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School of Medicine MBBS Programme Phase 3 Student Handbook 20122012-13 Use of Terms Throughout this Handbook use of the terms “School”, “School of Medicine”, “Medical School”, “King’s SoM”, or “KCLSoM” shall mean “King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals”. Disclaimer All information in this Handbook was believed correct at the time of publication on the KCLSoM Virtual Campus. Amendments and corrections shall be made from time to time as necessary. Any inaccuracies should be reported to the Phase 3 undergraduate officer ([email protected]). 2 TABLE OF CONTENTS PART 1 – Phase 3 of the MB BS Programme………………………………………… 1.1 Introduction to Phase 3 ...……………………………………………………………….......... 1.2 Learning Outcomes of Phase 3 ……………………………………………………………… 1.2.1 Core Aims of Phase 3 …………………………………………………………………. 1.2.2 Skills ...………………………………………………………………............................. 1.2.3 Knowledge ...………………………………………………………………................... 1.2.4 Attitudes ...………………………………………………………………....................... 1.2.5 Achieving competence in clinical skills ………………………………………………. 1.2.6 Logbooks ...………………………………………………………………..................... 1.3 Phase 3 Curriculum……………………………………………………………………………. 1.3.1 MBBS Curriculum Structure …………………………………………………………... 1.3.2 Phase 3 curriculum……………………………….…………………………………….. 1.3.3 Firm Structure…………………………………………………………………………… 1.3.4 Web-based Core Case Scenarios…………………………………………………….. 1.3.5 Representation of the Phase 3 Programme…………………………………………. 1 3 3 3 3 3 4 4 5 5 5 5 6 6 PART 2 – Courses, Groups and Lecture Information………………………………. 2.1 Term and Examination Dates 2012-13 ……………………………………………………… 2.2 Firm Timetables and Contact Information…………………………………………………… 2.3 CLINICAL ROTATION A: basic adult medicine and surgery including gastroenterology, urology, nephrology, endocrinology and related topics …………………………………… 2.3.1 Rotation A Aims and Objectives ……………………………………………………… 2.3.2 Logbook………………………………………………………………………………….. 2.3.3 Weekly Themes…………………………………………………………………………. 2.4 CLINICAL ROTATION B: basic adult neurology, ophthalmology, psychiatry and related topics …………………………………………………………………………………………… 2.4.1 Aims ………………………………………..……………………………………………. 2.4.2 Core Curriculum and Course Handbook……………………………………………... 2.4.3 Timetable………………………………………………………………………………… 2.4.4 Case Presentations…………………………………………………………………….. 2.5 CLINICAL ROTATION C: basic adult medicine and surgery including cardiovascular and respiratory diseases and related topics ……………………………………………….. 2.5.1 Aims and Objectives…………………………………………………………………… 2.5.2 Logbook…………………………………..……………………………………………… 2.5.3 Weekly Themes…………………………………………………………………………. 2.5.4 GP Tutorials during Rotation C……………………………………………………….. 2.5.5 Otolaryngology (ENT) Teaching during Rotation C…………………………………. 2.6 Clinical Pharmacology and Therapeutics……………………………………………………. 2.7 Pathology …………………………………… …………………………………………………. 2.8 Student Selected Components ………………………………………………………………. 2.9 Ethics Case Report Assessment …..……………………………………………………….. 2.10 Peer-led Education …………………………………………………………………………... 2.11 Interprofessional Learning in Practice……………………………………………………… 7 9 9 9 10 10 11 11 12 12 12 12 12 13 13 14 15 15 16 17 17 18 18 PART 3 – Monitoring of Students’ Academic Progress……………………………. 3.1 Assessment of Students in Phase 3 2012-13 …………….………………………………… 3.1.1 Introduction………………………………………………………………………………. 3.1.2 In-Course Assessment…………………………………………………………………. 3.1.3 Grand Round Presentation .…………………………………………………………… 3.1.4 Professional Development Sign-up…………………………………………………… 3.1.5 Clinical Skills…………………………………………………………………………….. 3.1.6 Clinical Examination …………………………………………………………………… 3.1.7 Written Examination……..……………………………………………………………… 3.1.8 Final calculation……..………………………………………………………………….. 3.1.9 Merits ……………………………………………………………………………………. i 19 19 20 21 21 23 23 24 24 25 3.1.10 Resits and Progress to Phase 4………………………...……………………………. 3.1.11 Mitigation & EDR2 Requests: Guidelines for Students…………………………….. 3.2 Sample Questions for the End-of-year Examinations……………………………………… 3.2.1 Examples of Questions for the Multiple Choice Paper……………………………... 3.2.2 Examples of Questions for the Problem Solving Paper…………………………….. 3.2.3 Examples of Questions for the Data Interpretation Paper………………………..… 3.2.4 Sample OSCE Station…………………………………………………………………. 25 26 29 29 30 30 33 PART 4 – The King’s Student Doctor and Fitness to Practise……………………. 4.1 Attributes of student and doctor………………………………………………………………. 4.2 Fitness to Practise Standards of Professional Conduct & Behaviour for Medical Students………………………………………………………………………………………………. 34 35 PART 5 – Planning for Phases 4 & 5 ………………..………………………………… 5.1 Studying Abroad During Phase 4…………………………………………………………….. 5.1.1 Studying Obstetrics and Gynaecology Abroad in Phase 4…………………………. 5.1.2 Independent Peripheral Attachments…………………………………………………. 5.2 Electives During Phase 5 (Final Year) ………………………………………………………. 38 38 39 40 PART 6 – Key Contacts & General Information ……………………………………… 6.1 Contacts for Phase 3 MB BS …………………………………………………………………. 6.1.1 Key Organizers and Campus Administrators………………………………………... 6.1.2 Clinical Rotation A Organizers…………………………………………….................. 6.1.3 Clinical Rotation B Organizers………………………………………………………… 6.1.4 Clinical Rotation C Organizers…………………...................................................... 6.1.5 SSC Organizers … ……………………………………………………………..……… 6.1.6 Academic Centre at Guy’s Campus ………………………………………………….. ii 41 41 43 43 43 43 44 PART 1. PHASE 3 OF THE MB BS PROGRAMME 1.1 INTRODUCTION TO PHASE 3 Welcome to Phase 3 of the MBBS Programme at King’s College London School of Medicine. The Phase 3 course aims to provide a smooth transition from the acquisition of knowledge and skills derived from the biomedical sciences, through the development of clinical skills and the application of clinical science, to basic competence in the practice of medicine. Phase 3 is concerned with the study of Adult Basic Clinical Medicine and much of your time will be spent with adult patients suffering from diseases of all the major systems. During the year you should master the basic clinical skills of history taking and clinical examination in the adult patient, and learn about pathology, therapeutics, public health, ethics and the clinical sciences that underpin diagnosis and treatment. Whereas most of your teaching and learning in Phases 1 and 2 took place in lectures and the timetable allowed you little choice as to how to spend your time, in Phase 3 the timetable is only a guide to your learning. Much of your learning will be self-directed, and you must seek out patients to clerk or procedures to observe at times that are not timetabled. Clinical medicine operates 24 hours a day, every day, and you must be flexible in taking full advantage of the wide range of clinical experiences available to you. Clinicians are busy people who give of their time generously, but you must be there to benefit. Phase 3 begins with a short Introductory Course in Clinical Medicine. The first week is based at the Guy’s Campus, and includes outlines of history-taking and examination skills, and guidance on making the most of pathology and therapeutics during the year. In the second week you will join your first firm for an induction to working in a clinical environment, You will practise the skills of history taking, physical examination and mental state examination in the “whole patient”, and build upon the communication skills learned in Phases 1 and 2. After the introductory course you will go through three clinical rotations, each of 12 weeks, that together cover the whole of basic adult medicine and some of the associated specialities. The structure of each clinical rotation is similar: you will be attached in groups of six or eight students to a team of teachers on a “firm”. Each rotation combines the elements of a Clinical Apprenticeship, when you work as part of a hospital-based team in wards, clinics, A&E, operating theatres and in the community, with periods of Clinical Science that link clinical experience with SSCs and e-learning on the Virtual Campus. Being a clinical apprentice means dedicating yourself to learning clinical and professional skills: you should immerse yourself in the clinical environment, and make full use of the ample time afforded to gain experience at ward rounds, clinics and on “take”, as well as attending surgical operations or visiting patients at home when appropriate. Becoming a clinical scientist means studying topics from the core curriculum and other areas of interest. This includes two student selected components (SSCs; on Thursdays in the first two rotations), and self-directed learning focusing on web-based interactive clinical scenarios (accessed via the School of Medicine Virtual Campus). Students on the firm will come together for regular tutorials and student grand round presentations. You will learn about the medical, surgical, psychological, pathological, therapeutic, ethical and public health aspects of the disciplines and disorders associated with the rotation. Lectures may be provided to assist your learning in some topics. Attendance at lectures is not compulsory and, if they clash with clinical sessions, you must be sure that your firm head is happy for you to attend them. Details of the firms, their location and teaching personnel can be found on the Virtual Campus. Every effort has been made to minimize travel between sites but some firms are based on more than one site due to the disposition of local NHS services from which we draw our teachers. Inevitably, the range of patients and of clinical problems encountered in each firm will vary, and no firm will cover the core curriculum in its entirety. However, the web-based interactive clinical scenarios to be studied in your own time have been chosen to give a broad coverage of the core curriculum. The remainder should be covered by the firms, by your own self-directed learning, and by additional attachments such as the general practice tutor sessions held during Rotations A and C. 1 The Phase 3 programme may include learning your clinical medicine in a firm in one of our associated University Hospitals in Kent or West Sussex. About 80 students in each term will be allocated to study at hospitals in Ashford, Canterbury, Chichester, Margate or Medway. These hospitals have been chosen for Phase 3 students on the basis of their excellent facilities, enthusiastic staff, and plentiful supply of patients. You have a separate Logbook for each term. The Logbook fulfils several functions: it lists the basic skills to be acquired and experiences to be gained throughout the whole of the MBBS course, and sets the Phase 3 skills in context. It also provides a record of assessment and sign-ups of the skills you will acquire in Phase 3. Finally, it provides a useful listing of the types of patients and presentations (“core cases”) a Phase 3 student should have seen and, wherever possible, clerked. In it you should make a record of all the cases you have clerked, whether or not you have presented them at a ward round or student grand round. Presentation skills, clinical knowledge and reasoning will be assessed during the grand round presentations. About mid-way through each term, you should have a review of progress with the firm head or another senior clinician. This provides an opportunity to discuss your progress, and focus attention on knowledge and skills still to be acquired and professional attitudes to be developed. Enthusiastic involvement with the firm brings out the best from your teachers and makes the most of your opportunities to learn. Good attendance and participation in the firm’s activities will be assessed and rewarded. Finally, the Logbook must be handed into Academic Centre at the end of each term. During the year you will do two SSC projects of your choice, one in each of the first two terms. The large range of projects available is set out in the Phase 3 SSC Handbook. At the start of the third term there will be a lecture based course in therapeutics and pathology. Phase 3 ends with the Part 3 examinations. To be eligible to enter the examinations, you must have obtained sign-ups in your Logbook for each of the basic clinical skills listed, and all sign-ups from your clinical adviser. Development of your clinical skills will be tested formally at the end of the second and third terms by Part A1 and A2, respectively, of the In-course OSCE: passing these examinations provides exemption from Part B of the In-course OSCE. The written examination is spread over three papers and consists of computer-marked questions. These examinations cover the integrative subjects as well as clinical knowledge and skills at a level appropriate to Phase 3 students. Progression to Phase 4 requires a pass at the Part 3 examinations and accumulation of the required number of SSC passes as stated in the Programme Regulations. Merits will be awarded to students who do particularly well in the components of Part 3. Many of the tasks that you need to perform involve contact with patients who are individuals with their own feelings and problems. You might find it hard to cope with these new problems unless you discuss them with your teachers on your firm, with other students or with your clinical adviser. Once the problems are recognised they can be addressed. The fact that generations of students have faced and solved these problems should give you the confidence to admit that it can be difficult and to discuss means by which these difficulties can be overcome. It is imperative that you contact your clinical adviser during the first term so that the two of you can start to plan your educational progress through the next three years. You will be advised of your clinical adviser by the Academic Centre. Finally, a word of warning: full attendance is essential. Clinical medicine is a “performing art” that cannot be mastered from textbooks: it must be practised and demonstrated before an audience of your fellow students, your teachers, your patients and their carers. You must develop confidence in performing your skills while under observation and scrutiny. This not only makes you a better doctor – one in whom patients will have confidence – but also makes it much easier to pass the OSCEs. I hope you have an enjoyable year; the Phase 3 clinical course is demanding but should be fun. Dr Teifion Davies Head of Phase 3 MBBS King’s College London School of Medicine September 2012 2 1.2 LEARNING OUTCOMES OF PHASE 3 1.2.1 Core Aims of Phase 3 1. To meet the stringent requirements set down in Attributes of Student and Doctor (see section 2.4, below) 2. To complete the learning of core knowledge appropriate to the subjects comprising adult basic clinical medicine, and to facilitate the development of clinical and professional skills and attitudes. 3. To stimulate the student to further his or her knowledge and understanding of basic medical and social sciences, and to apply it to the processes of diagnosis and management of adult patients. 