UCL MEDICAL SCHOOL
Year 4 Student Guide
2015-2016
The UCL Doctor
A highly competent and scientifically literate clinician, equipped to practise patient-centred
medicine in a constantly changing modern world, with a foundation in the basic medical and
social sciences. This vision is underpinned by the values of scholarship, rigour and
professionalism. The focus is on the development of the student as a scientifically informed,
socially responsible professional who, in turn, can serve the health needs of individuals and
communities.
The information contained in this Student Guide was correct at the time of going to press, but no
guarantees can be given that it will not be amended before the commencement of, or during, the degree
programme to which it refers. Please refer to the Year 4 Moodle Pages regularly throughout the year.
Year 4
Integrated Clinical Care
CONTENTS
Introduction and Overview
Section 1:
Introduction to Year 4
• The aims of the Year
• The structure of the Year
• Assessment and progression
• Timetable for the Year
• Attendance and engagement
• Medical Student code of conduct
Section 2:
The Horizontal modules in Year 4
• The Introduction and Orientation Module
• Module A
• Module B
• Module C
Section 3:
Clinical and Professional Practice in Year 4
Section 4:
The portfolio in Year 4
Section 5:
Medicine in the Community in Year 4
Section 6:
Case of the Month
Section 7:
Practical procedures checklist & sign-off card
Section 8:
Core conditions and common presentations
Section 9:
Contributing to patient notes, prescribing and data interpretation
Section 10:
Staff contact details
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Section 1: Introduction to Year 4
Welcome to Year 4 of the MBBS programme at UCL Medical School. This booklet acts as an
orientation to your studies in Year 4, outlining the overall structure of the year, how learning will
be organised, how you will be assessed, and the criteria for successful progression to Year 5.
The information in this booklet is not exhaustive and should be used alongside the resources on
the MBBS Year 4 website http://www.ucl.ac.uk/medicalschool/staff-students/course-information
and the Year 4 Moodle pages.
The purpose of this Student Guide
Workplace-based learning is the backbone of Year 4 and moving towards predominantly
workplace-based learning can be a challenging transition for students, whether they have just
completed Year 3 or Year 2 at UCL or have transferred from another university. The advice,
guidance and checklists in this booklet are set out to help you make the most of the complex
and varied learning environment and activities during Year 4 and focus your learning on both the
aims of the year and the individual modules within Year 4.
The aims of Year 4
The theme of Year 4 is ‘integrated clinical care’. The aims of this year are to:
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help you to learn from healthcare experiences
become skilled at interviewing and examining patients with a range of problems across
the range of healthcare settings
become familiar with the ways in which patients access the healthcare system and the
pathways of care for a range of common presentations
understand the integrated approach to diagnosing and managing patients’ problems
safely and clearly document information about patients and their care in a clinical notes
system
To achieve this, much of your learning will take place in healthcare settings to ensure you will
have exposure to patients with a wide range of healthcare needs including primary care and
community care presentations, chronic disease management, acute illness presentations,
mental health issues, and pre/peri and post-operative care.
The year is not focused on rotating through as many specialties as possible, but instead
about spending time in longer, more generic and integrated attachments to better understand
illness prevention, presentation and management. You will have further learning opportunities in
many of these specialities in year 5 & particularly year 6 so do not feel that year 4 is only about
learning about the medical and surgical specialities: it is about learning how to learn in the
clinical setting and becoming experienced in taking histories and examining patients. However,
you will see some specialist services and patients with rare conditions during the modules and
you should make the most of these unique learning opportunities that you might not see again
until your are qualified. Year 4 is also a time when you will be both looking backwards: to your
past learning, and understanding how theory and understanding of health and disease links to
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practice; and forwards: using the learning in this year as a key part of your journey to becoming
a Foundation doctor.
By the end of Year 4 you should:
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be an excellent workplace learner: being able to make the most of experiential learning
opportunities
understand how the NHS works and the roles of a range of healthcare providers within it
understand how a range of common diseases present and are managed in both community
and hospital settings
be able to communicate well with patients
have developed a wide range of clinical skills and be able to carry out practical procedures
competently
be able to use the information gathered from patients, together with your developing
understanding of medicine, to produce a differential diagnosis and problem list
The structure of the Year
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The year begins with an Introduction and Orientation Module (IOM) of three weeks, which
comprises: a general introduction and orientation to Year 4 including details of in-course
and end of Year assessments; opportunities to develop key skills in communicating with
and examining patients, and supported visits to clinical settings to reinforce these skills;
an introduction to some of the modules that run through Year 4 and to begin to define
your learning needs as you move into your next module
You will then undertake three further 13-week modules in rotation, mostly, but not
exclusively, at one of the three main clinical campuses. Each module will consist of a one
week introductory teaching programme followed by 12 weeks of clinical placements
Your medicine in the community attachment in general practice will run in parallel to your
hospital firms throughout the year
Following one week of personal revision time, you will complete the summative
assessment at the end of the year
During the year you will: maintain a portfolio, including in course assessments; complete
your record of completed procedures card; complete the Case of the Month activities;
attend your General Practice placements; complete the Cancer Patient Pathway and
attend the additional Clinical and Professional Practice teaching sessions which usually,
but not exclusively, take place on Thursday afternoons
Progression to Year 5 will depend on satisfactory progress in the summative
assessments, completion of required course work, satisfactory sign off in Modules A, B
and C, and the submission of a satisfactory portfolio.
You will have been sent details of the sites where you will undertake each module, your
allocated GP practice for the Year and your Clinical and Professional Practice group
details before you begin Year 4
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Assessment and Progression
In course assessment
Formative:
2015-16 will see the introduction of a single best answer (SBA) paper on Moodle in the final
week of each Module. The paper will be shorter than the end of year exam, as it will only be
based on topics relevant to the Module. There will also be a revision debrief session in the final
week to go over the SBA questions with faculty.
During the course of the year you will receive regular feedback on your performance and
developing skills and understanding. This will mostly be informal feedback in the context of
clinical care but may also include more formal feedback in end of module or placement reports
and discussions, following presentations, or as one of the structured learning events (SLEs).
You will also have two peer assessment activities (mini-PAT).
If you would like specific feedback, it is sensible to ask for this as part of the discussion of an
SLE; or approach a consultant who you have got to know such as the lead for your firm in a
Module. Obtaining feedback is vital to improving your abilities, and checking whether you are on
track. Clinicians are busy, with many doctors in training and medical students to supervise, and
may be less familiar with your SLE requirements than you are. Identifying opportunities for
formative assessment is your responsibility, so be pro-active, explain to supervising clinicians at
the beginning of suitable sessions that you would like their feedback, so that they can
deliberately consider your performance while working with you. This will lead to more useful,
specific and targeted comments that will help you improve.
In addition, you can make the most of these events by thinking about your own performance,
identifying aspects you are pleased with, and those you would feel could improve. Asking the
supervising clinician for specific guidance on areas you feel need a different approach or to
improve, will help to personalize the feedback you receive, and make it more informative.
