Med 5 Teaching: New curriculum Department of Anaesthaesia and Intensive Care Department of Clinical Oncology Department of Diagnostic Radiology & Organ Imaging Department of Medicine and Therapeutics Department of Orthopaedics and Traumatology Department of Surgery Accident and Emergency Medicine Unit

New curriculum: Year 5 10 week modules. 4 per year. 40 weeks total 2 each for Medical and Surgical Streams 20 weeks for each “stream” “Medicine” = Medicine, Oncology, ICU and Radiology. “Surgery” = Surgery, ENT, Eye, Anaesthesia, Orthopaedics and Radiology

New curriculum: structure of year 5 Weeks * Medicine 1 + SSMSurgery 1 + SSMMedicine 2Surgery 2 Surgery 1 + SSMMedicine 2 + SSMSurgery 2Medicine 1 Medicine 2 + SSMSurgery 2 + SSMMedicine 1Surgery 1 Surgery 2 + SSMMedicine 1 + SSMSurgery 1Medicine 2 *2 week gap between 2 nd and 3 rd modules SSM: Self-selected Module

Students Comments The final year’s schedule is too tight  40 weeks in total  Too many subjects to cover Medicine stream – clinical oncology, acute care medicine (AED & ICU), radiology plus all medical specialties Surgery stream – anesthesia, ophthalmology, ENT, orthopedics No time to play the role of assistant intern

Students’ Comments Students have forgotten what they have learnt (clinical skills) in medicine and surgery in Year 3 SSM is a waste of time!

Teachers’ Comments When they came to year 5, they tend to be deficient in clinical skills as well as basic scientific knowledge (as compared to those students in the old curriculum) For history taking, students are able to ask a lot of questions following some kind of protocols, but their ability to integrate the history and the clinical reasoning is weak For physical examination, students are able to perform step-by-step for organ systems but their ability to pick up physical signs and correlate the findings is weak

Teachers’ Comments Students are still asking for tutorials (and some teachers like tutorials too – may affect their ratings.) Too much preference for didactic teaching and book learning Some gaps in knowledge (e.g. interpreting ECG, management of coma) Students expected to learn about management but too much time has to be spent on the history and examination

Where are they? Weeks * Medicine 1 + SSMSurgery 1 + SSMMedicine 2Surgery 2 Surgery 1 + SSMMedicine 2 + SSMSurgery 2Medicine 1 Medicine 2 + SSMSurgery 2 + SSMMedicine 1Surgery 1 Surgery 2 + SSMMedicine 1 + SSMSurgery 1Medicine 2 Some students took the two week gap to travel to EUROPE!

SWOT in Year 5 Strength  Cluster clinical teams and other teaching hospitals are providing good clinical materials and patients for our students – good feedback about ward attachments in general  Highly committed clinical teachers  The introduction of 2 weeks of “intensive surgery course” at the start week of each surgical attachment is considered very useful  Acute medicine course (ICU) receiving very good feed back – at present run at 1 st week of one medical attachment

ICU course is very well received Basic Assessment and Support of Critically Ill patients for Medical Students Very

SWOT in Year 5 Weakness  Too many specialties where some teachers commented that their levels are obviously post-graduate  Spending 2 weeks on “intensive surgery course” means 2 weeks of clinical rotations (real patients encounters) are taken away  When med 5 students are attached to clinical teams, they do not really function as “assistant interns” or “part of the team”  Students increasingly absent themselves from clinical attachments in the last module (in library)

SWOT in Year 5 Opportunities (modification)  Clinical rotations may need to be repackagde so that less time is spent in rotating through surgical sub-specialties of post-graduate level (need modifications of teaching content as well)  Need to enhance as well as encourage med 5 students to participate “assistant interns” during ward attachments  Special sessions may need to provide for clinical skills training in preparing the students for their internship  Need to add learning and teaching outcomes for surgical rotations so that students can be clear about what they should do when they come to a clinical team

SSM in Year 5 Scrapped in 2006/7

New Possibilities Weeks Medicine 1Surgery 1Medicine 2Surgery 2 Surgery 1Medicine 2Surgery 2Medicine 1 Medicine 2Surgery 2Medicine 1Surgery 1 Surgery 2Medicine 1Surgery 1Medicine 2 ICU Course 4 additional Weeks Of Pre-year 5 Brush-up On Clinical Skills ICU course introduced in 2005/6 at week 1 of medical module

Final comment Are we expecting too much of the new curriculum? Are we expecting too much of the skills of the students at entry to year 5? The original idea of the new curriculum was that students would be ready by year 5 to take on ward attachments as “pre-interns”. This goal is not being met by most (although not all) students but is it a realistic goal?