4. To integrate the teaching of pathology, therapeutics, public health medicine and ethics with the clinical teaching. Core teaching and learning will centre on three 12-week clinical rotations, based in multidisciplinary firms comprising acute medical, surgical, neurological and psychiatric specialities, and general practice. These will be complemented by web-based interactive clinical scenarios covering core curriculum topics, and by teaching in clinical sciences such as pathology and therapeutics. Students will complete two SSCs during this year. The clinical rotations will comprise: Clinical Rotation A: basic adult medicine and surgery including gastroenterology, urology, nephrology, endocrinology and related topics Clinical Rotation B: basic adult neurology, ophthalmology, psychiatry and related topics. Clinical Rotation C: basic adult medicine and surgery including cardiovascular and respiratory diseases and related topics in hospital and general practice. 1.2.2 Skills a) Be proficient at listening to the patient, making him or her feel at ease, taking an appropriate history, and performing a thorough physical and mental state examination Incorporate information from other sources e.g. relatives, witnesses, notes, diagnostic tests Bring this together in an organized case record with a distillation of the problems that need to be dealt with (differential diagnosis) Plan the investigation and management of the patient and give relevant information to the patient Present the findings, conclusions and care plans both to your tutors and to your patients in appropriate terms Write concise and accurate clinical notes, and accurate prescriptions for medication Perform the practical skills listed in the Logbook to a competent standard (see below) Understand the basic techniques of surgery and their application including theatre procedures, preoperative and postoperative care and medication. b) c) d) e) f) g) h) 1.2.3 Knowledge i) k) l) Have a grounding in the epidemiology, pathology, clinical presentation, investigation and management of common and significant medical, surgical and psychiatric disorders (see Phase 3 core patient cases in your Logbook) Appreciate the social and psychological consequences of disease processes and their management Be familiar with the management of acutely ill patients Know the principles of fluid, electrolyte and nutritional support. 1.2.4 Attitudes m) Develop an informed, respectful and professional attitude towards people suffering from, or affected by, physical and mental illness j) 3 n) o) p) 1.2.5 Develop a professional approach to working in a multidisciplinary team with other health professionals in hospital, general practice and the community Take an active part in the work of the firm, including living-in for on call duties as often as possible Learn from the patients that you meet: revisit those you have clerked to learn from their management and to develop your interpersonal skills. Achieving competence in clinical skills During Phase 3 students should learn to perform a general clinical assessment of an adult patient, comprising: full history (including review of systems), general physical examination and specific examination of associated systems, and mental state and cognitive state examinations. In addition, students should learn about selecting and interpreting tests and investigations, performing clinical procedures, and initiating clinical management (including practical management such as resuscitation, prescribing medication, and psychological treatment). Students should be able to explain to patients (or their carers) the nature of their diagnosis, any investigations or procedures they may require, and the common treatments (medical, surgical or psychological) they might receive. Most students should expect to achieve basic competence in these tasks by the end of the first term, and all students may be tested on any aspect of these tasks during the third term. To achieve this you must attempt to perform a full clinical assessment (history, physical and mental state examination) of every patient. The sign-up skills are necessary but not sufficient components of the final complete clinical assessment and management of the adult patient. Therefore they do not constitute a syllabus for the in-course OSCEs nor the end-of-year OSCE. 1.2.6 Logbooks You are required to carry your Logbook with you at all times during your firms. Each book will become a record of the key clinical skills you have performed throughout each of the clinical rotations of Phase 3. Your teachers will certify that these skills have been performed to satisfactory standards. You should try and keep your Logbooks up to date, and ensure that you are signed up for all the relevant procedures so that you can progress to Phase 4. You should also take the Logbook to appointments which you will have with your clinical adviser throughout the year. Your firm head will enter your grand round grade and end-of-rotation grade in the mark sheet within your logbook. Please note that the Logbook is proof that you have performed these key skills satisfactorily and, if you lose it, you will be required to repeat and be assessed for all the skills again. 4 1.3 PHASE 3 CURRICULUM 1.3.1 MBBS Curriculum Structure The MBBS curriculum comprises five phases that mark a logical progression from studying medical science through clinical skills to medical practice. Phase 1 lasts one term and provides an introduction to the study of medical sciences. Phase 2 extends over five terms and uses clinical scenarios to provide a focus for the study of medical, social and psychological sciences. Phases 3 and 4 combine intensive patient contact with the study of clinical sciences. During Phases 3 and 4 there is a gradual transition from basic skills and adult patients to clinical specialities in patients of all ages. In Phase 5 final year students shadow practising doctors and apply the knowledge, skills and attitudes learned in earlier phases in preparation for Foundation posts. 1.3.2 Phase 3 Curriculum The MBBS curriculum makes explicit the amount and variety of teaching and learning experience that students should expect. Phase 3 (Adult Basic Clinical Medicine) commences with a two-week introduction for all students, one week on Guy’s campus, the other on your allocated site for Rotation 1. After this you will attend three clinical rotations lasting 12 weeks each. After a brief induction to the firm, learning will combine elements of clinical apprenticeship (CA, focusing on learning clinical skills and professional attitudes and behaviours) and clinical science (CS, including SSCs and self-directed study of the core curriculum). The latter is facilitated by web-based interactive clinical scenarios accessed via the School’s Virtual Campus. SSCs will run on Thursdays each week during the first and second terms, and it will be possible to take a language or psychotherapy SSC over two terms (unless you are allocated to one of the University Hospitals in Kent or Chichester, in which case you will have this opportunity in Phase 4 instead). In the Phase 3 course, formal in-course assessment of skills in the form of in-course OSCEs held at the end of the second and third terms (Part A1 and A2 OSCEs) will give exemption from the end-ofyear (Part B) OSCE for most students. Other in-course assessments will include: overall assessment of performance by the firm head; grades for presenting cases at student grand rounds; sign-ups for participating in interprofessional education; and completion of online scenarios. The end-of-year examinations will comprise written papers testing the application of knowledge in clinical medicine and science. 1.3.3 Firm Structure Each firm will comprise a firm head and three or four other clinicians of consultant or senior trainee grade from any discipline associated with the topics of the rotation (doctors of other grades may also participate). There will be a maximum of eight students attached to a firm. Firms are “sitebased” so that, as far as is practicable, students will receive all their teaching at a single hospital site in London, Kent or West Sussex. Firm teachers each perform a small number of specific teaching tasks: the firm head has overall organizational responsibility and takes a weekly teaching session for all students on the firm. Other teachers provide clinical teaching in ward or clinic, tutorial teaching, or organize the weekly student grand round. Continuity of teaching sessions should be the responsibility of a permanent (i.e. non-training grade) clinician regardless of which teacher delivers the sessions. Firms are paired, so some duties are shared with an appropriate teacher from the partner firm (e.g. grand rounds and some tutorials). Rooms have been booked on Guy’s, St Thomas’ and King’s Denmark Hill sites for grand rounds. Attachments to general practice will take place for all students during Rotation C, with additional attachments for some in Rotation A. • Firm head (Teacher 1): clinical teaching session each week for all students on firm, and responsible for mid-rotation and end-of-rotation reviews of progress and sign-ups • Teacher 2: clinical teaching session each week for about 4 students • Teacher 3: grand round student presentations each week for students from a pair of firms (up to 16 students) • Teacher 4: additional tutorials for about 8 students from a pair of firms • Teacher 5 (if available): additional teaching as directed by the firm head. 5 The Pathology and Therapeutics course will be held at the beginning of the third term. Students on Rotations A and C will be expected to see patients with all general medical and surgical problems but with a particular brief to be sure they cover the core problems related to the clinical rotation. Each firm will have access to acutely ill patients through general take in, specialty admissions or critical care patients. Clinical Rotation B firms covering neurology, ophthalmology and psychiatry may differ in some respects from the general firm structure noted above: for instance, there will be about six students attached to each firm. The firm head will be a psychiatrist in most cases; at least two other teachers will be psychiatrists also and each firm will have a neurology lead. Due to the geographical spread of clinical disciplines, firms might not be based in a single hospital site. 1.3.4 Web-based Core Case Scenarios The core case scenarios are an integral part of the clinical rotation. They aim to assist the student to cover the Phase 3 (adult basic clinical medicine) core curriculum in a systematic manner while encouraging both deeper inquiry into the scientific basis of core problems and a broader appreciation of their ethical aspects and of the professional role of the doctor. Much of the knowledge and problem-solving ability to be tested in the end-of-year written examinations will derive from the interactive scenarios. One of the most important attributes a doctor will require throughout his or her career is the ability to identify and take responsibility for his or her own learning. Working on the interactive scenarios encourages students to practise and improve their self-directed learning skills, including collecting and collating information, weighing clinical evidence and formulating clinical decisions to be discussed and debated with colleagues. The interactive structure of the core case scenarios encourages this. In order to answer the questions as you go through them, you will often need to make use of resources such as the web links provided, textbooks, discussions with colleagues, etc. At the end of the scenario you should review what you have learned and look back at the areas the scenario is meant to cover. Some scenarios direct you to study for yourself important core areas that are not addressed directly in any scenario. All the answers you enter online as you work on the scenarios will remain accessible and attributable throughout the year. You should print out a certificate of completion and staple this into your Logbook. 1.3.5 Representation of the Phase 3 Programme Students are randomised to streams A or B in September. This facilitates some firms to operate timetables based on small groups rather than the entire firm. SSC1 1 day/week SSC2 1 day/week 6 Clinical Apprenticeship and Clinical Science 10 Weeks No SSC Re-sit written exams: 1 week Clinical Apprenticeship and Clinical Science 12 Weeks Pathology and Therapeutics Teaching Block: 3 Weeks Clinical Apprenticeship and Clinical Science 12 Weeks Assessment Block Term 3 : 17 Weeks Term 2 : 13 Weeks In-course OSCE: 1 week Introductory Course : 2 Weeks Term 1 : 14 Weeks More information is available on the Virtual Campus at: http://virtualcampus.kcl.ac.uk/vc/news/mbbs3.aspx?y=year3 2.1 TERM AND ASSESSMENT DATES MBBS Phase 3 Rotation Timetable and Term Dates for 2012/13 Stream b Week commenc ing Notes 10-Sep-12 Term 1 starts Mon 10 Sep Guy's campus 17-Sep-12 2nd week of intro course on allocated site 1 24-Sep-12 Rotation 1 starts Mon 24 Sep 2 01-Oct-12 Week Number Stream a INTRODUCTORY COURSE Intro to clinical skills & sub-dean induction weeks 1 - 6 weeks 7 - 12 08-Oct-12 Mon 8 Oct Urology Intro Session 1 Tue 9 Oct Urology Intro Session 2 4 15-Oct-12 Monday 15 Oct ENT Teaching Day 5 22-Oct-12 6 29-Oct-12 7 05-Nov-12 8 12-Nov-12 9 19-Nov-12 10 26-Nov-12 11 03-Dec-12 3 12 17-Dec-12 HOLIDAY weeks 1 - 6 24-Dec-12 HOLIDAY Rotation 2 starts Wed 2 Jan 2 07-Jan-13 Mon 7 Jan ENT Teaching Day 14-Jan-13 Mon 14 Jan Urology Intro Session 1 Tue 15 Jan Urology Intro Session 2 3 4 21-Jan-13 5 28-Jan-13 04-Feb-13 7 11-Feb-13 8 18-Feb-13 9 25-Feb-13 10 04-Mar-13 11 11-Mar-13 13 Mid Rotation Interviews 18-Mar-13 End of Rotation Interviews 25-Mar-13 Part A1 OSCEs (Rotations 1 and 2) 01-Apr-13 08-Apr-13 15-Apr-13 PATHOLOGY & THERAPEUTICS BLOCK TEACHING CHRISTMAS AND NEW YEAR 31-Dec-13 12 ASSESSMENT WEEK End of Rotation Interviews 1 6 weeks 7 - 12 10-Dec-12 Mid Rotation Interviews 22-Apr-13 29-Apr-13 7 EASTER weeks 1 - 5 weeks 6 - 10 Rotation 3 starts Tues 7 May (bank hol) 1 06-May-13 2 13-May-13 3 20-May-13 Mon 20 May ENT Teaching Mon 20 May Urology Intro Session 1 Tue 21 May Urology Intro Session 2 4 27-May-13 Monday 27th May bank holiday 5 03-Jun-13 Mid Rotation Interviews 6 10-Jun-13 7 17-Jun-13 8 24-Jun-13 9 01-Jul-13 10 08-Jul-13 End of Rotation Interviews 15-Jul-13 22-Jul-13 29-Jul-13 ASSESSMENT BLOCK 05-Aug-13 12-Aug-13 19-Aug-13 Term 3 ends Friday 23 Aug 2013: Exam Results Published Thursday 22nd August TBC TERM DATES & BANK HOLIDAYS Term 1 (14 weeks) Mon 10 Sep - Fri 14 Dec 2012 INTRO DAYS Term 2 (13 weeks) Wed 2 Jan - Fri 29 Mar 2013 (A) Urology Intro Session 1 Rot 1 (8 Oct) Term 3 (19 weeks) Mon 15 Apr - Fri 23 Aug 2013 (A) Urology Intro Session 2 Rot 1 (9 Oct) Good Friday Easter Monday Early May Bank Holiday Spring Bank Holiday 29th March 2013 1st April 2013 (A) Urology Intro Session 2 Rot 2 (15 Jan) (A) Urology Intro Session 1 Rot 3 (20 May) 6th May 2013 27th May 2013 (A) Urology Intro Session 1 Rot 3 (21 May) (A) Urology Intro Session 1 Rot 2 (14 Jan) (C) ENT Day Rot 1 (15 Oct) Part A1 OSCEs (Rotations 1 & 2) w/c 25th March (C) ENT Day Rot 2 (14 Jan) Part A2 OSCEs (Rotation 3 and P&T)TBC (C) ENT Day Rot 3 (20 May) 8 2.2 FIRM TIMETABLES AND CONTACT INFORMATION You will be given the firm timetable during the induction day at the start of each clinical rotation by the firm head or the campus teaching administrator. If you have any difficulties with your firm timetable you should attempt to solve these problems amongst your colleagues on your firm, and with the firm head. Changes to firm timetables may be posted on the Virtual Campus and can be viewed as part of the medical course under "on line assessment". As well as seeing the timetable, this web site allows the students to comment on any timetabled teaching episode and staff to access this feedback. Please contact [email protected]; telephone 020 7848 6102. Please see the Virtual Campus for up-to-date contact information for firm heads and firm teaching members. 