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<?xml version="1.0"?>

<!DOCTYPE TEI.2 SYSTEM "base.dtd">




<title>"WMS, Phase 2 and the LWMS Curriculum"</title></titleStmt>

<publicationStmt><distributor>BASE and Oxford Text Archive</distributor>


<availability><p>The British Academic Spoken English (BASE) corpus was developed at the

Universities of Warwick and Reading, under the directorship of Hilary Nesi

(Centre for English Language Teacher Education, Warwick) and Paul Thompson

(Department of Applied Linguistics, Reading), with funding from BALEAP,

EURALEX, the British Academy and the Arts and Humanities Research Board. The

original recordings are held at the Universities of Warwick and Reading, and

at the Oxford Text Archive and may be consulted by bona fide researchers

upon written application to any of the holding bodies.

The BASE corpus is freely available to researchers who agree to the

following conditions:</p>

<p>1. The recordings and transcriptions should not be modified in any


<p>2. The recordings and transcriptions should be used for research purposes

only; they should not be reproduced in teaching materials</p>

<p>3. The recordings and transcriptions should not be reproduced in full for

a wider audience/readership, although researchers are free to quote short

passages of text (up to 200 running words from any given speech event)</p>

<p>4. The corpus developers should be informed of all presentations or

publications arising from analysis of the corpus</p><p>

Researchers should acknowledge their use of the corpus using the following

form of words:

The recordings and transcriptions used in this study come from the British

Academic Spoken English (BASE) corpus, which was developed at the

Universities of Warwick and Reading under the directorship of Hilary Nesi

(Warwick) and Paul Thompson (Reading). Corpus development was assisted by

funding from the Universities of Warwick and Reading, BALEAP, EURALEX, the

British Academy and the Arts and Humanities Research Board. </p></availability>




<recording dur="00:54:49" n="8686">


<respStmt><name>BASE team</name>



<langUsage><language id="en">English</language>



<person id="nm0445" role="main speaker" n="n" sex="m"><p>nm0445, main speaker, non-student, male</p></person>

<person id="nf0446" role="participant" n="n" sex="f"><p>nf0446, participant, non-student, female</p></person>

<person id="nf0447" role="participant" n="n" sex="f"><p>nf0447, participant, non-student, female</p></person>

<person id="nm0448" role="participant" n="n" sex="m"><p>nm0448, participant, non-student, male</p></person>

<person id="nf0449" role="participant" n="n" sex="f"><p>nf0449, participant, non-student, female</p></person>

<person id="nf0450" role="participant" n="n" sex="f"><p>nf0450, participant, non-student, female</p></person>

<person id="nm0451" role="participant" n="n" sex="m"><p>nm0451, participant, non-student, male</p></person>

<person id="nf0452" role="participant" n="n" sex="f"><p>nf0452, participant, non-student, female</p></person>

<person id="nm0453" role="participant" n="n" sex="m"><p>nm0453, participant, non-student, male</p></person>

<personGrp id="ss" role="audience" size="m"><p>ss, audience, medium group </p></personGrp>

<personGrp id="sl" role="all" size="m"><p>sl, all, medium group</p></personGrp>

<personGrp role="speakers" size="11"><p>number of speakers: 11</p></personGrp>





<item n="speechevent">Lecture</item>

<item n="acaddept">Medicine</item>

<item n="acaddiv">ls</item>

<item n="partlevel">Staff</item>

<item n="module">unknown</item>




<u who="nm0445"><kinesic desc="projector is on showing slide" iterated="n"/> just for those who <pause dur="0.3"/> perhaps were the far side of the room <pause dur="0.3"/> when i was # introducing myself in the sort of round robin there <pause dur="0.5"/> # i'll just say A <pause dur="0.3"/> who i am and <pause dur="0.6"/> quite why i'm <pause dur="0.2"/> standing up here <pause dur="0.3"/> talking to you <pause dur="0.6"/> and perhaps quite what i may be able to tell you <pause dur="1.0"/> # my name's <gap reason="name" extent="2 words"/> <pause dur="0.6"/> i'm a senior lecturer in medical education <pause dur="0.7"/> and <pause dur="0.2"/> i spend <pause dur="0.3"/> half of my time <pause dur="0.4"/> at <gap reason="name" extent="1 word"/> Medical School <pause dur="0.4"/> running <pause dur="0.2"/> the clinical element <pause dur="0.3"/> of phase two <pause dur="0.4"/> of the four year <pause dur="0.3"/> accelerated <pause dur="0.2"/> graduate entry course <pause dur="0.6"/> and pretty much <pause dur="0.8"/> the focus of what i'll be talking about in the next half hour or so <pause dur="1.0"/> but the other half of my time <pause dur="0.2"/> i'm a paediatrician at University Hospitals <gap reason="name" extent="1 word"/> and <gap reason="name" extent="1 word"/> N-H-S Trust <pause dur="0.5"/> # doing general paediatrics with a special interest in food allergy <pause dur="0.4"/> so that's kind of who i am <pause dur="0.5"/> and what i do <pause dur="5.0"/><kinesic desc="changes slide" iterated="n"/> what i've <pause dur="0.4"/> really been asked to do <pause dur="0.3"/> is <pause dur="1.2"/> to try and <pause dur="0.3"/> give you an overview <pause dur="0.3"/> of <pause dur="0.8"/> the phase two <pause dur="0.3"/> of our course <pause dur="1.0"/> perhaps <pause dur="0.2"/> for those of you who are particularly <pause dur="0.4"/> new to this enterprise it might be worth just <pause dur="0.3"/> very