It is often better to suggest a clinician completes the feedback there and then, or at the end of
the clinical session. Their memory of your performance will be fresher, more focused, and the
feedback will likely be more helpful. Make it easy for the clinician to do this. If they are unable to
complete documentation at the time, then an e-ticket can be emailed to them, but it is essential
that the request for feedback was made during, preferably at the start, of the clinical encounter.
It is not acceptable to send an e-ticket at a later date to a clinician who was not expecting
to formatively assess you while working together in the relevant session. When you send
an e-ticket, make it as easy as possible for the clinician. Remind them of the encounter, the
case, setting and what they may have said about your performance.
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Summative: Module Sign off for progression:
In line with the General Medical Council’s (GMC’s) guidance on expected outcomes for
graduates, you will prepare yourself for practice across all modules through the maintenance of
a portfolio and the completion of a procedures card. The submission of a record of completed
procedures card and portfolio are progression requirements for Year 4.
You will be required to be signed off from Modules A, B and C at the end of the 13 weeks by
either the firm lead or the module lead. The requirements of what is expected for evidence of
satisfactory progress in each module varies between the modules (see page 8), and includes
evidence of satisfactory attendance and engagement for the module. You should make yourself
aware of the module specific requirements when you start each module as it is your
responsibility to ensure you have the evidence required to be signed off for the module.
Summative assessment
At the end of the year you will complete an OSCE and a three hour written paper of single best
answer (SBA) questions. If you are
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successful in the assessment
have completed a satisfactory portfolio
Completed your record of completed procedures card
have three satisfactory end of module reports
you will progress to Year 5. Further details are available on the Medical School website:
http://www.ucl.ac.uk/medicalschool/staff-students/course-information
From Summer 2015, external examiners’ reports and departmental responses will be available
to students and discussed at Staff Student Consultative Committees. Details about the report
process may be found on the MBBS Staff:Student webpage at:
http://www.ucl.ac.uk/medicalschool/staff-students/assessments
Professionalism
An assessment of professionalism and fitness to practise underlies all parts of the MBBS course
and assessments. Mark schemes and progression criteria include provision for teachers and
examiners to submit reports of Concerns over Professional Behaviour(s) (CoPB) if any aspect of
a candidate’s performance during the course or assessments gives cause for concern about
engagement, attendance, behaviour, attitude or fitness to practise. CoPBs are reviewed at preexamination boards before presentation at examination boards and, in Years 2,4,5 and 6, can
lead to a student failing to progress and, in all years, for awards of merit and distinction being
rescinded. Further information about CoPB’s can be found at:
https://www.ucl.ac.uk/medicalschool/current-students/faqs/.
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Timetable for the Year
The following is an overall timetable for Year 4 in the academic Year 2015-2016. You are
advised to check the UCL Medical School website for the most up to date information.
Dates
01/09/2015 - 18/09/2015
21/09/2015 - 25/09/2015
28/09/2015 - 18/12/2015
04/01/2016 - 08/01/2016
11/01/2016 - 08/04/2016
11/04/2016 - 15/04/2016
18/04/2016 - 08/07/2016
11/07/2016 - 15/07/2016
18/07/2016 - 22/07/2016
25/07/2016 - 29/07/2016
Schedule
Introduction and Orientation Module
Module A, B and C core teaching weeks
Modules A, B and C (holiday 21/12/15 - 01/01/16)
Module A, B and C core teaching weeks
Modules A, B and C (holiday 24/03/16 - 30/03/16)
Module A, B and C core teaching weeks
Modules A, B and C (Bank holidays on 2/5/16 and 30/5/16)
Personal revision
Clinical assessments
Written assessments
Attendance and Engagement
Good attendance is part of your professional responsibility. Clinical placements at UCL Medical
School are organised to ensure that you have access to lots of different learning opportunities
and we expect student to fully engage with their learning opportunities whether they be formal
teaching activities or work-based learning opportunities. You are expected to attend every
weekday in term time in line with the Medical School attendance policy:
http://www.ucl.ac.uk/medicalschool/staff-students/general-information/a-z/#attendance and any
out of hours sessions organised within the modules. As part of EU regulation there are a
minimum number of hours that must be spent in clinical placements in order for you to
qualify as a doctor. At times there will be conflicting opportunities and you will need to use
your judgement about which sessions you should prioritise. By looking ahead you may be able
to arrange ‘swaps’ with fellow students to avoid clashes or let clinicians know if you have a fixed
commitment when they are arranging ward based teaching. Remember that patients and
clinicians have often made a special effort to support your learning and you should make every
effort to attend patient based teaching.
Attendance at 80% of the course is the minimum for completion of each Module and for Year 4.
If attendance is falling below 80% during a Module then this may trigger ‘Concern over
Professional Behaviours’ (CoPB) proceedings which will entail referral to the Divisional Tutor
and the possibility of being placed on close supervision.
The following methods are used to evaluate your attendance and engagement in Year 4:
1) you will be required to complete a daily diary of activity during the Module with brief
reflections of the day. This will be reviewed at the time of Module completion.
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2) Some obligatory sessions will be registered or will require a signature from a clinical
teacher (this may include tutor-led sessions in Thursday’s Clinical & Professional Practice
sessions)
3) If attendance at a certain clinical session is below the level deemed acceptable by the
clinician then they are entitled to take the names of the absentees and the reason for the
lack of attendance will be explored by the Module administrator
4) Acceptable number of SLE’s in each Module.
5) Module B only: Using a logbook (as a guide) to record the procedures that have been
completed and which activities have been attended.
The Year 4 timetables are complicated, sometimes with more than one learning opportunity at
the same time. The flow chart below indicates the priorities for your attendance in Year 4.
With the exception of GP days, you should let a clinical teacher or firm lead know of your
absence beforehand for formal teaching sessions (which may also include theatre sessions,
outpatient clinics, ward rounds at the discretion of the clinician). If you are not sure, let the
clinician or firm lead know that you are going to miss a session and why. It is also essential to
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inform the following student administrators and to email the Year 4 generic email
medsch.year4@ucl.ac.uk. (see below).
Module Teaching Administrators
Royal Free Campus
Module A & C
Francesca Harrison
Module B
Zoe Lau
Whittington Campus
Module A & C
Eibhlin Mullarney
Module B
Ruth Fox
Bloomsbury Campus
Module A & C
Tricia O’Dell
Module B
Julie Power
General Practice
Petra Oluyemi
f.harrison@ucl.ac.uk
zoe.lau@ucl.ac.uk
e.mullarney@ucl.ac.uk
r.fox@ucl.ac.uk
tricia.o'dell@ucl.ac.uk
julie.power@ucl.ac.uk
p.oluyemi@ucl.ac.uk
If you are absent during community-based teaching, you will also need to contact your individual
practice as early as possible and inform the GP administrator Petra Oluyemi,
(p.oluyemi@ucl.ac.uk).
Further details of the rules on student absences are given at:
http://www.ucl.ac.uk/medicalschool/staff-students/general-information/a-z/#absence
Medical Student code of conduct
UCLMS enjoys a reputation as a world class medical school and prides itself on creating
Tomorrow’s UCL Doctors – highly competent and scientifically literate clinicians, equipped to
practice patient-centred medicine is a constantly changing modern world, with a strong
foundation in the basic medical and social sciences.
