Identify key aspects of effective written communications.
List basic abbreviations and their meanings commonly used in medical
histories.
Describe ways in which a patient’s individuality can be maintained in
written communications.
List the contexts in which they will present patients.
List reasons why oral presentations are used in medical education.
Identify key aspects of effective presentations.
Outline their own strengths in presentation skills.
Identify areas in which their own presentations skills may improve.
Understand and be able to use in practice verbal and non-verbal
communication skills.
Conduct a patient-centred interview which asking questions relevant to
a medical history.
Build upon feedback received on their use of communication skills
from simulated patients, colleagues, and tutors.
Develop an awareness of their own strengths and weaknesses.
Have gained experience in having an interview videotaped.
Understand the importance of and have gained practice in giving
feedback to colleagues.
Reflect on how they will improve their communication skills.
Reflect on how they will maintain the skills they already have.
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Continue the development of self-awareness in relation to their
strengths and weaknesses in communicating with patients.
Think about how they might improve their communication skills.
Describe the different cultural groups to which people can belong and
why these may not always be obvious to others.
Identify how cultural issues may affect communication.
Describe the difficulties that may arise if family members or relatives
are used as interpreters.
Describe the skills required by health professionals when working with
interpreters.
2.3.2 Epidemiology and Public Health
Understand the major sources of routine data on health and illness in
the UK.
Understand the difference between crude and class (e.g. age-)
specific rates.
Understand standardised mortality ratios and provide examples of
their use in comparing health in populations.
Understand the role and principles of descriptive studies.
Understand the role and principles of analytic studies: case control,
cohort and controlled trials.
Understand the difference between quantitative and qualitative data.
Understand the possible explanations for observed associations
(chance, bias, confounding, causation), and discuss examples of
each.
Understand the different levels of prevention.
Understand the principles and practice of screening.
Understand the criteria for screening programmes.
Understand the main methods of intervention to improve health.
Know the strengths and weaknesses of routine health data.
Understand the complexity of collecting data on lifestyles.
Know the strengths and weakness of different methods for measuring
prevalence.
Interpret data from epidemiological studies.
Distinguish cross sectional and ecological studies.
Recognise the different types of epidemiological study.
List the Bradford-Hill criteria for establishing causation, and apply
these to specific examples.
Define prevalence.
Calculate and interpret measures of association (relative risk,
attributable risk, odds ratio) from simple examples.
Define validity for screening tests and calculate specificity, sensitivity
and predictive value.
2.3.3 Medical Ethics
Define the essential elements necessary for valid consent in
competent adults.
Define the elements of capacity to consent.
Understand the ethical foundations of consent.
Understand the role of confidentiality in medical practice.
Define situations where confidentiality can lawfully be breached.
Understand the importance of truthfulness in medical care.
Understand the role of the relative in the doctor-patient relationship.
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2.4
Understand children’s capacity to consent.
Understand the difference between consent and refusal of treatment in
children – Re W, Jehovah’s witnesses.
Define and analyse “best interests”.
Understand the legal basis of parental care and control of children.
Understand the Royal College guidelines on withdrawing/withholding
lifesaving treatment in children.
Understand the basic functions of the Mental Health Act and the
meaning of treatment for mental illness in the Act.
Understand the balance between care and control in the Mental Health
Act and proposed revisions.
Understand the relationship between mental and physical illness.
Understand the relationship between withdrawing and withholding
treatment.
Understand the relationship between omitting lifesaving care and
actively killing.
Understand the Do Not Resuscitate order.
Understand the ethical merits and demerits of forms of euthanasia.
Understand the concepts of “quality” and “sanctity” of life, and the
meaning of “dignity”.
Understand the legal status of the embryo.
Understand the basic features of the Abortion Act.
Understand the basic features of the Human Fertilisation and
Embryology Act.
Understand the role of conscience and religious conviction in ethics.
Understand the role of public consensus in ethics and medicine.
Integrated Body Function and Dysfunction
By the end of this theme students are expected to have achieved the
following learning outcomes in relation to the topics indicated.