2.3 CLINICAL ROTATION A: Basic Adult Medicine and Surgery including gastroenterology, urology, nephrology, endocrinology and related topics 2.3.1 Aims and Objectives Welcome to Clinical Rotation A of Phase 3 of the MBBS course. The aim of this rotation is to cover a core syllabus relating mostly to medical and surgical conditions affecting the abdomen and renal tract and associated systems. The objectives of the firms are to cover a number of general topics relating to management of medical and surgical patients and to deliver core teaching in medical and surgical sub-specialities relevant to abdominal disease. Teaching firms for this rotation are based at hospitals in London and Kent. Students will be attached to teaching firms led by consultant physicians and surgeons who care for acutely ill patients. Teaching firms also involve consultants with sub-specialty interests including anaesthetics. The teaching firms are multi-disciplinary and teaching will also be delivered by training grade medical staff and by non-medical members of the team. Your timetable will include details of members of the teaching firms and their interests. The first year of predominantly clinical medicine is a transition year for most students. It is an important time in your development as a medical student and it is a period when you will develop some of the skills needed for your future careers as doctors. During this year you will be able to apply some of the concepts learnt during the basic medical science course to the day-to-day problems encountered by patients. Successful transition into clinical medicine requires the acquisition of new skills, skills that this attachment will introduce and reinforce. No student comes to medical school with all the skills needed in clinical practice already in place. The ability to talk to a patient and to make that patient feel at ease, the ability to examine a patient appropriately and the ability to answer the questions that a patient may ask are skills which need to be learnt. The ability to analyse the information obtained from a patient when taking a history and to integrate this with information gained from physical examination is also a learnt skill that you will develop during this year. You will develop the ability to organize the information that you have obtained in such a way that other members of the team can understand the problems a particular patient faces. An objective of Phase 3 is to provide an introduction to the epidemiology and management of common medical and surgical conditions. With practice, you will be able to analyse a patient’s history and physical signs in the light of your knowledge of epidemiology and clinical management. You will also begin to be able to construct a differential diagnosis for a patient’s condition and to plan rational investigation. As well as general concepts of medicine and surgery you will be taught core topics predominantly related to the abdomen during this rotation. During this attachment you will be taught and assessed on a number of core skills that will allow you to develop as clinically competent students during the rest of the medical course. Although a number of core topics and skills will be taught during this rotation it is important to remember the place of self directed learning in your medical education. 9 Time has been set aside for self-directed learning during the SSCs and there are also opportunities in the timetable for private study. We hope you enjoy the teaching opportunities offered during this clinical rotation and will be pleased to receive feedback from you as the course progresses. 2.3.2 Logbook Please try and keep your Logbook up to date, and make sure you are signed up for all the relevant procedures. Your firm head will want to check this half way through the term and again at the end before he gives you your mark, so try not to fall behind. Above all, enjoy the firm! We think you will find it one of the most stimulating attachments in the course, and the 12 weeks will pass all too quickly. Good luck! 2.3.3 Weekly Themes A number of themes have been defined within Rotation A (for example upper GI, endocrine and hernia/testis/scrotum). All firms will cover these themes with different student working through the list at a different point in order to avoid too much competition for learning resources, including patients on the wards! It is important not to miss opportunities of seeing patients on the ward who do not fit within the weekly theme, particularly those with less common conditions. The medical and surgical teachers on the firm will guide you in this, but a certain amount of initiative on your part is essential. The Handbook and Logbook contain a list of conditions, investigations and procedures with which you should be familiar by the end of the firm, and hopefully you will have seen examples of the majority of these conditions in “real life”. If not, it is important that you have read about and understand the conditions on these lists. Some of the teaching will be based on interactive scenarios. The scenario problems are designed to cover key conditions from within the core syllabus, so it is important that you participate fully in these sessions. Emergencies - Each firm will provide the opportunity to see patients who present acutely with surgical and medical emergencies. You should understand the principles of initial management on take-in of each of these problems. You will be instructed as to which days are the medical and surgical emergency take days, and the teaching on those days may well vary according to the type of patients who present at those times. Again it is important not to miss the opportunity of seeing acute cases, and each firm will make arrangements for students to be resident within the hospital in rotation for the take nights. If you do not see them by the end of the firm, then read about them. Procedures/Operations - You should read about and understand the principles of these procedures, and should try and follow your patients through the procedures wherever possible. The procedures listed in the Logbook should be observed at some time during your training. Core Cases - Students should try and see patients with each of these conditions. In each firm you should expand your knowledge of the epidemiology, pathophysiology, clinical features, diagnosis and management of each problem Ideally, you should clerk at least one case of each in the ward or outpatients and then read about the subject. There are many other important conditions, which you will see and which do not appear on the basic list. This must not stop you learning about these as you see them. Patients provide the best introduction to your learning about clinical problems. The following list consists of the weekly themes that will be taught, in any order, throughout the firm. The emergencies, procedures/operations and cases have been linked with each of these themes. It is most important to remember that this is not an exclusive list but a guide to what students should practise and observe throughout Rotation A. 10 ROTATION A CLINICAL THEMES A B C D E F G H I J K L Upper GI Lower GI Hepato-Pancreato-Biliary GI Haemorrhage/Trauma/Shock Abdominal pain Hernias/Testis/Scrotum Renal/Fluid balance Bladder/Ureter/Prostate Endocrine (inc. Thyroid) and Diabetes Diabetes General Topics General i.e. Revision & assessment GENERAL THEMES 1. 2. 3. 4. 5. 6. 7. 8. Infection Inflammation Sinuses/fistulae/stomas Organ failure Alcohol Abdominal masses spleen, ascites Nutrition Surgical principles pre-op assessment post-op management complications of surgery wound healing 2.4 CLINICAL ROTATION B: Basic Adult Neurology, Ophthalmology, Psychiatry and related topics Welcome to Clinical Rotation B, which will cover neurology, ophthalmology and psychiatry (known as NOP) as studied in adult patients. We have created an integrated firm-based course that includes all disciplines and is taught over 12 weeks. We have tried to match N, O, and P timetables in order to keep travelling between sites to a minimum. Your firm head, who may be a neurologist or a psychiatrist, will conduct your mid-rotation and end-of-rotation reviews of progress, and you will be awarded grades separately by both your neurology and psychiatry teachers for your grand round presentations and your overall performance in the firm. 2.4.1 Aims This course aims to give you: 1. confidence in obtaining an accurate history from patients with NOP problems 2. practical skills to elicit appropriate NOP clinical signs and symptoms 3. sufficient knowledge to formulate a differential diagnosis and plan investigations and management 4. opportunities to communicate your clinical opinion to patients and families in a sensitive manner. 11 2.4.2 Core Curriculum and Course Handbooks We have taken great care to incorporate and deliver in Rotation B problems derived from the School of Medicine Core Curriculum. We have prepared both Neurology and Psychiatry handbooks, which outline the aims, objectives and core curriculum for each discipline to be covered in this rotation. 2.4.3 Timetable The timetable will be different for each firm and the time spent on neurology and psychiatry should be roughly equivalent. You will be released from neurology and psychiatry commitments to attend four ophthalmology sessions in clinics and theatre. The timing of these will depend on the site of the firm. At induction onto the firm you will receive more detailed information on the timetable. At the same time you will be told how the group will split up to enable you to attend the three specialties. You will also receive further detailed information about the aims and objectives for each of the three components of the rotation. A course of lectures covering NOP topics will be held at the Denmark Hill campus on Wednesday mornings during the rotation. Attendance at lectures is desirable but is not compulsory. It is recognized that students at some campuses might not be able to attend regularly; and those with conflicting clinical commitments must obtain their firm head’s permission to attend. The lectures will be recorded and will be available to all students via the Virtual Campus. 2.4.4 Case Presentations During the firm you will be expected to clerk a number of patients. At least two patients will be chosen by each student for formal presentation and in-depth case discussion at the student grand rounds during the rotation, i.e. at least one psychiatric case and one neurological case. These presentations will contribute to your in-course assessment grade and, like other clinical skills, are compulsory. Both must be completed during the 12-week rotation. We all consider that punctual attendance at teaching sessions, and your contribution in case presentations and discussion, are vital to learning. If you work hard this should be reflected in your marks. If you plan to be away or are unexpectedly absent, please inform your tutor of the reason for this as soon as possible. Please note that Rotation B tutor contact details can be found on the Virtual Campus. 2.5 CLINICAL ROTATION C: Basic Adult Medicine and Surgery including cardiovascular and respiratory diseases and related topics 2.5.1 Aims and Objectives During your time on this clinical rotation you will be attached to a clinical firm comprising several teachers from different departments and specialities. There will be a physician, surgeon and anaesthetist, together with junior doctors, from the main departments practising general medicine and surgery, with the emphasis on cardiovascular and respiratory medicine and surgery. This clinical attachment will provide you with opportunities to see patients with all the main cardiac, vascular and respiratory conditions within the core curriculum. You should be allowed to attend at least four “Clinical Practice in the Community” sessions. An experienced general practice teacher will observe you taking a history from and performing an examination of specially invited patients. You will be given the opportunity to present these patients to your GP teacher. You will also be able to discuss patient management in the community with your GP teacher. Your GP teacher will contribute a mark to your in-course assessment based on your performance in these sessions. 12 The main purpose of this attachment is to enable you to develop and practise your clinical skills under supervision. You will be expected to see and examine patients on the wards and in outpatient clinics and present your findings, analysis and treatment plans to the staff and to other students during grand rounds. This means that you have to read and research the subject in order to understand the nature of your patients’ problems. You will be expected to follow the progress of your patients and know about their investigations and treatment. You will be expected to attend the A & E Department when members of your firm are “on take” so that you can see patients with medical and surgical emergencies. These emergency cases will not, of course, be confined to cardiovascular and respiratory conditions. You will attend a limited number of operating theatre sessions to observe surgical technique and learn basic anaesthetic procedures and skills. You will attend ENT clinics, tutorials and operations in order to learn about conditions affecting the upper parts of the respiratory system. You will receive as part of your induction a handbook on ear, nose and throat disorders produced for you by Prof. Gleeson and Ms Chevretton. This will provide you with more detailed advice about aims and objectives for the ENT section of this rotation. 