PAPER 10/PC/55
UPDATED 13 April 2011 - BASED ON PAPER 10/PC/33
A MODEL FOR THE EDINBURGH MBChB DEGREE BASED ON LEARNING OUTCOMES
Outcomes-based education
Outcomes-based education is an approach which has gained acceptance in medical education in recent years.
It starts by defining the curriculum outcomes at the time of graduation. These outcomes are defined to match
the requirements of medical clinical practice. The curriculum is then aligned to support students in achieving
these outcomes. There are many advantages to such an approach, but perhaps the main one is that it gives
students, graduates, employers (the National Health Service), patients and society a clear statement of what
they can expect from medical graduates entering the workplace. Medical schools are then accountable for
the degree to which these expectations are met.
Definitions
What is a learning outcome? One attempt to synthesise various definitions states:
“A learning outcome is a written statement of what the successful student/learner is expected to be able to
do at the end of the module/course unit, or at qualification.”
(Adam, S., 2004. Using Learning Outcomes. Report for Bologna Seminar 2004, Edinburgh.)
As such there is inevitable confusion with “aims” and with “learning objectives”. In Edinburgh we have
traditionally used “aims” to refer to the highest level, most general statements of what the medical school is
trying to achieve. “Objectives” is a somewhat older term which has been used in Edinburgh to describe the
detailed, discrete items of learning pertaining to specific learning experiences, such as problem-based
learning, lectures, modules, or attachments.
In the interests of simplicity, we will abandon use of the terms “aims” and “objectives”, and apply the
Adam definition of learning outcomes. The outcomes will constitute a framework going from the highest
level, most general MBChB degree outcome (Level 1) to the most detailed outcomes for specific
components of the curriculum (Level 5).
How should the outcomes be decided?
Graduating outcomes for a UK medical curriculum are subject to various influences:

Discussion and negotiation within the Medical School and with NHS partners

The General Medical Council (GMC) "Tomorrow's Doctors" (2009). The 2009 version for the first
time contains an explicit, multi-level outcomes framework, which has been subjected to very
extensive consultation.

“The Scottish Doctor – a competent and reflective practitioner” – published by the Scottish Deans
Medical Education Group after a national consultation process (2002).

“The Tuning Project (Medicine) – learning outcomes/competences for undergraduate medical
education in Europe” published by the University of Edinburgh (2008).
At the more detailed levels, input from subject representatives, individual teachers, feedback from students,
and the context of learning will all play a role in defining the outcomes, and the particular character of the
Edinburgh medical degree programme will be reflected.
The Edinburgh curriculum will be structured and described in terms of the learning outcomes, and its
assessment strategy and framework aligned with that change. Since the medical school will be
accountable for the achievement of the GMC “Tomorrow’s Doctors” outcomes by all its graduates, and
required to show evidence of this, it seems strategically desirable to use those outcomes as the primary
basis for the new structure - albeit with appropriate adjustments to reflect the nature and character of the
Edinburgh graduate.
Tomorrow’s Doctors (TD) 2009 specifies 16 major outcomes (and 32 skills). This is quite a large number to
manage effectively at curriculum level. A very simple adjustment, as shown below (Table 1) reduces the
number to 12, and makes alignment with the current Edinburgh structure, the Scottish Doctor, and the
Tuning Project very simple.
Outcomes as the end-product of programme themes
A simple approach to linking curriculum content to the outcomes is to say that each outcome is supported by
a programme theme. These themes then encompass the teaching, learning and assessment in all five years of
the curriculum. Each theme has an identified theme head, supported by a team of staff active in the field.
The assessments related to each theme accumulate and allow us to be confident that graduates, at the time of
graduation, have been adequately assessed in each of the outcomes.
Levels of outcomes
All existing outcome frameworks have some degree of hierarchical structure, usually referred to as levels.
These are not defined in terms of the importance of the outcomes, but rather the detail of specification, and to
some degree, their scope and dimensions.
The Edinburgh learning outcomes will be structured in levels 1-5, each level being a more detailed breakdown of the level above. Each level will have an appropriate descriptor as shown.
