Unit information: Year 2 MB ChB in 2020/21

Unit name	Year 2 MB ChB
Unit code	BRMS20001
Credit points	0
Level of study	I/5
Teaching block(s)	Academic Year (weeks 1 - 52)
Unit director	Dr. Lloyd
Open unit status	Not open
Pre-requisites	Successful completion of Year 1 Unit MB21.
Co-requisites	None.
School/department	Bristol Medical School
Faculty	Faculty of Health Sciences

Description including Unit Aims

Unit Directors: Dr Charlotte Bradbury and Dr David Morgan

Effective Consulting Clerkship (ECC): 3 weeks

This is a development of the GMC-commended Learning in the Hospital environment (LiTHE) element in the current (MB16) curriculum. This has specific learning outcomes and also gives students experience of the environment in the Clinical Academies where much of their learning in subsequent years will take place. Through direct patient contact, students will consolidate the clinical skills developed in the Effective Consulting theme in Year 1, develop their abilities to obtain a clinical history from a patient, apply the principles of case-based learning in the clinical environment and, using a combination of real and simulated cases, start to develop their understanding of differential diagnosis and management of patients’ clinical problems.

Choice Placement: 3 weeks
This placement will sit alongside the ECC. Half the year group will do their placements while the other half follow ECC and then switch over. The placements will be an opportunity to explore a diverse range of interests through our developing portfolio of placements and supervisors. Students will usually work in small groups and will write a report on their placement, which will be summatively assessed by the placement supervisor and feedback provided. It is intended that this placement could be stand-alone (offering transferable knowledge and skills) or may serve as a primer for a longer 6-week project in Year 3, possibly linking into an elective period of study between Years 3 and 4 of the curriculum.

Systems-based CBL (Foundations of Health, Disease and Therapeutics): 8 weeks
Continuing from year 1 this block will complete the systems-based approach to health and well- being using a ‘blended approach to learning’ that includes: small group learning, large group plenary sessions and lectures, practical sessions, self-directed learning, peer-assisted learning, patient involvement, knowledge of fundamental medical science, development of consultation and procedural skills, integration of technology enhanced learning. It will also introduce concepts required for the students to develop their skills in formulating differential diagnoses based on patients’ clinical presentations or problems and how to set about resolving these into the most probable cause of illness. This will require the students to develop an understanding of drugs and their actions, which will be achieved by the introduction of learning about Pharmacology and Therapeutics during this phase.

Symptom-based CBL (Disease Processes and Differential Diagnosis): 16 weeks
This case-based learning cycle will mirror the blended approach to learning around which learning about health and wellbeing was structured in Year 1. In Year 2 of MB21 curriculum, this will move from a systems-based to a symptom-based approach, centred on common clinical presentations (chest pain, breathlessness, etc.) that have diverse explanations and which introduce the concept of differential diagnosis. As previously, these will use a combination of small group learning, large group plenary sessions and lectures, practical sessions, self-directed learning, peer-assisted learning, patient involvement, knowledge of fundamental medical science, development of consultation and procedural skills, and integration of technology enhanced learning.

Patient contact
Regular and consistent contact throughout the year with patients within various settings, including general practice, secondary care and patients’ own homes. Year 2 includes a specific 3-week attachment (ECC) based in one of our Clinical Academies. Students will have a half-day attachment to primary or second care every two weeks throughout the year that will be supported by a half-day teaching session on an aspect of effective clinical consultation.

Intended Learning Outcomes

The overall structure of the year will be familiar to students as it is analogous to the structure of year 1. Following the Effective Consulting Clerkship and Choice placement, learning will be based around two-week case-based learning cycles. Foundations of Health, Disease and Therapeutics will introduce topics in skin and integument, body defence, pharmacology and blood sciences. This component will use Systems-based Case Base Learning (CBL) and will provide continuity between Years 1 and 2, as well as introducing concepts around disease. The remainder of the year will be dedicated to considering common clinical presentations using Symptom-based CBL to formulate a differential diagnosis of presenting diseases.