2.5.2 Logbook Please try and keep your Logbook up to date, and make sure you are signed up for all the relevant procedures. Your firm head will want to check this half way through the firm and again at the end, so try not to fall behind. Above all, enjoy the firm! We think you will find it one of the most stimulating attachments in the course, and the 12 weeks will pass all too quickly. Good luck! 2.5.3 Weekly Themes The following list consists of the weekly themes that will be taught throughout the firm, the order varying from firm to firm. It is most important to remember that this is not an exclusive list but a guide to what students should practise and observe throughout the cardiovascular and respiratory clinical rotation. Emergencies - You should understand the principles and try to see the initial management on takein of each of these problems. If you do not see them by the end of the firm, then read about them. Procedures/Operations - You should read about and understand the principles of these procedures and should try and follow your patients through the procedures wherever possible. The procedures listed in your Logbook should be observed at some time during your training. Core Cases - Students should try and see patients with each of these conditions. In each firm you should expand your knowledge of the epidemiology, pathophysiology, clinical features, diagnosis and management of each problem. Ideally, you should clerk at least one case of each in the ward or outpatients, and then read about the subject. There are many other important conditions, which you will see and which do not appear on the basic list. This must not stop you learning about these as you see them. Patients provide the best introduction to your learning about clinical problems. ROTATION C CLINICAL THEMES A B C D E Assessment of respiratory system. Assessment of cardiovascular and peripheral vascular systems. Respiratory infection. Cardiac and circulatory failure Respiratory failure 13 F G H I J K L Ischaemic heart disease Asthma and chronic obstructive airways disease Other cardiac topics (e.g. vascular, endocarditis, pericarditis, hypertension) Intrathoracic tumours Peripheral arterial and venous disease Flexible or other respiratory disease General, i.e. Revision and assessment GENERAL THEMES 1. 2. 3. 4. 2.5.4 5. 6. 7. 8. Haemodynamic monitoring Anaesthesia Intensive Care Pre-admission clinic: stress reduction Communication with relatives in ITU Bereavement Audit (PATS) Informed consent GP Tutorials during Clinical Rotation C – “Clinical Practice in the Community” All students on their Clinical Rotation C placement will have four tutorials, in pairs, with a GP tutor in the community. These should complement your hospital-based learning. Objectives of GP tutorials • Identify areas of the cardiovascular and respiratory curriculum where you feel less confident. • GP tutors will cover the topics from a community perspective. • Use the GP tutor to help you increase confidence in these areas. • Practise some key clinical skills. • Receive feedback on your history taking and examination skills. • Learn about some aspects of medicine in general practice, such as the management of patients with complex, chronic diseases and managing patients in a community setting. Format • Tutorials last 2-3 hours. • The GP tutor has ‘time-out’ to teach you and will have invited a patient especially for your tutorial. • You will be encouraged to share with the GP tutor how your learning is progressing. • You should have an opportunity at each tutorial to take a history, examine or present a patient, and discuss the management. • Skills such as history taking require you to be generic in the questions you ask and not follow a "checklist" approach; therefore you will not have one set of questions for taking a chest history, another set for taking an abdominal history etc. You can use your GP teaching sessions for practicing these techniques. • Your GP tutor will feed back on your progress to the consultant firm head. What do you need to do? • The person organising the GP teaching will contact you by e-mail in the first week of your Rotation C firm, explain the GP sessions and tell you when, where and with whom your first GP tutorial is. • You should contact your GP tutor/surgery as soon as possible to confirm date, time and location/travel. • You should arrive promptly at your GP tutorial as your GP has taken time out to teach you and will have arranged a patient to come in especially for your teaching. Please phone if you are late or can’t attend. • Arrange subsequent sessions with you GP tutor. • Prepare the appropriate web-based scenarios before arriving at the surgery. 14 Reimbursement of travel expenses • A number of students will have to travel from their hospital base to their GP tutors by public transport. • We expect students to pay their own travel costs to the equivalent of an “off-peak one day Travelcard zones 1-6”. This means that, at current rates, students will need to budget for £30.00 for 4 tutorials. • A proportion of students may need to travel before the off-peak time (9.30 am) to get to a morning GP tutorial. For these students the Department of General Practice will reimburse any additional public transport costs. These students will need to send their invoice for a claim, with receipts (e.g. the Travelcard), to the administrator named below. If you have any concerns or problems about your GP teaching then please contact your hospital consultant firm head and: Simon Power Phase 3 GP Teaching Administrator Dept of General Practice Capital House 42 Weston Street London SE1 3QD Tel: 020 7848 4311 e-mail: [email protected] 2.5.5 Otolaryngology (ENT) Teaching during Clinical Rotation C Otolaryngology teaching takes place in outpatients, on the wards and in operating theatres both at Guy’s and St Thomas’ and Lewisham Hospitals as well as the hospitals outside London for students on placement there. Satisfactory attendance at teaching sessions is essential and without it we cannot sign you up. You will receive a series of lectures during the ENT Core Study Day which is part of Rotation C. Each lecture addresses one of a set of core problems and will be delivered by a different member of staff. A programme and outline notes for these lectures can be found in the ENT course handbook that is distributed by the Academic Centre during the introductory course. You are expected to attend outpatient clinics where you can practise your skills of problem solving as they relate to ear, nose and throat conditions. Otolaryngological disease accounts for about a third of all attendances in general practice and is certainly a sizeable cause of attendance in the A&E Department. Examination of the ear, nose, throat and neck requires skills and equipment not used in other disciplines. It is therefore very worthwhile attending the ENT teaching in order to acquire these skills and in-depth knowledge of ENT conditions. 2.6 CLINICAL PHARMACOLOGY AND THERAPEUTICS Clinical Pharmacology and Therapeutics is at the core of all medical practice, and a good grasp of this subject is necessary both for understanding the proper use of medicines in humans and for safe prescribing. The latter has gained particular importance in recent years due to widespread coverage in the media of prescribing errors and poor prescribing practices, particularly among recently qualified doctors. The specialised teaching, which takes place at the beginning of term 3 of Phase 3, in the Pathology and Therapeutics block, will cover the important principles of the use of medicines in patients, and consolidate the knowledge of therapeutics gained during the year. This will help you to learn the general principles of the subject and understand how these are applied in the management of common clinical conditions, so providing a sound basis for safe prescribing. To get the most from it you should: 15 1) Review the "basic" pharmacology you have learned in Phases 1 and 2; 2) Keep a list of all the drugs that are prescribed to the patients you clerk and follow on the wards and in outpatients, and familiarise yourself with the class of drug that they belong to, their clinical uses, mode of use and main adverse effects. Learning clinical pharmacology is effective only if accompanied by clinical experience: it is a practical subject and the patient is the best teacher. In learning about therapeutics of common acute and chronic diseases you should integrate your knowledge of the mechanism of drug action (basic pharmacology) with relevant pathophysiology. Think about therapeutic goals (e.g. alleviating symptoms, slowing disease progression, etc) for classes of patients and for individual patients. Always take a drug history; always read the prescription chart of in-patients and review medications being taken by out-patients. Learn about these drugs as you encounter them and you will rapidly build up your knowledge of drugs used in current practice. For each drug, learn about clinical use, mechanisms of action, adverse effects and contraindications, relevant pharmacokinetics (i.e. relevant to clinical use, route of administration and frequency of administration) and clinically important drug interactions. Special situations (e.g. prescribing for patients with renal disease or with chronic liver disease) are particularly relevant in the context of Phase 3. “Textbook of Clinical Pharmacology” (Ritter, Lewis, Mant and Ferro, 5th edition, 2008) follows this approach. There is an appendix of commonly used drugs in “Pharmacology” (Rang, Dale & Ritter, 4th edition), which also caters for students with a particular interest in drug mechanisms. You should consider safe prescribing practice for all the patients you see. You should begin by becoming familiar with, and checking, prescription charts, and then practise writing prescriptions (replica prescription charts may be downloaded from the Virtual Campus: see your Logbook for details). Finally, you should ask to accompany a ward pharmacist on a ward round (again, see the Logbook for sign-up information). Therapeutics features in all modes of Phase 3 assessment, including in-course and end-of-year OSCE stations, and the written papers. 2.7 PATHOLOGY Pathology is an essential part of medicine, since the study and understanding of disease lies at the heart of diagnosis and management of patients’ disorders. In Phase 3, the pathology teaching will help you in your medical, surgical and NOP learning, and will also provide useful systematic revision of the key conditions. Pathology teaching is run in conjunction with therapeutics in the Pathology and Therapeutics block at the beginning of term 3. It is a good idea to try and keep pathology in mind throughout the year and read up on various topics when you see clinical cases or have specific teaching on the wards. We intend to have some firm-based tutorials with pathologists (all disciplines) running through terms 1 and 2, and are exploring the logistic feasibility of this at all sites. In order to help you with all this, we produce a Phase 3 pathology handbook, which highlights key pathology topics, including an indication of the depth of knowledge required for Part 3 exams. Also, we will run the pathology block with an eye on the end-of-year written and clinical exams. 16 2.8 STUDENT SELECTED COMPONENTS For details of SSC assessment, merits, credits and annual progression requirements please consult the SSC regulations on the Virtual Campus. Students in Phase 3 are required to complete two SSCs, one during Term 1 and one during Term 2. • SSC in Period 1 (October to December), which corresponds to Term 1. • SSC in Period 2 (January to March), which corresponds to Term 2. Students will have one days a week for SSC work: this will be Thursday each week, unless this is not possible, in which case it needs to be discussed with your Firm Head and site administrator. Students may normally take only one library project SSC in a single academic year. Students may also undertake a modern language SSC. Modern language SSCs are taught from September until the end of the second KCL semester, and are examined during May/June. Students who take a modern language SSC must undertake one other SSC, usually in Period 1 or 2 depending on the pattern of their clinical rotations. Students taking modern language SSCs must register at the Modern Language Centre, where they will be allocated to an appropriate teaching group taking into account their other timetable commitments. Unfortunately, it is not possible for students who are allocated to term 1 and 2 placements at the University Hospitals in Kent and West Sussex to undertake modern language SSCs during Phase 3. Initial queries should be directed to the Academic Centre (Gill McCormack is responsible for Phase 3 SSCs). Further advice is available from Prof R R Swaminathan (Phase 3 SSC coordinator). 2.9 ETHICS CASE REPORT ASSESSMENT For your second meeting with your clinical adviser towards the end of your first rotation, you are required to submit to your clinical adviser, in advance, a reflective account of some aspect of clinical practice which you found interesting. The reflective account should be typed, and about 800 words in length. You should briefly describe the clinical situation (keep the names of patients and staff anonymous). You should then reflect on the practice you encountered, identifying those aspects that you found interesting and why you found it so. You should draw upon the relevant literature, in particular the GMC's Good Medical Practice. Your reflective practice account will form part of the discussion with your clinical adviser. Clinical adviser will forward to the Head of Year and the Senior Adviser in Medical Ethics those accounts that they consider worthy of a prize. Further details are obtainable from Peter Haughton, Senior advisor in medical ethics and law ([email protected]; 020 7848 4150/6993), and from Lucy Watts ([email protected]) in the Academic Centre. 17 2.10 PEER-LED EDUCATION Peer-led education is a scheme that is run by students for students. It aims to introduce Phase 3 students to clinical skills in a setting that is run by Phase 4 students in the School of Medicine. This scheme has been introduced as a way of being trained by those who are experienced at learning and applying clinical skills in a curriculum-aligned way and is hoped to be a useful start and adjunct to the Phase 3 clinical attachments. Phase 3 students will be taught how to perform examinations and other clinical skills relevant to their current clinical rotation in small groups of ten by a trained Phase 4 student. Sessions will take place at the Clinical Skills Centre at Guy’s Campus and will run from 5 till 7 p.m. during the first week of each new term. It is hoped that this environment will allow time for Phase 3 students to practise clinical skills under supervision of a Phase 4 student who will be able to take the time to go through any questions that might otherwise be lost in larger and shorter group sessions. Most of all these should be enjoyable sessions for all involved and the more you put into the session the more you will get out of it. 2.11 INTERPROFESSIONAL LEARNING IN PRACTICE (ILP) As part of your clinical experience in Phase 3 you may be invited to participate in an interprofessional learning seminar. Health care students that are based in the Trust are invited to attend. The seminar will be patient focused and will involve either talking with a patient about their experiences or working with a patient in the clinical area. As far as possible the patients’ health care needs will be related to the rotation you are in. It is anticipated that by the students discussing your differing responsibilities and perspectives on the patient you will learn from each other and thereby more about each other. If you are included you will be notified and provided with preparatory information. You will be expected to join the other students in attending the session. Time spent will count towards your professional development and you will receive a certificate of attendance. The GMC places great importance on interprofessional learning. If you are requested to attend you should do so. 18 PART 3. MONITORING OF STUDENTS’ ACADEMIC PROGRESS 3.1 ASSESSMENT