Blueprinting of Assessments
Blueprinting is the process by which the content of an integrated examination is mapped on a matrix grid
against the programme outcomes. This allows the University to track the assessment of students over time
under each programme outcome, and therefore allows us to assure the General Medical Council (GMC) that
our graduates have been adequately assessed in each outcome at the time of graduation. This, in turn, allows
the GMC to enter graduates on the medical register and provide them with a provisional licence to practise.
The OPALplus project
The level 5 learning outcomes (previously referred to as learning objectives), of which there are many,
define discrete items of teaching, learning and assessment for the various components of the programme e.g.
a lecture, module, or attachment. They will be specifically mapped against Level 3 and 4 outcomes. This is
currently being undertaken as part of the OPALplus project.
Table 1. Proposed Edinburgh outcomes with corresponding TD 2009 statements.
EDINBURGH MBChB OUTCOMES
GMC TOMORROW’S DOCTORS 2009
DEGREE OUTCOME (For Degree of MBChB; Level 1)
Edinburgh medical graduates will be caring, competent,
ethical and reflective doctors who make the care of
patients their first concern. They will be excellent
communicators, able to work well with others, prepared
for increasingly complex and uncertain situations,
equipped for ongoing personal development, and trained
for high professional achievement and leadership.
GMC 7. Medical graduates are
tomorrow’s doctors. In accordance with
Good Medical Practice, graduates will
make the care of patients their first
concern, applying their knowledge and
skills in a competent and ethical manner
and using their ability to provide
leadership and to analyse complex and
uncertain situations.
A. THE DOCTOR AS SCHOLAR AND SCIENTIST (Roles; Level 2)
As a scholar and a scientist the Edinburgh medical graduate will be able to apply to medical
practice and ongoing training, the principles, methods and knowledge of the relevant areas of
academic study; take a scholarly approach to clinical practice; and apply scientific method and
approaches to questions in patient care, in medical research and in improving health service
delivery.
PROGRAMME OUTCOMES; Level 3
In more detail, the Edinburgh medical graduate will be able to:
1. BIOMEDICAL SCIENCES
(BMS)
apply to medical practice the biomedical scientific
principles, method and knowledge relating to relevant
sciences including anatomy, biochemistry, cell biology,
genetics, immunology, microbiology, molecular biology,
nutrition, pathology and physiology.
2. PSYCHOLOGICAL ASPECTS OF MEDICINE
(PAM)
recognise and assess important psychological and
behavioural aspects of health, illness and disease; and
respond appropriately to these aspects, using strategies
such as explanation, advice and reassurance to address
them.
3. SOCIAL SCIENCES AND PUBLIC HEALTH
(SSPH)
implement, at a clinical level, knowledge of how to
prevent disease, prolong life and promote health through
the organised efforts of society; and demonstrate
understanding of how to analyse a population’s health
problems, establish the causes and effects of these
problems and assist appropriately in implementing
effective solutions.
GMC 8. Apply to medical practice the
biomedical scientific principles, method
and knowledge relating to: anatomy,
biochemistry, cell biology, genetics,
immunology, microbiology, molecular
biology, nutrition, pathology,
pharmacology and physiology.
GMC 9. Apply psychological principles,
method and knowledge to medical
practice.
GMC 10. Apply social science principles,
method and knowledge to medical
practice. GMC 11. Apply to medical
practice the principles, method and
knowledge of population health and the
improvement of health and health care.
EDINBURGH MBChB OUTCOMES
GMC TOMORROW’S DOCTORS 2009
4. EVIDENCE-BASED MEDICINE and RESEARCH
(EBM&R)
GMC 12. Apply scientific method and
approaches to medical research.
use the best available medical evidence, found through a
systematic search and appraisal of the relevant
information sources, to inform their clinical decisions;
and develop new knowledge or personal understanding
through the application of basic research methods and
skills.
B. THE DOCTOR AS PRACTITIONER (Roles; Level 2)
As a practitioner the Edinburgh medical graduate will be able to undertake initial assessment,
management, review and ongoing care of patients safely, under supervision proportionate to
the clinical situation, recognising limits of competence and experience, and seeking help from
colleagues appropriately.
