Welcome to Year 6 Applied Clinical Practice And so begins your final year at the clinical school, a busy year comprising senior attachments in medicine, surgery, acute care and general practice. You will undertake your final exams, both written and clinical, and finish with the highly valued 6-week apprenticeship block when you shadow a Foundation Year (FY) doctor, work their rota, including out of hours, and gradually take on more of their role in preparation for starting as an FY1 in August 2024. In all five senior rotations, focus on honing your clinical reasoning and practical skills, applying your theoretical knowledge in clinical situations. Become embedded in the clinical teams you work with, making the most of clinical opportunities, and accompany the patients you meet on their illness journeys. In the Autumn, you will be applying to the UK Foundation Programme. We are here to support you through that process and guide you through Year 6. Dr Anita Gibbons, Year 6 Clinical Course Coordinator Year 6 Outcomes By the end of Year 6, students will have developed the consultation, clinical management, diagnostic judgement and professional skills required for graduation. Students will have had responsibility for patient care, under close supervision, in a variety of clinical environments. Students will be able to: · Recognise the severity of illness and institute immediate and continuing care to patients of any age group who are acutely and seriously unwell; · Demonstrate an understanding of general medicine, surgery and acute care; · Have acquired the Intermediate Life Support (ILS) Certificate; · Demonstrate the knowledge, skills and attitudes required by the clinical school in Final MB and by the General Medical Council to practice as a doctor in the Foundation Programme. For a full set of learning outcomes, please see the MedEd Learning Outcomes page.
MEDICINE SURGERY · 6-week attachment providing broad experiences of medicine, including the Acute Admissions Unit. · Regular ward rounds and MDT meetings. · Practice focused history taking and full examinations with a chance to present to other members of the clinical team for directive feedback. · Encounter a wide variety of medical presentations, with reference to the clinical problems list. · 6-week attachment divided between in-patients, outpatients and theatres. · Embed within a surgical team. · Scheduled clinics and theatre lists in ophthalmology and ENT. · Encounter a wide variety of surgical presentations with reference to the clinical problems list. ACUTE CARE GENERAL PRACTICE · 3 weeks in the emergency department; 3 weeks in anaesthetics & ITU. · Timetabled experiences and shifts to maximise exposure to different clinical conditions. · Fast-paced attachment, seeing patients first and then presenting to ED team. · Review patients prior to operations during anaesthetics block. · Get practice in basic skills such as cannulation and catheterisation. · Student-led consultations to develop clinical history taking, examination skills and clinical reasoning, followed by discussion of cases with supervising GP. · Seminars in ENT, ophthalmology and dermatology. · Further information in Y6 GP guide.
Apprenticeship This is a 6-week block after clinical finals to hone clinical skills prior to starting your Foundation job. Students essentially undertake the role of a junior doctor with direct responsibility for patient care under close clinical supervision. There will be weekly 'Wardcraft' seminars delivered by undergraduate clinical supervisors, including a simulated on-call. Additional professionalism and liaison psychiatry sessions are also delivered. One day of the placement is in a hospice, with a focus on the care of patients in the dying phase. Assessment is based on attendance and successful completion of a portfolio of supervised learning events. Final sign off will be required in order to graduate. Assignments & Coursework Palliative Care: GP reflective case written assignment, hospital case summary with presentation at a seminar and half-day with hospital palliative care team. Professional Responsibilities Course: In January, you will be asked to submit your teaching course coursework, consisting of your reflections on the experience of teaching others, the evaluation of your teaching by your students and a peer review of your teaching. Psychiatry Workbook: Students will have access to five case-based liaison psychiatry discussions on the psychiatry Learning Resources pages of MedEd. These cases should be used to guide your learning in conjunction with the liaison psychiatry seminars running through the year. In addition, students will be required to undertake a case-based discussion with a liaison psychiatry theme as part of the Apprenticeship Handbook sign-off. Formative Assessments Students will receive formative OSCEs during the surgery and medicine blocks. End of placement assessments on MedEd will identify your strengths and weaknesses and provide constructive advice. If a student fails a placement they will meet with the placement lead to agree a remediation plan. All placements must be passed before students sit Final MB.