OF STUDENTS IN PHASE 3 2012-13 3.1.1 Introduction The curriculum for the School of Medicine is complemented by a scheme of assessment with a particular focus on using appropriate methods of assessment for the innovative teaching and learning methods that are used. The GMC requires that a significant proportion of the assessment is carried out within the course and the overall final marks at the end of the year must include the in-course assessment marks. Knowledge, understanding, skills and attitudes must all be assessed. This section of the Handbook is designed to clarify the methods of assessment that the Part 3 Board of Examiners have approved on behalf of the School Undergraduate Examination Board. It includes examples of the assessment forms that will be used in the process, and how the information will be collected and stored. It also indicates who will have access to the information to ensure that students receive regular informal feedback and assistance during the year. One of the aims of the assessment is to ensure that students have acquired the skills, knowledge, understanding and attitudes needed as a doctor, to identify excellence, and to assist students who may require additional help in their studies. Some firms may choose to have additional assessment tools within the firm to assist them in their teaching. It is important that students participate in all aspects of the firm. This marking scheme is bound by the Academic and Related Regulations of the College and the Programme Specification and Regulations for the degrees of Bachelor of Medicine and Bachelor of Surgery. This marking scheme applies equally to students in Year 3 of the MB BS Programme, the fourth year of study of the MB BS (Extended) Programme and Year 2 of the MB BS Graduate / Professional Entry Programme. This marking scheme is concerned with the assessment and examination of the core curriculum, and therefore does not cover the assessment and examination of Student Selected Components. MB BS Part 3 is a Module consisting of three components, which are weighted as follows In Course Assessment 20% Clinical Examination 40% Written Examination 40% The pass mark for the module shall be 50. For all assessments marks shall be awarded on the scale 0 to 100, with 50 representing the level of minimum competence. Appendix A details the grade descriptors to be used for the assessment of essays, posters, problem solving exercises and clinical assessments (excluding OSCEs). For assessments where the minimum competence level (pass mark) is not 50%, marks shall be standardised between 0 and 100 with a mark of 50 representing the level of minimum competence. The same methodology to calculate a standardised mark will be used across all assessments when required. Students that defer either the OSCE or Written examinations will normally be offered a replacement examination prior to the next academic year, but in some instances it may be necessary for students to repeat the year in full. 19 3.1.2 In-Course Assessment There will be 3 clinical rotations in Part 3. For in-course assessment in each rotation, students will be graded as either Exceptional, Pass, Fail or Non-Attendance. In-course marks will be assigned as follows: Grade Firm Head Assessment (per rotation) Grand Round Presentations (per rotation) Exceptional Good Pass Borderline Fail Nonattendance 2.5 2 1.5 1 0.5 0 2.5 2 1.5 1 0.5 0 General Practice Assessment Rotation C 2.5 2 1.5 1 0.5 0 General Practice Assessment Rotation A 2.5 2 1.5 1 0.5 0 See appendix A for the performance descriptors The maximum number of marks achievable in each rotation is: Rotation A: Rotation B: Rotation C: GP Assessment: 5 5 5 5 Total: 20 (i.e. 20% of the final mark for MB BS Part 3) Each candidate will normally be required to achieve at least 12 marks out of the 20 in-course assessment marks available in order to be eligible to enter the end of year examinations. Any candidate whose performance has been graded in the “Fail” category for one or more elements will be considered by the MB BS Part 3 Exam Board, which will use its discretion in determining whether a candidate has satisfactorily passed the in-course assessment. Any candidate who is deemed to have failed the in-course assessment will not be permitted to enter the end of year examinations and will have failed MB BS Part 3. In exercising its discretion, the School Board of Examiners will consider a student’s academic and professional progress on the programme to that point, including, but not necessarily limited to, attendance levels, compliance with instruction or advice, evidence of disruption of study during the previous year and evidence of academic achievement, or lack thereof, over the duration of the student’s registration on the programme. Each candidate will also be required to complete a logbook of clinical and practical skills and associated sign-ups. Logbooks must be submitted for checking by the stated deadline and be completed to the satisfaction of the Board of Examiners. Any candidate who does not submit a completed logbook will not be permitted to enter the end of year examinations and will have failed MB BS Part 3. 20 3.1.3 Grand Round Presentations Structure • These take place weekly throughout the firm, and involve all students. • The firm head (or a firm Tutor), preferably with at least one other consultant colleague, will conduct and assess the Grand Round presentation. • Normally two or three (it could be more) clinical apprenticeship students each present cases for approximately 10 minutes with 5 minutes for questions. • Firms may wish to draw up their own suggestions for students on the type of patient suitable for presenting, and issue this to students at the start of the clinical rotation. • Generally, cases should be chosen which demonstrate a particular clinical, social or ethical issue. For example one might choose on a Cardiorespiratory firm a patient with an atypical pneumonia, and the discussion could focus not only on the differential diagnosis, pathology and management, but also on issues related to immunosuppression, consent and the impact of HIV testing. • You will be expected to read around the subject, supporting the management decisions with evidence from the literature. • Grand Round Presentations should be accompanied by visual aids such as overhead projection acetates, or PowerPoint slides. • You will not be expected to go into great detail on all aspects, but we would expect you to be able to interpret an ECG if you show it, or any other piece of data. • Using clinical data, X-rays, etc., makes the presentation more interesting to the other students. • Remember that you will be asked questions at the end and you should be prepared to defend your differential diagnosis and proposed management plan. If you feel you would have done something different, by all means say so but also say why with evidence to support it. Marking system • The presentation will be assessed using the form to be found in the Logbook. • Note that roughly equal importance is attached to each category, i.e. your presentation skills, analysis of the clinical problem, ethical and social problems, and your use of science and the literature to illustrate the presentation. • If your presentation achieves an unsatisfactory mark, your firm head may want to discuss it with you individually. • On average you will do two or three grand round presentations on each firm, and be marked on two. • The firm head or tutor will then provide an overall grade for the grand rounds, which takes into account the presentation and your attendance and contribution at other students’ presentations. 3.1.4 Professional Development Sign-up There is no separate mark for Professional Development but a student’s professional behaviour is taken into account by the firm head for the end-of-rotation grades. The guidance below together with the Performance Descriptors given in the Logbook will help firm heads and students know the important areas that are assessed. Assessment of professional development requires the assessor to review the behaviour of the student throughout the course of the firm. The firm head should meet the student and sign-off his or her professional development on the appropriate pages of the Logbook at both mid-rotation and end-of-rotation interviews. • • • Normally you should have a short interim review of progress about half way into the firm. This should identify potential problems you are having and pre-empt any “failure” in the final assessment. You should be interviewed individually by the firm head or another senior member of the firm during the final week of the firm. The interviewer will have talked to the other teachers on the firm about you, including the GP attached to the firm in Rotation C. 21 • • • • Some parts of the firm may have a formal attendance register; in some sections attendance is noted informally. It is essential that you attend all the scheduled teaching including the out of hours work “on take”, and the special clinics. The interviewer will be discussing particular aspects of your behaviour which concerns them. This may be examples of late attendance, poor support of colleagues, or perhaps concerns over some aspects of your attitude. Any concerns may be communicated to the student’s clinical adviser or, in the case of concerns about fitness to practise, to the head of Phase 3 or the senior clinical advisers. Assessments are confidential to the student, firm head, firm tutor, and Board of Examiners. The following list of behaviours can be used by the firm head and the student as a checklist to assist in reviewing the student’s academic, clinical and professional development. They are areas where the student might demonstrate either appropriate or inappropriate behaviour. The list of behaviours based on the Attributes of Student and Doctor document and from the GMC recommendations. It is therefore self-evident that not all students will demonstrate all behaviours, for example, a student might not have the opportunity to demonstrate support for other students if there is no situation in which this would be required. It is also important that other teachers are asked for their contribution, as it is often the general practitioners, anaesthetists, specialist registrars or nursing staff on the firm who have the most contact with the student. It is important for the firm head to record details of what behaviour is felt to be inappropriate and to discuss this with the student. This should normally be kept by the firm head, and not sent to the Academic Centre, but it can be used to provide feedback to the student. It should be forwarded to the head of Phase 3 or to a senior clinical adviser if there are concerns about the student’s fitness to practise. Behaviours The student… • Is courteous to patients, carers, healthcare professionals, teachers and fellow students • Demonstrates empathy with patients regardless of the nature of their illness or distress • Shows willingness to support others: i.e. fellow students on ward rounds or nursing staff • Attempts to compromise and to resolve conflict when opinions are diverse • Identifies and directs his or her own learning and identifies future learning needs • Is enthusiastic to learn: i.e. attends and participates in all aspects of clinical and academic work, clerks patients in his or her own time • Is aware of ethical dilemmas in healthcare, including confidentiality issues • • • • • Shows an ability to communicate on an appropriate level to patients and their carers, senior staff and peers Shows an ability to contribute to a learning encounter and to allow others to contribute equally for example in the tutorials and other group sessions (such as interprofessional education) Is aware of his or her own strengths and weaknesses, and a willingness to seek advice about improvement and to act on that advice Shows an ability to organize his or her personal circumstances to allow prompt attendance at all academic sessions and completion of projects as required Is aware of the opportunities of the firm as demonstrated by acquisition of new knowledge and skills during the firm It is the responsibility of the firm head to ensure that each student has both a mid-rotation and an end-of-rotation review of progress, that these are recorded in the student’s Logbook, and submitted to the Academic Centre at the end of each rotation. 22 3.1.5 • • • • • • • • • • • • Clinical Skills For each clinical rotation there is a set of skills which you are required to perform to a satisfactory level in order to progress. These skills are a mixture of generic skills and skills specific to the rotation. Each skill has an accompanying set of performance criteria, similar to that used in OSCEs. PLEASE MAKE SURE YOU SHOW THESE CRITERIA TO THE ASSESSOR. You should be observed performing the task in the clinical environment or in the practical skills laboratory, by a Specialist Registrar/Consultant or Lecturer practitioner. Skills assessments can take place on ward rounds, in out-patients, in general practice or whenever convenient for you and the assessor. The skill is assessed as being either carried out competently or not. There is no grading system for performance. These skills do not contribute a numerical mark to the final score for the year; however, you will need to have completed all the skills to the satisfaction of the Part 3 Board of Examiners in order to successfully complete MB BS Part 3. All Logbooks will be checked for completeness prior to the end-of-year examinations, as noted earlier. If you do not perform adequately on the first attempt, you may have another attempt at least one week later. Remember that you have 12 weeks in which to learn and be assessed on each skill. You may request to have a skills assessment at any time during the firm, but it is suggested that you do not present yourself for assessment until at least 4 weeks of the rotation has passed, as you are unlikely to have gained sufficient proficiency until that time. However once you are into the second half you will find that the time will go very quickly. Try to spread out your assessments and be aware of what you need to be assessed on. Some of the procedures will be less common, and you will need to take every opportunity you can to practise and be assessed. The list of skills with space for sign up will be kept in the Logbook, you must therefore take the Logbook with you wherever you are, and keep it safe. There are no copies of the signed up skills kept anywhere except in your Logbook. 