Programme Structure

The duration of the course is three academic years, starting in September of year one and finishing in June of year three (2 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):

Year 4: Core Clinical Practice

Year 5: Specialist Clinical Practice

Year 6: 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.

Year 4 – Core Clinical Practice (CCP)

The aims of Year 4 are:

• To enable students to acquire the core clinical assessment, diagnostic and professional skills required of a doctor.
• To provide students with experience of patient care in a variety of clinical settings (primary care, secondary care, emergency departments, ward care, elective/day case units, ambulatory/outpatient care).
• To build on the scientific foundation of the MVST programme with opportunities for student selected research activity.

CCP objectives are achieved by the integration of curriculum themes with clinical material. Students are supported in moving into the clinical environment and towards self-directed, experiential learning. They begin their personal and professional development through exploration of ethical dilemmas, through examining students’ own attitudes and values and via an appreciation of the patients’ perspective of illness.

 

Introductory Course – 2 weeks

Students start Year 4 with a two week introductory course which will provide a grounding in the core skills required – clinical communication skills, clinical examination skills, practical procedural skills/resuscitation, professionalism and palliative care. There will be a mixture of large group lecture style sessions and smaller group rotational experiences.

CCP Core Clinical Method – 2 x 4 weeks

Students will have four weeks of experience at one of the seven regional hospitals (Bedford, Hinchingbrooke, Ipswich, Kings Lynn, Stevenage or Peterborough) and four weeks of experience based in CUHT (Addenbrookes Hospital). During this time, students will be embedded in a clinical team and will develop their skills in basic clinical method including history-taking, clinical examination and basic diagnostic reasoning. This includes core clinical method relating to paediatrics and psychiatry. The hospital placements are supported by a weekly placement in General Practice.

Following these core clinical method blocks there will be a formative assessment to ensure that students have developed the required core skills to proceed, and to identify students who may be experiencing difficulties in order to provide additional clinical teaching support. (Please note that for 18/19 the formative review will take place in January.)

CCP Placements – 4 x 6 weeks

 

 After the Core Clinical Method, students will enter a rotation of four placements; three of these will be clinical placements either at CUHFT (Addenbrooke’s) or at one of seven regional hospitals (Bedford, Hinchingbrooke, Bury St Edmunds, Ipswich, Kings Lynn, Stevenage or Peterborough). 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. Students will obtain experience in:

• General Medicine (including Elderly Care)
• Emergency Care
• Elective Surgery and Peri-operative care
• Two x 2 week placements in General Practice are included in the General Medicine and Emergency Care placements in a teaching practice in Cambridge or linked to the regional teaching hospital.
• The fourth placement is a six-week Student Selected Component during which there will be an opportunity to obtain clinical research experience.

Educational resources

Learning in the clinical environment will be supported by online learning resources. A group of core clinical cases will provide a framework for the Year 4 curriculum and students will be able to access these via an ePortfolio. In addition there will be a series of seminars and tutorials throughout the year which will cover clinical pharmacology, radiology, clinical communication skills, professionalism and palliative care.

Review and Integration Weeks 1- 4 

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, whereever possible, with the presentations discussed in the CPCs. Three other courses start in weeks 1 – 4 and run through the R & I programme. “Frontiers in Medicine” showcase the excellent translational and clinical research being undertaken on the Cambridge Biomedical Campus by members of the Clinical School and partner research organisations. There is a series of guest lectures around the subject of “Humanities in Medicine”, with invited speakers from the wider University setting and beyond. “The Patient’s Voice” enables a set of expert patients to meet the students and discuss their experiences of the health service and their illness.

CCP Portfolio 

Students develop a portfolio based on patients that they have seen including case write-ups and pieces relating to the various curricular themes.

Year 5 – Specialist Clinical Practice (SCP)

The aims of Year 5 are:

• To enable students to build on their clinical assessment, diagnostic and professional skills, including in more challenging 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 8 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, 4 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 5 – 10 

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. The “Frontiers in Medicine”, and “Humanities in Medicine” and “Patients’ Voice” courses continue.

Portfolio: Students continue to assemble their portfolio based on patients that they have seen. This includes case write-ups and pieces relating to the various curricular themes. In particular, students identify patients with different cancers and with cardiovascular disease to form the basis of the reflective portfolio.

Year 6 – 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 and Acute Care enable students to build on their experience and confidence and play a real part in direct patient care.

Elective

The Elective Studies Student Selected Component occupies seven weeks between Year 5 and Year 6. 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 hospital placements, either at CUHT (Addenbrookes) or at one of the seven regional hospitals (Bedford, Hinchingbrooke, Ipswich, Bury St Edmunds, Kings Lynn, Stevenage or Peterborough), students will become involved in teams and have roles and responsibilities; they may be rostered to work in the evenings and weekends. In each of the hospitals, 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 around the region. 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 and form part of their portfolio of learning. During these placements, students will also build on their sub-specialty skills including Dermatology, ENT, Medicine for the Elderly, Ophthalmology, Palliative Care and Radiology.

Acute Care – 6 Weeks 

Students learn about the practicalities of assessing and managing patients with serious, acute and life-threatening illness across all specialities, 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 (11 & 12) 

Review and Integration programmes continue, the focus in Year 6 being on clinical management and all aspects of professionalism. The “Frontiers in Medicine”, Patient’s Voice and “Humanities in Medicine” courses continue.

Portfolio 

Students complete their portfolio based on patients that they have seen including case write-ups and pieces relating to the various curricular themes including Palliative Care.

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.