Summative Assessments Final MB Part III SAQ paper (Friday 12th January 2024) The SAQ exam is a two-hour, six-question paper which assesses your ability to apply what you have learned during the Clinical Ethics & Law and Improving Health courses. Questions are based on the material covered in these courses, including the discussion exercises that you will have participated in during workshops over the course of Years 4, 5 and 6. Final MB Part III SBA papers (Monday 15 th and Tuesday 16 th January 2024) There are two 2.5-hour SBA papers, 125 questions each, which will assess medicine, surgery, psychiatry and acute care (including presentations of these specialties in general practice). These papers will assess the following skills: diagnostic skills; selecting appropriate investigations; data interpretation; pharmacology, toxicology and prescribing; patient management; application of biomedical science. There will be no paediatrics or obstetrics & gynaecology in these papers. Prescribing Safety Assessment (PSA) (2 nd February 2024) Practice papers will be released on the official PSA website nearer the time. Final MB Part III Clinical Finals (15 th – 26 th April 2024) Clinical finals comprise an OSCE and a SCEE exam. Please see the dedicated Assessment pages on the VLE for more information.
Applying for Foundation Jobs Foundation job applications are administered centrally via the UK Foundation Programme (UKFP) portal (Oriel). You will be required to submit your application between 20th September (9.00am) – 4 th October 2023 (midday). No late submissions are accepted and once you have finalised your application it cannot be amended. You will be required to provide one academic reference from the clinical school or your college (e.g. DoS). All applicants will be required to upload their degree certificate and official transcript as a single pdf document. In addition to the standard Foundation Programme, you may choose to apply for Specialised Foundation Programmes and Foundation Priority Programmes. Applications will be made on one all-encompassing form, which will also include application for pre-allocation. More guidance can be found on the UKFP website under UKFP 2024. Undergraduate Clinical Supervisors During Year 6, you will continue with your Cambridge-based undergraduate clinical supervisor (in your college group). As in Years 4 and 5, you should try and meet with your undergraduate clinical supervisor whenever you are in Cambridge on attachments. As was the case in Year 4, you will also be linked with a regional undergraduate clinicalsupervisor, based in yourregional teaching centre, who will meet with you whenever you are on regional placements - these regionalsupervision groups are not college-based. Both your Cambridge and yourregional undergraduate clinicalsupervisors will generally focus on getting your clinical reasoning and assessment skills up to speed ready for Final MB. Before January, they may be prepared to do some specific sitdown sessions with you on things like interpretation of ECGs or CXRs as you prepare for the knowledge component of Final MB. After January, it is likely they will do some timed examination routines ready for the clinical exams. After Final MB Part III in May your undergraduate clinical supervisors will be involved in helping with the 'Wardcraft' programme in the Apprenticeship block, giving you some useful tips on surviving life as a juniordoctor. Please contact [email protected] if you have any issues.
