Medicine course overview: Educating Tomorrow’s Doctors

Medicine course overview: Educating Tomorrow’s Doctors

September 18, 2019 1 By Ronny Jaskolski


Welcome to this short video on Educating Tomorrow’s
Doctors from the University of Birmingham Medical School. My name’s Jamie Coleman
and I’m a senior Lecturer in Medicine and the Deputy Programme Director of the MBChB
course. You can’t take the educational principles
out of a senior lecturer so here are some of the learning outcomes. In the Medical School
I work with a team of educators to ensure that we’re training the very best doctors,
fit for practice, that’s part of a much wider staff. I’m very fortunate to work
with committed scientists, clinicians, educational specialists and administrative staff to deliver
the medical undergraduate course. So I’m going to talk about teaching and learning,
different teaching methods and the importance of advances in medicine in keeping the curriculum
up to date. Every institution has a mission and this is
the mission of the Medical School; ‘We aspire to train the very best doctors through a distinctive
curriculum to be safe, competent, good communicators and well equipped to meet the challenges of
tomorrow’s National Health Service. Our students will graduate with an enquiring mind
that will both challenge and innovate future medical knowledge and practice. Life interests
outside Medicine, that in turn enhance the quality of being a doctor, will be nurtured
and enhanced. Students will look back on their undergraduate time in Birmingham as “the
best years of their life” ‘. Jut to set the scene, we’re one of the largest
of thirty medical schools in the UK with 385 funded contracted places from the Higher Education
Funding Council. About 345 on our five year main programme and 40 are places on our four
year graduate entry course. And of course again for context, we’re the biggest programme
on campus making up 2% of the total university undergraduate activity. We interface with
a complex and diverse National Health Service as our local education providers and we’re
situated in a large super-diverse region in terms of ethnicity and social mix. In terms
of manpower planning, we have good relationships with the Deanery. Very important given that
over 50% of our graduates do their postgraduate training in this region. We have 140 medically
qualified academic members of staff but many more honorary academic staff situated in clinical
practice. Running such a programme requires a large administrative engine and we have
about 55 full time equivalent staff in our programme office. And the Medical School is
embedded in a wider research rich College of Medical and Dental Sciences, which itself
is one of five colleges across the University. I’m going to give you a brief overview of
things as they are at present with the curriculum but clearly the curriculum does need to change
from time to time. Not to confuse students as they sometimes think but to provide the
most advanced, up to date curriculum that we can. The MBChB programme is in fact two degrees:
a Bachelor in Medicine and a Bachelor in Surgery, and there are many more core subjects that
make up the degree, other than Medicine and Surgery, including general practice, obstetrics
and gynaecology, paediatrics and psychiatry. But there’s even more than that that make
up the whole, including specialist medicine and surgery subjects as shown here. Our curriculum is broadly split into four
phases. This diagram outlines the five year course but the only main difference for the
graduate entry programme is that Years 1 and 2 are combined. Phase I starts by building,
synthesising and applying the medical knowledge base. Within this, semester based modules
which contain the under-pinning biological and social science content of the course,
alongside regional anatomy and integrated professional and academic skills. From Phase II onwards students spend the majority
of their time in clinical practice and in this phase students learn to take histories
and perform physical examinations and start learning clinical procedural skills and diagnostic
awareness. This is the time when students are acquiring and utilising clinical information. Phase III is a year when students broaden
this professional base by undertaking many of the specialist medical and surgical specialties,
as well as other subjects such as psychiatry and anaesthetics. Phase IV happens just before students qualify
and start their Foundation Programmes and at this time students learn to manage the
patients, sick and well. In addition to paediatrics, obstetrics and gynaecology, and a longer community
based medicine placement in general practice, recent modifications provide a new acutely
ill patient module to ensure that our graduates the knowledge and skills to deal with emergency
presentations effectively. So what drives teaching and learning in the
undergraduate course? Our main driver is the General Medical Council’s document ‘Tomorrow’s
Doctors’, published in 2009. This provides the outcomes and standards for undergraduate
medical education and all of our own module learning outcomes map clearly to this document.
