Lessons from King`s College London

Report
King’s College London School of
Medicine
The first two years of MBBS
Despo Papachristodoulou
October 2011
King’s College London School of Medicine
and associated District General Hospitals
2
The standard programme
 5 Years
 5 Phases
– Progression from studying medical science – clinical
skills – medical practice
In addition:
GPEP programme 4 years (graduate/professional entry
programme)
EMDP programme 6 years (extended medical degree
programme)
King’s curriculum
professionalism
• 2 years integrated science &
clinical
• 2 years attachments in clinical
areas
• 1 year “student house officer”
attachments
knowledge
skills
How did we get here?
• St Thomas’s
• Disciplines
• UMDS 1983 ( St T and Guy’s)
• Systems
• King’s 1998
• phase 1 and phase 2 (scenarios)
336 5 year
entrants
Phase 1
50 EMDP
Phase 2
28 GPEP
Phase 2
Phase 3 444
Phase 4
Phase 5
34 Oxbridge
The first two years
YEAR
ONE
Phase 1
12 weeks getting
started
YEAR
TWO
Phase 2
First 12 scenarios, integrated
learning with a clinical context
Phase 2
Next 23 scenarios
Core and student selected
components
• The course consist of
• ‘core’ material which is common for all
students
• Student selected components which vary in
format
Phase One
Overview:
Phase 1 runs over a single term.
It provides a platform of :
knowledge
skills
attitudes
that will enable students to progress to the clinical
scenario-based part of the course that constitutes the
rest of Year 1 and all of Year 2
Summary:
Systems covered in phase 1:
Cardiovascular,
Respiratory,
Nervous,
Musculoskeletal,
Gastrointestinal,
Renal,
Immunology,
Statistics,
Psychology, Sociology, Ethics.
Early patient contact opportunities in clinical
attachments
Development of professional skills and attitudes
In a multidisciplinary inte-professional education
programme.
Using lectures as a guide:
•
•
•
•
•
•
•
•
Cell biology
Anatomy
Immunology
Biochemistry/ metabolism
Microbiology
Pathology/histopathology
Pharmacology
Psychology /sociology/ethics/stats
21
18
6
8
2
5
5
10
Phase 2
• Phase 2 runs over a year and a half and allows
the promotion of understanding between
normal structure and function and their
interrelationships.
• It also continues to extend training in
professionalism: communication skills, attitudes
and behaviours as well and teaching basic
clinical skills.
Summary:
• 35 weekly clinical scenarios
• a variety of learning sessions
including:
lectures,
small group teaching
workshops,
student presentations
clinical attachments in hospital and
community settings
Clinical aspects linked to basic medical
science
• The clinical scenarios
• Practical classes e.g. Blood pressure, ECG, lung function
tests, nerve conduction velocity, hearing and visual field
• Communication skills with simulated patients
• Self directed learning
• Attachments to primary care centres (general practice)
• Hospital visits
Content of phase 2
•
Scenarios cover the topics:
•
•
•
•
•
•
•
•
•
•
Cardiovascular and respiratory systems
Gastrointestinal and renal systems
Metabolism and Nutrition
Musculoskeletal system
Endocrinology
Fertility and reproduction
Head and Neck Anatomy
Neuroscience
Genetics
Infections
•
Scenarios given a patient’s name and condition
Scenario title examples
• Sanjay’s malaise; is it influenza?