Dress Code When on placement in a hospital or in any clinical environment, please ensure you adhere to the dress code principles. It is important that as a student doctor, you dress in a manner that inspires patient and public confidence and work wear must be always smart and professional. Be aware that patients, colleagues, and other clinical staff, may make an initial judgement about your professional competence based on your appearance. The requirements below are drawn from the guidance issued across all the regional hospitals where you may be placed. It is important to follow local trust guidelines if they differ from these general guidelines. General principles: · Wear your student name badge and a Trust identity badge at all times. · Casual wear i.e., denim, football shirts, shorts, T-shirts with logos or writing are not permitted. Short skirts, low cut tops and bare midriffs should be avoided. · No tie, bow tie or tucked in tie. · Clothes/head coverings should be clean and tidy (e.g., ironed shirts) · Hair must be clean and tidy (long hair must be tied back, head coverings secure). · Facial hair must be tidy. · To be compliant with bare below the elbow policy, clinical staff not in uniform may only wear one plain band ring and must not wear a wristwatch whilst in clinical areas. · Nails must be clean, short and neatly manicured; artificial nails and nail polish should not be worn. · No jewellery worn through visible body piercing, other than small earrings. · Staff should wear smart footwear. Students must not wear flip flops, crocs, or stilettos (no more than 2.5 inches). Open toe shoes must not be worn in clinical areas. · If the hospital expects you to wear scrubs on placement, these must only be worn in the hospital. They definitely should not be worn for travel between the hospital and student accommodation. · The University and NHS respect that we need to be considerate towards
student and staff religious beliefs and cultural practices; however, we need to balance this with hygiene requirements. This is particularly relevant to ‘bare below the elbows’. Each trust will have a specific policy and students should discuss this with their trust. Central NHS guidance can be found on page 12 of Uniforms and workwear: guidance for NHS employers Attendance Clinical medicine can only be learned through experience in a range of clinical environments. Clinical teachers guide students' patient-based learning, and this is supported by lectures, seminars, and private study. Full attendance at clinical placements is required by the Clinical School and the General Medical Council; we expect that students will attend all clinical placements and scheduled clinical teaching diligently and trust them to take responsibility for their own learning and professional behaviour. We are currently considering/piloting sign-in sheets for placement attendance due to recent poor attendance from significant numbers of students. Attendance Students should attend all timetabled teaching and other scheduled clinical activities. If you expect to be absent, you should notify your placement administrator in advance. Information about approved absence from the course (for example: illness, compassionate leave, academic reasons, or discretionary leave) is available on the Absence Guidance pages of MedEd under Supporting Information. Extended unexplained absence will result in students failing the placement. In that situation, the year coordinator and administrator will be informed, and the student will need to liaise with the placement lead to devise a plan to make up the missed experiences. Students will need to complete this plan to the satisfaction of the placement lead in order to pass the placement. Students need to pass all clinical placements and complete all coursework before sitting end-of-year exams each year. Attendance log Students are expected to keep their own attendance log, noting what clinical activities they have undertaken on a weekly basis and reflecting on their learning. Working Hours The expectation is that students work 48 hours per week, which includes both clinical time and personal study. Students should expect to be doing clinical work every day and sometimes during the evenings and weekends. The following is a general guideline for required attendance at clinical placements:
Monday to Thursday 0900 – 1700 and Friday 0900 – 1300. However, you may be timetabled to (and expected to attend) clinical placements outside of these hours. Many opportunities exist at weekends and evenings, which can be useful. Start times may be variable and students should expect that on some placements their attendance is required before 0900 or after 1700. Friday afternoons can be flexible. If clinical work such as outpatients, theatre lists or consultant ward rounds on a student's firm or specialty are on Friday afternoons, then students must attend them. If there is no obvious learning opportunity available, students may use Friday afternoons for administration tasks, personal study, attending appointments, etc. Students are expected to attend placements on Friday mornings. Students with multiple unauthorised absences from placements on Fridays will be given a fail grade for that placement and be required to do additional work to achieve a pass. Staying in Cambridge during exam weeks All students must stay in Cambridge during exam weeks and until the end of terms. Asking students to stay until the end of term is standard practice at this university and other educational institutions. The main reason for this (for the clinical school and elsewhere) is that it is possible that there could be problems with an exam requiring last minute cancellation and rescheduling to later the same week. Whilst this has not happened here recently, it is very important that we keep this contingency in place for you. Hospital placement expenses should be submitted to Stacey Cutler ([email protected]). GP expenses should be submitted to the GP Tariff Administrator at the IPH ([email protected]).
Support & Other Information Pastoral care We recognise this year can be stressful at times and there are many people to whom you can turn. Pastoral care is available via your Pastoral Advisor, Dr Fiona Cooke, the Sub-Dean for Welfare, ([email protected]), your Clinical DOS and your College Tutor. If you are on placement outside of Cambridge, the local Regional Pastoral Advisor, the Regional Sub-Dean, your supervising consultant, and the regional administrator team will also be very happy to help (see Hospital and Mental Health Trust Placement Information on MedEd). Leave requests It is vital that any requestsfor leave are made formally using the leave request form on MedEd at least 6 weeks in advance. To take any time away from a placement you will need the permission of your placement administrator. Please do not request leave for days when core teaching, such as ILS, is scheduled. These sessions are arranged long in advance and extremely difficult to reschedule. More information can be found under Supporting Information on MedEd. Travel Expenses Hospital placement expenses should be submitted to Stacey Cutler ([email protected]). GP expenses should be submitted to the GP Tariff Administrator at the IPH ([email protected]).
