Medical Students Handbook
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Medical Education in Cambridge
Section B Course and Assessment Information
Outline of the Medical Course
Colleges and the University
First Year Courses
Second Year Courses
The Third Year
The Clinical Years
Student Feedback and Representation
Estimated additional course costs 2012-13
Course and Assessment Summary Medical Students' Register
Medicine at Cambridge: The first two years
Welcome to Cambridge, and congratulations on gaining a place to study medicine. This is the beginning of an exciting and challenging time: going to University, perhaps leaving home for the first time, and embarking on a demanding course which will lead you to qualification in a highly respected profession.
This booklet provides a general introduction to the Cambridge medical course for students starting their course in October 2012 and covers mainly the first two years.
Dr David Good
Our ever-increasing knowledge of biology, physics and chemistry provides the fundamental underpinning to the practice of medicine. The first two years of your medical course is designed not only to give you a thorough knowledge of that science base, but also to make you aware that because this knowledge base is continually changing, you will need to develop this knowledge and its application during your professional career.
We will encourage you to adopt an approach to learning based on curiosity and the exploration of knowledge rather than on its passive acquisition, because we believe it is important for you to develop this ability to apply new knowledge, and to adapt to changing circumstances in your professional life.
We will also help you to develop your intellectual skills, such as the understanding and interpretation of scientific evidence, problem solving skills, and skills in oral and written communication; skills which can be transferred to later stages of your medical education.
However, being a doctor involves much more than just knowing about biomedical science and the effects of illness on people. By the end of the first two years we aim to give you a sound grounding in the basic knowledge and skills necessary for working with patients in the clinical part of the course. These include certain technical skills, and the skills of listening and talking to people, generically known as communication skills which are essential for a doctor.
We expect you to practice and develop these skills, both in the Preparing for Patients programme, and also in the supervisions arranged by your College. Do participate in supervisions - they are not just teaching sessions, they are learning sessions, and learning requires self-expression. Also, ask questions in practical classes; the demonstrators are there to help.
The behaviour and performance of all medical professionals, including student doctors, is regulated by the General Medical Council. During your first year you will be sent a copy of the General Medical Council’s (GMC) “Duties of a Doctor.” This summarises the duties of a doctor registered with the GMC and you should familiarise yourself with these as they apply equally to your private and professional lives. However, from the very beginning of your course, you will be expected to behave in a manner appropriate to a medical professional.
At your first introductory session you will be admitted to the Medical Student Register, a copy of which is included in this handbook. Please read this carefully, because in signing this Register you are making a formal commitment to observe the standards of attitudes and behaviour appropriate to an entrant to the medical profession.
As a student of the University, you are subject to the disciplinary provisions set out in the University Statutes. As a student doctor, you are studying for a degree that will automatically allow you to register provisionally as a medical professional. During your studies you will be working within this professional environment and the General Medical Council (GMC) expects you to behave in a manner appropriate to your future role.
The standards of behaviour expected of you are set out in guidance published by the GMC and Medical Schools Council: "Medical students: professional values and fitness to practice” (November 2009), paragraphs 15 – 38;
A copy of the guidance will be provided on your first day. The University has also agreed a Code of Conduct for student doctors to guide you during your studies. This is reproduced below. You are expected to have read this and the GMC guidance before you come up to Cambridge. Make sure you understand these and if you have any concerns consult your tutor.
On the first day of term you will be asked to confirm that you are willing to adhere to these standards by signing the declaration which is copied at the end of this booklet. Your name will then be entered in the Medical Students Register and this entitles you to have patient contact, which begins in the first year of medical studies. Throughout your course you will receive reminders about the importance of the Register.
Students whose health or conduct give rise to concerns that they may be a risk to patients will be removed from the Medical Student Register and will be subject to Fitness for Practice procedures. This can lead to students being prevented from entering the Final MB examinations for the award of the MB/BChir. Provisional registration with the GMC is subject to a declaration of fitness to practise.