briefly <pause dur="0.3"/> mentioning phase one of the course <pause dur="0.3"/> and how they fit together <pause dur="0.2"/> would that be useful for people </u><pause dur="0.3"/> <u who="nf0446" trans="pause"> yes </u><pause dur="0.2"/> <u who="nm0445" trans="pause"> yeah <pause dur="1.6"/> as hopefully you're aware <pause dur="0.6"/> this is a <pause dur="0.2"/> four year <pause dur="0.3"/> accelerated <pause dur="0.4"/> graduate entry <pause dur="0.6"/> medical school <pause dur="1.1"/> and <pause dur="0.3"/> we are <pause dur="0.6"/> the only <pause dur="0.4"/> pure graduate entry medical school <pause dur="0.4"/> at the moment <pause dur="0.7"/> # although there are a number of graduate entry streams <pause dur="0.5"/> that operate either <pause dur="0.6"/> fairly well integrated to school leaver streams <pause dur="0.2"/> or relatively as separate entities just within the same school <pause dur="0.3"/> in other places <pause dur="0.9"/> and <pause dur="0.4"/> compared <pause dur="0.5"/> to <pause dur="0.8"/> other graduate entry streams and they're slowly coming online round the country <pause dur="0.6"/> # <pause dur="0.5"/> we are <pause dur="0.3"/> probably <pause dur="0.2"/> the narrowest in terms of the sorts of graduates <pause dur="0.3"/> we take in that we accept <pause dur="0.4"/> biomedical <pause dur="0.3"/> science <pause dur="0.2"/> graduates <pause dur="1.1"/> there is a separate stream that's just started off <pause dur="0.3"/> at <gap reason="name" extent="1 word"/> this summer <pause dur="0.3"/> which is obviously following a fairly similar course and certainly with the same assessments <pause dur="0.2"/> which

is taking <pause dur="0.3"/> healthcare <pause dur="0.2"/> science <pause dur="0.2"/> graduates <pause dur="0.7"/> but we here are only currently taking biomedical science graduates <pause dur="1.2"/> we can discuss over coffee afterwards if that's a good thing or a bad thing or or whatever but <pause dur="0.2"/> that's <pause dur="0.3"/> who we currently get in <pause dur="1.6"/> # <pause dur="0.4"/> so for instance you could get into ours <pause dur="0.2"/> with <pause dur="0.2"/> biochemistry <pause dur="0.5"/> genetics physiology those kind of things as first degrees <pause dur="0.2"/> but we wouldn't let you in <pause dur="0.5"/> with a physiotherapy degree <pause dur="0.4"/> or with a pure <pause dur="0.4"/> chemistry degree <pause dur="0.4"/> or a pure physics degree <pause dur="1.1"/> so we're taking a relatively narrow tranche of students <pause dur="1.4"/> we're giving them a four year course <pause dur="0.8"/> as opposed to the five year <pause dur="0.2"/> course # that <pause dur="0.3"/> runs for the school <pause dur="0.4"/> leavers at Easter <pause dur="0.7"/> and <pause dur="0.3"/> all <pause dur="0.2"/> the time we've chopped off the course <pause dur="0.2"/> is chopped off the early <pause dur="0.4"/> part of the course <pause dur="1.3"/> the school <pause dur="0.2"/> leavers who go to <gap reason="name" extent="1 word"/> do five years <pause dur="0.3"/> they do <pause dur="0.2"/> two-and-a-half years of phase one <pause dur="0.5"/> two-and-a-half years of phase two <pause dur="1.3"/> broadly speaking <pause dur="0.6"/> phase one is university based <pause dur="0.3"/> and broadly preclinical <pause dur="1.0"/> and phase two <pause dur="0.3"/> is pretty

