After successful completion of clinical training a student graduates as a Bachelor of Medicine, Bachelor of Surgery, abbreviated as
Applications for entry into medical school (in common with other university courses) are made through the Universities and Colleges Admissions Service. UCAS generally allows students to apply for up to five places at different universities, however applicants for medical school may use only four of these places for medical courses; the remaining one must be left blank or be used to apply for non-medical courses, with many students applying for courses in biomedical science, medical genetics etc. as insurance options. Most UK medical schools now also require applicants to sit additional entrance tests such as the United Kingdom Clinical Aptitude Test (required by 23 universities) and the BioMedical Admissions Test (required by 6 universities). As of 2008 there are approximately 8000 places for medical students annually, 3500 more than there were 10 years ago .
Other primary medical qualifications registrable with the General Medical Council exist in the UK, some of which have only recently become defunct, and many people in the UK still practising medicine have these qualifications. These include the 'LMSSA' (the licentiate in Medicine and Surgery of the Society of Apothecaries), the 'LRCP, MRCS' (conjoint diploma of the London Royal Colleges) and the 'LRCPE, LRCSE, LRCPSG' (the 'Scottish Triple Diploma', given by the Royal Colleges in Glasgow and Edinburgh).
The delivery of medical education is divided into two distinct methods, utilised to different extents by each medical school. It should be noted that these teaching methods feature most heavily in the first two years of medical school, after which clinical teaching predominates; and this will vary between hospitals, an aspect that is often overlooked during application to medical school.
Problem-based learning is a principle based on the educational philosophy of the French educationalist Célestin Freinet in the 1920s., and is used in many subject areas, not just medicine. It has been developed in relation to medical education at McMaster University , and Maastrict University, and subsequently by the School of Medicine, University of Manchester who introduced the system to the UK. It refers to a whole process, and not merely to a specific event (the PBL tutorial).
In the UK, the focus is on a PBL-tutorial which is conducted in small groups of around 8-10 students (although this varies with seniority and between medical school) with a tutor (or facilitator) who usually comes from either a clinical or academic background, depending on the level of the course. There is an academic, clinical or ethical scenario, where the students select which areas of study to pursue in their own time. Academics at Maastrict University developed seven steps of what should happen in the PBL process:
In keeping with the ethos of self directed learning, during sessions it encourages a shift in power from an academic tutor to the students in a PBL group. However, it will be seen that lectures, tutorials and clinical teaching sessions can play a part in problem-based learning - but the emphasis is on the student to decide how these will enable them to fulfil their learning objectives, rather than passively absorb all information.
The introduction of PBL in the UK coincided with a General Medical Council report, Tomorrow's Doctors , which recommended an increased proportion of learning should be student-centred and self-directed. This encouraged medical schools to adopt PBL, however some medical schools have adopted other methods to increase self-directed learning, whilst others (notably Oxford and Cambridge) have always had a high proportion of student-centred and self-directed learning, and have therefore not introduced PBL. Manchester Medical School adopted a new PBL curriculum in 1994, and were followed by Liverpool Medical School and Glasgow Medical School. Some of the UK medical schools created since that time have adopted problem based learning, although Brighton and Sussex Medical School which, although one of the newest medical schools in the UK, has a lecture-based approach supported by small-group and self-directed work.
Tomorrow's Doctors also criticised the amount of unnecessary scientific knowledge irrelevant to clinical practice that medical students were required to learn, meaning that the curricula were altered in other ways around the same time that PBL was introduced in the UK. One study criticising problem-based learning found that some medical specialist registrars and consultants believe that PBL can promote incomplete learning and educational blind spots; particularly in anatomy and basic medical sciences, due to ultimate decision making within the PBL group resting with the students. This has also brought into question whether the lack of anatomical knowledge adequately prepares graduates for surgery, or negatively affects enthusiasm to enter certain specialties; including academic medicine, surgery, pathology and microbiology., although the purposeful reduction in anatomy teaching within all medical curricula which occurred following Tomorrow's Doctors may be in part to blame for reduced anatomical knowledge, rather than it being due to PBL.
Studies have shown that students believe that PBL increases the educational effect of self study and their clinical inference ability, and although studies are conflicting, one showed that UK PRHO graduates believed that they were better at dealing with uncertainty and knowing their personal limits. Students feel less detached from clinical medicine through PBL and thus this may increase their enthusiasm for learning.
Notably, universities that pioneered successful Problem-based-learning such as University of Montreal or McMaster are themselves prestigious institutions that hold worldwide reputations for clinical and academic excellence, taking the top few percent of worldwide graduate applicants. PBL can be considered to be more suitable to teaching of graduate medicine, whos students may benefit from the maturity of an existing degree and previous experience of self directed learning, and perhaps unsuitable for less able students and undergraduates.
LBL learning consists of information delivered mainly through large lectures or seminars. This was the predominant method of delivering medical education prior to the introduction of PBL, hence the label 'traditional'. Emphasis is placed on factual knowledge in the traditionally pre-clinical components of medicine - physiology, pharmacology, anatomy and biochemistry as well as covering communication skills, ethics and law etc through separate teaching.
