Unit information: Year 4 MB ChB in 2020/21

Unit name	Year 4 MB ChB
Unit code	BRMS30002
Credit points	0
Level of study	H/6
Teaching block(s)	Academic Year (weeks 1 - 52)
Unit director	Dr. Wong
Open unit status	Not open
Pre-requisites	Successful completion of Year 3 MB ChB BRMS30001.
Co-requisites	None
School/department	Bristol Medical School
Faculty	Faculty of Health Sciences

Description including Unit Aims

Unit directors: Dr Liang Fong Wong and Dr Fergus Caskey

Year 4 is the ‘Lifecycle’ year and covers medicine from conception to death. It includes Reproductive Health and Care of the Newborn RHCN, Child Health CH, Mental Health MH, Primary Care and Community PCC and Complex Medicine in Older People CMOP with end of life care and life limiting illness.

Year 4 aims to

• Embed students within the culture of the Bristol Medical School community and as valued members of multidisciplinary clinical teams
• Inspire students to further explore and expand their clinical and science learning
• Expand understanding of presentation, differential diagnosis and management of common clinical problems and emergencies including in the specialities introduced in year 4
• Further develop students’ clinical reasoning and decision-making skills through drawing on their biomedical science knowledge and understanding
• Build students’ confidence in their diagnostic and decision-making skills and coping with uncertainties
• Refine students’ effective consultation skills and practical and procedural skills
• Facilitate a holistic understanding of the experience and needs of patients and their carers
• Encourage students to be self-reflective and further develop their professional identity and behaviour
• Provide regular opportunities for students to receive feedback and reflect and act on it
• Provide opportunities for students to learn about giving feedback and to practise this

Structure of Year 4

Year 4 will have two 18-week teaching periods. Students will spend 18 weeks in a Bristol academy and 18 weeks in an out of Bristol academy. Secondary Care specialities are organised as continuous blocks with PCC placements every Wednesday seeded through them over the year. This means that Secondary Care teaching weeks are four days long. There are three shorter six weeks long Secondary Care blocks (RHCN, MH, CH) and 18 week long block (CMOP). In one half of the year students will rotate through the shorter blocks, in the other they will be in CMOP.

CMOP and PCC placements are longitudinal clerkships which will provide continuity of place of learning, tutor and patients. This enables students to participate in patient care over time, helps students to maintain empathy with patients, promotes clinical learning and enhances professional development.

Learning methods

Experiential and Case Based learning, simulation and Hub learning sessions.

Year 4 students will be placed in clinical academies where the focus will be on experiential learning with patients. Learning will start with symptoms and patient experiences rather than facts about diseases.

Learning in Primary & Secondary Care

Students will spend every Wednesday in PCC and help care for patients through first contact consultations and home visits. In Secondary Care, students will consult with patients in Outpatients and on the wards, carry out ward tasks, attend diagnostics (e.g. radiology) and operating theatres.

Clinical Case Based Learning and Helical Themes

Fourth year students will practice clinical reasoning by working through cases in small groups. There will be core cases, a curriculum of topics and exemplar cases including prevention, differential diagnosis and management. Helical Themes will be seeded through the cases.

Biomedical Sciences Learning

Students will apply their biomedical science knowledge to appropriate investigation and management of common conditions. Safe and effective prescribing, Polypharmacy and ‘deprescribing’ will be explored.

Simulation & Interprofessional Learning

Students will work through interprofessional clinical scenarios, including patient safety.

Intended Learning Outcomes

The Year 4 Intended Learning Outcomes (ILO) are a progression from Year 3 ILOs and additional ILOs from Year 4 specialist clinical areas. These comprise of Complex Medicine in Older People (CMOP), Reproductive Health and Care of the Newborn (RHCN), Mental health (MH), Child health (CH) and Primary Care and Community. They are designed to extend students’ ability to manage a wide range of clinical encounters at increasing levels of clinical complexity and uncertainty.