As a medical student you will study for a degree that automatically allows you to work as a
Foundation doctor. The Medical School has a duty to ensure that its students can fulfil the
requirements of the General Medical Council, both for studying medicine and for working as a
doctor, and it fulfils this duty by enabling students to acquire the knowledge and to develop the
skills and attitudes appropriate to their future role. These include professional behaviour and
fitness to practice right from the start of the programme.
This code of conduct sets out the School’s expectation of you as a UCLMS student and should
be read in conjunction with:
Medical School policies set out at: http://www.ucl.ac.uk/medicalschool/staff-students/generalinformation/a-z
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Policies specific to conduct include:
o Absence reporting
o Additional placement-related
experience
o Attendance and engagement
o Communications
o Concerns over Professional
Behaviour(s)
o Dress and Behaviour
o Disclosure and Barring Service
checks
o Duties of a doctor and student ethics
o Exceptional Leave
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Fitness to Practise proceedings
Freedom of information
Harassment and bullying
Health clearance /Immunisations and
BBVs
Honesty and probity
Patient confidentiality
Patients in medical education
Personal beliefs
Use of social media
Student Support Card
Substance use and misuse
GMC policies set out at:
o www.gmc-uk.org/guidance/good_medical_practice/index.asp
o www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp
o www.gmcuk.org/education/undergraduate/undergraduate_policy/professional_behaviour.asp
If you anticipate any difficulty adhering to any element, please make an appointment with a
Student Support Tutor who will discuss with you how best to reconcile it. A copy of the code of
conduct is signed on entry to the School as confirmation of your understanding and agreement
to abide by it. We recommend that you keep a copy for your records.
In the interests of public safety, in accordance with Tomorrow’s Doctors, and in your own best
interests, information pertinent to your educational achievements and to your fitness to practise
may be shared by UCL Medical School with training providers, employers, regulatory
organisations and other medical schools.
As a UCL medical student:
I agree to:
• abide by the medical school code of conduct and policies at:
www.ucl.ac.uk/medicalschool/staff-students/general-information/a-z
• where applicable, carry a student support card outlining any restrictions to my practice or
any special requirements and to present the card to each educational supervisor to whom
I am attached so that they are aware of my circumstances
• update the Portico website (www.ucl.ac.uk/portico) with any change to personal or
contact details
I consent to:
• my photograph being made accessible to teaching/professional services staff at UCL and
associated NHS Trusts and Primary Care colleagues
• my examination results being emailed to my UCL email account
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my examination results being copied by email to my Personal Tutor
my personal details and UCL email address (student ID number, full names, date of birth,
home address, telephone numbers and photograph) being passed to the General Medical
Council for the purposes of provisional registration
my personal details and UCL email address (full names, home address, telephone
numbers) being passed to the NHS Bursaries Office for bursary applications
You are advised to:
• join either the MDU or the MPS, both of which offer free student membership and
provides advice in instances of medical student negligence
1. Attendance must be satisfactory throughout the programme. You are expected to attend
between 9am – 5pm on Monday, Tuesday, Thursday and Friday and 9am – 12.55pm on
Wednesday and to attend some teaching events starting at 8.00am or finishing at 6.00pm
During Years 4-6 there may be times when you are also expected to attend in the evening,
early morning and at weekends. We expect you to spend a minimum of 10 hours per week in
personal study outside the programme.
You are required to inform us of any absence from teaching following the process set out in
the School’s attendance and engagement policy. Exceptional leave may only be taken with
prior permission after completing the process set out in the School’s exceptional leave policy.
2. You are expected to listen to patients and respect their views, treat them politely and
considerately, respect patients' privacy and dignity and respect their right to refuse to take
part in teaching.
3. You should not allow personal views about a person’s age, disability, lifestyle, culture,
beliefs, ethnic or national origin, race, colour, gender, sexual orientation, marital or parental
status, social or perceived economic status to prejudice your interaction with patients,
teachers, professional services staff or colleagues.
4. You are expected to be honest. You should not abuse the trust of a patient or other
vulnerable person. You should not plagiarise material from other sources and submit it as
your own work. You should not present false information or omit important information in
your dealings with the Medical School or in any application related to your studies, including
UCAS form and Foundation School application. Dishonesty is a fitness to practise issue.
5. You should not enter into an improper personal relationship with another person, for
example, with a school pupil whom you are mentoring or a member of staff who is teaching
you.
6. You must always make clear to patients that you are a student and not a qualified doctor.
Introducing yourself as a “medical student” or “training to be a doctor” is preferable to
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describing yourself as a “student doctor”. You must always act within the direction of your
educational supervisor(s) and within the remit and competencies of a medical student.
7. You are bound by the principle of confidentiality of patient records and patient data. You
must therefore take all reasonable precautions to ensure that any personal data relating to
patients that you have learned by virtue of your position as a medical student will be kept
confidential. You should not discuss patients with other students or professionals outside the
clinical setting, except anonymously. When recording data or discussing cases outside the
clinical setting you must endeavour to ensure that patients cannot be identified by others.
You must respect all hospital and practice patient records.
8. You are expected to maintain appropriate standards of dress, appearance, and personal
hygiene so as not to cause offence to patients, teachers, or colleagues. The appearance of a
student should not be such as to potentially affect a patient’s confidence in their professional
standing.
9. You are expected to be aware of safe drinking guidelines for alcohol and to adhere to these
guidelines. Misuse of alcohol and any use of an illegal drug is a fitness to practise issue.
10. To ensure appropriate communication, students are required not to cover their faces in any
part of the programme, including assessments/examinations, except where clinically
indicated.
11. You are required physically to examine patients of both sexes (which includes touching and
intimate examinations) in order to establish a clinical diagnosis, irrespective of the gender,
culture, beliefs, disability, or disease of the patient. In order to qualify as a doctor in the UK,
it is required that the practitioner is willing to examine any patient as fully and as intimately as
is clinically necessary.
12. You are required to keep your health clearance and immunisations up-to-date and to inform
the Divisional Tutor of any changes which might affect your ability to undertake Exposure
Prone Procedures, e.g. exposure to, or infection with, blood-borne viruses. Exposure Prone
Procedures (EPPs) are practical procedures which carry a risk of transmission of bloodborne viruses. If you have not had HIV and Hepatitis C testing prior to entry to Medical
School then you will either need to undergo testing as part of your OH clearance or you will
not be able to do EPPs. If you opt not to undergo testing and are not cleared for EPPs, you
will need to carry a student support card to present to your clinical placement supervisor
explaining that you are not cleared for these procedures and you will not be able to perform
or assist in some surgical procedures, for example episiotomy in Obstetrics, and much of
Orthopaedic surgery. This will not stop you qualifying but may have a bearing on your future
career.
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13. You are required to adhere to the local NHS Trust policy on infection control, which may
include bare arms, during your clinical placements
(www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuid
ance/DH_078433).
14. You must inform us if you are investigated, charged with, or convicted of a criminal offence
during your time as a student at UCL Medical School. Although you are required to have a
Disclosure and Barring Service check upon entering the programme, we also need to know if
you receive a subsequent warning, reprimand, caution or conviction.