Details of the - Fitness for Practice procedures
And in the University’s regulations:
Although most of the teaching which you receive during years one to three is under the supervision of the Faculty Board of Biology, it is the Faculty Board of Clinical Medicine, working through the Director of Medical Education in the Clinical School, which is formally responsible for the supervision of your contact with patients.
Reproduced here is the University’s formal Code of Conduct for student doctors. On the first day of your course you will be asked to sign a declaration (reproduced at the bottom of this online handbook) stating that you have read these documents.
As a medical student and budding doctor you must now be prepared to take responsibility for your own actions and your own personal development. This means thinking about what you do and in particular, facing up to and dealing with problems in the context of your work and relationships with others. However, the University has many support systems in place. For a compendium of essential information for any student in the University see the on-line student handbook.
Motivational problems - Are you on the right course?
If you are having serious doubts, talk about them immediately with your Tutor and/or Director of Studies. There are students who realise, having got to this stage, that it was all a big mistake. If you really do want to get out, then don’t hesitate to say so; it is never too late to change your mind. Cambridge offers exit routes from medicine into other Triposes, so you can still acquire a degree.
Are you having difficulty coping with the demands of the course?
Again, talk to your supervisor and /or your Director of Studies. If you have a serious problem they will help, or in some cases direct you to sources of professional help such as the Counselling Service, but the College Tutorial system should be your first port of call.
Are you having Academic problems?
Begin by asking your College Supervisor in the appropriate subject, but University teachers can be approached if a problem remains unresolved and, in practical classes, demonstrators are on hand to deal with immediate queries. Problems with lectures and practical sessions can be raised with those who are lecturing or running a particular class.
Complaints or concerns about other students or staff
The Student Code of Conduct requires students to 'take action at an early stage when any problem arises'. All medical students should seek advice if they think another medical student has behaved in a way that suggests that he or she is not fit to practice; examples of such behaviour include:
• misusing information about patients;
• treating patients without properly obtaining their consent;
• behaving dishonestly in financial matters, or in dealing with patients, or research;
• making sexual advances towards patients;
• misusing alcohol or drugs.
Complaints and concerns about your fellow students should be raised in the first instance with your College Tutor or Director of Studies. Complaints about academic staff should be raised with the relevant course organiser, or with the Director of Education (Biological Sciences). The University has a formal student complaints procedure.
The General Medical Council has certain expectations regarding the attitudes, behaviour and performance of medical students from the beginning of their course through to graduation and provisional registration and this guidance places the responsibility for monitoring this on the University.
In the University of Cambridge, much of the day-to-day responsibility for this rests with the college tutorial and pastoral care system.
This is backed up by the Medical and Veterinary Student Progress Panel, which will monitor the cases of students who for one reason or another may be having problems with the course.
The College tutorial and pastoral system is backed up by the Medical and Veterinary Student Progress Panel, which maintains a general overview of medical student progression throughout both the preclinical and clinical course at Cambridge. It will also monitor the cases of students who, for one reason or another may be having problems with the course. This may be because of illness, personal difficulties or due to repeated examination failures. The Medical and Veterinary Student Progress Panel consists of senior members of the School of Biological Sciences, the School of Clinical Medicine and Department of Veterinary Medicine together with College tutorial representatives.
However, the Medical and Veterinary Progress Panel is aware of the GMC expectations of medical students and it will have the option of referring cases which raise serious concerns to the Fitness for Practice Committee. Details of the Fitness to Practice procedures can be found here.
And in the University’s regulations:
Even as a trainee Doctor, the safety of patients must
be your paramount concern.
These notes are taken from the Clinical Course Guide and set out broad principles and are intended to clarify the legal position for student doctors in regard to work undertaken with patients. For these purposes, a student is one who is registered on the Clinical School's Medical Students' Register and who has access to patients as part of an agreed attachment under the supervision of a specified medical practitioner.