PROGRAMME OUTCOMES; Level 3
In more detail, the Edinburgh medical graduate will be able to:
5. THE CONSULTATION
(TC)
GMC 13. Carry out a consultation with a
patient.
undertake an effective and efficient consultation that is
sensitive to the needs of the patient
6. PRESENTATION, DIAGNOSIS AND
MANAGEMENT
(PDM)
GMC 14. Diagnose and manage clinical
presentations.
describe the modes of presentation and natural history of
diseases; recognise and interpret the signs and symptoms
with which people present to doctors, construct a
differential diagnosis, and choose appropriate methods to
investigate, treat and care for patients in a multiprofessional setting.
7. CLINICAL COMMUNICATION
(CC)
communicate clearly, sensitively and effectively with
patients and their relatives, and with colleagues from the
medical and other professions.
8. EMERGENCY CARE, CLINICAL AND
RESUSCITATION SKILLS
(ECCARS)
recognise and systematically assess acutely unwell
patients and institute immediate management, including
first aid and resuscitation; and perform a range of clinical
skills and procedures safely and effectively.
GMC 15. Communicate effectively with
patients and colleagues in a medical
context.
GMC 16. Provide immediate care in
medical emergencies. GMC 18. Carry out
practical procedures safely and
effectively.
EDINBURGH MBChB OUTCOMES
GMC TOMORROW’S DOCTORS 2009
9. CLINICAL PHARMACOLOGY AND
THERAPEUTICS
(CPT)
GMC 17. Prescribe drugs safely,
effectively and economically.
describe how drugs act and apply this knowledge to
clinical practice to prescribe clearly and accurately, to
match appropriate drugs to the clinical context, to review
the appropriateness of medication and to evaluate the
potential benefits and risks.
10. MEDICAL INFORMATICS
(MI)
GMC 19. Use information effectively in
a medical context.
use computers, computing, information and information
technology effectively in a medical context.
C. THE DOCTOR AS PROFESSIONAL (Roles; Level 2)
As a professional the Edinburgh graduate will be able to take a reflective and self-directed
approach to the study and practice of medicine, promote multi-professional teamworking,
accept responsibility for teaching others, and continuously enhance patient care. The graduate
will demonstrate professional judgment and adherence to the ethical, professional and legal
responsibilities of a junior doctor in everyday practice, whilst paying attention to his or her
own health, wellbeing and professional development and seeking assistance where necessary.
PROGRAMME OUTCOMES; Level 3
In more detail, the Edinburgh medical graduate will be able to:
11. MEDICAL ETHICS, LEGAL AND
PROFESSIONAL RESPONSIBILITIES
(MELPR)
GMC 20. Behave according to ethical and
legal principles.
practise medicine safely, within an ethical framework,
with insight and compassion, according to the legal
requirements and professional expectations of medical
practice in the UK.
12. PERSONAL PROFESSIONAL DEVELOPMENT
(PPD)
take a reflective and self-directed approach to the
ongoing study and practice of medicine, promote
teamworking and develop others’ learning in order to
enhance patient care, maximise effectiveness and enjoy
career satisfaction.
GMC 21. Reflect, learn and teach others.
GMC 22. Learn and work effectively
within a multi-professional team.
GMC 23. Protect patients and improve
care.
EXAMPLE OF POSSIBLE LEVEL 4 DETAILED PROGRAMME OUTCOMES
Level 3: Apply principles and knowledge of pharmacology and therapeutics, including prescribing.
Level 4:
a.
Establish an accurate drug history, covering both prescribed and other medication.
b.
Plan appropriate drug therapy for common indications, including pain and distress.
c.
Provide a safe and legal prescription.
d.
Calculate appropriate drug doses and record the outcome accurately.
e.
Provide patients with appropriate information about their medicines.
f.
Access reliable information about medicines.
g.
Detect and report adverse drug reactions.
h.
Demonstrate awareness that many patients use complementary and alternative therapies, the
existence and range of these therapies, why patients use them, and how this might affect other types
of treatment that patients are receiving.
Professor Allan Cumming
Director of Undergraduate Learning and Teaching, CMVM
Dr Helen Cameron
Director of the Centre for Medical Education
Updated 28 January 2011
Updated 13 April 2011