15. You must inform us if there is any significant change to your health that might affect your
fitness to study medicine or to practise as a doctor. It is a student’s responsibility to
recognise when they are ill, to seek medical advice, to accept appropriate treatment, and to
recognise when their fitness for clinical work is, or could be impaired.
16. You are required to maintain a portfolio and to present it as requested.
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Section 2: The Horizontal modules in Year 4
The Introduction and Orientation Module (IOM)
During this three week module, you will begin to develop the skills, competencies and
understanding to help you make the most of your experiences in Year 4. A range of teachers
and clinical teams contribute to your learning in the Year 4 IOM. This includes the PALS: senior
students in their final year at UCL, who will help you make this important transition into patient
based learning in the context of delivering clinical care. You will spend time in the lecture
theatres, in the clinical skills centres, in small group work sessions, in general practices, and on
hospital wards.
All students take the IOM together then students rotate through the three remaining Year 4
modules.
The aims of the Year 4 IOM are to:
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prepare you for the integrated clinical care year
prepare you for maximising the benefits of workplace-based learning that is the backbone
of Year 4
ensure that you recognise a range of issues that contribute to the provision of safe, high
quality, patient-centred care
equip you with foundation skills in the following
o interviewing (history taking)
o clinical examination
o completing and documenting a full medical clerking
o developing a problem list and an action plan for a patient
o developing an understanding of clinical reasoning
The timetable for the IOM can be found on the Year 4 Moodle site
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Module A
During this 13-week module you will learn skills and knowledge central to being a doctor. The
emphasis is on the global management of individuals as well as pathways of care for specific
presentations and disease conditions.
The aims of Module A are for you to:
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become fully competent in undertaking a full history and examination
acquire competence in differential diagnosis, problem lists and patient management
observe and participate in medical practice i.e. to be a junior apprentice
be aware of pathways of care for common presentations and conditions
participate in on-take activities including out of hours
Structure of the module
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All students begin the module with a one-week introductory programme - the core
teaching week - of lectures and tutorials that both orientate them to the learning in the
module and direct you to core knowledge in the domains covered in the module. The
introductory week mainly takes place at the Whittington Campus
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Students then undertake three-week attachments in acute medicine, cardiology and
respiratory medicine, and one-week attachments in vascular surgery, liaison psychiatry
and preparation for practice
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Each student will attend their GP surgery for three days and will be attached to the
PARRT team for a day
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It is expected that each student will clerk fully at least one patient every week. A full
clerking includes a full history and examination, as well as a differential diagnosis,
problem list and management plan. 4 pages of A4 would be an average length for a full
clerking. Some should be done on A4 notepaper; some should use proformas. Some of
these may be the basis for Case-based discussions (CBDs)
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Students should observe and be conversant with the roles of the junior doctors and other
members of staff, and this will include all aspects of care (such as observing, prescribing,
completion of fluid balance and other charts, practical procedures, communication of bad
news)
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The emphasis of this module is to assess ALL of an individual patient’s problems, not just
the presenting symptom
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The timetable for Module A can be found on the Year 4 Moodle site
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Module B
The aims of Module B are for you to:
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gain competence in the clinical assessment, diagnosis, investigation, and medical and
surgical treatments of patients presenting with the common problems related to digestive
health
gain competence in the clinical assessment, diagnosis, investigation and medical and
surgical treatments of patients presenting with common musculoskeletal problems and
trauma
obtain competence in the fundamentals of surgery, and experience the culture of a
surgical hospital firm
obtain competence in the principals of pre-intra and post-operative care
meet patients in the community with problems related to digestive health; movement; or
post-operative care
acquire and gain confidence in undertaking basic clinical skills
Structure of the module
All students begin the module with a one-week introductory programme - the core teaching week
- of lectures and tutorials that both orientate them to the learning in the module and direct you to
core knowledge in digestive health, movement, and peri-operative care addressed in the
module. The introductory week takes place at the Royal Free campus.
Students are then divided into one of three groups based at the Royal Free, the Whittington or
Bloomsbury for the rest of the 12-weeks of the module. The 12-weeks consist of:
•
Six weeks digestive health - this means you will be attached to both a GI/hepatobiliary
surgical firm and a gastroenterology/hepatology medical firm
•
Six weeks movement - this is also an integrated surgical/medical attachment of
orthopaedics, trauma and rheumatology
•
Weekly tutorials related to peri-operative care are run by anaesthetic consultants on each
site. These sessions are based on a student workbook that you can find on Moodle.
Please have a look at this workbook for an introduction and the aims and objectives of
these sessions
•
Weekly tutorials in the Clinical Skills Centre
•
Three days in your GP surgery seeing patients with surgical, digestive health, and
musculoskeletal problems
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•
It is expected that each student will clerk fully at least two patients every week. A full
clerking includes a full history and examination, as well as a differential diagnosis,
problem list and management plan. Some of these may be the basis for Case-based
discussions (CBDs)
•
The timetable for Module B can be found on the Year 4 Moodle site
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You are required to complete a Module B logbook during the Module to guide you through
the expectations of clinical experience during the 12 weeks.
Module C
The aims of Module C are for you to:
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become fully competent in undertaking a full medical history from any patient and to be
able to perform a full physical examination
be able to begin to formulate differential diagnoses from the information obtained
know how to look up and interpret all relevant investigations pertaining to the patient biochemical, pathological and radiological - and to be able to discuss these intelligently
learn how to document all the above in a structured way
develop an awareness of common chronic diseases and how these are managed
learn how patients are managed in a specialised unit in conjunction with a GP
learn how to work effectively in a team
be proactive in seeking out learning opportunities
Structure of the module
•
All students begin the module with a one week introductory programme – the core
teaching week - of lectures and tutorials that both orientate you to the learning in the
module and direct you to core knowledge in the domains addressed in the module. The
introductory week takes place at the Bloomsbury Campus
•
Students then undertake a four week attachment in neurology and an eight week
attachment in hospital specialties including endocrinology, nephrology, infectious
diseases and haematology
•
Students based at the Royal Free Campus will see nephrology patients in the hospital as
part of their attachment. Students based on the Bloomsbury and Whittington Campuses
will attend nephrology teaching sessions at local satellite dialysis centres. Opportunities
will be provided for students to attend nephrology clinics, and additional teaching
sessions in nephrology at the Royal Free Campus will be planned
•
All students will have the opportunity to attend outpatient clinics and teaching activities on
their non–home firms. There will be teaching arranged locally to cover all major topics of
the specialities
18
•
It is expected that each student will clerk fully at least one patient every week. A full
clerking includes a full history and examination, as well as a differential diagnosis,
problem list and management plan. Some of these may be the basis for Case-based
discussions (CBDs)
•
Each student will attend their GP surgery for three days during the main module
•
The timetable for Module C can be found on the Year 4 Moodle site
During this 13-week module, you will learn generic skills essential to being a doctor. You will see
patients with a number of different conditions, managed largely by specialists. Many of the
conditions you see are common and may well be encountered in Primary Care (General
Practice). Others will be more unusual and will usually be managed in a secondary care
(hospital) setting, often within a specialised unit.