Identification: Always wear a badge, identifying you as a student doctor, and introduce yourself as such.
Permission: Always obtain a patient's permission to see/examine him/her.
Laboratory Investigations: Do not initiate X-ray or other diagnostic investigations; never request blood for transfusion.
Practical Procedures: Do not perform any practical procedure nor give any medication (intravenous or oral) without authorisation and supervision by a medical practitioner.
Certificates and Documentation:
You may not: -
• make a formal diagnosis of death;
• sign statutory certificates (e.g. death) or prescription sheets;
• obtain patient consent;
• witness a patient's signature on any official hospital document;
• sign hospital accident forms;
• 'identify' patients before operation;
• check blood bags for transfusion;
• authorise any patient to be discharged from hospital (particularly A&E)
• • All patients in hospital are under the care of a clinical team led by a consultant whose most junior member is normally an F1 trainee doctor. Any student carrying out clinical duties does so as an assistant to this trainee doctor. When the trainee doctor is absent he/she is required to designate another qualified doctor to cover him/her and a student may be an assistant to the official deputy. Whenever doubt exists as to patient management, seek assistance from a qualified doctor or, in obstetrics, from a certified midwife.
If a patient suffered injury as a result of a procedure carried out by a student, a Medical Defence Organisation would be expected to support the member responsible for the student at the time, provided that the student had been authorised to undertake the procedure in question.
The level of responsibility which had been delegated to the student by the member must be held to be reasonable in regard to the student's experience and level of attainment.
This is not, repeat, not an option. You must be vaccinated.
Vaccinate yourself against cancer
Hepatitis B is a small DNA virus transmitted by blood contact, by sexual contact and perinatally (around the time of birth) from mother to child. It currently infects around 5% of the world’s population and once infected, it is possible that you will carry the virus for life. Depending on the virus level in your body and the state of your immune system, you may be a highly infectious or low-level infectious carrier.
Infectious carriers will require increased screening if admitted to medical school and their clinical practice will be restricted should they be considered a potential infection risk to patients. Students or doctors who become infectious carriers will have problems in training and will not be permitted to specialise in disciplines in which they may put their patients at risk, e.g. surgery, obstetrics. In addition, their ability to perform the full range of care in other disciplines may be limited.
If you are not vaccinated, you risk infection from a needle-stick injury during your clinical practice. It is for this reason that Hepatitis B vaccination is compulsory. Our immune system is not very good at recognising and making a protective response against the Hepatitis B vaccine (unlike some of the other vaccines you have had, e.g. measles, mumps, rubella). Therefore, you must have three separate injections with the Hepatitis B vaccine.
It is vital to make sure that your Hepatitis B immune status is established while you are still a student and, therefore, among all the other things we demand of you, so is attendance at the vaccination sessions at Fenner’s. This is an absolute must!
Although you may already have begun to have the vaccine course and may even have a result confirming that you have responded, the Clinical School policy is for all students to have their immunity verified by the local laboratory, so you will need a blood test. You will also be screened for exposure to tuberculosis, hepatitis C and HIV.
Should you need any further convincing, remember that being a carrier of the Hepatitis B virus may lead to liver failure and also gives you a greater than 100-fold increased risk of developing primary liver cell cancer. The reason that this cancer is still one of the 10 commonest in the world is almost entirely due to Hepatitis B. There are few reliable ways of preventing cancer. This is one, so take the opportunity.
Keeping appointments with Occupational Health
With around 300 new medical students to be processed through this time-consuming procedure in a short time, the staff responsible are working to tight deadlines under a great deal of stress; ensure you do not add to this by missing appointments or being late. If you are required to complete a course of Hepatitis B vaccinations by Occupational Health, staff will do their best to provide you with appointment times, which minimise (but which cannot completely avoid) interference with your academic work. Not all appointment times are totally convenient, and some may involve you having to get up rather early or missing part of a practical class. Too bad! You must not miss your appointment/s. Failure to keep an appointment for a trivial reason will be treated as a very serious matter.