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Due to the integrative nature of this theme students are required to
attain the following overall outcomes in addition to those identified
below.
Demonstrate the ability to add to the taught material of the course
through self directed learning.
Integrate knowledge gained across the five areas of the course and
integrate them into the healthy and sick person.
Demonstrate how defects in one system may lead to defects in others
systems.
2.4.1 Nutrition
Demonstrate how nutritional requirement change throughout life.
Integrate basic science of appetite regulation to the rise in obesity in
the UK.
Identify patients at risk of malnutrition.
Explain the differences between starvation and trauma and the effects
they have on nutritional status and refeeding.
Demonstrate why aging has an effect on nutritional status and how
this affects the hospitalised patient.
2.4.2
Exercise
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Understand the normal physiological responses to exercise and the
mechanisms involved.
Understand some of the methods of investigating the physiological
changes during exercise.
Appreciate the health benefits of exercise.
Appreciate the exercise response at the extremes of ‘health’- i.e. the
elite athlete and the cardio-respiratory patient.
To have an appreciation of the physiological impact of performance
enhancing aids in sport.
Gained experience of team based human physiological experiment
centred on exercise.
Gained experience of self-directed learning.
2.4.3 Water and Electrolytes
Appreciate the centrality of water in the control of cell volume, blood
pressure and metabolism.
Understand the physiological implications of dehydration and how the
body responds to it.
Understand the physiological implications of water loading states and
how the body responds to them.
Understand the intracellular and extracellular balance of sodium and
potassium ions including how and why the gradients are maintained.
Understand how the body responds to overload and deficiencies of
sodium and potassium, including the pathological features found in
each situation.
Determine the implications of sodium and potassium abnormalities in a
number of different clinical scenarios.
Understand why maintenance of appropriate pH is important
physiologically.
Identify several clinical scenarios in which acid-base balance is
disrupted.
Describe how the body deals with acid-base abnormalities in a number
of different situations.
Outline the principal causes of acute and chronic renal failure.
Show awareness of the clinical features people may develop in acute
and renal failure.
Outline the possible ways of managing these patients.
Show awareness of the different modalities of renal replacement
therapy.
2.4.4 Drugs & the Hospitalised Patient
Identify the role of the intensivist and be aware of the importance of an
integrative approach and the role of self-directed study.
Understand the factors that affect fitness for surgery, and the concept
of surgical preparation.
Have
considered
factors
affecting
pharmacokinetics
and
pharmacodynamics of drugs used in anaesthesia and have some
appreciation of how this can cause problems for the anaesthetist.
Have experience of integrating their knowledge of biochemistry,
physiology and pharmacology in order to understand complex
conditions presented as clinical situations.
Have had practice of relating basic biomedical science to clinical
treatment and outcomes.
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3
Appreciate the necessity for integration of knowledge in delivering
effective patient care.
Been given the opportunity to develop the appropriate skills to present
challenging clinical cases to a mixed audience.
Been introduced to the concept of 'whole body' therapeutics utilising
the hypothetical example of an Intensive Care Unit.
2.4.5 Sepsis
Demonstrate an understanding of the pathogenesis of sepsis.
Demonstrate an understanding of innate immune response to
microbiology challenge.
Explain how bacteria and other pathogens stimulate the immune
system.
Understand how the immune response can be protective or harmful.
Demonstrate an understanding of the immune response to
microorganisms.
Explain the immunological changes following infection in the critical ill.
Year 3
By the end of this year students are expected to have achieved the following
learning outcomes in relation to the topics indicated. Students are issued with
a log book outlining the common conditions with which they are expected to
be aware.
3.1
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3.2
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History taking and communication
Take a comprehensive clinical history, focusing on its presenting
problem, encompassing the past medical history, family history, social
and familial circumstances and any other elements relevant to the
overall clinical assessment of the patient.
Develop an awareness of the need for consent and for confidentiality,
respecting the limits of what the patient may be prepared to discuss,
for personal, cultural or religious reasons.