3.1.6 Clinical Examination This will consist of an integrated Objective Structured Clinical Examination (OSCE). The OSCE will consist of two parts: Part A and Part B. The pass mark for the OSCE will be the safe minimum competence mark as determined by the Board of Examiners. In addition, it will be necessary to pass a minimum percentage of stations as determined by the Board of Examiners. There will be no “sudden death” stations. Part A shall normally consist of two equal parts: Part A1 and Part A2. Part B will be of similar length to Part A and be made up of equivalent stations. All candidates will attempt Part A and those who achieve the safe minimum competence mark and who pass the required percentage of stations will be exempt from taking Part B. The OSCE marks of such candidates will be adjusted pro-rata and rounded down to the nearest integer on a scale of 0-100 with a mark of 50 representing the safe minimum competence mark. Candidates who do not achieve the safe minimum competence mark and/or who do not pass the required percentage of stations will, at the discretion of the Board of Examiners, be referred for further assessment and will be required to enter Part B. Part B is an extension of Part A (1&2) and for those candidates who are not exempt from Part B, the OSCE marks and number of stations passed from Part A and Part B will be summated. The summated OSCE marks will be adjusted pro-rata and rounded down to the nearest integer on a scale of 0-100 with a mark of 50 representing the safe minimum competence mark. The OSCE mark of any candidate who does not pass the required percentage of stations will be capped at 49. A candidate must pass the OSCE in order to pass MB BS Part 3. 23 3.1.7 Written Examination There will be an in-course written examination consisting of three integrated papers which will take place after the final clinical rotation. Each paper will consist of single best answer MCQs and/or extended matching MCQs and will be computer marked. Negative marking will not be used in any part of the in-course assessment written examination. Candidates who pass with a standardised mark of 50 or more will be exempt from the end of year written examination. Candidates with a standardised mark of less than 50 will fail the in-course written examination. Such candidates may, at the discretion of the Undergraduate Board of Examiners, be permitted to sit the end of year written examination. The structure and content of the end of year written examinations will be comparable to the incourse assessment examination. Candidates who take the end of year written examination but do not achieve a standardised mark of 50 will be deemed to have failed MB BS Part 3. The pass mark for each written examination is determined by minimum competency and will be criterion referenced. Raw marks will be adjusted pro rata and rounded down to a mark on the scale 0-100, with a mark of 50 representing the minimum competence. The adjusted minimum competence mark of 50 will be the pass mark. 3.1.8 Final calculation In order to pass MB BS Part 3 candidates must: (i) Pass the in-course assessment AND (ii) Have submitted their logbook, completed to a satisfactory standard AND (iii) Achieve a standardised mark of at least 50 in the clinical examination AND (iv) Achieve a standardised mark of at least 50 in the written examination. The marks from the in-course assessment, clinical examination and written examination will be totalled in accordance with the weightings in section 1.4 above to produce a mark out of 100. This mark shall be rounded down to the nearest integer which shall be the total final mark. The final mark of candidates who fail to meet the requirements in section 5.1 above will be capped at 49. Candidates who fail the in-course assessment and/or who do not satisfactorily complete the log book will be deemed to have failed MB BS Part 3 and will, at the discretion of the Undergraduate Board of Examiners, be required to repeat MB BS Part 3 in its entirety. Should a candidate fail the in-course assessment yet sit the end of year examination, their end of year examination results will not be considered. 24 Candidates who (following the end of year OSCE examination where required) have failed to achieve a mark of at least 50 in the clinical examination will be deemed to have failed MB BS Part 3 and will, at the discretion of the Undergraduate Board of Examiners, be required to repeat MB BS Part 3 in its entirety. Candidates who do not achieve a standardised mark of 50 in the written examination will be deemed to have failed MB BS Part 3 and will, at the discretion of the Undergraduate Board of Examiners, be required to repeat MB BS Part 3 in its entirety. Following the final meeting of the MB BS Part 3 Board of Examiners, candidates shall be recommended one of the following results: • • • • • Defer Fail and Withdraw Fail and Repeat Part 3 Pass Pass with Merit (see section 6) 3.1.9 Merits Merits will be awarded to candidates who have met the requirements in section 5.1 above and who have achieved a final year mark that meets or exceeds the merit threshold as determined by the Part 3 Board of Examiners. Part 3 Board of Examiners will set the merit threshold in the same way as they set the pass marks for the end of year assessments. The Merit threshold will normally be between 70 and 75. Merit will not be available to any candidate who is repeating MB BS Part 3. 3.1.10 Resits, and Progress to Phase 4 • A minimum competence will be expected for those who have to take the end-of-year OSCE. If you do not achieve the minimum competence, your performance over the whole year will be reviewed by the Board of Examiners but you will usually be required to resit the entire year. • The Board of Examiners together with the Head of Phase will determine whether a student will be permitted to resit the year. For example, if a student has failed the examinations and is known to have a poor attendance record, or if significant concerns in terms of fitness to practise have been raised, the student may not be permitted to resit the year. If a student’s attendance is poor during the year, a student may be asked by the Head of Phase to discontinue their studies and restart the year again the following September. • Failure in the written exam will require you to resit all three papers. • If you miss one part of the written exam because you are ill you may take the resit paper as a replacement (i.e. as for the first time), providing you have a medical certificate. • If you miss one or more parts of the exam because of other problems, your case will be discussed by the Board of Examiners. • All students who do not achieve a satisfactory mark in all parts of the assessment (in course and exams) will be considered individually by the Board of Examiners. 25 3.1.11 Mitigation & EDR2 Requests: Guidelines for Students Disruption of Studies Form You may be affected by a particular issue that you feel is having an adverse affect on your studies. The appropriate way for you to inform the School of these issues to complete a Disruption of Studies Form (DoS) Typical circumstances might include: • Difficult family situations • Long-term health conditions • Extreme and ongoing financial pressures These types of issue would not usually constitute valid mitigating circumstances (see below). The purpose of describing these ongoing circumstances to the School, through use of a Disruption of Studies Form (DoS), is to provide background information which may be taken into account when an Examination Board makes progression decisions. The form can be found on the Virtual Campus Information submitted via DoS forms will never be used as follows: • in lieu of a formal submission of Notification of Examination Absence form for the purpose of determining whether an assessment should be deferred; • retrospectively to defer an assessment already taken but failed; • or to overturn an academic fail and award a pass. A DoS may be considered by a Board in determining whether, if you have failed an assessment, you should be given a further attempt or should be asked to withdraw from the programme. Notification of Examination Absence form Please Note: This form has replaced the Mitigating circumstance Form (MCF) for all students undertaking study in 2012/13 onwards You should submit a Notification of Examination Absence form (NEA) if you are or will be unwell or incapacitated on the day of an assessment. An NEA should clearly state why you will be or were unable to attend on the day of assessment. It also needs to be submitted with supporting evidence. The form can be found here: http://www.kcl.ac.uk/college/policyzone/assets/files/students/201213_NEA_Final.pdf Guidance notes can be found here: http://www.kcl.ac.uk/aboutkings/quality/academic/assessment/mitguide.pdf Submission of an NEA would be appropriate for acute or sudden or unforeseen circumstances which affect a specific assessment. • You should submit the form no later than seven days after the date of the assessment. • You will be notified of the decision within 14 days of the form being submitted. • If you submit the form more than 14 days prior to the assessment you should continue to prepare for the examination until you receive a decision. • If you submit the form within 14 days in advance of the date of the assessment, acceptance or rejection of the NEA may not be available in advance of the assessment but the School will do as much as possible to obtain a quick decision. • If you submit an NEA and then attend the assessment, you have declared yourself fit to sit and the NEA will be disregarded . It is important to note the following in relation to retrospective requests: 26 • If you attempted an assessment you are deemed to have declared yourself fit for that assessment. • If you seek retrospective withdrawal from an assessment having taken it, you will have to demonstrate that you were either taken ill during the assessment and thus unable to complete it, or submit evidence that illness or other circumstances rendered you unable to make a rational decision as to your fitness. Appealing a decision of the Examination Board You may appeal against the decision of the Examination Board if you feel you have grounds to do so. The grounds for appeal fall in two distinct categories: • “Where there is evidence that the candidate's examination may have been adversely affected by illness or other factors which the candidate was unable, or for valid reasons unwilling, to divulge before the Board of Examiners reached its decision; • Where there is clear evidence of an administrative error on the part of the College or that the examination was not conducted in accordance with the Instructions/Regulations.” Information about the appeal process can be found here: https://www.kcl.ac.uk/aboutkings/orgstructure/ps/acservices/conduct/index.aspx The form that needs to be completed is called an EDR2 and can be found here: http://www.kcl.ac.uk/college/policyzone/assets/files/students/EDR2_Jan_2011.pdf The first page of the EDR2 form highlights a number of relevant regulations; these should be considered before completing the form. You are also advised to consult Regulation A3 44 of the regulations for taught programmes. http://www.kcl.ac.uk/college/policyzone/assets/files/assessment/A3_Regulations_for_taught _programmes_2011_12.pdf EDR2 forms must be submitted within 14 days of the publication of the result of the relevant assessment. EDR2 forms submitted after this deadline may not be sent to the Board of Examiners for consideration. The completed form should be submitted directly to the Student Conduct complaint and Appeals Office. The students Conduct Complaint and Appeals Office can be contacted via: [email protected] The Student Union offer advice on appeals, they can be contacted via: [email protected] Academic Centre September 2012 27 Appendix A PHASE 3 MARKING SCHEME & PERFORMANCE DESCRIPTORS For use by Firm Head / GP Assessor when awarding grades for in-course assessment . Grade Exceptional All-round excellent performance, especially with respect to knowledge and application of clinical issues for a Phase 3 student. Evidence of contribution to organisation of teaching, excellent attendance record, demonstrated initiative, enthusiasm and developing professionalism. Good Full attendance, good level of clinical knowledge and skills in all areas with no deficiencies. Evidence of continual improvement and progress overall. Pass Adequate attendance, clinical knowledge and skills. Evidence of progress and improvement, with no significant deficiencies in any area. Borderline Attendance and performance that is adequate overall, but showed significant deficiencies in at least one area of skill or knowledge. Fail Inadequate attendance, knowledge below acceptable level and/or inadequate progress. Non-attendance Inadequate presence on the firm to be awarded a grade. Grand Rounds Mark In each rotation, students will be awarded one of the following grades by the respective Firm Head: Exceptional, Good, Pass, Borderline, Fail or Non-attendance. Grade Exceptional Good Pass Borderline Fail Non-attendance Outstanding presentations, demonstrating personal knowledge and involvement with clinical case and full understanding of the clinical and non-clinical issues. Consistently useful contributions to Grand Round discussions. At least 2 presentations of good quality. Personal assessment and knowledge of the cases. Understanding of the clinical and non-clinical issues Frequent useful contributions to discussion. At least 1 presentation of good quality and one other of adequate quality. Adequate assessment and knowledge of the cases. Regular useful contributions to discussion. At least 2 presentations of adequate quality. Acceptable assessment and knowledge of the cases. Occasional contributions to discussion. Very poor presentations, without evidence of personal effort in clerking patients and researching background. Inadequate presence at the Grand Rounds to be awarded a grade. 28 3.2 SAMPLE QUESTIONS FOR THE END-OF-YEAR EXAMINATIONS 3.2.1 Examples of Questions for the Multiple Choice Paper Questions can be in one of five (single best answer) format, extended matching format, or Data Interpretation and Problem solving containing multiple single best answer or extended matching format (see earlier for a description of the written papers). NOTE THAT NORMAL RANGES FOR PATHOLOGY TESTS ARE PROVIDED IN THE EXAMINATIONS. Example 1 – Best One of Five Questions A man aged 45 presents to the A&E Department with severe central chest pain which had started five hours previously. His vital signs were pulse 100 regular and BP 125/80 mm Hg. The JVP was normal and the heart sounds normal apart from a third sound heard best at the left sternal edge. The ECG shows an acute anterior myocardial infarct. The most appropriate immediate management is 1. 2. 3. 4. 5. I /V infusion of nitrate /V streptokinase Oral aspirin 300 mg chewed and swallowed Cardiac catheterisation I /V heparin Correct answer: no. 4 I Example 2 – Extended Matching Theme: Causes of chest pain A: Metastatic bronchial carcinoma B: Angina C: Reflux oesophagitis D: Pulmonary embolism E: Acute pericarditis F: Dissecting aortic aneurysm G: Pneumothorax H: Fibrosing alveolitis The typical presentation of which condition above is best described by: 6. 7. 8. 9. 