Medical Student Code of Conduct As a student member of the medical profession, you are expected to: · Make the care of patients your first concern. · Demonstrate respect for others: patients, fellow professionals, teachers and student colleagues. · Treat patients politely and considerately, respect their views even if you do not agree with them, respect their privacy, their dignity and their right to confidentiality. · Engage fully with the teaching programme, including clinical placements, bedside teaching, lectures, seminars and workshops. · Act without discrimination, whether on grounds of age, race, sex, disability, religion or belief, marital or civil partnership status, pregnancy and parenthood, sexual orientation, gender reassignment or perceived economicworth. · Abide by rules and policies, follow procedures and guidelines which apply to all aspects of the course as advised by the professionals supervising you. · Be an effective communicator: always make clear to patients and other healthcare professionals that you are a student and not a qualified doctor; be aware of your limitations and do not exceed your ability when giving information to patients. · Be open and honest: do not break the law in any way, never threaten violence, act violently towards others or act dishonestly. Do not engage in bullying and harassment of fellow students or professional colleagues. Inform your Senior Tutor and the Clinical Dean immediately if you are involved in any University or police investigation which may lead to charges being brought; concealment of involvement in an incident that may lead to prosecution may be viewed as an even greater offence than the incident itself. Do not cheat in examinations (including recalling and recording questions used in examsthat you have sat and passing these onto otherstudents). · Understand, accept and agree to be bound by the principle of confidentiality of patient data and also of information concerning staff and students. Do not discuss patients with other students or professionals outside the clinical setting, except anonymously. When recording data or discussing cases outside the clinical setting, ensure that patients cannot be identified by others.
· Demonstrate respect for patients and forfellow students and professionals when using social media or sharing communications. Do not use mobile electronic devices to record and store patient images or any other identifiable patient information; never use e-mail or social media to share information about patients or electronic messaging, including systemsthat are encrypted, ('WhatsApp' etc.). Do not abuse fellow students or colleagues on social media platforms. · Ensure that you can be reliably contacted by University and NHS staff; reply promptly to emails and other communications. · Contribute to improving teaching by completing feedback asrequested by course organisers and reporting any difficulties as they arise through the appropriate channels. · Comply with appropriate health-testing requirements as advised by the University, NHS and Occupational Health. · Maintain a professional appearance and demeanour and comply with the recommended Dress Code. · Take action at an early stage if a problem arises. Immediately inform the Clinical Dean, Sub-Dean for Welfare or a College Tutor if you become aware of any personal problems arising that may put at risk the health and wellbeing of patients. · Seek immediate advice from the Clinical Dean or one of the Clinical Sub-Deans if you think a doctor or colleague has behaved in a way that suggests that he orshe may not be fit to practise. Examples ofsuch behaviour include: making serious or repeated mistakes in diagnosing or treating a patient's condition; not examining patients properly or responding to reasonable requests for treatment; misusing information about patients; treating patients without properly obtaining their consent; behaving dishonestly in financial matters; or in dealing with patients, or research; sexual misconduct; misusing alcohol or drugs. · Avoid abusing alcohol or drugs.
Key Contacts Dr Paul Wilkinson Clinical Dean [email protected] Dr Fiona Cooke Sub-Dean (Welfare) [email protected] Dr Mark Lillicrap Sub-Dean (Curriculum) Director (Undergraduate Clinical Supervisor Programme) [email protected] Prof MarkGurnell Sub-Dean (Assessment) [email protected] Dr Anita Gibbons Year 6 Coordinator [email protected] Dr Ruchi Sinnatamby Sub-Dean (Addenbrooke's) [email protected] Dr Jessica White Sub-Dean (Cambridge Graduate Course) [email protected] Stacey Cutler Year 6 Administrator [email protected]
Key Dates