Make a written record of the history obtained, which should be
concise, accurate and an adequate guide for any other professional
who may not know the patient.
Within the limits of their knowledge and with the agreement of qualified
colleagues pass on to patients information about their care and
answer queries and concerns.
Basic clinical skills
Carry out, with consent, a comprehensive physical examination and be
able to make a basic assessment of the patient’s cognitive and
psychological state.
Carry out, if appropriate on models rather than people, and under
supervision, a range of clinical procedures which would be within the
scope of a pre-registration house officer (in year 1 of the Foundation
Course). These procedures are specified below:
Performing an ECG
Reporting an ECG
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Normal ECG
Abnormal ECGs
Reporting a chest radiograph
Reporting an abdominal radiograph
Aseptic technique
Scrubbing up
Gowning
Donning gloves
Administering a subcutaneous injection
Administering an intradermal injection
Administering an intramuscular injection
Lung function tests – Peak Expiratory Flow Rate
Using a Blood Glucose meter
Recording a temperature
Inserting urinary catheter into the male urethra
Inserting a urinary catheter into the female urethra
Local anaesthetics
Simple interrupted sutures
Excising a lesion
Using an ophthalmoscope
Using an otoscope
Digital rectal examination
Taking blood
Inserting intravenous cannula
Arterial blood gas sampling – femoral artery
Arterial blood gas sampling – radial artery
3.3
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3.4
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3.5
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Roles of Health Care Professionals
Appreciate the roles of doctors in their own team and in others, as well
as of other health care professionals involved in the care of patients.
Understand the relative roles and interactions of professionals in
primary and secondary care.
General Medicine
Recognise the clinical significance of common symptoms and signs as
indicators of illness.
Know the likely modes of presentation of a range of common clinical
diseases and conditions that might be admitted to an acute medical
firm.
Understand the aetiology and pathophysiology of these conditions and
how these relate to the clinical presentation.
Understand the principles of the process of clinical reasoning, which
integrates symptoms, signs and appropriate investigations to arrive at
a diagnosis.
Understand the basic principles of the management of the common
specified conditions.
General Surgery
The same points apply as for medicine, except in the context of
conditions managed by surgeons, and in addition:
Understand the procedures and precautions involved in the functioning
of operating theatres but not the technical details of operations.
Appreciate the role of the anesthetist in pre-and postoperative
assessment and preoperative care and in the management of pain.
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3.6
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4
Interprofessional Learning
Promote effective and appropriate communication between health
professionals with the aim of improving the patient pathway. This will
be assessed through
 demonstrated knowledge of interprofessional working and
learning
 establishing and maintain collaborative working relationships
with members of the health and social care team

Demonstrate an understanding and respect for the role of others by
participating in interprofessional working practices. This will be
assessed through
 reviewing and evaluation of care with members of the health
and social care team
 working within the health and social care team to maintain and
enhance integrated care

Demonstrate sound clinical judgment across a range of differing
professional and care delivery contexts. This will be assessed through
 Using evidence based knowledge from own and related
disciplines to select and individualise professional interactions.
Year 4
Learning outcomes for Year 4 (the BSc) are currently under development.
Programme specifications for all BSc pathways are available on the Faculty of
Medicine Internet teaching pages.
5
Year 5
By the end of each attachment in the subjects listed students are expected to
have achieved the following learning outcomes.
5.1
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Obstetrics and Gynaecology
Advise patients on family planning, contraception and hormone
replacement therapy issues.
Understand the basic principles of obstetrics summarise an obstetric
history and perform an obstetrical examination without supervision.
Understand the basic principles of intra-partum care and perform both
a normal vaginal delivery and simple resuscitation of the newborn
without supervision.
Recognise the cause and effect relationship between general disease
and pregnancy and value the emotional aspects of pregnancy.
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5.2
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5.3
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Summarise a gynaecological history and perform a gynaecological
examination without supervision. The student should also be able to
perform a cervical smear without supervision.
Understand the basic principles of common and important
gynaecological conditions and their treatment, including infertility and
assisted reproduction techniques.