Key points in support of LBL include that students gain the opportunity to interact with leading clinicians and academics, whereas PBL tutors may be either underused, or have no medical experience at all. LBL is argued to produce graduates that are capable of practicing across a wide range of medicine, not just key pathologies that are concentrated on by a 'dumbed down' curriculum.
LBL has been criticised for 'spoon feeding' students and thus not preparing them for future continued medical education, which is by necessity, self directed. It also overloads students with information that may not be relevant to their first years in clinical practice.
Significantly, despite the introduction of PBL learning on a UK wide scale, meta-analyses have suggested that PBL education produces graduates with no better factual or clinical knowledge than students from a traditional course, despite in some cases the graduates' belief that they are, questioning whether PBL learning is merely a popular trend. It is accepted by many that although PBL may feature too heavily in certain medical schools at the expense of other medical subjects, PBL itself is a useful tool to facilitate medical education, provided it is not seen as an 'all or nothing' education.
Another division of medical curricula is on the basis of how they integrate or separate the theoretical learning in areas such as anatomy, physiology, ethics, psychology and biochemistry from the clinical areas such as medicine, surgery, obstetrics, paediatrics.
Traditionally, medical courses entirely split the theoretical learning, teaching this on its own for 2-3 years in a pre-clinical course before students went on to study clinical subjects on their own for a further 3 years in a clinical course. In some cases, these were taught at geographically distinct sites or even separate universities, with an entirely separate staff for each course, sometimes with the award of a BA or BSc at the end of the pre-clinical course.
There has been a move for universities have tended to integrate teaching into "systems-based teaching" rather than "subject-based teaching". Eg rather than studying separate distinct modules in anatomy, physiology, ethics, psychology and biochemistry, students study distinct modules in different body systems, eg "heart and lungs" or "nervous system" - during which they will study the anatomy, physiology, biochemistry, psychology, etc relevant to that system. The same also has happened with clinical subjects, so for example rather than studying "medicine" and "surgery" separately, students may have a "heart" module in which they study clinical cardiology and cardiothoracic surgery together. In some medical schools there is integration of clinical and pre-clinical subjects together - eg a "heart" module would include anatomy of the heart, physiology of the heart, clinical examination, clinical cardiology and cardiothoracic surgery being studied in one module.
Since Tomorrow's Doctors , there has been a move in the UK towards integrating clinical and non-clinical subjects together to a greater extent. This has varied considerably between universities, always with an emphasis towards non-clinical subjects towards the start of the course and clinical subjects towards the end. A variety of models are in operation. Any model may use PBL or LBL learning methods: for example Manchester has a PBL-based curriculum but a strong pre-clinical/clinical divide, whilst Brighton and Sussex Medical School has a more integrated curriculum, delivered via a lecture-based programme. Many factors influence the choice of model, including the educational philosophy of the institution and the distance of the attached teaching hospitals to the university base (it is much easier for universities with teaching hospitals nearby to offer an integrated curriculum).
Support for a less integrated course includes that it achieves a basic scientific foundation from which to build clinical knowledge upon in later years. However it is criticised for producing graduates with inferior communication skills and making transition into the clinical environment more difficult in year 3 or 4. Support for a more integrated course includes that by allowing patient interaction early, the course produces students who are more at ease with communicating with patients and better developed interpersonal skills. Criticisms include, questioning whether students in the first year have a place in the healthcare environment, when actual clinical knowledge may be virtually nil.
Students in their final year will begin the process of applying for jobs. The new system, called the UK Foundation Programme, (implemented by the NHS Modernising Medical Careers) involves a simplified online application process, without interviews, based on a matching scheme. Students rank their preferred Foundation Schools (which often comprise a catchment area of two or three cities). They are ranked based both on the answers given on their application form, and their marks gained in examinations during their undergraduate career, the resulting score determines which job the student will get when they graduate. After being selected to a Foundation School, applicants are then selected into specific jobs by a selection procedure determined locally by each Foundation School, which may include an interview, submission of a CV or use of the score gained in MTAS
Previously, another online system called Multi-Deanery Application Process (MDAP) system was used for applications to the Foundation Programme in some areas of the UK. This was criticised in the media and in some medical publications, and was replaced by Medical Training Application System in 2006.
Recently several four year graduate entry schemes have been introduced which cover a similar range and depth of knowledge to the undergraduate scheme but at a more intensive pace. The accelerated pace is largely in the pre-clinical phase of the medical programme, with the GMC mandating a minimum number of clinical hours in the clinical phase of medical degrees.
These courses have a limited number of spaces and include some funding after the first year, so competition is very high. Some sources report in the region of 60 applicants for each place as these courses have become more widely known. Until relatively recently, people over thirty were strongly discouraged from applying. Entrance to these programmes usually involves sitting a competitive selection test. The most common entry examinations are the GAMSAT (Graduate Australian Medical Schools Admissions Test or MSAT (Medical Schools Admissions Test) Some schools may use existing entrance examinations that school leavers are also usually required to take e.g. UKCAT or BMAT (see above).