What to do if you have problems.
It is an unfortunate fact that, with a large student body, some individuals will encounter problems in their private lives and these can affect their progress on the course. The table below gives a list of confidential sources of advice for many types of problem..
An advantage of the Cambridge course is that all medical students have the opportunity in the third year either to specialise in a medically related subject such as pathology, anatomy or psychology, or to widen their educational horizons by taking courses in, for example, social science, management or philosophy. This freedom of choice gives a wide range of educational opportunities.
You will also acquire experience of meeting patients from an early stage in your studies, in the "Preparing for Patients" component of the course, which forms a clinical strand through first, second and third years.
You will graduate with a BA after three years but the degree course also gives you the science grounding needed for professional education, which should result in your acquiring the degrees of Bachelor of Medicine and Bachelor of Surgery after your clinical study. The table below gives an outline of the course.
In the clinical part of the course, you will acquire further knowledge and clinical skills and apply your scientific knowledge to clinical problems. On passing their Final MB examinations, students who have qualified in the United Kingdom are provisionally registered with the General Medical Council subject to demonstrating to the GMC that their fitness to practise is not impaired. The initials you acquire vary: MB, BChir (if you stay in Cambridge), MB, BS (if you complete your course in London), BM, BCh (if you go to Oxford), or MB, ChB (if you go to various other places) but are generally known as primary medical qualifications (PMQ).
Provisionally registered doctors can only practise in approved Foundation Year 1 posts: the law does not allow provisionally registered doctors 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. You need to be aware that regulations relating to medical registration may change from time to time. For details, see national and local websites:
For general info about the Foundation Programme in the UK - http://www.foundationprogramme.nhs.uk/pages/home
Cambridge is a collegiate University, and responsibility for your education is shared between the University and your College. You were admitted by a College and you will, I hope, soon make friends with other students in your College. Your College Director of Studies will get to know you as an individual, and will organise the provision of supervisions to support and enhance the formal teaching given by Departments. Your College Supervisors, Director of Studies and Tutor provide a unique pastoral network designed to support your studies while at Cambridge.
Within the University, the Faculty of Biology is responsible for organising your teaching for the first three years. The Faculty delegates responsibility for delivery of this formal teaching to Departments, or to course management committees: the majority of your formal teaching (lectures and practicals) is delivered by staff from six departments (Biochemistry; Genetics; Pathology; Pharmacology; Physiology, Development and Neuroscience and Psychology). This teaching will be augmented and enhanced by small-group teaching (supervisions) organised by your College. The supervision system can help with academic work, but also helps you to develop communication and writing skills.
Departments will provide course handbooks for each of the courses you take, and these will include details of the arrangements for lectures and practical classes in that subject, and detailed guidance about the form and conduct of examinations. Much more information, especially on timetables, is available on the Faculty of Biology web site and you should become accustomed to consulting this
University is not like school. There are significant differences between the way you were taught at school and the way you will learn at University, and sometimes you may feel bewildered by the transition. In place of relatively small school classes, information at University is delivered by means of lectures, (essentially a 50-minute monologue) to groups of over 300 students. Lecturers will issue hand-outs, but you will also need to develop your listening, concentration and note-taking skills to get the best out of this. The material will be delivered quickly, and it is then up to you to understand and assimilate it. The information you are provided with in lectures will be developed and set in context in practical classes. Although classes may be large you will work in small groups with demonstrators on hand to help and answer questions. These sessions are vital to your education and attendance is mandatory.
The supervision system is there to complement the formal teaching and the onus is very much on you to make use of it, and to develop study and time management skills to help you cope with, and master the material. College supervisions will play a very important part in your education. Make them interactive and take full advantage of them to ask questions about any parts of the course you need help with.