Assess common obstetric and gynaecological emergencies requiring
intervention and perform the basic (and appropriate) first aid
measures, without supervision.
Paediatrics
Understand the multidisciplinary interagency work in the community
child health services including:
 how child health is monitored and good health promoted.
 how children with developmental problems are identified,
assessed and managed.
 how children at risk of any abuse are identified and managed.
Undertake a paediatric history.
Undertake a paediatric examination.
Define common childhood conditions including an understanding of
the surgical and psychiatric dimensions.
Recognise the sick child.
Understand the emotional issues in families with acutely and
chronically ill children.
Understand the problems of coping with acutely and chronically ill
children.
Know how to play with children.
Psychiatry
5.3.1 General Psychiatry
Describe and recognise common psychiatric presentations.
Perform a psychiatric history, mental state examination and basic
assessment of patients’ risk to themselves and others.
Prepare a differential diagnosis and a management plan based on
available information.
Discuss with patients and their carers the main treatment approaches
in psychiatry.
Describe referral pathways to and within psychiatric services, including
outlining roles and tasks within the multidisciplinary team.
Describe the provision for treatment of medical and psychiatric
conditions under common law and under the Mental Health Act.
5.3.2 Child and Adolescent Psychiatry
Demonstrate a basic knowledge of the main psychiatric disorders of
childhood and adolescence to include
 Identification of the distinction from normal variations in
development
 description of the main disorders in relation to age of
onset
 links with paediatric health problems
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5.4
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5.5
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Generate basic formulations of psychiatric problems in individual
children in terms of multi-factorial aetiology (incorporating child and
family influences) differential diagnosis and effective treatments.
5.3.3 Older Adults Psychiatry
Describe the impact the physical, social and psychological
consequences of ageing on metal health.
Compare the differences in epidemiology, presentation and treatment
of common mental illnesses between older adults and younger
patients.
Understand the ethical and legal issues relevant to old age psychiatry
including capacity, driving and use of enduring power of attorney and
court of protection.
Perform a history and mental state examination of a person with
dementia including assessment of the principal domains of cognitive
function.
State the common causes of dementia and describe the treatment of
dementia, including Behavioural and Psychological Symptoms of
Dementia (BPSD).
Neurology
Take a neurological history from a patient (or a relative or witness).
Examine the central and peripheral function of the nervous system.
This should be active, practical and patient based so that the student
can observe the common neurological signs (e.g. lost/increased
reflexes, ataxia, hemiplegia, cranial nerve palsies).
Identify the main outpatient neurological syndromes, such as
headaches, loss of consciousness, seizures, dizziness, loss of or
double vision, weakness and numbness, tremor, difficulty in walking.
Recognize and act on acute severe syndromes that require urgent
referral or immediate treatment, such as meningitis, brain
haemorrhage and other strokes, status epilepticus, acute
quadri/paraplegia.
Understand the main causes producing the major neurological
syndromes, the sort of special investigations required for establishing
the main diagnoses and the principles of their treatment.
Core 1 – General Practice
Apply a patient-centred (‘bio-psycho-social’) approach to illness,
integrating the physical, psychological and social factors when taking a
history, making a diagnosis, and formulating management plans.
Understand the ways in which family/personal relationships affect the
presentation, course and management of illness.
Evaluate the role of the general practitioner’s continuing relationship
with the patient in managing present and ongoing problems.
Understand principles of General Practice as a career.
Identify and critically appraise the role of health promotion and
screening interventions in general practice.
Describe the roles and responsibilities of members of the primary
health-care team and demonstrate an understanding of the multidisciplinary team and its importance in the delivery of effective patient
care.
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5.6
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5.7
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Understand the diagnosis and management of chronic diseases such
as: hypertension, asthma, chronic obstructive airways disease,
coronary heart disease and diabetes.
Identify the important aspects of child health, antenatal care and
elderly care in a general practice setting.
Differentiate between the presentation and management of illnesses
seen in primary and secondary care and be able to understand the
interface between them, including referral pathways.
