The duration of the course is four academic years, starting in September of year one and finishing in June of year four (3 ¾ “actual” years). Each year has its own focus, which complies with the General Medical Council (GMC) guidance in Promoting Excellence: Standards for Medical Education and Training (2016):
Years 1 and 2: Core Clinical Practice and Core Medical Science
Year 3: Specialist Clinical Practice
Year 4: Applied Clinical Practice
The curriculum timetable is arranged to ensure experience in all major specialities across the three years. Within those specialities curricular themes are addressed by collaborative working between groups of specialists to deliver integrated learning objectives. The Core Clinical presentations form the backbone of the clinical core curriculum and the basis of clinical tutorials throughout the course.
Core Medical Science
Introduction – 1.4 Weeks
Students spend five days in the West Suffolk Hospital where they are introduced to the environment in which they will learn clinical medicine, have instruction in essential health and safety and have their first experience of clinical situations in hospital and General Practice. Then one day is spent at the Clinical School in Cambridge where students are introduced to the learning facilities provided on site; one day is spent in College.
During the Introduction, students meet their CGC Tutor to discuss their strengths and weaknesses and to identify specific learning needs; and also their General Practitioner tutor.
Years 1-2: Core Medical Science and Clinical Medicine – 20 Months
Core Medical Science (5 x 8-week terms)
CGC students work alongside Standard Course students attending the same programme of lectures, seminars, tutorials, practical classes and supervisions.
Year 1
Functional Architecture of the Body
Topographical anatomy of the human body by dissection and demonstration with strong emphasis on functional, living and surface anatomy.
Introduction to the Scientific Basis of Medicine
Three sets of lectures covering history and philosophy; principles of epidemiology; principles of medical statistics.
Homeostasis
Physiological systems which underpin regulation of the body’s internal environment and its responses to external threats; related practical classes in experimental physiology and histology.
Social Context of Health and Illness
Introduction to the broader cultural aspects of healthcare and the medical profession.
Molecules in Medical Science
Molecular basis of how cells and organisms work including structure, function, biosynthesis and control, metabolic processes and the ways in which the genetic information in DNA is organised, expressed and inherited; core principles illustrated, where possible, by examples relevant to medical science to emphasise the significance of this basic knowledge to clinical practice – a practical course uses a range of biochemical techniques and includes a problem-solving component.
Principles of Cell Biology (optional)
A short course introducing basic principles.
Year 2
Biology of Disease
The nature and mechanisms of disease processes, includes cellular pathology, immunology, microbiology, parasitology and virology – practical classes integrated with lectures.
Mechanisms of Drug Action
General principles of drug action and specific effects of some drugs; selective toxicity and effects on neuromuscular, endocrine, cardiovascular and respiratory systems.
Neurobiology & Human Behaviour
The brain and mind; structure and function of the sense organs and CNS, effects of drugs on brain function; physiological aspects including emotion and emotional disorders (especially depression, anxiety, schizophrenia) child development, intelligence, learning and memory.
Head and Neck Anatomy
Structure and organisation of the human head and neck, with a focus on the relationship of structure to function; the anatomical basis for clinical examination, and the use of anatomical knowledge to understand common pathological conditions and interpret diagnostic images.
Human Reproduction
The biology of human reproduction, its clinical relevance, social context and influence on demographic trends; ethical and legal principles surrounding the practice of medicine in general and reproduction in particular.
Clinical Medicine
Opportunistic Learning
Initially, student learning is largely tutor-led. When students have acquired the basic clinical skills, they can benefit from opportunistic, self-directed learning by finding patients on the wards. Students can do this through: allocation to Consultant Tutors and their teams in medicine and surgery; joining designated Consultant Tutor teams while on emergency intake; identifying patients on the ward who will form the basis of the portfolio cases.
Clinical placements are based in West Suffolk and occur during the University vacations. A number of days are spent in General Practice and the remainder of the time in the hospital.
During each placement, different clinical systems are addressed: signs and symptoms relating to the system are demonstrated in the hospital setting with clinical case demonstrations based on the Clinical Problem List, all being reinforced in General Practice.
During the early clinical placements, students aim to develop clinical method (process) and in later placements the emphasis is more on content.
Similarly, the student’s time during the early placements is well structured, but later there is more emphasis on self-directed study on the wards.
Clinical Skills 1 (3-4 weeks) – Learning the framework of Clinical Method, with an introduction to examination of major systems.
