Your Journey to Being a Clinician
Systems in Practice Years 1-3
Systems in Practice (SiP) runs from the beginning of Year 1 until the end of Year 3. It is based on the various organ systems of the body and is an integrated course that focuses on normal and abnormal structure, function and behaviour, basic and clinical sciences, and hospital and community perspectives. Problem-oriented learning (where learning is structured around examples of clinical problems) is employed wherever appropriate.
- Introduce the biomedical-scientific principles underlying the practice of medicine
- Develop an understanding of normal and abnormal structure, function and behaviour of the various body systems
- Provide an introduction to clinical practice in both hospital and community settings
- Demonstrate how basic and clinical science integrates with clinical practice
- Instil the values of professionalism and enable development of students’ professional identities
Structure of SiP
Each year is made up of a period of system-based teaching (Principles and three systems are covered in Year 1, seven systems in Year 2, and five in Year 3), Integrating Science and Specialties (ISS) blocks, examinations and Student Selected Components (SSCs). The systems programme is integrated so you will learn about the basic science and clinical aspects at the same time. Basic science including anatomy by dissection is taught in all body systems with periods of time to allow you to consolidate your learning in each semester. A transition module at the end of Year 3 will prepare you for your studies on clinical attachments in years 4&5.
The Principles Block
The first 8 weeks of first year are the Principles Block, which gives an introduction to the basic principles underlying the practice of medicine. These are:
- Structural Principles
- Functional Principles
- Molecular Principles
- Psychosocial Principles
- Disease Mechanisms
- Defence Mechanisms
- Principles of Drug Therapy
- Safe Medical Practice
The curriculum outcomes from the GMC’s Tomorrow’s Doctors 2009, Basic Emergency Care (BEC), interprofessional learning, the problem-oriented approach to learning and the principles of Medical Ethics are also introduced in this phase. Clinical relevance is emphasised throughout and early patient contact is achieved utilising primary care teaching. You will consider the safe practice of medicine in regular clinical skills sessions. Self-directed learning is well represented in the timetable and established as a significant component of this part of the curriculum. The first year Student Selected Component (SSC) is timetabled and runs parallel to the core from early in semester 1.
The Systems Blocks
Following on from the Principles Block there are teaching blocks covering the various body systems:
- Child and family
- Special Senses: ENT, Ophthalmology and Dermatology
Teaching in each system is structured around core clinical problems, and is supported by an online study guide. There is a topic for every week of the systems-based courses. For example, in the Cardiovascular system, the topics are:
- Week 1&2: Cardiovascular principles
- Week 3: Cardiovascular risk factors
- Week 4: Vascular and Ischaemic heart disease
- Week 5: Acute MI
- Week 6: Structural cardiac abnormalities
All teaching for a particular week is structured around a clinical example of the week’s topic. Each of these scenarios has a set of learning outcomes which should enable you to identify:
- Which aspects should be revised from Principles Block
- What learning opportunities there are to achieve these learning outcomes
- How this relates to other aspects of the curriculum
Preparation in Practice, Years 4-5
Years 4 and 5 form Preparation in Practice (PiP) which moves towards a task-based learning approach. A series of around 100 ‘core clinical problems’ provide students with a framework for an integrated view of medicine. PiP begins with a transition block, followed by a series of core clinical placements and a final Preparation for Practice block.
The systematic approach to learning about normal and abnormal structure, function and behaviour, and to developing clinical skills in Systems in Practice Phase provides a springboard to take advantage of a wide range of clinical learning opportunities in Preparation in Practice (PiP) Phase.
PiP aims to provide the medical student at graduation with:
- The knowledge and skills necessary to fulfil the responsibilities of a Foundation Doctor
- Sound professional attitudes towards patients and colleagues
- An understanding of the obligations of the medical profession
- The ability to take responsibility for self-directed continuing medical education and lifelong learning.
Structure of PiP
The Transition Block takes place in the first eight weeks of year 4 and is designed to enable you to recognise the need to integrate the knowledge, skills and attitudes learned in the systems-based context of the previous three years to the setting of managing a patient presenting with a core clinical problem. This should prepare you for learning in the clinical environment by enabling you to elaborate, reorganise and refine their learning.
Core clinical attachments
Following on from the Transition block there are five clinical attachments, each of eight weeks duration. Development towards the Curriculum Outcomes takes place within the framework of roughly 100 core clinical problems. You will be expected to organise your learning around these common problems / concerns with which patients present, each problem being supported by an online study guide.