Carry out consultations with real and simulated patients and display an
ability to recognize patients’ verbal and non-verbal cues and reflect
critically on their own performance.
Demonstrate an understanding of issues relating to patients with
chronic illnesses and consider the impact the illness has on the patient
and family in terms of physical and psycho-social domains. This shall
be achieved in the form of a patient project.
Perform clinical skills such as taking blood pressure, venepuncture,
using an auroscope and ophthalmoscope.
Reflect, analyse and critically appraise two ‘significant events’ which
occur during the placement and discuss issues including ethical
considerations and use these events as a basis to generate learning
objectives.
Oncology
Understand the management of pain, including knowledge of the
analgesic ladder, how to prescribe opiates and how to manage opiate
related side effects.
Understand what radiotherapy is and how it is used to treat patients
with malignancy.
Understand when radiotherapy is used for radical and palliative
treatments.
Explain to patients what is going to happen when a patient undergoes
radiotherapy and be able to understand the common side effects of
radiotherapy treatment.
Understand when chemotherapy is used to treat patients radically and
when it is used to palliate symptoms.
Understand the concept of adjuvant chemotherapy and give examples
of when this is used to treat common tumours.
Understand how chemotherapy is given and what common side
effects are associated with chemotherapy treatment.
HIV, GU Medicine and Infectious Diseases
Take a sexual history unsupervised.
Perform male and female genital examination.
Describe common sexually transmitted infections.
Advise patients on the issues relating to HIV antibody testing.
Relate the relevance of CD4 lymphocyte counts and HIV viral loads.
List the presentation of common AIDS diagnosis in the UK.
Give examples of combination anti-retroviral therapy.
Understand about needle stick risks, prevention and management.
Take a history and examine returning travellers.
Describe in outline initial management of patients with community
acquired pneumonia, meningitis, tuberculosis, gastroenteritis and
urinary tract infection.
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5.8
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5.9
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Arrange relevant tests for patients with suspected infection.
Get up-to-date information on malaria prophylaxis and treatment.
Describe initial treatment of common acute infectious emergencies
(e.g. Meningitis, septicemia and the confused pyrexial patient).
Musculoskeletal
Describe the anatomy and its relationship to histology, biomechanics
and physiology of the joint and bone.
Take a comprehensive history of musculoskeletal disease.
Perform a detailed examination of the hands, shoulders, hips, knees
and spine.
Perform the GALS screen as the musculoskeletal component of a
general medical examination.
Describe the mechanisms of autoimmunity and inflammation as
applied to rheumatic disease.
List the principles of diagnosis and management of common
musculoskeletal disease in the paediatric patient.
Recognise the indications for surgical intervention, including
arthroscopy, in patients with bone and joint disease.
Outline the management of the polytrauma patient including
resuscitation and principles of treatment of severe injuries.
Describe the management of fractures of the spine, wrists, shoulder,
humerus, femoral neck, tibia and ankle.
Describe the clinical features, laboratory tests, imaging and treatment
of: rheumatoid arthritis, seronegative spondyloarthtropathies, systemic
lupus erythematosus, osteoarthritis and osteoporosis.
Outline the principle clinical features and laboratory tests to recognise
Sjogren’s syndrome, scleroderma, poly/dermatomyositis and the
different types of systemic vasculitis.
Interpret serological tests to help identify inflammatory arthropathies.
Define the role of x-rays in diagnosing arthritis and fractures and
understand the principles of MRI, isototope bone scans, DEXA scans
and CT scans.
Identify and describe the roles of allied health professionals in the
holistic treatment of patients with musculoskeletal disease.
Dermatology
Define the structure and principal functions of skin.
Take a history from a patient with a dermatological problem.
Undertake a dermatological examination.
Describe precisely the characteristics of a lesion or an eruption.
Evaluate and form a management plan for a patient presenting with
eczema, psoriasis and other common skin eruptions.
Evaluate and form a management plan for a patient presenting with a
common benign or malignant skin neoplasm.
Evaluate and form a management plan for a patient presenting with a
hair or nail disorder.