10. Sudden onset of pleuritic pain with breathlessness and haemoptysis Continuous, central chest pain associated with pain on inspiration following a viral illness Chest pain associated with an ache in arms relieved by use of nitrolingual spray Crushing, central chest pain worse on exercise Continuous back pain, radiating round the chest, and hypercalcaemia 29 D E B B A 3.2.2 Examples of Questions for the Problem Solving Paper A 65 year old man who has been a cigarette smoker since age 16 is sent to Accident and Emergency by his GP feeling acutely unwell, breathless, feverish and with a worsening cough. Oxygen saturation is measured at 92% on air. In addition to a chest X-ray, first-line investigations should include: QUESTION SET 40 (a) Lung function tests (b) Arterial blood gases (c) Ventilation-perfusion scan (d) Echocardiogram (e) Blood cultures His chest X-ray shows consolidation in the left lower zone. Appropriate first line treatment is likely to include: QUESTION SET 41 (f) Flucloxacillin (g) Metronidazole (h) Gentamicin (i) Aminophylline (j) Salmeterol Despite several courses of antibiotics covering common lower respiratory tract pathogens, he remains unwell, his chest X-ray has not changed and he has developed diarrhoea. What further investigations might be appropriate? QUESTION SET 42 (k) Ziehl-Neelsen staining of sputum (l) Test the stools for Clostridium difficile toxin (m) Skin testing for allergens (n) Bronchoscopy (o) Measure urinary catecholamines FTFFT 3.2.3 FFFFF TTFTF Examples of Questions for the Data Interpretation Paper As mentioned earlier, all normal ranges for Pathology tests are provided. QUESTION 1 A 48- year old man had a total colectomy for ulcerative colitis. Although he had excessive fluid loss from the ileostomy he did well initially. However, four days post-operatively he complained of a sudden sharp pain on the right side of his chest. On examination he was breathless and pale and the doctor noticed swelling and tenderness of his left calf. A pulmonary embolus was suspected. After the following investigations he was started on subcutaneous low-molecular weight heparin. Investigation Full blood count Plasma: sodium potassium creatinine Urine: sodium Doppler ultrasound Result All results normal 128 mmol/L 2.6 mmol/L 80 µmol/L Less than 10 mmol/L Thrombus extending from the popliteal vein downwards 30 A. The patient is sodium depleted B. The potassium concentration is low because thrombus affected the renal vein C. Potassium supplementation is indicated in this patient D. The INR should be checked again in 6 weeks’ time E. The warfarin should be continued indefinitely in this patient QUESTION 2 A 44- year old woman, previously diagnosed as having systemic lupus erythematosus, was referred to hospital by her GP following a recent history of excessive fatigue and headaches. On examination the joints were normal but the liver was enlarged by 4 cm below the costal margin at the lateral rectus border. The consultant physician suspected renal failure and ordered several investigations: Investigation Full blood count: haemoglobin white blood cell count platelets ESR Plasma creatinine Creatinine clearance Urine microscopy Result 115 g/L (11.5 g/dL) 2.9 x 109/L 90 x 109/L 78 mm/h 380 µmol/L 15 Ml/min ++protein, + red cells Granular casts A. The patient has renal failure B. The results indicate a nephritis C. The treatment of choice is corticosteroid therapy D. The presence of granular casts in the urine suggests renal tubular disease E. A renal biopsy would be important in confirming the diagnosis QUESTION 3 A 27 year old white Caucasian television producer presented to Casualty complaining of graduallyincreasing headache, feeling hot and feverish. The symptoms came on over the past two days but now she reported aches and pains all over in the past 12 hours; she vomited once and felt dreadful. She was previously well and was not on any medication. On direct questioning she said that she has been to South Africa on last-minute work-related business, but she took anti-malarial prophylaxis while she was there; she returned to the UK three weeks earlier. On examination she was pyrexial, 38.9 C, with a pulse of 100 bpm, and a BP of 135/70 mm Hg; there were a few crackles in the chest at the bases, otherwise there was nothing else to find. You performed a number of urgent tests: Investigation Full blood count: Haemoglobin white blood cell count platelets Malaria thin film Plasma: sodium potassium creatinine BM Stix Blood glucose on ward Result 84 g/L (8.7 g/dL) 2.9 x 109/L 27 x 109/L Malaria parasites present (identified as Plasmodium falciparum) 6% parasitaemia 128 mmol/L 3.2 mmol/L 83 µmol/L 5.0 mmol/L 31 The patient was started on intravenous quinine. A. She has a benign form of malaria. B. She should be barrier-nursed in a side room on the ward. C. In view of the diagnosis she could not have taken the anti-malarial prophylaxis. D. She could be sent home the same day on oral quinine. E. She is at risk of acute renal failure. 32 3.2.4 Sample OSCE Station – this is for illustration only. Clinical Skills: Respiratory Student Name: ________________________ Examiner: Student Candidate No. H 9[ 8[ 7[ 6[ 5[ 4[ 3[ 2[ 1[ 0[ ________________________ Instructions Examine the respiratory system of this patient. (Peak flow and/or spirometer, NOT required). Present your findings to the examiner as you go along. T ] ] ] ] ] ] ] ] ] ] [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] ] U [ [ [ [ [ [ [ [ [ [ Examiner No. H 9[ 8[ 7[ 6[ 5[ 4[ 3[ 2[ 1[ 0[ ] ] ] ] ] ] ] ] ] ] T ] ] ] ] ] ] ] ] ] ] [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] ] U [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] ] 1 0 Adequate Not Done / Inadequate • Examine hands for clubbing and peripheral cyanosis [ ] [ ] • Looks for central cyanosis [ ] [ ] • Assesses position of trachea [ ] [ ] • Assesses position of apex beat [ ] [ ] • Checks for supraclavicular lymphadenopathy [ ] [ ] • Assesses wall movement appropriately [ ] [ ] • Percusses chest appropriately [ ] [ ] • Assesses tactile voice fremitus or conducted voice sounds appropriately [ ] [ ] • Auscultates – technique (correct and effective instructions to patient) [ ] [ ] • Auscultates areas of chest appropriately (identical areas side to side, Anterior or posterior, axillae, lateral). [ ] [ ] • Establishes and maintains rapport with patient throughout [ ] [ ] EXAMINER GLOBAL RATING 5 4 3 2 1 Overall rating of competence in respiratory examination and Interpretation of findings [ ] [ ] [ ] [ ] [ ] 5 = Outstanding 4 = Good 3 = Average 2 = Poor 1 = Very poor/Not done TOTAL MARKS OUT OF 16 MINIMAL COMPETENCE = 10 (63%)1 1 Note: Minimal competence will vary between stations depending on the nature of the task to be performed. 33 PART 4. THE KING’S STUDENT DOCTOR AND FITNESS TO PRACTISE 4.1 ATTRIBUTES OF STUDENT AND DOCTOR The King’s SoM student will aim, throughout the undergraduate course, to become a doctor who will aspire to the highest standards of clinical practice and patient care. He or she will train to achieve professional excellence, to have good relationships with patients and colleagues, and to observe the profession’s ethical obligations. On entering the School of Medicine the student will • have a high level of commitment to entering a caring profession • demonstrate an interest in people and their health, and in the importance of the health and cultural issues in society • have achieved high academic standards and have shown qualities of self-motivation • show a sense of personal responsibility and a wide range of personal interests During the undergraduate course the student will • be educated in a multi-faculty college with the cultural opportunities offered by a central London location • study medicine in a local community of wide ethnic, cultural and socio-economic diversity • develop an inquiring and critical approach to learning • understand the scientific principles of medicine • learn about patients in a variety of settings- in hospitals, general practice and the community • learn the essentials of good clinical practice which will be based on the core knowledge, skills and attitudes required for the safe practice of medicine The student will learn about • health and its promotion • the scientific basis, presentation, management and prevention of common diseases and the impact of illness on the patient and the patient’s family • the environmental and social basis of health and illness in the context of populations • the ethical and legal issues relevant to the practice of medicine • the organisation, management and provision of health care The student will develop skills by • learning to communicate effectively with patients, relatives and professionals • becoming proficient in essential clinical examination skills • becoming proficient in essential practical procedures The student will demonstrate appropriate attitudes by • treating patients with politeness, consideration and learning to involve them in decisions about their care • showing respect for patients and colleagues that encompasses, without prejudice, diversity of background, language, culture and way of life. • recognising the rights of patients, particularly with regard to confidentiality and informed consent • respecting the professional values of competence in performance, reliability and conduct The King’s SoM graduate doctor will be guided by • a commitment to build on the essentials of good clinical practice acquired during the undergraduate course • sound reasoning and judgement in the establishment of medical diagnosis and management of patients • awareness of the limitations of medical knowledge and knowing how and when to seek help 34 • the importance of offering treatment based on evidence of clinical effectiveness • the need for continuing professional development throughout his or her working life • the need to monitor and maintain an awareness of the quality of care that he, she or their colleagues provide 4.2 FITNESS TO PRACTISE STANDARDS OF PROFESSIONAL CONDUCT & BEHAVIOUR FOR MEDICAL STUDENTS Medical students are entering a profession where appropriate standards of behaviour and performance are expected by the public and this is regulated by the General Medical Council. Medical students are involved with patients, their families and the healthcare staff caring for them from the start of the MBBS programme so many of these expectations apply from the beginning of their undergraduate career. It is clear from Attributes of student and doctor that the School regards this as an important element in attaining satisfactory progress through the undergraduate programme. This document provides a brief guide to some of the most important areas. Fitness to Practise The GMC documents Good Medical Practice and Duties of a Doctor are essential reading for undergraduate students. All students are expected to be familiar with these publications and to revisit them periodically throughout their programme. King's College London has a fitness to practise committee that deals with misconduct (under the terms of the College's misconduct regulations) and all matters of behaviour and health that raise issues of fitness for registration and practice. The School of Medicine also has an internal fitness to practise advisory panel that advises the Head of School on these matters, where it is deemed necessary. Students must inform the School through the Academic Centre of any issues of personal health or behaviour that might affect their fitness to practise status. The types of issues about which the School should be informed are suggested below: • • • • • • • • • Police or court proceedings once they are initiated Convictions Cautions Warnings Reprimands Fixed Penalty Notices Penalty Notices for Disorder Changes to your state of health, both physical and mental Complaints made to another institution or organisation This list is by no means exhaustive and police or legal involvement is not the threshold at which the School should be notified. If you are in doubt, contact the Academic Centre for advice. At the end of the programme, students are eligible to apply to the GMC for provisional registration. As part of the registration process, a declaration of fitness to practise must be signed. The current declaration and questions which must be answered can be found here: http://www.gmc-uk.org/doctors/registration_applications/declaration_of_ftp.asp 35 Any matter that would come up under these questions must be reported to the School. Medical students also have a duty to report issues that relate to the fitness to practise of other students or staff of the College or associated NHS Trusts. This can be done in confidence to a senior member of the College such as a Phase Head, Clinical Adviser, or senior Clinical Adviser. Taking this action is an important duty for the safety of patients, staff and students. Attendance Students are expected to attend all scheduled teaching, and the minimum satisfactory attendance standard is 90% for any Phase of the MBBS course. Occasionally planned and unplanned absences reducing attendance below 90% of the year may be acceptable where absences can be accounted for (e.g. due to illness). A student who attends less than 75% of any Phase of the course for any reason will normally be deemed to have failed the course and will not be permitted to enter end-of-phase examinations or to progress to the next Phase. Requests for leave of absence. Leave of absence for short periods may be granted in exceptional circumstances. Students in clinical firms should first discuss their plans with their Clinical Advisers to ensure they are able to make up for lost time; they should then obtain permission from their firm head and SSC tutor. Only then should formal consent for absence be requested, via the Academic Centre, from the Head of Phase. In granting or declining leave of absence, the Head of Phase will take into account previous absences (including periods of illness) and the student’s general academic and professional progress. A record of all absences will be kept in the Academic Centre. Requests to interrupt the programme for health, academic or other personal reasons must be put in writing to the Head of School after discussion with the personal tutor / clinical advisor and/or Phase Head. The only exception to this is maternity leave which may be granted by Phase Heads without referral to the Head of School. Behaviour Students are expected to behave at all times in accordance with the rules, regulations and standards of the School and College, and associated NHS Trusts. Students in clinical environments, and particularly when in contact with patients, should conduct themselves in a manner likely to earn the respect and trust of colleagues, and of patients and their carers. • Student attitudes and behaviours should be in accord with the demands of the Attributes of student and doctor and the Core Aims of Phase 3 at all times. Criteria by which these are assessed in Phase 3 are set out later in this Handbook. • Codes of practice for the student examination of patients (including intimate examinations) are given in the Phase 3 Logbook and on the Virtual Campus. As all of healthcare is a multiprofessional process, medical students will often find themselves in teaching and learning environments with students or staff from disciplines other than medicine. Interprofessional education is seen as important by the School, and forms a component of the medical student’s continuing professional development. More importantly, the medical student in an interprofessional environment is a representative of the School of Medicine, and his or her conduct will be judged accordingly. You should be courteous to all staff including teaching, Academic Centre and support staff as well as other health professionals. Rudeness to staff, whether verbally or in writing is unprofessional and may lead to disciplinary action.” 