You are encouraged to develop a wealth of clinical experience of patients and their problems, to master the competencies relating to the core clinical problems outlined in the study guides, and to learn to look at the patient as a whole rather than from the perspective of a disease entity. This strategy is aimed at enabling you to pursue a career in medicine where patients’ concerns and problems are central to your practice.
There are five clinical attachments, each of eight weeks in duration.
Surgery: General Surgery and Surgical Specialties (ENT, Ophthalomology and Urology)
Integrated Specialties: Old-age medicine, Dermatology, Orthopaedics, Rheumatology, Emergency Medicine and Anaesthetics
Obstetrics and Gynaecology & Child Health
General Practice & Psychiatry
All students have the exciting opportunity of an 8 week elective during PiP. This is a period of clinical practice organised by the student anywhere in the world and focused on their own objectives. Most go overseas and around half to developing countries. Dundee has been leading the development of a ‘Responsible Elective’ program which has includes some opportunities for extended attachments, presently in Malawi.
Preparation for Practice
There is a change of emphasis towards the end of Year 5 to the development of experience provided by a particular specialty, and final preparation for practice as a Foundation doctor. Students maintain and further develop their achievements in relationship to the curriculum outcomes. These developments now take place within a framework of Student Selected Components and Pre-registration (Foundation) Apprenticeship blocks: the former provide an opportunity for in-depth study in selected areas and the latter for integrating theory and practice in preparation for the Foundation appointments the following year.
Student Selected Components (SSCs)
Student-selected components have been part of the undergraduate medical curriculum in the UK for nearly twenty years. One of the key innovations of Tomorrow’s Doctors (1993) was the provision of student choice on a scale that had never been seen before. It was seen as essential if students were to engage with the process of reform
In the original Tomorrow’s Doctors (1993) document it was identified that:
“...the greatest educational opportunities will be afforded by that part of the course which goes beyond the limits of the core, this allows students to study in depth in areas of particular interest to them, that provides them with insights into scientific method and discipline of research, and that engenders an approach to medicine that is constantly questioning and self-critical. This part of the course we refer to in terms of ‘special study modules.”
Not all student-chosen elements are modular. In recognition of this, the term ‘special study module’ was replaced some years ago by the more generic ‘student-selected component’ or SSC.
SSCs provide the opportunity to study areas of your own choice in depth; indeed this remains the explicit purpose. They also allow you to develop generic skills that are essential to your professional development. In addition, students can, through SSCs, achieve core learning outcomes not related to specific fields of knowledge, but concerned with transferable skills, like information handling, computer literacy, critical thinking and independent learning. SSCs aren’t an ‘optional extra’ – they’re a very important part of the curriculum.
The relation between core and SSC varies in different parts of the Dundee curriculum. In Year 1 the SSC is a longitudinal exercise running throughout the year. In Years 2 and 3 (Systems in Practice), SSCs are delivered as modules interspersed with other elements of the curriculum. In Years 4 and 5 (Preparation in Practice), SSCs are delivered in both ways: longitudinal (fourth year project) and modular (elective and clinical SSC).
Currently the GMC stipulates that SSCs must occupy at least 10% of curriculum time, compared with one-third originally. This represents an attempt to shift the emphasis from quantity to quality, i.e. to ensure that genuine student choice achieves its fullest expression. In Dundee, the proportion of curriculum time devoted to SSCs varies from one year to the next, but is on average about 25%.
“The purpose of SSCs is the intellectual development of students through exploring in depth a subject of their choice.”
Outcome of the course
At the end of the undergraduate course you will receive your MBChB (or equivalent ) degree, which is a primary medical qualification (PMQ). Holding a PMQ entitles you to provisional registration with the General Medical Council, subject only to its acceptance that there are no Fitness to Practise concerns that need consideration. Provisionally registered doctors can only practise in approved Foundation Year 1 posts: the law does not allow provisionally registered doctor to undertake any other type of work.
To obtain a Foundation Year 1 post you will need to apply during the final year of your undergraduate course through the UK Foundation Programme Office selection scheme, which allocates these posts to graduates on a competitive basis. So far, all suitably qualified UK graduates have found a place on the Foundation Year 1 programme, but this cannot be guaranteed, for instance if there were to be an increased number of competitive applications from non-UK graduates.
Successful completion of the Foundation Year 1 programme is normally achieved within 12 months and is marked by the award of a certificate of Experience. You will then be eligible to apply for full registration with the General Medical Council. You need full registration with a licence to practise for unsupervised medical practice in the NHS or private practice in the UK.
Although this information is currently correct, students need to be aware that regulations in this area may change from time to time.