Recognise, evaluate and form a management plan for patients
presenting with common dermatological emergencies.
Understand the relationships between the skin and general internal
medicine.
Discuss the topical therapies, surgical techniques and diagnostic tests
available to dermatologists.
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Understand the physical and psychological impacts of skin disease on
patients.
5.10
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Pathology
Demonstrate a basic knowledge of the principles of haematology,
chemical pathology, immunology, microbiology and histopathology.
Apply this pathological knowledge to making a clinical diagnosis,
formulating a treatment plan, and monitoring patient progress and
outcome.
Understand the scientific basis of medicine that underpins your
knowledge of clinical practice.
Request appropriate laboratory tests.
Understand the consequence of inappropriate sample taking.
Interpret laboratory data in a clinical context and apply this to your
daily practice.
Recognise pathological patterns and be able to separate complex data
into component parts.
Practice blood transfusion safely.
Understand the role of the pathology laboratory as an integrated
component of patient care.
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6
Year 6
6.1
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ENT/Head and Neck
Describe basic anatomy of the ear, nose and throat/neck in relation to
health and disease.
Take a comprehensive history of ENT/Head and Neck disease.
Perform anterior rhinoscopy, otoscopy, tuning fork tests, oral cavity
examination and neck palpation.
Recognise other examination modalities including indirect
laryngoscopy, flexible endoscopy, rigid Hopkin’s Rod endoscopy and
videostroboscopy.
List the principles of diagnosis and management and of common
Otological problems including hearing loss, vertigo, tinnitus, otorrhoea,
otalgia/referred otalgia and facial palsy.
List the principles of diagnosis and management and of common
Rhinological
problems
including
nasal
obstruction,
nasal
discharge/rhinorrhoea, postnasal drip, facial pain, nasal trauma and
epistaxis.
List the principles of diagnosis and management and of common Head
and Neck problems including lumps in the neck, dysphagia,
hoarseness and stridor.
Interpret audiometry, tympanometry and skin allergy tests.
Define the role of CT scans of the sinuses and temporal bone, and
MRI of the cerebello-pontine angle
Recognise the indications for surgical intervention in patients with
common ENT problems including middles ear effusion, chronic otitis
media, recurrent tonsillitis, sepal deviation, chronic rhinosinusitis and
head and neck malignancy.
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6.2
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6.3
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6.4
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6.5
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Identify the role of multidisciplinary approach in the management of
Head and Neck malignancy.
Ophthalmology
Evaluate the visual system by taking a history.
Understand the importance of ophthalmic symptoms or signs as a clue
to a systemic disease.
Understand the major ophthalmic conditions, and the principles
underlying their medical treatment.
Understand ophthalmic surgery, and specifically the journey of the
patient undergoing cataract surgery.
Define the major causes of vision impairment in the UK and other
countries.
Understand how vision impairment may impact life’s activities, at all
ages.
examine the visual system, including the following specific skills:
assessment of: visual acuity, the pupillary responses, the visual field,
eye movements, anterior segment of the eye by slit-lamp
biomicroscopy, the fundus using direct ophthalmoscopy.
Define methods of ophthalmic investigation, including: orthoptics,
retinal photography including the fluorescein angiogram.
Cardiology
Establish the history of a patient with heart disease.
Examine a patient with heart disease proficiently.
Make a clinical diagnosis from a history and examination and
understand the nature and significance of investigations carried out.
Know in detail what the investigations involve from a patient’s point of
view and should appreciate what interventional cardiology means to
the patient.
Understand therapeutic procedures from the patient’s point of view.
Demonstrate a detailed clinical and theoretical knowledge of the main
clinical syndromes in cardiology.
Radiology
Understand the referring doctors’ responsibility in relation to radiation
exposure of patients, particularly the unborn child.
Know the common contra indications to and complications of imaging
procedures using IV radiological contrast and MRI.
Be able to recognise major radiological abnormalities on plain chest xray and abdominal films including: lobar collapse and consolidation,
pleural fluid, pneumothorax and mediastinal air and abdominal
calcification.