Section 3: Clinical and Professional Practice in Year 4
There are 15 Clinical and Professional Practice modules in the MBBS curriculum; organised into
three groupings. These are:
•
•
•
Integrated Clinical and Professional Practice
Overarching Themes
Student-centred Learning, Patient-centred Learning
Clinical and Professional Practice is key to understanding medicine as an integrated whole.
Although linked where possible to the horizontal module in which the teaching takes place, each
modules has its own internal coherence over the six years of the course and so will also be built
on your existing capabilities developed in earlier years.
Clinical and Professional Practice learning takes place in both additional sessions and in
learning activities embedded in the horizontal modules. The detailed timetable for Year 4
additional Clinical and Professional Practice teaching can be found on the Year 4 Clinical and
Professional Practice Moodle site, and further details about Clinical and Professional Practice
can be found in the separate Clinical and Professional Practice student guide. It is important to
ensure that you are familiar with your own Clinical and Professional Practice timetable
throughout the year and consider this alongside any placement or modules timetables you are
given. Please be aware that timetabled Clinical and Professional Practice sessions take priority
over other teaching.
19
Section 4: The portfolio in Year 4
In Year 4, the portfolio is delivered via the NHS e-Portfolio platform. The aims of the portfolio in
Year 4 are to: encourage you to take responsibility for your own learning; provide a place for you
to store evidence of your learning and experience; encourage reflection on learning and
experience; and prepare you for postgraduate practice where portfolios form the core of
assessment in foundation and higher training, and in gathering evidence for revalidation.
The Year 4 portfolio gathers evidence of both clinical and academic learning. You will use it to:
• record Supervised Learning Events (SLEs)
• record your end of module reports and meetings with your personal tutor
• complete reflective and achievement logs to record and reflect on particularly significant
learning events or experiences
• gather feedback from your peers using the mini-PAT
• record other learning or achievement in your personal library
• record evidence of required pieces of course work (your cancer patient pathway essay
and two pieces of reflective writing) in your personal library.
Your cancer patient pathway essay due towards the end of Block 2 will consist of the following
sections:
•
•
•
History of the patient including presentation and treatment as for any other case
report. This section should be restricted to the essential facts and lists of normal
findings should be excluded (25%)
One aspect of the diagnosis, treatment or management in greater depth (60%)
A reflection on your interaction with the patient (15%)
Further information can be found at:
https://moodle.ucl.ac.uk/course/view.php?id=22057&section=5
Two pieces of reflective writing due in Block 2 and Block 3.
•
•
1st Piece - consists of your experience of using ‘Ask One Question’ during your
clinical attachments. Asking UCL Medical Students to ask patients, that they have
contact with, “What can I do to improve your stay today?".
2nd Piece - free choice of subject to reflect on.
Further information can be found at:
https://moodle.ucl.ac.uk/course/view.php?id=22057&section=11
Each module will have specific instructions for how many SLEs are expected to have been
performed as evidence of satisfactory engagement and therefore be required for you to be
signed off for the module.
You will get more information about the e-Portfolio in the Introduction and Orientation Module,
and at: http://www.ucl.ac.uk/medicalschool/staff-students/course-information/portfolio/Year-4
20
Section 5: Medicine in the community in Year 4
Running through the year are your placements in a general practice. The aim of these
placements is to give you a better idea of how people with illnesses are managed. The
sessions are not about general practice (which you will do in Year 5), but sessions to
teach you how medicine is delivered in the community (where most care is now
delivered).
GP based teaching in Year 4 will take place on 9 days across the whole academic Year
(September-June). Teaching may be on Mondays, Tuesdays or Fridays but, for any individual
student, it will be on the same day of the week throughout the Year.
You will be allocated to a single GP surgery for the whole Year; attending in a group of between
two and six students approximately every four weeks, three times in each module.
The focus will be on providing small group, tailored teaching to supplement your learning in Year
4 by providing you with a community focus to both how patients present and how they are
managed in primary care settings. You will have plenty of opportunities to focus on practising
and receiving feedback on your developing clinical skills. GP tutors will cover a wider range of
topic areas, ideally matching them as closely as possible to the module you are currently
undertaking. For example:
Module A: Acute presentations, cardio respiratory medicine
Module B: GI presentations, orthopaedics and rheumatology, surgery
Module C: Haematology, infection, diabetes, endocrine, renal, neurology
Mental health is now an important part of Year 4 so GP tutors will be asked to incorporate this
into all of their teaching – for example, by discussing depression or somatisation where
appropriate.
Section 6: Case of the Month
Case of the Month is a virtual learning environment, patient-centred activity that students
complete in all Years of the curriculum. It is an important part of your portfolio during Year 4
because these cases raise issues ranging from communicating with patients in very difficult
circumstances to safe prescribing: areas that are examined and in which students often struggle
when they qualify. Each case integrates professional skills with core clinical problems from the
fourth year syllabus but will not be specific to each module. All students will complete the same
case at the same time irrespective of the module they are currently doing.
Over the course of the year, you will complete six cases: two in each module. You will receive
an email to let you know when each case is ready for completion and a reminder when the case
is about to close for marking. Each case will have approximately 10 individual tasks ranging from
SBAs to short answer questions. When you have submitted your answers through Moodle, it will
take you to instant feedback and the correct answer to read through. Tutors, who are clinicians,
will review your work, mark any of the free text answers and provide you with some feedback.
21
Case of the Month is compulsory course work and so needs to be completed to a satisfactory
standard for you to progress to Year 5.
More detail about how to fill in the cases can be found on the Moodle site when you first login.
Section 7: Record of completed procedures card
In Year 4, as in all other years of the programme you will need to demonstrate your developing
competence and engagement with the programme by submitting a fully completed Record of
Completed Procedures Card (RCP). This will be given to you at the beginning of the year, and
you will be expected to
•
•
at the end of each of the first two 13 week modules: submit the card to the Year 4 office
at the end of the final module: ensure the card is fully completed then upload it to your eportfolio and submit the hard copy to the Year 4-6 Student Office
Submission of a satisfactory RCP at the end of the year is a requirement for progression
to Year 5.
In Year 4, the Record of Completed Procedures card includes:
Competency in the following skills and practical procedures:
• Venepuncture
• BLS
• Cannulation
• Simulated suturing
• Basic airway management
• Assessment of the critically ill patient
Completion of the following tasks:
• Phlebotomy
• Cannulation
• Arterial blood gas
• ECG recording
• Assisting in the operating theatre
• Rectal examination
• Writing safe prescriptions
• Perform full set of observations and record on a NEWS chart
• Venous thromboembolism
• Cranial nerve examination
• Neurological examination – upper and lower limbs
The entries on the RCP card should be completed by a member of clinical staff: this includes the
clinical skills team, doctors of any grade, and for some skills, allied health professionals.
22
Section 8: Core conditions and common presentations
The learning experiences in the MBBS programme are focused on a set of core conditions and
presentations. This list is included here. Those conditions and presentations in BOLD are most
likely to be seen or addressed in learning in Year 4.