You will need to use the internet to consult library resources, past examination papers, databases of scientific literature, timetables - and much, much more. The departments which provide your teaching are providing an increasing amount of supplementary information in the form of on-line course materials on their web sites, and the Faculty of Biology website (www.bio.cam.ac.uk/sbs/facbiol/mvst/ ) also provides a lot of basic information.
You need to be aware that the University takes plagiarism very seriously. You can read more about it on the Faculty website.
Courses have been designed to allow students, wherever possible, to learn for themselves rather than being passive recipients of instruction, and you will get far more out of your course and are more likely to do well in your exams if you regard university as an opportunity to study what interests you, rather than just learning a syllabus to pass an exam.
You will encounter two kinds of assessment.
Formative assessment is designed to indicate to you how you are progressing, on a weekly or termly basis. Your College supervisor and Director of Studies are the persons mainly responsible for providing this kind of feedback and continuous performance review. Formative assessment, more or less informal, may also form part of some University-based teaching.
Summative assessment (end of year exams) determines your ability to proceed with the rest of the course. The main science courses in your first and second year will be examined in this way for two qualifications:
- Second MB, which determines whether you are able to proceed to the clinical part of your medical course
Each of the exams for the major courses is divided into three sections, and the marks awarded to Sections I and II count for the Second MB qualification. The general format is a 1-hour theory exam (Section I), which covers the lecture material and consists of MCQs or short notes, and a 1 or 2 hour practical exam (Section II) covering the practical material. Because these Second MB exams constitute a professional qualification, you will be expected to pass them at a qualifying level, and to demonstrate a good knowledge and understanding of the whole of the subject material in the courses. The marks obtained in these two sections will then be added to those of Section III, to give a final Tripos mark.
Students often ask, “How much do I need to know to pass the exams?” The bottom line is that to pass your professional qualification (Second MB) you will be expected to show a good working knowledge of the subject material in all your courses. Furthermore, you will be expected not merely to know this material but, more importantly, to understand it and apply that understanding to the solving of problems.
Courses will provide you with the scientific knowledge which doctors need to have in order to cope with today’s clinical practice, but we are also trying to show you that learning is a continuous process and that practitioners will have to continue to develop their knowledge and skills throughout their working careers. To do well in the Tripos, you will need to show a deeper understanding of the material, and to be able to marshal facts into coherent arguments.
If you do not pass the Second MB sections, you are allowed one further attempt at a separate Second MB examination in September. Students are permitted only two attempts at Second MB examinations unless there are extenuating circumstances, such as illness or other good cause. If you require a third attempt, your College has to apply for this on your behalf to the Faculty Board of Clinical Medicine.
Section III consists of a 2-hour exam, during which you will be asked to write essays from a wide choice of topics; this section does not figure in your professional qualification, and the marks obtained count only towards your Tripos class.
In addition to the main science courses, there are other courses, for example the Social Context of Health and Illness, which are assessed only for the Second MB.
You should be aware that details of your academic performance in all aspects of the course currently counts as a major factor in your application for Foundation Year placements at the end of your undergraduate medical programme.
Further details of these exams and how they relate to the course can be found in the tables at the back of this booklet and on the MVST website.
(a) About courses
For each course that you take there is a Course Organiser. If you have problems with the organisation of a particular course, you should communicate with him/her. You can also tell the student representatives who sit on the management committee for the course you are concerned about, and ask them to raise the problem on your behalf. It may be a general problem, and this is one way of bringing it to the notice of the organisers. A problem arising within a particular department may be raised, if all else fails, with the Head of the Department.
Problems with the teaching provided for you by your College should be raised with your Director of Studies or, if that fails, with your Tutor or with the Senior Tutor.