Unit Aims

The aims of Year 2 may be summarised as follows:

1 To build on the culture developed in Year 1 in embedding students within the Bristol Medical School community

2 To continue to inspire students to learn about medicine

3 To build on the foundations laid in Year 1 to enable students to start learning about disease processes

4 To develop students’ understanding of medical terminology

5 To continue the development of communication skills and effective consultation

6 To develop students’ professional behaviour

7 To continue to help students to function as part of the NHS and as part of multidisciplinary teams

8 To allow students to meet patients and discuss their disease and how it impacts on them

9 To encourage students to deal with uncertainty and doubt within their practice

The Intended Learning Outcomes for Year 2 are:

1. Students will develop their consultation skills through experience in obtaining a clinical history from patients in primary and secondary care settings
2. Students will study a topic of their choice from a portfolio of placements offered in a variety of academic and clinical settings. They will study an aspect in detail through self-directed learning and production of a written report.
3. Students will develop their presentation skills through production of an individual or group poster for a student conference.
4. Students will develop an understanding of normal processes in the functions of skin and integument, body defences and blood and will consider how deficiencies in these processes can give rise to disease.
5. Students will develop an understanding of how drugs work by considering the pharmacology and pharmacodynamics of important drug classes used in the treatment of human disease.
6. Students will develop knowledge and understanding of the common presentations of disease in UK medical practice.
7. Students will understand the application of knowledge about common diseases to the formulation of a differential diagnosis based on a common presenting feature.
8. Students will begin to develop an understanding of the application of probability to clinical reasoning in order to prioritize a differential diagnosis by the likelihood of individual diseases.
9. Students will gain an initial understanding of how evidence-based practice informs their clinical decision-making.
10. Students will deepen their understanding of the helical themes underpinning medical practice by returning in the clinical cases during year 2 to themes visited in year 1 at a higher level of knowledge and complexity.

All learning Outcomes specified in the General Medical Council’s Outcomes for Graduates (subject to revision in 2018) will be mapped to the MB21 curriculum using SLS Curriculum Map.

Teaching Information

The year will be delivered using a blended learning style that includes both face to face learning where possible and online synchronous and asynchronous lectures, interactive cross-disciplinary plenary sessions, online learning resources, facilitated case-based learning (CBL) small group sessions, specialised small group tutorials, practical sessions and clinical days throughout the year. At the start of the year, students will complete a three-week group placement as part of the Student Choice Programme, and at the end of the year students will be assigned to a Clinical Academy for a two-week placement (Effective Consulting Clerkship).

Assessment Information

Assessments Assessments in Year 2 will comply with our overall Assessment Strategy for MB21. Most of the assessments in Year 2 will be formative, including all three sittings of the Progress Test, which students first encountered in Year 1. A single end of year, summative written examination will take place at the end of the year covering all of the Year 2 taught material and is aimed at testing students’ abilities to integrate their learning into clinical scenarios. To progress to Year 3 of the curriculum, students will be required to pass the end of year written paper, produce a satisfactory report (assessed using the 21 point scale; see page 94 of the Assessment Strategy) and poster presentation on their Student Choice placement, to have been deemed satisfactory overall with their attendance and engagement of the Effective Consulting Clerkship, to fulfil the predefined criteria for overall engagement in the curriculum, which includes meeting with their professional mentor on three occasions, monitoring through e-learning resources, such as e-Biolabs and completion of team assessments of behaviour (TAB). Engagement with the curriculum will be necessary to progress to Year 3. This will be assessed according to the principles established for Year 1 and set out in the accompanying document, “Management of Marks Year 2.” Summative AssessmentYear 2 Student Choice placement satisfactory assessment by the project supervisor and poster marking team.Year 2 end of year written multiple choice paper coving all Year 2 material.Satisfactory engagement with the vocational aspects of the course.Formative Assessment* Progress Test (three times during the year)* Portfolio (reflection, procedures, career thoughts etc.)* Self-assessment on learning (via portfolio)* Peer-assessment of group work (during CBL)* Patient review of student contact experience (clinical setting, via portfolio)* A written multiple-choice quiz on material from CBL cycles 1-6 * Creative prize in Effective Consulting Feedback on Assessment* Regular professional mentor meetings (three times a year) including portfolio reviews* Facilitation session leads (facilitators) feedback on group performance during small group sessions* Worked examples on e-learning resources* Feedback within e-learning quizzes, for example on Blackboard and eBiolabs* TurningPoint quizzes – instant feedback on individual’s choice against that of the whole cohort* Briefing and feedback sessions on formative and summative assessments* Self-assessment, peer and near-peer assessment and patient assessment reports* Regular feedback/Question and Answer sessions with Year Co-leads* Sessions following Student-Staff Liaison Committee (SSLC) led by student reps to whole cohort* Summary of any issues raised at examination boards to be published to the students* Student representatives to be invited to contribute to assessment set-up, procedures and formats* Recognising success: prize-giving for excellent work etc. There will be a poster conference to present work done in the Choice placement and prizes will be offered to the best posters, in addition to overall prizes for the best report and poster presentation combined.

Reading and References

Medical Sciences 2^nd edition, edited by Naish

Macleod’ Clinical Diagnosis, edited by Japp and Robertson