In particular there are three clear domains that underpin the training objectives. Namely
‘the Doctor as Scholar and Scientist’, ‘the Doctor as a Practitioner’ and ‘the Doctor
as a Professional’. One of the other things that drives our educational objectives is
of course patient centred care. Indeed, that desire to provide care for people who are
sick is what drives most of us to study medicine in the first place. I believe that we’re
in a privileged profession and placing patients at the centre of everything we do, even the
education we provide, means that care must be central to the curriculum. What is even
more clear, as seen in this schematic of the health and care system, is that we have to
provide a foundation of knowledge and we have to ensure that graduates are capable of practising
across many different areas of care, whether it be in broader roles such as regulation
and commissioning, or as hospital doctors, general practitioners, or any other medical
career path that they may choose. I’ve already mentioned that as we’re a
Medical School we’re responsible to the General Medical Council for the standards
and quality of the education that we provide. But all doctors, be they training or in practice,
are regulated by the GMC for their own professional standard. The document shown is one of those
that we make our students aware of and allows us to focus on professional values and behaviours
that we expect of them. Basic medical training gives students opportunities to learn professional
behaviour in a supervised environment that is safe for patients. And what’s even more
incumbent on us as a School is to identify at an early stage where behaviours exist that
require some modification, such that we can support remenial action to help students improve
their behaviour – a responsibility we take very seriously. Teaching and learning for tomorrow’s doctors.
That’s something that our current Dean is very proud of, the Birmingham Stamp. These
are, as it were, the special delivery items that make our graduates recognisable as Birmingham
raised. With a research active university comes students who are exposed to and inspired
by advances in research. All of our students get a taster of research in various places
on the course and many choose to do an intercalated degree with a substantial research component.
Community based medicine is a thread that runs throughout all phases of the curriculum
with GP placements taking place every fortnight up until the final year when a longer placement
in practice occurs. As a result, our students get an outstanding experience of community
based learning. Another area of excellence is in prescribing skills training; an important
area for providing safe patient care and we pride ourselves on preparing our students
in this area, particularly important given the national prescribing skills assessment
which takes place in the final year in all UK Medical Schools. Lastly, all of our students
rotate through hospitals with world-class clinical facilities. Here is a picture of
the Queen Elizabeth Hospital, co-located with the University of Birmingham campus, a hospital
with international expertise in many areas such as military care and trauma, organ transplantation
and cancer services. Teaching in Phase I is not dissimilar to other
undergraduate courses. With, for example, large group lectures, made more interactive
by electronic audience response systems to keep our students on their toes. And there
are many other teaching modalities such as small group tutorials and practical sessions,
some of which are self-directed and many of which are problem based. The basic unit is
the M-group which consists of about fifteen students per group. And like all other university
courses, private study is an important component and there are plenty of learning materials
available from our library, e-books and online learning system to support students in this.
Many courses have specific attributes to their course and MBChB is certainly no exception.
We have many added extras in terms of teaching and learning. Problem based learning and enquiry
based learning are blended with the traditional teaching methods within our course and certain
elements related to the profession are obviously important, such as anatomy teaching, including
sessions in our prosectorium and early placement days out in general practice. It’s probably worth pointing out the difference
that university style learning has over some school based learning and being self-directed
is extremely important and that requires some degree of planning and reflection. One important
principle in Medical School is illustrated in this document from the General Medical
Council, which I think is telling of some of the support that we need to give our students
on the course. It says don’t be distracted by how well others are doing. It goes on to
say that medicine is a competitive subject to study and your fellow students will be
some of the brightest in the country and so you may find that it’s not as easy to stay
ahead as it was at school. So we also have a lot of activities and welcome
week and other academic support to ensure that our students can quickly engage with
the different learning environment of university and particularly medical studies. Our aim
is to promote a good collaborative rather than competitive learning environment. Hospital based training. It was once said
humorously that starting third year is like going to a foreign country. You don’t speak
the language, you don’t understand the customs and the natives are not always necessarily
friendly. The hospital environment is again a different type of learning environment and
we are required to prepare our students. Several years ago, even before central guidance came
out, we’d instituted a course at the end of Phase I which is specifically focused on
the preparation of students from this transition to being a clinical medical student and this
continues to run with great success and is appreciated by the students and teachers in
the Trust who recognise the value of some dedicated time to familiarise themselves with
