Welcome to Year 4 Core Clinical Practice Welcome to Year 4 of your studies in medicine and moreover a very warm welcome to Clinical School. You have worked extremely hard to get to this point in your studies and you must be excited at the prospect of starting your clinical training. This will be a truly extraordinary year, during which you will encouter patients with a range of acute and chronic conditions whilst rotating through community and hospital settings. Clinical medicine is best learnt by immersing yourself in the clinical environment, interacting with patients and engaging with fellow healthcare professionals, using these experiences as a catalyst to study patient presentations and medical conditions from a recommended text, guided by Y4 learning outcomes. Whilst amazing and exciting, clinical training can be daunting and at times overwhelming; please take time to look after your own health and wellbeing and do not be afraid to ask for help or support. I look forward to meeting you all and really hope you enjoy your next steps on the way to becoming a doctor! Dr Nicola Jones, Year 4 Coordinator Consultant in Cardiothoracic Anaesthesia and Intensive Care Medicine Year 4 Outcomes By the end of Year 4, you will be competent in basic clinical method. You will have met patients in hospital and in primary care with a wide range of acute and chronic general medical and surgical problems and pursued a clinically-orientated studentselected placement or research project. You will be able to: · Communicate effectively in a range of clinicalsettings · Take a clinical history · Perform a physical examination · Document your findings appropriately · Show competence in basic practicalskills · Prepare and discuss a differential diagnosis · Suggest appropriate investigations · Interpret the results of simple clinical investigations
Year 4 Clinical Placements You will rotate through a series of clinical placements based in Cambrigde and a hospital from one of the three Regional Clinical Teaching Centres (RCTCs). Core Clinical Method General Practice This block aims to help you gain a basic grounding in core clinical skills and practice. You will spend 4 weeks at the Clinical School and 4 weeks in a hospital. By the end of the block, you should be confident approaching patients to take a clinical history, undertake an examination of the major organ systems and perform simple practical procedures. You will be based in general practice for 4 weeks in total, during which time you will practice and refine basic consultation and examination routines across a wide range of patients, presenting with a variety of problems. You will also begin to understand how responsibility for patient care is shared by a variety of agencies. Surgery Medicine During this 6-week block, students will experience elective and emergency surgery. You will be attached to surgical and peri-operative teams, learning about the management of common surgical problems as well as encounter general surgery and various surgical specialties. During this 4-week block, you will be embedded in a firm to give you experience of a range of medical practice. You can expect regular teaching as well as experiences in various specialist medical outpatient clinics to introduce you to aspects of chronic disease management.
Emergency Care SSC During this 4-week block, you will gain experience in emergency medicine (e.g. resuscitation, major injuries and minor injuries) as well as time in acute medical settings (e.g. acute assessment units, ambulatory care). The Student Selected Component (SSC) is an opportunity to undertake a piece of research of your choice. The successful completion of the SSC will be demonstrated by a satisfactory supervisor assessment and student report. These will be submitted via myprogress at the end of placement meeting with your supervisor. During each placement you will be assessed on your attendance, knowledge and skills, and professionalsim and receive an overall outcome; outstanding, pass, borderline pass or fail. Outcomes can be viewed on MedEd along with accompanying comments that aim to provide constructive advice for your future development. If you fail a placement you will need to liaise with the placement lead to devise an outline of required actions to pass the placement. This must be completed to the satisfaction of the placement lead in order to pass the placement. You must pass all of your clinical placements and have a satsifactory SSC supervisor assessment to progress to sitting the Final MB Part I at the end of Year 4.
Review and Integration (R&I) Weeks R&I weeks occur throughout the Clinical Course and their aims are: a) that students will apply their reasoning skills based on their understanding of the underlying biomedical sciences (linked with their previous MedST (preclinical) learning) b) that students will be able to integrate their scientific, practical and professional learning in the context of clinical case discussions c) that students will develop a rigorously scientific approach to their reasoning, which is integrated into the development of understanding of the process of clinical care. d) to ensure that all students have opportunities to develop the core outcomes for graduates defined by the GMC. There are four R&I weeks in Year 4 and each includes a series of Clinical Pathalogical Conferences (CPCs) as well as sessions on themes including Professionalism, Palliative Care and Improving Health. There are additional pre-recorded CPCs which are available for use during self directed study time on clinical placements. • R&I Week A has a respiratory focus to the CPCs • R&I Week B has a cardiology theme. • R&I Week C will focus gastroenterological/haematological presentations . • R&I Week D is just before the exams there will be time for self-directed learning and review of all the content covered in previous weeks. There is an additional formative review week, after the core clinical method block, where, as well as formative assessments, there is an opportunity to reflect and review learning from the previous blocks.