By the end of Year 4 students should be able to:

• Demonstrate the knowledge, skills and attitudes to pass the End of Year 4 Summative Written and Objective Structured Clinical Examinations (“Finals”)
• Apply and evaluate their understanding of biomedical sciences in the context of patient care across the lifecycle
• Show application of the principles of Effective Consulting learned in Years 1-4 and communicate effectively with a range of patients including children, pregnant women, people with mental health problems, with disability, with language problems, people lacking capacity and very old people.
• Demonstrate competent examination of all body systems and evaluate the findings- cardiovascular, respiratory, gastrointestinal and renal, musculoskeletal, neurological, skin, ear, nose and throat, eyes and mental state, and examine children and pregnant women

Recognise a wide range of common conditions, presentations and situations and provide initial management for them in Primary and Secondary Care settings

• Describe the common presentations and management of diseases in pregnant women, children, older people and those with mental health problems
• Discuss the common presentations and management of patients with cancer, life limiting and incurable conditions and be able to evaluate factors enabling personalised approaches to management
• Synthesise the principles of therapeutics and appropriate non-pharmacological treatments in end of life care and the care of people with life-limiting illness
• Describe the interface between health and social care of older people by working with multidisciplinary teams in hospital and community care settings and by experiencing discharge planning of complex patients from hospital to the community
• Utilise a holistic understanding of the experience and needs of patients and their carers
• Prioritise patient safety and wellbeing
• Demonstrate and evaluate strategies for managing complexity and uncertainty
• Apply principles of prescribing safety to complex patients with multimorbidity
• Demonstrate clinical reasoning, problem solving and decision-making skills through applying their knowledge of human behaviour, biomedical science and medical conditions in patient care
• Demonstrate effective learning strategies and the skills for life-long learning
• Demonstrate reflection and self-awareness of their limitations
• Show evidence of professional development and growing into the doctor role
• Describe and evaluate their experience of leadership, followership, teamwork and ‘Human Factors’
• Take care of their own wellbeing while studying in year 4, preparing for finals, learning in the Year 5 apprenticeships and working as a Foundation doctor

All learning Outcomes specified in the General Medical Council’s Outcomes for Graduates will be mapped to the MB21 curriculum using SLS Curriculum Map

Teaching Information

The year will be delivered using a blended learning style. The major focus will be on experiential learning in the clinical environment, enhanced and supported by facilitated small group case-based learning (CBL), simulation and interactive cross-disciplinary sessions, Microsoft Hub sessions, specialised small group tutorials, practical sessions and online learning. In 20-21 a variable proportion of these sessions may be delivered virtually due to pandemic restrictions.

Assessment Information

Formative Assessment Year 4 students will continue to sit Progress tests of applied medical knowledge. They will sit the first two Progress tests of the academic year which will be formative. Students can trace their personal achievement trajectory and compare this to their cohort. Year 4 students will not sit the third Progress Test of the year but instead take the end of Year 4 written exam and a practical clinical assessment. In MB21 Year 4 students will undertake a number of workplace-based assessments. These include Case based discussions (CBDs) and Mini clinical examinations (MiniCex). These assessments are used for Foundation doctors and will prepare students for the assessment schedule in Year 5 and the Foundation Years of postgraduate training. As in year 3, students will be required to complete a Team Assessment of Behaviour (TAB) and to collect patient feedback. Students will receive feedback and are expected to reflect these experiences through use of their online portfolio and multi-source feedback. Students will have an opportunity to sit the Mock Prescribing Skills Assessment (PSA) in Year 4. The PSA is a national exam that all medical students must pass in order to graduate.

The full list of all required engagement and assessment is detailed in the relevant Management of Marks document.

Reading and References

Medical Sciences 2nd edition, Naish J, Court DS.

Macleod’s Clinical Diagnosis 2nd Edition, Japp AG, Robertson.

Macleod’s Clinical Examination 14th edition, Innes JA, Dover AR.

Details of further reading materials for Year 4 are available to students on Blackboard.