Understand the principles of plain film imaging in bone trauma and be
able to recognise common fractures on plain film including; Scaphoid
fracture, Radial head fracture, Femoral neck fracture and Skull
fracture.
Be able to describe to a patient what will happen to them when they
have common radiological procedures including ultrasound, CT, and
MRI.
Accident and Emergency
Take a rapid history, examination and diagnosis on new presentations.
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6.7
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Demonstrate underlying knowledge of the following and an ability to
apply that knowledge in the analysis of each individual patient.
 Resuscitation skills
 Minor injuries and wounds
 Acute presentations of medical, surgical, orthopaedic,
psychiatric and gynaecological emergencies in adults and children
– the undifferentiated problem
 Health system management
 Intravenous cannulation
 Taking of blood gases
 Administration of oxygen and nebulisers
 Wound dressings
 Slings and bandages
 Splints
 Plaster casts
 Suturing
 Removal of foreign bodies
 GCS observations and interpretation
 Examination of the eye
recognise the indications for the following, comprehend the meaning of
abnormal results and generate a suitable management plan based on
results of the following:
 ECGs
 Haematological and biochemical test results
 ABG results
 Imaging needs in the A & E scenario
 Interpretation of x-rays in A & E
Core 2- General Practice- Residential
Describe and assess the complex interplay of physical, social and
psychological factors in the presentation and management of illness in
the community.
Perform a GP surgery under supervision.
List the members of the Primary Health Care Team and understand
their roles.
Perform a clinical audit.
Assess the effectiveness of teamwork in Primary Care.
Identify those aspects of Primary Care that GPs find challenging.
Understand common obstructions to effective communication between
Primary and Secondary care.
Assist effective communication between Primary and Secondary care.
Practical Medicine
Demonstrate a working understanding of the main issues in relation
to:
 Medical negligence
 Medical ethics
 The role of the GMC
 Clinical governance
 Communicating with difficult patients and relatives
 The recognition and management of the critically ill patient
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6.8
 What to do when a patient dies
Understand (revise) the epidemiology of major diseases in the UK.
Understand the concepts of sensitivity and specificity in clinical
practice.
Understand the epidemiology of emerging infectious diseases.
Understand the key role F1s can have in secondary prevention.
Reflect on what it means to be ‘patient centred’ in relation to the use of
diagnostic tests.
Appreciate the importance of resource management in health care
delivery.
Appreciate the potential impact of targets on the work of a F1.
Appreciate the role of clinical governance and audit in the NHS.
List the major causes of morbidity and mortality in the UK and globally.
Determine when death has occurred.
Take appropriate action to reduce the spread of communicable
disease.
Apply epidemiological knowledge in clinical decision making.
Recognise possible cases of emerging infections and act
appropriately.
Clinical Pharmacology and Therapeutics
 Understand the basic concepts of pharmacokinetics
 Understand the main processes of drug metabolism and elimination
 Understand the nature of important adverse reactions to drugs,
appreciate their clinical importance and be aware of the systematic
approaches to their detection
 Understand the nature of drug interactions and their clinical relevance
 Understand the process of new drug development, including basic
principles of clinical trial design, and the role of regulatory agencies
 Appreciate the importance of critical appraisal of information about
new and existing therapies
 Understand the nature of therapeutic drug monitoring and be aware of
the major drug therapies where it is clinically important
 Appreciate the special considerations that apply in prescribing for the
very young and the elderly and for pregnant and breast-feeding
women
 Appreciate the ways in which prescribing may need to be modified in
patients with renal, hepatic and cardiac impairment
 Appreciate the importance of obtaining comprehensive drug histories
for all patients, including over the counter and complementary
therapies
 Understand the requirements for writing unambiguous, complete and
legally valid prescriptions
 Understand the principles of safe and rational therapy in
cardiovascular, respiratory, gastrointestinal, neurological , psychiatric
and endocrine diseases; in rheumatology and cancer medicine; in
infectious diseases; and in the management of pain
32