Remember:
•
•
•
•
•
This list is not exhaustive but it should form the basis of your learning
Workplace-based teaching takes place in the context of clinical care. This means that we
cannot guarantee you will see all conditions and presentations on this list nor that patients
will present only with these conditions and presentations
You will need to see patients and you will need to read around the subject: neither approach
is sufficient on its own
In clinical practice, patients present with symptoms and problems, not necessarily with a
diagnosis as laid out in a textbook, so your learning needs to reflect this
You should recognise that in up 30% of cases, no firm diagnosis is ever made
23
UCL MBBS Core Conditions and Presentations
NOTE: this list applies to the whole of MBBS, and not just Year 4. It is likely that many of
these conditions and presentations will be encountered in Year 4, and others more likely
in Year 5 for example.
However, if a learning experience presents itself that will improve your knowledge or
skills that is not expected in a certain year or is strictly defined as ‘required’ here then it
should still not be overlooked.
Common presentations
• Abdominal pain
• Acute confusion and coma
• Blackouts / loss of consciousness
• Bloating
• Change in bowel habit
• Chest pain
• Cough
• Dizziness
• Falls
• Fever
• Headache
• Itching / pruritis
• Low back pain
• Nausea / Vomiting
• Obesity
• Palpitations
• Polysymptomatic
• Rectal or other GI bleeding
• Shortness of breath
• Sleep problems
• Swollen legs
• Tired all the time
• Urinary symptoms
• Weight loss
• Wheeze
Cancer
• Breast
• Head and neck
• Larynx
• Metastatic cancer - Bone, Liver, Brain
• Prostate
24
•
Testes
Child health
• Autism, Aspergers & ADHD
• Birth asphyxia
• Bronchiolitis
• Cerebral palsy
• Coeliac disease
• Congenital heart defects – ventricular septal defect and patent ductus arteriosus (PDA)
• Congenital infections
• Croup
• Cystic fibrosis
• Developmental delay
• Developmental dysplasia of the hip
• Down syndrome
• Failure to thrive / Faltering growth
• Febrile convulsions
• Gastro-oesophageal reflux disease
• Henoch-Schönlein purpura
• Immune thrombocytopaenia
• Infantile colic
• Infantile hypertrophic pyloric stenosis
• Inherited disorders of metabolism
• Intussusception
• Kawasaki disease
• Neonatal jaundice
• Neuroblastoma
• Normal development and puberty
• Pre-term infants
• Respiratory distress syndrome/Hyaline membrane disease
• Rickets
• Separation anxiety / school refusal
• Transient synovitis
• Turner syndrome
• Wilms tumour
Circulation and breathing
•
•
•
•
Arrythmias - atrial fibrillation, flutter, nodal tachycardia, ventricular ectopics,
tachycardia, fibrillation first, second & third degree (complete) heart block
Asthma
Blood vessel disorders (aneurysms, varicose veins, peripheral arterial disease,
atherosclerosis)
Chronic obstructive pulmonary disease including bronchiectasis
25
•
•
•
•
•
•
•
•
•
•
•
•
Heart failure and its consequences
Hypertension
Interstitial lung disease
Ischaemic heart disease
Pericarditis & tamponade
Pleural effusion
Pneumothorax
Lung cancers
Respiratory failure: type 1 and 2
Superior vena cava obstruction
Thromboembolism - arterial and venous
Upper and lower respiratory tract infections
immunocompromised patients
• Valvular heart disease including infective endocarditis
including
infections
in
Endocrine system regulation and reproduction and genetics
• Adrenocortical insufficiency and excess
• Diabetes mellitus Type 1 and type 2
• Diabetic emergencies: ketoacidosis, hypo and hyper glycaemia, hyperosmolar nonketotic Coma
• Disorders of calcium metabolism
• Endocrine emergencies: Addisonian crisis, thyrotoxicosis, myxoedema,
phaeochromocytoma, pituitary failure
• Gonadal dysgenesis
• Lipid metabolism disorders
• Metabolic syndrome
• Pituitary and adrenal tumours
• Syndrome of inappropriate anti-diuretic hormone (SIADH) and diabetes insipidus
• Thyroid cancer
• Thyroid dysfunction: hyperthyroidism, hypothyroidism, goitre
Ear, nose and throat
• Acoustic neuroma
• Acute vertigo/ Meniere's disease
• Cholesteatoma
• Epistaxis
• Facial palsy
• Hearing loss
• Obstructive sleep apnoea
• Otitis Media and Externa
• Otosclerosis
• Pleomorphic salivary adenoma
• Presbyacusis
26
• Rhinitis
• Safe perforations
• Salivary gland disorders
Gastroenterology
• Alcoholic liver disease
• Anal conditions – abscess, haemorrhoids, fistula, fissure
• Cancers of the bowel, stomach, oesophagus, liver and pancreas
• Diverticular disease
• Enteropathies and malabsorbtion
• Functional disorders of the GI tract
• Gallstone disease
• Gastrointestinal (GI) bleeding
• Gastro-oesophageal reflux disease (GORD) / Dysphagia
• Hepatitis, cirrhosis, drug related liver injury and metabolic liver disease
• Infection and infestations of the GI tract
• Inflammatory Bowel Disease
• Jaundice
• Oesophagitis / Barrett’s oesophagus
• Pancreatic disorders - pancreatitis, insufficiency
• Ulcers – peptic and duodenal
Haematology
• Anticoagulation
• Bleeding disorders: thrombocytopenia; disseminated intravascular coagulation
(DIC); haemophilia
• Blood transfusion
• Haematological malignancies: lymphoma; leukaemia; myeloma
• Haemolysis
• Iron deficiency
• Megaloblastic anaemia
• Neutropaenic sepsis
• Polycythaemia
• Thrombophilia
Infection and defence
• Bone and joint infection: osteomyelitis, septic arthritis of joints,TB
• CNS infections: meningitis; encephalitis; abscess; infections
immunocompromised
• ENT infections
• Genitourinary infections: syphilis; gonorrhoea, chlamydia
• Hepatobiliary infections
• HIV
27
in
the
• Imported fevers including malaria
• Septic shock
• Tuberculosis
• Urinary tract infection and pyelonephritis
• Vaccination
• Viral hepatitis
Kidneys and urinary tract
• Acute kidney injury
• Acute nephritic syndrome
• Bladder and urothelium cancers
• Chronic kidney disease
• Diabetic nephropathy
• Glomerulonephritis
• Hypertension & the kidney
• Kidney cancer
• Microscopic haematuria
• Nephrotic syndrome
• Prostatic hypertrophy
• Renal replacement therapy
• Upper urinary tract obstruction, hydronephrosis
• Vesicoureteric reflux and nephropathy
Acute Kidney Injury
• Functional anatomy of the kidney
• Creatinine as marker of AKI
• Differentiating AKI from CKD
• Emergency treatment of hyperkalemia and fluid overload
• Pre-renal, post-renal and intrinsic renal causes of AKI
• Assessment of volume status
• Assessment of renal tract obstruction
• Exogenous and endogenous toxins as a cause of AKI
Chronic Kidney Disease
• Relationship between plasma creatinine and GFR
• Use of estimated GFR and urinary albumin to stage CKD
• Common causes of CKD - diabetes, vascular disease
• Blood pressure management in CKD
• Management of fluid overload/hypertension/proteinuria in CKD
• Mineral Bone Disorder (particularly hyperparathyroidism)
• Anaemia
• Drugs and the kidney
28
•
Assessment and significance heamaturia and proteinuria
Intrinsic kidney disease
• Nephrotic syndrome
• Glomerular disease as a cause of AKI and CKD
• Glomerular disease as part of systemic inflammatory disorders
• Interstitial nephritis
• Vesicoureteric reflux and chronic pyelonephritis
• Treatment of glomerulonephritis e.g. Rapidly progressive GN
Renal replacement therapy
• When should dialysis be started in end-stage kidney disease?