(b) Queries or complaints about examinations
Any complaints about the conduct or the results of examinations must be raised in the first instance with your College Tutor, and not directly with the Examiners concerned. It is your Tutor’s responsibility to advise on these matters. Cambridge exam rules and regulations make provision for cases of illness or other misfortune; if you encounter any kind of illness or other impediment to exam preparation, the sooner you inform your College Tutor, the better. All liaison between a student and the central administration, particularly in matters relating to examinations, must be conducted through your College Tutor.
Attendance at practical classes (but not lectures) is recorded, and if your attendance at the practical classes is unsatisfactory, the Head of the Department concerned will be unable to provide a certificate of diligent attendance, and your progression in the course and professional future may be put in jeopardy.
If there are good reasons why you are unable to attend a practical class then you should tell your Director of Studies and the appropriate Course Organiser. It may be possible for you to do the practical at some other time. Organisers of practical classes may notify students and their Colleges if a student’s attendance record is unsatisfactory.
As a student your timetable is likely to be very full. Most of the teaching in the first three years is carried out on the University’s Downing site. If you haven’t time to return to College for lunch, undergraduates are welcome at the University Centre which is at the University Centre which is at the end of Mill Lane.
Three courses are assessed for Second MB and Tripos. They cover the following topics:
Three other courses are assessed only for Second MB, and during these you will:
Four courses are assessed for Second MB and Tripos, and they cover:
You will also have the opportunity to study aspects of these subjects in more detail in two Option courses, chosen from a range of subjects and also to continue to develop your experience in Preparing for Patients B and C (PfPB and C).
Summaries of the subject matter in these courses and detailed timetables will be provided in the individual course handbooks and on the MVST website.
After two years of preclinical study you do a further year’s study and take a final Tripos exam to complete the requirements for the BA degree. This year allows you to choose which course you want to study, and a big advantage of the Cambridge system is that it offers an enormous range of courses in your third year. You may choose to take in-depth courses in many of the subjects you studied in the first two years, or you may take courses in something completely different, such as Anthropology, Management Studies or Philosophy, or you may decide to combine different subjects via a course such as NST Part II Biological and Biomedical Sciences.
Your Director of Studies will be able to help you make a decision about what to take in your third year, and there will also be the opportunity to attend the "Subjects Fair" in March 2014, where the various course organisers will explain what they offer. In April 2014, you will be asked to state preferences for which course(s) you want to take in your third year.
If you are an affiliated student, you will start the clinical part of your course in Cambridge or elsewhere after two years of undergraduate study.The Preparing for Patients strand continues in your third year (PfPD).
Many of you will stay in Cambridge and go on to clinical study at Addenbrooke’s, but some may choose to go to the John Radcliffe in Oxford, or to one of the several London Clinical Schools.
Your College Director of Studies in Clinical Medicine should be able to advise you, and the various clinical schools run Open Days and are also represented at an annual meeting organised by the Medical Society at which the Deans of the various London schools come to Cambridge to tell you about what they offer. In November 2014 (or November 2013 for affiliated students) you will have to complete an application form for your Clinical study and attend interviews.Information about the Clinical School selection process is published on the Clinical School Intranet
Course organisers will actively solicit opinions from you about the teaching you receive. We do change our teaching as a response to comments and suggestions made by previous students, and you owe it to those coming after you to respond to questionnaires, so that those responsible for organising the teaching know when something is right, and when something is wrong. When you complete a teaching questionnaire try to be honest, informative, and, if possible, helpful.
Course liaison committees also have student representatives and it is at this level that most of the useful work is done in providing feedback to those who teach from those who are trying to learn.The Faculty Board also has student representatives, and we hope that some of you will wish to contribute in this way to discussions about how the teaching is organised. The student elected to the Faculty Board from the medical and veterinary students also sits on the Medical Education Committee, which maintains an overview of Cambridge medical education from admission to qualification. There is also a Faculty Committee, the MVST Part I Committee, which oversees MVST IA and IB, and includes student representatives. Please feel free to take any thoughts you have about the course to any of your student representatives.