36 Appearance and Dress With your professional role as a clinical medical student comes the privilege of meeting patients on the wards, in clinics, in general practice, or in their homes. This privilege is associated with a professional obligation to treat patients with courtesy and respect. Your appearance is an important part of this relationship with patients. You should be clean, tidy and conservatively dressed. Casual or revealing clothing may make patients feel uneasy, or cause offence to their personal or cultural values. It may even lead to accusations of impropriety against you. You must conform to the dress code of the NHS Trust to which you are attached (If in doubt this should be discussed with your firm head at the start of your attachment). Confidentiality Patients, their families and carers have a right to confidentiality, and healthcare staff and students have a duty to treat patient information confidentially. The School of Medicine Confidentiality Code is to be found in the Logbook. Fraud or Deception Attempts to evade the requirements of the course or examinations by deception will be deemed serious misconduct. Examples include: forging signatures on Logbook sign-ups; fabricating details of patients clerked; failing to declare absences; providing untruthful explanations for absences; feigning illness. Plagiarism Plagiarism is not tolerated. The College’s statement on plagiarism and related forms of cheating (appendix to the regulations concerning students) may be found on the Kings website. http://www.kcl.ac.uk/depsta/healifsci/download/students/statement_on_plagiarism.pd f Bullying and Harrassment The College and the Medical School are committed to providing students with a learning environment that is free from all forms of harassment, bullying and discrimination. Being subjected to such behaviour can lead to stress and anxiety. It is important that students behave towards each other and staff with dignity and respect, and avoid behaviour and communication that upsets your colleagues and staff. If you have concerns about the way you are treated, who you contact depends on where the incident took place. In College, you should discuss in confidence with your personal tutor and/or Year Head who will support, help and advise you. If you are on clinical placement, you should raise your feelings with your Sub-dean or administrator, and Year Head. Further support can be obtained from your senior house tutors and clinical advisers, the Student Welfare and Advice service, and the College Harassment Adviser. Further details are available on: http://www.kcl.ac.uk/college/policyzone/assets/files/students/Policy_on_Harassment_Bullyi ng_and_Discrimination_for_Students.pdf 37 PART 5. PLANNING FOR PHASES 4 & 5 5.1 STUDYING ABROAD DURING PHASE 4 5.1.1. Studying Obstetrics and Gynaecology or Paediatrics Abroad in Phase 4 (Twin Links via the Elective & Exchange Office) Students may apply to do a three-week O&G or Paediatrics placement in Phase 4 at one of the School of Medicine's twin universities. Application for this must be made during Phase 3. For details of the institutions we are partnered with, please see the below link (note that only some take peripheral-exchanges) http://kcl.ac.uk/schools/medicine/ugstudy/electives/twinned/ What is the application procedure? If you wish to do an O&G or Paeds attachment at one of the School of Medicine’s twin universities you must attend the briefing meeting, usually held in early October, and then complete an application for the programme. Details of this will be sent out at the beginning of phase 3. As we have a reciprocal agreement with each institution to exchange a specific number of students each year, a decision will be made on the strength of a student’s application and their results to date. In some cases, students will be called for an interview. . Once a decision has been made, the names and details of the students will be sent to our partner institutions. Success at this stage does not guarantee that the host institution will offer you a place. We strongly advise that you make alternative arrangements just in case you cannot be offered a place at the institution of your choice. Interviews normally take place early in November. Once confirmation of your elective is received by the Academic Centre, you will be notified and sent details of where you should register on arrival at the host institution, and information about the university and location, based on previous students’ experiences. Flight tickets should not be bought until you have received written confirmation regarding your placement. Is accommodation provided? Accommodation is provided by some of the partners, by not all. Further details will be provided in the confirmation letter from the host institution. What is the cost of studying abroad? All students will be responsible for the cost of accommodation and travel. The cost of living varies between institutions. Some institutions will charge a fee for an attachment. However, as a result of the twinning agreements, all students are exempt from fees. Will you be assessed? All students will be assessed. The consultant to whom you are attached will be asked to sign your Phase 4 Logbook for attendance and to complete a Student Assessment Form. This will be returned to the Academic Centre. You will also be asked to write a detailed report of your visit and complete a record in EARS. 38 5.1.2 Independent Peripheral Attachments in Obstetrics and Gynaecology and Paediatrics Students wishing to organise independently 3-week attachments in Obstetrics and Gynaecology or Paediatrics with a teaching hospital either in the UK or abroad must follow an application procedure, outlined on the Virtual Campus, at the following address: http://virtualcampus.kcl.ac.uk/vc/medicine/year3/planning.aspx An independent exchange may only be undertaken abroad at an internationally reputable medical school or at a participant teaching hospital of a UK medical school within their Obstetrics and Gynaecology or Paediatrics undergraduate programme. Please note that students who have organised Twin Link attachments DO NOT need to undergo any part of this application procedure as your plans are pre-approved by the School. Will you be assessed? All students will be assessed. The Consultant to whom you are attached will be asked to sign your Phase 4 Logbook & attendance form. This will be returned to the Academic Centre. You will also be asked to write a detailed report of your visit. 39 5.2 ELECTIVES DURING PHASE 5 (Final Year) The elective period is part of MBBS Phase 5 and runs between late July and early October each year, incorporating a minimum of eight weeks of clinical attachments. Although most students plan their elective during Phase 4 there are a number of placements worldwide, and in particular in Australia, that become booked up more than a year in advance. It is therefore recommended that you begin to think about your elective during Phase 3 and look into possible destinations and clinical attachments at an early stage and discuss it with your clinical adviser. Information on the student elective, including the Elective Handbook and information on previous electives (Elective Abstract Record System) can be found at: http://virtualcampus.kcl.ac.uk/vc/medicine/year4/electives.aspx 40 PART 6. KEY CONTACTS AND GENERAL INFORMATION 6.1 CONTACTS FOR PHASE 3 MB BS 6.1.1 KEY ORGANIZERS AND CAMPUS ADMINISTRATORS Head of Phase 3 Deputy Head of Phase 3 Dr Teifion Davies Dr Martin Mueller Division of Medical Education King’s College London School of Medicine Guy’s Campus, London, SE1 1UL T: 020 7188 3739 (Secretary) E: [email protected] Department of General Practice KCL School of Medicine Guy’s Campus, London SE1 3QD T: 020 784 88708 E: [email protected] Chair of Part 3 Board of Examiners Dr Eithne MacMahon Phase 3 Undergraduate Officer Lucy Watts Division of Infection St Thomas’ Hospital London SE1 7EH T: 020 7188 3099 (Secretary) E: [email protected] King’s College London Academic Centre Henriette Raphael House, Guy’s Campus London Bridge, London, SE1 1UL T: 020 7848 6102 E: [email protected] Senior Clinical Adviser Revd Dr John Philpott-Howard Senior Clinical Adviser Dr Anne Stephenson Health Protection Agency London/Medical Microbiology King’s College London School of Medicine King's College Hospital, Bessemer Road, SE5 9PJ T: 020 3299 3213 E: [email protected] Department of Primary Care and Public Health Sciences, King's College London School of Medicine 4th Floor, Capital House, 42 Weston Street London SE1 3QD T: 207 848 8704 E: [email protected] Senior Clinical Advisor Dr Sonji Clarke Undergraduate Administrator – Ashford Debbie Greensmith 10th Floor North Wing St Thomas' Hospital, London SE1 7EH 020 7188 2319 (sec 0207 188 6865) [email protected] William Harvey Hospital, Postgraduate Centre Kennington Road, Ashford, Kent TN24 0LZ T: 01233 616717 E: [email protected] Undergraduate Administrator – Canterbury Rosemary Patton Medical Student Administrator – Chichester Nissrine Tollaz Canterbury Centre for Health & Clinical Sciences Kent & Canterbury Hospital Ethelbert Road, Canterbury CT1 3NG T: 01227 866394 E: [email protected] Chichester Medical Education Centre, St Richard’s Hospital, Spitalfield Lane, Chichester, West Sussex, PO19 6SE T: 01243 788122 EXT 2795 E: [email protected] Medical Student Administrator – King’s Emma Jones MBBS Administrator – King’s Mary McCarthy Deanery Offices Weston Education Centre Cutcombe Road, London SE5 9RJ T: 020 7848 5224 E: [email protected] Deanery Offices Weston Education Centre Cutcombe Road, London SE5 9RJ T: 020 7848 5618 E: [email protected] Medical Student Administrator – Lewisham Samantha Newman Undergraduate Administrator – Margate Lisa Fletcher Education Centre University Hospital Lewisham Lewisham High Street, London SE13 6LH T: 020 8333 3000 ext 8734 E: [email protected] Queen's Centre For Clinical Studies QEQM Hospital, Ramsgate Road Margate, Kent, CT9 4AN. T: 01843 225544 Ext: 62042 E: [email protected] 41 Medical Student Administrator – Medway Daniella James Medical Student Administrator – St Thomas’ Maria Fernandes King's College London School of Medicine Sub-Dean’s Office, Residence 9 Medway Maritime Hospital Windmill Road Gillingham ME7 5NY T: 01634 830000 ext. 3238 E: [email protected] KCL Medical School Office Site Dean’s Office, The Prideaux Building, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH T: 020 7188 5183 E: [email protected] 42 6.1.2 ROTATION A (basic adult medicine and surgery) ORGANIZER Rotation Head Rotation Coordinator - Denmark Hill Campus Mr Simon Atkinson Consultant Surgeon Dr Simon Aylwin Department of Surgery St Thomas’ Hospital T: 020 7188 4195 E: [email protected] Consultant Endocrinologist Dept of Endocrinology Denmark Hill T: 020 3299 2996 E:[email protected] 6.1.3 ROTATION B (basic adult neurology, ophthalmology, psychiatry) ORGANIZERS Rotation Head Prof Leone Ridsdale Psychiatry Coordinator Dr Paola Dazzan Academic Neuroscience Centre King's College Hospital T: 020 7848 5182 E: [email protected] PO40 Psychological Medicine Institute of Psychiatry T: 020 7848 0590 E: [email protected] Ophthalmology Coordinator – St Thomas’ Mr Danny Morrison Ophthalmology Coordinator – King’s & Lewisham Mr Tim Jackson Children's Eye Department 3rd Floor, South Wing, St. Thomas' Hospital Westminster Bridge Road, SE1 7EH T: 020 7188 4334 E: [email protected] Department of Ophthalmology King’s College Hospital T: 020 3299 3385 E: [email protected] Neurology and Psychiatry Teaching Administrator Wiktor Madejczyk Education Support Team Office KCL Institute of Psychiatry T: 020 7848 5182 E: [email protected] 6.1.4 ROTATION C (basic adult medicine and surgery) ORGANIZERS Rotation Coordinator - Denmark Hill Campus Dr Rebecca Lyall ENT Coordinator Miss Elfy Chevretton Consultant ENT Surgeon Guy’s Hospital T: 020 7188 2217 (Secretary) E: [email protected] (Secretary) Respiratory Physician King’s College Hospital T: 020 3299 4292 E: [email protected] General Practice Teaching Lead Dr Martin Mueller GP Administrator Simon Power Department of General Practice KCL School of Medicine Guy’s Campus, London SE1 3QD T: 020 7848 8708 E: [email protected] Department of General Practice KCL School of Medicine Guy’s Campus, London SE1 3QD T: Tel: 020 7848 8689 E: [email protected] 6.1.5 STUDENT SELECTED COMPONENTS Head of SSCs for Phase 3 SSC Undergraduate Officer Psychiatry SSC Coordinator Ramasamyiyer Swaminathan Department of Chemical Pathology St Thomas’ Hospital SE1 7EH T: 020 7188 1285 E: [email protected] Gill McCormack Academic Centre, Henriette Raphael House, Guy’s Campus London Bridge, SE1 1UL T: 020 7848 6725 E: [email protected] Dr Matthew Allin PO63 Psychological Medicine Institute of Psychiatry T: 020 7848 0900 E: [email protected] 43 6.1.6 ACADEMIC CENTRE AT GUY’S CAMPUS The Academic Centre is part of the School of Medicine and supports various aspects of the organisation of the MBBS course, including enrolment, timetabling and examinations. The Academic Centre should be your first port of call for general help and information. There is no ‘Academic Centre’ presence at the King’s Denmark Hill, Lewisham or St Thomas’ campuses. For students on these campuses, the Campus Administrators should be your first port of call for general help and information (see addresses above). Academic Centre Address 2nd Floor, Henriette Raphael House, Guy’s Campus, London Bridge, SE1 1UL Tel: 020 7848 6700/6701 Fax: 020 7848 6730 Academic Centre Opening Hours 9 a.m. to 5 p.m., Monday to Friday Closed on Bank Holidays and over the Christmas period. Academic Centre Staff Academic Centre Manager (UG) Student Records & Programme Manager (MBBS) Senior Undergraduate Officer (MBBS Phases 3-5) Undergraduate Officer (MBBS Phase 5) Undergraduate Officer (MBBS Phase 4) Undergraduate Officer (MBBS Phase 3) Undergraduate Officer (Medical Electives) Senior Undergraduate Officer (MBBS Phases 1&2) Undergraduate Officer (MBBS Phase 1&2) Undergraduate Officer (SSCs Phases 2&3) Senior Undergraduate Officer (SSCs Phases 4&5) Assessments Manager (MBBS) Senior Assessments Officer (MBBS Phases 3-5) Assessments Officer (MBBS Phases 1&2) Senior Reception Services Officer (Counter Services) Ms Hannah Sewell Ms Rosalind Fuller Ms Catherine Smith Mr Steven Hedley Ms Selina McClure Ms Lucy Watts Mr Robert Boyd Ms Catherine Stewart Ms Sarah Gamble Ms Gill McCormack Mr Paul Jones Mr Philip Wright Ms Jo Wilson Mrs Sheetal Parmar Mrs Michelle Cross-Glasgow 020 7848 6369 020 7848 6724 020 7848 6714 020 7848 6715 020 7848 6720 020 7848 6102 020 7848 8151 020 7848 6712 020 7848 6710 020 7848 6725 020 7848 6711 020 7848 6706 020 7848 6723 020 7848 6722 020 7848 6702 Full contact details are available via the Virtual Campus. Examinations OSCE IT and Data Administrator Mr James Hollands Clinical Skills Centre, Ground Floor, Shepherd’s House [email protected] 020 7848 6101 Intercalated BSc Undergraduate Programme Officer st Academic Centre, 1 Floor, Henriette Raphael House Ms Angela Lewis [email protected] 020 7848 6366 NHS Bursaries Pastoral Care / Clinical Adviser Liaison Mr Steven Hedley Ms Catherine Smith 020 7848 6715 020 7848 6714 44