Assignments & Coursework This is an overview of what to expect over the year but is not exhaustive. More information is available on MedEd and your 'To-Do' page on will show you what assignments and coursework you have coming up. Clinical Writing/Presentation Skills Tasks During Year 4, you will be expected to complete three clinical writing/presentation tasks, which link to key skills required of a junior doctor. One task is undertaken each term and submitted to your Cambridge undergraduate clinical supervisor for marking. All three tasks must be completed satisfactorily to progress to the Final MB Part I. Improving Health You will be required to write a ‘Population health reflective case study’: this piece of reflective work will demonstrate your thinking at a population level based on a patient, service or organisation encountered either in the community or in secondary care. This will be marked and a selection will be discussed during the joint GP/IH seminar on the final Friday of your GP attachment. This must be completed satisfactorily to progress to the Final MB Part I. Palliative Care You will be asked to submit a one-page summary of a patient you have met during the year with palliative care needs for seminar in R&IWeek D. Practical Skills All students will receive compulsory teaching sessions, followed by tutor sign offs on specific skills and clinical practical skills sign-off. These will be documented in your Practical Skills Portfolio which must be completed. Professional Responsibilities Course You will be asked to write four short pieces of reflective writing before your Year 4 Professional Practice Groups, where they will form the basis of the discussion. SSC Key Skills Any Key skills that are not completed during your Y4 SSC block, or through the Year 4 Clinical Writing/Presentation tasks will need to be completed during Year 5 (with submission prior to starting your final Year 5 block). You need to demonstrate the following key skills: writing an abstract; describing a literature search; presentation of material (departmental level or above, enclose feedback and poster or PowerPoint); a literature review, manuscript introduction or case report.
Formative Assessments These take place during the ‘formative review’ week in November and include: 1. Mock Single Best Answer Paper (SBA): this is taken online and is followed by a debriefing event, during which questions and answers will be discussed and exam technique reviewed. 2. Mock Clinical Assessment: this provides you with an opportunity to demonstrate your commincation skills, examination technique and practical procedures and receive individualised feedback. Summative Assessments In Year 4, the summative assessment take the form of the Final MB Part I, which comprises: 1. Final MB Part I SBA paper: the written paper will consist of 150 single best answer questions. 2. Final MB Part I Clinical Assessment: this will consist of communication, clinical examination and practical skills stations. Undergraduate Clinical Supervisors Undergraduate Clinical Supervisors are junior doctors who have received training in delivering small group clinical teaching and they will meet you approximately once a week for about an hour of teaching, throughout the course. The supervisions are usually bedside teaching sessions and you should receive at least 8 supervisions per term. They will be arranged by you and your undergraduate clinical supervisor at a mutually convenient time each week - they are not timetabled. They should not be arranged at timesthat clash with other timetabled learning opportunities. You will have a Cambridge-based undergraduate clinical supervisor (in your college group), whom you meet whenever you are on attachments in Cambridge. You will also be linkedwith a regional undergraduate clinicalsupervisor, based inyourregional teaching centre, who will meet with you whenever you are on regional placements; these regional groups are not college-based. Since you move around regional teaching centres each year, your regional clinical supervisor will change at least annually (and sometimes for each attachment). Your Cambridge undergraduate clinicalsupervisor will only change if they need to step down for any reason (due to clinical rotations etc.) or if there is a problem with the supervision. 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. Students must also record their attendance at core clinical teaching during R&I weeks. Random checks of student attendance logs will be made and regular head counts performed during R&I weeks.
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. Students who are regularly absent from placements on Fridays will be given a fail grade for that placement and required to do additional work to achieve a pass. 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. If clinical work such as outpatients, theatre lists or consultant ward rounds on a student's firm orspecialty 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, personalstudy, attending appointments, etc. 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 never happened, it is very important that we keep this contingency in place for you. Support & Other Information
Pastoral care There may be times when life and studies become stressful and there are many people you can turn to. Pastoral care is available from many different sources including your Clinical DOS, your College tutor, the Welfare Team or a Pastoral Advisor (see FAQs). If you are on attachment outside of Cambridge, you can still contact these people for advice but you can also talk to yoursupervising consultant, regional pastoral advisor and the regional administrator team will also be very prepared to help. Please see the Hospital Information pages on MedEd for further details. Finances Students should be aware that the way clinical studies are funded changes after Year 4 and you will no longer be eligible for a full student loan. The NHS Bursary covers students' tuition fees and gives a small living allowance. Please see MedEd or FAQs for more guidance on finance or speak to your college tutorial office for more information. Those who receive the Cambridge Bursary will continue to do so. Leave requests See FAQs for advice about absence from the course. It is vital that any requests for 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 Regional placement administrator, Year Admin or the Administrators at Addenbrookes. More information can be found under Supporting Information on MedEd but please do not request leave for days when core teaching is scheduled. Travel expenses Hospital placement expenses should be submitted to Hannah Dennis ([email protected]) and GP expenses should be submitted to the GP SIFT Administrator at the IPH ([email protected]). Please see their respective policies on MedEd.
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 don't 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 economic worth. · 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 exams that you have sat and passing these onto other students). · 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 respectfor patients and forfellow students and professionalswhen 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 systems that 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 asrequestedby course organisers and reporting appropriately any difficulties as they arise. · Comply with appropriate health-testing requirements as advised by the University, NHS and Occupational Health. · Maintain a professional appearance and demeanor and comply with the recommended Dress Code. · Take action at an early stage if a problem arises: inform the Clinical Dean, the Sub-Dean for Student Welfare or a College Tutor immediately if you become aware of any personal problems arising which 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 or she may not be fit to practise. Examples of such 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; orin dealing with patients, or research; sexual misconduct; misusing alcohol ordrugs. · 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 Dr Ruchi Sinnatamby Sub-Dean (Curriculum) [email protected] Director (Undergraduate Clinical Supervisor Programme) [email protected] .ac.uk. Prof Mark Gurnell Sub-Dean (Assessment) [email protected] Sub-Dean (Addenbrooke's) [email protected] Dr Nicola Jones Year 4 Coordinator [email protected] Hannah Dennis Year 4 Administrator Year4Admin@ medschl.cam.ac.uk Mildrade Cherfils Student Experience and Communications Manager [email protected]
Key Dates