where and how learning takes place in hospitals. Birmingham Medical School is on the main university
campus in Edgbaston which is just about a mile south of Birmingham city centre. We’re
co-located with the University Hospital Birmingham but we have many more teaching hospital sites,
or teaching academies as we know them, across the West Midlands who provide placements for
various parts of the course. There are many wide and varied learning opportunities available
within hospitals and teaching is led not only by a medical team but it involves many other
healthcare professional staff as part of multi-professional teams. At each teaching academy there’s a
Head of Academy, the lead undergraduate teacher who oversees their local education provision
and together they have a team of administrative support who organise the timetable. All of
our Trusts also employ dedicated teaching staff in the form of Clinical Teaching Fellows
who often coordinate specific teaching events and supplement the teaching of other healthcare
staff. As in Phase I, a substantial amount of independent learning and increasing self-direction
is required on the clinical course. There are many learning opportunities, be it watching
a surgical operation in theatre, doing procedural skills, and often our senior clinical leaders
get involved by teaching and supporting more junior peers in clinical practice. In most Medical Schools tradition has it that
medical students spend some time away to study in another institution for a prolonged period
– the elective – and this occurs for eight weeks at the end of the fourth year in the
case in Birmingham. Most students choose somewhere exotic and combine study with travel and immersion
in a different culture. Our students benefit from seeing medicine practiced in very different
settings, whether it be a trauma unit in downtown Washington DC, the Australian Flying Doctor
Service, or immunisation clinics in South Africa. The elective is usually juxtaposed
to a week or two of holiday so that some vacation can also be spent whilst away. However, not
all students go abroad and many choose to stay at home, arranging attachments in order
to see practice in more depth or to study an unusual specialty. Now we don’t teach our students to know
how to perform complex operations such as hernia repairs or appendectomies, but clearly
they need to know about these procedures. We, however, wouldn’t want to graduate a
student who was unable to take blood or give an immunisation, so they have to be fairly
proficient at these more basic skills. What we therefore have is a hierarchy of procedural
skills and we know exactly those that are required for newly graduating doctors, at
different levels of competence. Most recently my colleagues in the College have organised
these into a highly successful clinical procedural skills passport, which exists in both a paper
and online format. This provides a log of proficiency at various skills that the students
need to perform and they work on this throughout their clinical years of training. The lessons learned and benefits accrued from
other high reliability industries that we’ve adopted and integrated into simulation has
been very important for Medicine. For example, you wouldn’t want the pilot of our plane
when going on holiday to be flying it for the first time and you wouldn’t want the
junior doctor trying how to take blood or stitching a wound to be doing that for the
first time without doing it first on a mannequin. So many of our teaching sites have dedicated
facilities with access to many different types of simulation from inserting a drip into a
vein on a fake arm, to total immersion simulation with sights and sounds and even smells in
a ward-based environment. Keeping the curriculum up to date. This historical
article on the purpose of medical education contains a quote that I often find myself
reciting to our students, “half of what you will be taught as medical students will
in ten years have been shown to be wrong”. The trouble is, none of your teachers knows
which half. This exemplifies why we need to future proof the curriculum and also ensure
that our students understand the importance of keeping up to date and continue professional
development. And
these days the pace of change can be even
faster and the information age is on us so just when we think about medical evidence,
the information on which we base our diagnostics and treatments, there’s a huge amount and
the burden is quite significant. Again, we have to prepare our students to be able to
deal with these challenges and have specific content on evidence based medicine and critical
appraisal so that students can reliably understand and assimilate new information into their
clinical practice in the future. And talking of the future, we have to remain innovative
in our teaching delivery and tools available to students. We actively promote e-books and
the use of novel technology to facilitate the learning process and in addition we have
a modern and user-friendly virtual learning environment that works with students’ social
media to provide interactive and easily available content on the move. There’s just one Dean but he has a team
of Vice-Deans and core programme staff and this is our collective vision. Here at Birmingham
Medical School we want to train the very best doctors to the required standards, ensuring
that we provide a quality and innovative learning environment. Secondly, we wish to give added
value to students with an enhanced experience whilst undertaking their training. And lastly,
but perhaps most importantly, we want to prepare our graduates to be 21st Century doctors who
are safe and sensible, well equipped for any challenges that the postgraduate training
will throw at them and through their continuing professional development, aspire to success
in their future careers. Thank you for listening and to find out more
about the Medical course at the University of Birmingham, please browse our website or
follow our Twitter feed at the College of Medical and Dental Sciences @unibirm_MDS.