Clinical Skills 2: (4 weeks) – Reinforcement of Clinical Method.
Clinical Skills 3: (10 weeks) – Further development of Clinical Method and clinical features of the systems in general practice and on the wards so that the student has a basic competence in “clinical clerking” and a working clinical knowledge of all the body systems. Exposure to patients with a wide range of general surgical and medical problems.
Clinical Skills 4: (4 – 5 weeks) – Opportunity to spend the attachment shadowing a junior doctor at the West Suffolk Hospital.
Clinical Skills 5: (3 – 4 weeks) – Review of the clinical aspects of all the systems and further clinical experience.
Review and Integration Weeks
Clinical and diagnostic reasoning teaching forms the educational backbone of the R&I weeks, with a number of Clinico-Pathological Presentations (CPCs) relating to the clinical subjects being studied. The CPCs frequently focus on the application of core pathology and radiology learning. Other core curricular material is also presented in R&I weeks, including Pharmacology/Practical Prescribing, Improving Health, Palliative Care and topics from the Professional skills theme including medical ethics and law. This additional material is linked, wherever possible, with the presentations discussed in the CPCs.
Library Based Project
Opportunity to research a topic of interest.
Year 3 – Specialist Clinical Practice (SCP) (joint with Y5 of Standard Course)
The aims of Year 3 are:
- To enable students to build on their clinical assessment, diagnostic and professional skills, including in more specialist clinical environments;
- To provide students with experience of patient care in a variety of clinical settings based on the stages of the human lifespan;
- To enable students to pursue areas of clinical and research interest in specialist and tertiary clinical care settings in a programme built around the research interests of the Clinical School and Cambridge Biomedical Campus.
SCP objectives are achieved by the integration of curriculum themes with clinical material. Students continue their personal and professional development through exploration of ethical dilemmas relating to the specialist services and supported by the professional practice groups.
SCP Placements – 4 x 6 weeks
The SCP course comprises four x 6-week placements:
- Maternal and Child Health
- Neurosciences and Mental Health
- Specialist Medicine (including Cardiology and Infectious Diseases)
- Specialist Surgery (including Oncology)
Core material is presented in hospital and primary care settings. The Specialist Medicine and Specialist Surgery blocks are Student Selected Placements in which students are able to choose a specialist clinical area of interest to pursue in more depth. The majority of these placements are at present based on the Cambridge Biomedical Campus, but there are also placements available elsewhere, including at Papworth Hospital and at Cambridgeshire and Peterborough NHS Foundation Trust.
Hospital Placements
These will be in Maternal and Child Health, and in Neurosciences and Mental Health. Students will be based at CUHT (Addenbrookes) and/or at a partner regional Trust. During these placements students are again embedded within a clinical team and are expected to be involved in day to day clinical work as well as undertaking shift work (including night duties) alongside their team.
Primary and Community Care, 2 x two weeks
The Maternal and Child Health, and the Neurosciences and Mental Health rotations include linked placements studying the relevant specialties in primary care and the community. They explore the realities of living with illness in the community including meeting with community-based carers and organisations.
Student Selected Placements
Two of the four rotations in Year 5 are Student Selected Placements (SSPs) in Specialist Medicine and Specialist Surgery. In these SSPs students will be given the opportunity to explore some specialist and tertiary clinical care, which in most cases will be at Addenbrooke’s Hospital or elsewhere on the Biomedical Campus. This may include undertaking projects in clinical or translational research. There are also a small number of opportunities available to undertake SSPs at other Trusts, such as Papworth Hospital or Cambridge and Peterborough NHS Foundation Trust. The Specialist Medicine and Specialist Surgery placements also include core experiences in Cardiology (delivered at Papworth Hospital), Oncology (delivered at CUHT), and Infectious Diseases (delivered at CUHT).
Review and Integration Weeks
Core curriculum teaching continues in the Year 5 R&I weeks, the CPC programme forming the “backbone” of the programme, together with the linked themes (Professional Skills, Improving Health, Prescribing/Pharmacology and Palliative Care.
Year 4 – Applied Clinical Practice (ACP)
The final year builds on the core learning and the clinical experiences students have had in previous years of the course and there are regular opportunities (through R&I weeks) to embed core learning, linking this with clinical experiences. The focus of the final year is on equipping students with the knowledge, skills and attitudes that allow them to practice independently. Placements in Medicine, Surgery, Acute Care/Perioperative care and General Practice, enable students to build on their experience over the previous 5 years, improve their confidence and play a real part in direct patient care.