The admissions criteria for these graduate entry programmes vary between universities - some universities require the applicant's first degree to be in a science-related discipline, whereas others will accept a degree in any subject as sufficient evidence of academic ability.
For detailed advice about entrance to medical school as a graduate or mature student in the UK, visit the Medschools Online website or the good 'Mature FAQ' on graduate programmes Medical forums and sites such as and this are also helpful.
The following 15 Universities offered four year graduate entry programmes to Medicine for entry in September 2007:
University of Birmingham
University of Bristol
University of Cambridge (candidate may offer BMAT)
University of Keele (require GAMSAT)
King's College London (require UKCAT)
University of Leicester (require UKCAT)
University of Liverpool
Newcastle University (require UKCAT)
University of Nottingham (require GAMSAT)
University of Oxford (require UKCAT)
Barts and The London, Queen Mary's School of Medicine and Dentistry (require UKCAT)
University of Southampton (require UKCAT)
St George's, University of London (require GAMSAT)
University of Wales, Swansea (require GAMSAT)
University of Warwick (require UKCAT)
Imperial College London, will offer graduate entry medicine from September 2008 onwards, requiring the UKCAT. Applicants to the standard 6 year undergraduate A100 programme are required to take the BMAT.
It must be noted, however, that graduates are free to apply to the regular five/six year courses. Indeed, universities offering both graduate entry and school leaver entry courses often encourage applications to one of the two course types, depending on the graduate's educational background.
The way the programme is implemented varies across the country: sometimes the intercalated degree will be specifically for medical students (e.g. a supervisor-led research project culminating in a dissertation), whilst sometimes the intercalated student will complete courses offered to final year BSc or masters students. At some medical schools the intercalated degree may be undertaken in a specific subjects (e.g. Immunology, Pathology, Cardiovascular Science, Respiratory Science, Social Medicine, Management, History Of Medicine, Humanities etc), whilst at other medical schools there is a common curriculum for all intercalated students (often with some choice within it).
At many medical schools, the year is optional, and a relatively small percentage of students elect to study for it. In contrast to this, all students at University College London, Imperial College London, Bute Medical School (St Andrews), Oxford and Cambridge study for a BSc/BA in addition to their medical degrees. These five medical schools have a six-year curriculum, in which students complete a three-year pre-clinical course, which leads to a BSc or BA, followed by a three year clinical course, which in combination with the BSc or BA leads to a full medical degree. The degree awarded is BA at Oxford and Cambridge (which later becomes an MA), and BSc at the others. At these five medical schools, it is sometimes also possible to spend extra optional year(s) where one can study for an intercalated masters or doctoral degree in addition to the BSc/BA which all students receive, for example, the University of Cambridge offers an MB PhD programme of nine years total duration comprising preclinical training, the intercalated BA (see above), clinical training and within the clinical training period a PhD.
In contrast to the intercalated degrees mentioned above, there also exists a Bachelor of Medical Science degree (BMedSci). This degree is usually awarded to students who have successfully complete the first three years of pre-clinical medical education. At most universities, students who go on to complete the full clinical course (and are awarded MB ChB or equivalent) do not get the BMedSci, however, at Nottingham, a BMedSci(Hons) is awarded to all students after the first three years of their course whether they continue with clinical studies or not. This due to the inclusion in their 3rd year of a 5,000 to 15,000 word dissertation in an area of their choosing, and completion of 2 special study modules, also in areas of their choosing not always directly related to clinical medicine.
However, Sheffield University Medical School call their intercalated programme of study BMedSci(Hons), while Barts and The London School of Medicine and Dentistry) offer both BMedSci and BSc intercalated qualifications. Like other intercalated degrees, these increase the length of the course by one year.
Until 2003 a BMedSci degree from Newcastle involved a year of intercalation, with a year-long research project, but Newcastle now call their intercalated degrees BSc.
Concluding the year of intercalation students are awarded a Bachelors of Science degree in their chosen subject. Degrees are classified according the British undergraduate degree classification system. This is taken into account in the Foundation Schools Application Form, in which applicants are awarded extra points for a higher class degree. As of 2008, 4 points are awarded to a 1st class BSc, 3 points for a 2:1, 2 points for a 2:2 and 1 point for a third class degree. Interestingly, BMedSci degrees were initially awarded only 1 point regardless, this has now changed and BMedSci degrees are treated the same as Bsc degrees.
The largest free publication in the UK for medical students is the award-winning Medical Student Newspaper It is written and produced entirely by medical students and is distributed in hard copy to the five medical schools of London, and available online for all.
Many students also focus on extracurricular academic activities, for example many UK schools have their own student society dedicated to improving health both within the local area through various action projects and globally, through campaigning and working abroad. Medsin is a fully student run network of healthcare students and is the UK's member of the International Federation of Medical Students' Associations. Other societies are dedicated to raising awareness about careers in surgery or other.
Contrasting Cross-Sectional and Longitudinal Early School Leaver Rates in Canada/ contrastes Entre Les Taux De Décrochage Des ÉLèves Canadiens Des ÉTudes Transversales et Longitudinales
Apr 01, 2009; ABSTRACT. Data analysis is critical to educational planning. Determining the number of school leavers is crucial for a school...