• Types of dialysis
• Dialysis access and infection
• Conservative care of end stage kidney disease
• Kidney Transplantation and major complications
Movement and musculoskeletal biology
• Bone cancers
• Common disorders and injuries of the hip, knee, ankle, foot, neck, back, shoulder,
elbow, wrist and hand
• Common fractures of upper and lower limbs including principles of treatment
• Compartment syndrome
• Connective tissue disorders including systemic lupus erythematosis (SLE)
• Gout & pseudogout
• Inflammatory arthropathies including rheumatoid arthritis (RA)
• Management of spinal injuries
• Metabolic bone disease e.g. Paget's, osteoporosis and Vitamin D
• Osteoarthritis
• Rehabilitation after joint replacement, fractures or severe injuries, especially spinal
injuries
• Seronegative arthritis
Mental health
• Alcohol and substance misuse
• Anxiety including generalised anxiety disorder, phobias, post traumatic stress disorder
(PTSD) and obsessional-compulsive disorder (OCD)
• Deliberate self harm and assessment of suicide risk
• Depression and anxiety related to physical health
• Eating disorders : anorexia and bulimia nervosa
• Mental health problems in people with learning disabilities
• Mood (affective) disorders including depression and bipolar disorder
29
• Personality disorders
• Post-partum mental health disorders
• Psychoses, and schizophrenia
• Sexual dysfunction
• Somatoform disorders including somatisation and hypochondriacal disorder
Neuroscience and behaviour
• Cerebrovascular disease including transient Ischaemic episodes (TIAs),
intracerebral thrombosis and haemorrhage
• Cranial nerve lesions
• Dementias - vascular, Alzheimer's, Lewy Body
• Functional neurological disorders
• Guillain Barré syndrome
• Intracranial and spinal tumours
• Migraine
• Motor neurone disease
• Multiple sclerosis
• Myaesthenia gravis
• Myopathies
• Nerve root and cauda equina compression
• Organic causes of psychiatric disorders
• Parkinson's disease
• Peripheral and autonomic neuropathy
• Seizure disorders
• Spinal cord compression
Ophthalmology
• Cataracts
• Causes of acute and gradual visual loss
• Children and the eye
• Diabetes and the eye
• Eye in systemic disease
• Glaucoma
• Neurophthalmology – diplopia, ptosis, visual field defects, pupils
• Red eye
• Screening and public health in Ophthalmology
30
Plastic surgery / skin
• Acne
• Benign & malignant lesions of skin and oral mucosa
• Blistering disorders
• Breast reconstruction & reduction
• Burns
• Cutaneous infections
• Cutaneous manifestations of systemic disease
• Dermatological emergencies
• Leg ulcers/ chronic venous insufficency
• Papulosquamous disorders - eczema, psoriasis, lichen planus
• Pigment disorders
• Pressure sore
Surgical care and interventions
• Acute abdomen
• Benign breast disease: fibroadenoma and cyst
• Benign enlargement of the prostate
• Bowel obstruction
• Causes of persistent fistulae
• Diagnosis & management of shock
• Diagnosis of postoperative pyrexia
• Haemorrhoids
• Hernias
• Lipoma, cysts, ganglion, inclusion dermoid, warts & moles
• Phimosis, paraphimosis, balanitis
• Testicular problems including maldescent and torsion
• Urinary calculi: renal, ureteric & vesical
Women's health
• Abnormal menstruation
• Abortion
• Benign gynaecological conditions including: pelvic pain, endometriosis and polycystic
ovarian disease
• Care of the pregnant woman and delivery of her baby and placenta
• Complications of early pregnancy, including ectopic pregnancy
• Congenital genital tract abnormalities
• Congenital infections of the newborn
• Contraception
• Drugs in pregnancy
• Foetal development – normal and abnormal
• Genital tract cancers including ovary, uterus, cervix and vulva
31
•
•
•
Infertility and fertility
Menopause
Obstetric emergencies – haemorrhage, eclampsia, delivery emergencies, amniotic fluid
embolism
• Medical complications of pregnancy - pre-eclampsia, gestational diabetes, cholestasis
• Urinary incontinence
• Vaginal discharge
Special situations
• Anaphylaxis and allergy
• Deprivation of liberty
• Domestic violence
• Drug reactions
• Health promotion
• Major trauma
• Medically unexplained symptoms
• Multiple co-morbidities, especially in the elderly
• Pain and analgesics
• Palliative care
• Public health disasters
• Safeguarding including child protection and female genital mutilation
32
Section 9: Contributing to patient notes, prescribing and data interpretation
Writing patient notes is a challenging but important skill to acquire. Patient notes are important
for clearly communicating the patient’s condition and management plan to a range of health
professionals.
More legal actions are lost on behalf of doctors because of poor note keeping than for any other
reason. You will not be believed as a defendant if you have no contemporaneous notes to
support you. Each time you have the opportunity to write up case notes, look at this list of best
practice and check you have written acceptable notes. Do this until keeping good case notes is
well established in your mind.
Written succinct and legible notes should include:
History of presenting complaints, past, personal, family and drug history allergies
Patients’ ideas and/or concerns and their expectations
Written legible, ordered details of the physical examination
Documented risks factors and the aspects of social occupational history relevant to the
patient’s care
• A summary, including differential diagnosis and problem lists
• On each notes entry: time and date; name, DOB and hospital number of patient; your name,
signature and grade.
•
•
•
•
During Year 4, you will have opportunities to write in patients’ paper notes or to make entries
into clinical information systems; the electronic patient record, both in hospital and Primary Care
settings. Learning how to use these systems is a key part of the Year. Take every opportunity to
observe doctors entering and retrieving data in these systems, and where appropriate, and
under supervision, make your own entry into written and electronic notes, observing the best
practice outlined above.
Prescribing
You need to ensure that you can prescribe medicines safely. As well as developing a thorough
knowledge of therapeutics, it is important that you begin to learn how to use the British National
Formulary (BNF), how to complete a drug chart, how to complete a discharge prescription, and
how to complete a prescription in general practice.
Year 4 will provide you with opportunities to develop and practise these skills. It is important
however to remember that students MUST NEVER sign prescriptions in hospital or general
practice.