• Wilma’s woeful wrist
• Diana’s diarrhoea
• Sheila’s sore shoulder
• Harold’s painful hip
• Donna’s diabetes
• Silly? Easy for students to remember
First two years: weekly clinical scenarios
Practical skills
lectures
Clinical
scenarios
tutorials
Self-directed
learning
dissection
interprofessional
learning
communication, ethics
= clinical
component
prosection
patient
contact
Example of a clinical scenario in one week
Dissection of
thorax
In phase one
Tutorial on CVS
physiology
Tutorial on CVS
pharmacology
GP or hospital
visit
Histology of
blood
Clinical problem: ‘John has chest
pain’
Professor of Cardiology
Lectures:
The cardiac cycle 2
Blood cells, haemopoiesis
Atherosclerosis
Embolism and infarction
Heart disease pharmacology 2
Clinical problem debrief
/summing up
Professor of Psychology
Problem solving
workshop
Co-arctation
Problem solving
workshop
Diseased and
healthy heart
Clinical skills
Blood pressure
ECG
Example of a clinical scenario in one week
Problem solving
workshop
Regression and
correlation
Clinical problem: ‘weight loss and
obesity
Clinician from IT
Presentation of Patient with
Crohn’s
Lectures:
Energy balance and body weight
Macronutrients PEM
Vitamins
Minerals
Lipid synthesis and transport/
hyperlipoproteinaemias
Integration of metabolism
Diabetes mellitus
Eating disorders
Stats: regression and correlation
Clinical problem debrief
/summing up
IT clinician/ biochemist
Problem solving
workshop:
metabolic
syndrome
Another example of a clinical scenario in one week (YEAR TWO)
Clinical
epidemiology
tutorial
randomised
control trials
Clinical skills
communication
skills
Explaining and
exploring
CAL session
Case history
and
management
Clinical problem: ‘Donna and Tony
have diabetes’
Introduction by Professor of
Diabetology
Lectures:
Diagnosis and classification
Insulin secretion
Insulin action and insulin resistance
Therapeutic use of insulin
Pathogenesis of type 1 diabetes
Pathophysiology of symptoms of
diabetes
Randomised control trials
Monitoring control in diabetes
Hyperglycaemic emergencies
Pharmacology of type 2 diabetes
Metabolic syndrome and obesity
Diabetic complications
Scenario debrief: What is new in
diabetes
Professor of Diabetology
PSW insulin
therapy
PSW
hypoglycaemia
Living with Diabetes
Hospital visit
Diabetic Centre
Self directed learning
The clinical skills
centre allows
students to practise
their practical skills
Medicine in the community:
year 1 aims
• Orientate students in clinical environment
• Direct experience of working with patients
• Set context for basic science
• Encourage reflection
• Encourage self-directed learning
• Develop professionalism
Community: year 2 aims
• To be able to take a patient history
• To understand issues involved in access to
healthcare
Assessment : Year one
MB BS Part 1 is a Module consisting of two main
components, which are weighted as follows:
• End of Year Examinations
• In-Course Assessment (ICA)
80 %
20 %
The end of year examination component
consists of three units, which are weighted
as follows:
Examination Assessment
1
2
3
Phase 1
Scenarios 1-7
Scenarios 8-13
Duration(hours)
3
2
2
1-7 cardiovascular and respiratory
8-13 gastrointestinal, renal , nutrition and metabolism
Students must pass all three written examinations
One further attempt is possible
% of final mark
34
23
23
total 80
Assessment Year 2
• MB BS Part 2 is a Module consisting of two
main components, which are weighted as
follows:
• End of Year Examinations
• In-Course Assessment (ICA)
82 %
18 %
The end of year examination component consists of
four units, which are weighted as follows:
• Examination
Duration(hours) % of final mark
•
•
•
•
3
3
1.5
Scenarios 14-23
Scenarios 24-32
Scenarios 33-36
OSCE
14-23 musculoskeletal, endocrinology
24-32 head and neck, neuroscience
33-36 genetics, infections
Students must pass all three written papers and the OSCE
One further attempt is possible
28
28
14
12
total 82
OSCE
• Objective Structured Clinical Examination
• Examines skills, knowledge and understanding in clinical
situations
• It is a minimum competence exam
Each OSCE has a mix of:
• History taking
• Practical skills
• Communication skills including sensory awareness
• Living Anatomy
Evaluation: looking at
• Scenario format
• Clinical experience
• examinations
Student evaluation from end of year
questionnaires (2010-11)
• Presenting the basic science material in scenario
format made it interesting
•
•
•
•
•
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
60%
33%
6%
1%
0%
Student evaluation from end of year
questionnaires (2010-11)
• Presenting the basic science material in scenario
format made it interesting
•
•
•
•
•
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
60%
33%
6%
1%
0%
Student evaluation 09-10
• Presenting the basic science material in
scenario format helped learning
•
•
•
•
•
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
53%
43%
2%
1%
1%
Student evaluation 10-11
• Presenting the basic science material in
scenario format helped learning
•
•
•
•
•
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
55%
33%
8%
3%
1%
Student evaluation 10-11
• I found the clinical sessions in hospital and
general practice interesting
•
•
•
•
•
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
28%
49%
17%
4%
1%
Evaluation 10-11
• The end of year examinations were :
• Too difficult
• About the right level of difficulty
• Too easy
36%
64%
1%
Strengths of our course
• Scenario format of teaching. (strong student
feedback, frequently cited as one of the best
features )
• Learning in the community
• The relevance of basic science to clinical medicine
is made obvious.
Weaknesses
• Huge amount of organisation needed to
allocate 850 students in 3 hospitals and
primary care centres
• Too many lectures.
• Timetable loses flexibility
If you are using specialist teachers
(clinical)
• make sure they appear on the day
• If the member of staff changes, ensure that any
new presentation follows the aims of the session.
Any ‘innovation’ should be agreed by the MEC
• Make sure that the specialist does not teach his
specialty but uses it to demonstrate the
importance and relevance of basic science in
medicine
Tips
• Do not start a scenario on a Monday

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