Elective
The Elective Studies Student Selected Component occupies seven weeks between Year 3 and Year 4. During this placement, students may study at home or abroad, following a clinical or research area of their own interest.
ACP Clinical Placements
Students will rotate through four x 6 week placements in Senior Surgery, Senior Medicine, Senior Emergency (Acute) Care/Perioperative Care and Senior General Practice. While some of the same subject matter may be covered, the emphasis in ACP is very different. Students will be focused on ‘preparing for practice’ in this final year. They will have acquired, and been signed off for, key clinical skills including phlebotomy, cannulation and catheterisation and will be expected to play a direct part in the care and management of patients under appropriate close supervision.
In their placements at West Suffolk Hospital (Bury St Edmunds), students will become involved in teams and have roles and responsibilities; they may be rostered to work in the evenings and weekends. Clinical Supervisors will guide students through any problems and direct students to patients.
General Practice – 6 Weeks
Students are attached in pairs to a practice that they have not attended earlier in the course. They will see patients independently under the supervision of GP tutors, taking supported clinical decisions and following patients up. They are introduced to a patient with terminal illness in order to gain experience of palliative and terminal care in the community.
Hospital Placements: Senior Medicine and Senior Surgery and Peri-operative Care– two x 6 Weeks
Students are attached to medical and surgical teams. As far as possible, they play an integral role in the day to day work of patient care. They take responsibility for clerking and following up identified patients, including presenting the patients on rounds, performing practical procedures, escorting patients to investigation or therapy units, attending discharge planning meetings and other activities related to direct patient care. They prescribe using student prescription sheets which are inspected by the clinical team. During these placements, students will also build on their sub-specialty skills including Dermatology, Rheumatology, Orthopaedics, ENT, Medicine for the Elderly, Ophthalmology, Palliative Care and Radiology.
Acute Care/Perioperative Care – 6 Weeks
Students learn about the practicalities of assessing and managing patients with serious, acute and life-threatening illness across all specialties, to ensure that they are both competent and confident in this area before qualification. Time on this attachment will be divided between Emergency Departments, Intensive Care Unit and Theatres.
Review and Integration Weeks
Review and Integration programmes continue, the focus in Year 4 being on clinical management and all aspects of professionalism.
Practical Prescribing
A mixed methods teaching programme including on-line teaching , at the end of which students should be able to use the British National Formulary (BNF) correctly to support decisions about drug prescription; apply BNF general prescribing advice and current legislation regarding prescribing controlled drugs; record and report adverse drug reactions; carry out a range of drug dosage calculations and use Trust guidelines on good prescribing to identify and resolve inappropriate prescribing practice. Students will take the National Prescribing Safety Assessment exam during Year 6
Apprenticeship Block – 6 weeks
After the clinical finals exams, there is a formal apprenticeship block where students work semi-independently under supervision of nominated consultants to deliver direct patient care in an in-patient environment. This will be under close mentorship by both junior and senior doctors. It will be a unique opportunity to develop further working knowledge of what it really means to be a Foundation doctor, to practice key skills, to experience night shifts, and to hone the ‘wardcraft’ needed to be a successful junior doctor. Alongside this, students will also spend a day in a Hospice, will undertake a number of Liaison psychiatry seminars, and will continue to build on their Communication Skills and Professionalism learning. Satisfactory completion of this block will involve sign-off of a log book and a report from supervising senior and junior doctors.
Foundation Programme – 2 years
To be eligible for full registration with the General Medical Council, a doctor must complete a period of supervised service in an approved post.
Recruitment is by open competition through the FPAS procedures of the UK Foundation Programme.
Themes
Themes serve as scaffolding around which different specialties specify coordinated learning objectives and collaborate to deliver an integrated programme over the four-year period of the course. Learning and teaching in these areas forms the backbone of the Review and Integration programme.
The curriculum themes are as follows:
- Core Science and Pathology
- Clinical Communication Skills
- Practical Procedures
- Diagnostic reasoning and Patient Investigation
- Therapeutics and Patient Management
- Professional Skills, comprising
- Professional behaviour
- Medical Ethics and Law
- Multiprofessional Teamworking
- Reflection, learning and teaching
- Management and Leadership
- Patient Safety
- Public and Population Health
- Palliative Care
- Research and the INSPIRE programme