During Year 4, you should learn how to:
•
•
understand how drugs work, why they are prescribed and how they interact with each
other (having revised previous studies in pharmacology)
take an accurate drug history, including current and past treatment and adverse reactions
33
•
•
•
•
•
•
write prescriptions according to guidelines for prescription writing in the BNF in both
primary and secondary care settings
explain drug treatment to patients
assess adherence to medication and the reasons for non-compliance with recommended
drug treatments
write prescriptions for intravenous infusions
list drugs commonly associated with drug interactions and how to interpret the information
on drug interactions in the BNF
become familiar with all the drugs listed in the UCL Student Formulary
Data Interpretation
During the course of Year 4, you will be expected to become able to identify normal results as
well as correctly interpret examples of common abnormalities in radiology, all disciplines of
pathology, electrocardiography and pulmonary function/blood gases.
This list is not exhaustive but will prompt you to develop your skills. Make sure you have seen
plenty of x-rays, scans, ECGs and blood results.
Data Interpretation: Imaging – Chest
•
•
•
•
•
•
•
•
•
•
•
•
•
Normal chest x-ray
Pleural effusion
Pneumonia
Pulmonary oedema
Pneumothorax
Haemothorax
Fractured ribs
Pulmonary fibrosis
Hilar mass/adenopathy
Solitary/multiple round shadows
Apical tuberculosis
Pulmonary embolus
Cardiomegaly
Data Interpretation: Lung function/blood gases
•
•
•
•
•
Normal & reduced peak flow
Normal & reduced vital capacity
Complex lung function for changes to residual volume or diffusion
Reduced arterial O2 with or without raised CO2
Changes to arterial pH & CO2
34
Data Interpretation: Imaging – Skeletal
•
•
•
•
•
•
•
•
•
Fractures, e.g. clavicle, neck of humerus, Colles, neck of femur, femoral/tibial shaft, ankle
Osteoporosis with vertebral collapse
Sclerotic & lytic metastases
Paget’s disease spine/pelvis/long bone
Spine degenerative changes
Osteoarthritis – hip/knee
Rheumatoid arthritis – hands
Gout with tophus
Nuclear scan of the skeleton
Data Interpretation: Imaging – CT/MRI Brain
•
•
•
•
•
•
•
•
Subarachnoid haemorrhage
Brain haemorrhage
Cerebral infarct
Cerebral atrophy
Intracerebral lesion with oedema, e.g. primary secondary tumour
Mid-line shift
Pituitary tumour
Extradural/subdural haematoma
Data Interpretation: Electrocardiography
• Sinus rhythms
• Atrial & ventricular ectopic beats
• Atrial fibrillation & flutter
• Atrial & nodal tachycardia
• Wolff-Parkinson-White (WPW) syndrome
• Ventricular tachycardia
• Ventricular fibrillation
• Atrial ventricular conduction defects
• Bundle branch blocks
• Bradyarrhthmias (heart block of varying degrees)
• Ischaemic changes
• T wave changes
• Myocardial infarction/acute coronary syndrome
• Ventricular hypertrophy
• Changes in pericarditis
• Changes in pulmonary embolus
• Screening tests for coronary artery disease
• Functional tests of coronary blood supply
35
Data Interpretation: Pathological Sciences
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Changes to red cell count & indices
Leucocytosis/leucopenia
Haematinics
Thrombocytosis/thrombocytopenia
Lengthened / therapeutic International normalised ratio (INR)
Other clotting defects (Prothrombin time (PT), Activated Partial Thromboplastin Time (APTT)
Raised Erythrocyte sedimentation rate (ESR) / C-reactive protein (CRP)
Screening for haemoglobinopathies
Common electrolyte changes, including high or low values for sodium, potassium, calcium,
magnesium & phosphate
High plasma creatinine & urea
Disordered liver function tests for obstruction, hepatitis or haemolysis
pH changes – acidosis or alkalosis
Typical laboratory results in cardiovascular and pulmonary disease (including troponin T and
I, D-Dimer)
Blood glucose changes & glucose tolerance tests
Common hormonal changes, especially thyroid, and dynamic function tests
Changes in immunological tests in arthritis & GI disease
Immunological changes in thyroid disease
Viral/Immunological results in hepatitis/HIV
Common bacterial culture results from sputum, urine, stool, blood & cerebrospinal fluid (CSF)
Aminoglycoside levels
Therapeutic drug monitoring
Data Interpretation: Pathology
You will be expected to:
•
•
•
Demonstrate your knowledge of gross anatomical changes visible to the naked eye for
common major pathologies and to identify them in pictures or pots
Recognise the histological changes in common major pathologies
Explain the causal and other links between the gross pathology and histopathology on the
one hand and the patient’s symptoms, signs and prognosis on the other
36
Information technology
You will be expected to use (and understand the limitations of)
•
•
•
•
•
Hospital medical records (paper/ electronic)
GP electronic records and patient summaries (drugs/ allergies/ PMH)
Referral letters / Discharge summaries as key methods of communication between 1y and
2y care
An awareness of the NHS spine and summary care record
Develop an awareness of security of patients confidential medical records (in what ever
format)
37
Section 10: Staff contact details
MBBS Management contacts
Year 4 Manager
Year 4 Student Administrator
Year 4 Email
Student Support Clinics
Academic Leads
Academic Lead for Year 4
Academic Lead for Module A
Academic Lead for Module B
Academic Lead for Module C
Victoria Clausen-Thue
Molly Lavender-Rose
Marta Darrat
Dr Gavin Johnson &
Prof Alan Salama (deputy)
v.clausen-thue@ucl.ac.uk
m.lavender-rose@ucl.ac.uk
medsch.year4@ucl.ac.uk
medsch.support4-6@ucl.ac.uk
via Victoria Clausen-Thue
TBC
via Carolyn Cohen
Mr Mike Oddy & Prof Kevin
via Zoe Lau
Moore (deputy)
Prof David Wheeler &
via Tricia O’Dell
Dr Catherine Lunken
(deputy)
Module Teaching Administrators
Royal Free Campus
Module A
Carolyn Cohen &
carolyn.cohen@ucl.ac.uk
Francesca Harrison
f.harrison@ucl.ac.uk
Module B
Zoe Lau
zoe.lau@ucl.ac.uk
Module C
Francesca Harrison
f.harrison@ucl.ac.uk
Whittington Campus
Module A & C
Eibhlin Mullarney
e.mullarney@ucl.ac.uk
Module B
Ruth Fox
r.fox@ucl.ac.uk
Bloomsbury Campus
Module A & C
Tricia O’Dell
tricia.o'dell@ucl.ac.uk
Module B
Julie Power
julie.power@ucl.ac.uk
General Practice
Petra Oluyemi
p.oluyemi@ucl.ac.uk
Clinical and Professional Practice Teaching
CPP Academic Lead
Dr Faye Gishen
f.gishen@ucl.ac.uk
CPP Administrative Lead
Tara-Lynn Poole
tara.poole@ucl.ac.uk
CPP Assistant Administrator
Izzie Jay
i.jay@ucl.ac.uk
Absence reporting
Please contact the relevant module administrator from the list above and email the Year 4
generic email address on medsch.year4@ucl.ac.uk.
Absence reporting - GP
If you are on your allocated GP
Petra Oluyemi
p.oluyemi@ucl.ac.uk
day please contact the practice
directly AND inform the GP
administrator
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