much hospital based <pause dur="0.4"/> and broadly clinical <pause dur="0.7"/> having said that <pause dur="0.3"/> as i'm sure you're aware <pause dur="0.3"/> everybody integrated their courses years ago so we're not actually allowed to use those labels <pause dur="0.4"/> but in terms of understanding <pause dur="0.2"/> where the students are and what they're doing <pause dur="0.2"/> that's broadly the case although clearly there was clinical exposure <pause dur="0.2"/> from the beginning within phase one <pause dur="1.6"/> phase one <pause dur="0.4"/> is modular <pause dur="0.5"/> mainly systems based modules but also a number of <pause dur="0.3"/> # social science based modules and <pause dur="0.3"/> health policy and other such such modules <pause dur="0.5"/> and <pause dur="1.0"/> the <pause dur="0.3"/> students that come here <pause dur="0.3"/> broadly <pause dur="0.4"/> miss <pause dur="0.2"/> the basic <pause dur="0.2"/> science modules <pause dur="0.4"/> because the presumption is that we've collected a stream of people <pause dur="0.2"/> who have <pause dur="1.0"/> either that to a great depth or the ability <pause dur="0.3"/> to <pause dur="0.4"/> get up to that level relatively rapidly <pause dur="1.3"/> as an interesting aside <pause dur="0.5"/> irrespective <pause dur="0.4"/> of your first degree <pause dur="0.7"/> you do the same course <pause dur="0.7"/> so we don't run all modules and we chop and change depending on where people's strengths and weaknesses are <pause dur="0.2"/> they all do the same stuff <pause dur="0.6"/>

they all miss out <pause dur="0.2"/> the same modules from phase one <pause dur="2.6"/> as a sort of reaction to that or perhaps a way of of dealing with that a lot of phase one <pause dur="0.4"/> is based around <pause dur="0.4"/> group learning <pause dur="0.9"/> and <pause dur="0.6"/> the groups are deliberately structured <pause dur="0.5"/> to have a range of <pause dur="1.1"/> students with a range of first degrees <pause dur="0.3"/> so hopefully as they go through phase one <pause dur="0.7"/> if they operate nicely within their groups the strengths of those individuals <pause dur="0.2"/> will help the group <pause dur="0.4"/> and the balance between the groups <pause dur="0.6"/> should <pause dur="0.2"/> help hopefully ensure that <pause dur="1.1"/> # <pause dur="1.0"/> perhaps that works well perhaps in some groups that doesn't there's a lot of dynamic <pause dur="0.3"/> industry going on there <pause dur="2.1"/> after they've done <pause dur="0.2"/> that <pause dur="0.2"/> eighteen months of phase one <pause dur="0.2"/> shortened from two-and-a-half years <pause dur="0.3"/> they come into phase two <pause dur="0.4"/> which is in effect the full-time <pause dur="0.2"/> clinical placements <pause dur="1.8"/> that's pretty much all i planned to say about phase one <pause dur="0.4"/> because that's not the main topic of what i'm talking about here <pause dur="0.8"/> but can i just pause for a second just in case there is anything that <pause dur="0.2"/> people want

clarification <pause dur="0.3"/> bearing in mind i'm not the phase one coordinator and it's not my prime role but if there is anything <pause dur="0.4"/> that <pause dur="0.9"/> that people will <trunc>al</trunc> be always be desperate to know or that doesn't make sense of what i've just said <pause dur="3.6"/> okay <pause dur="0.2"/> thank you very much so i'll <pause dur="0.2"/> i'll <pause dur="1.3"/> carry on with with perhaps the sort of main meat of what i was going to say <pause dur="1.5"/> what i'm hoping to do <pause dur="0.6"/> is <pause dur="0.4"/> tell you why <pause dur="0.2"/> the clinical course <pause dur="0.3"/> at <gap reason="name" extent="1 word"/> Medical School is arranged in the way it is <pause dur="0.4"/> because as will become <pause dur="0.7"/> fairly clear <pause dur="0.3"/> fairly quickly <pause dur="0.7"/> unless <pause dur="0.2"/> you're a recent <gap reason="name" extent="1 word"/> graduate <pause dur="0.2"/> it will be <pause dur="0.9"/> fundamentally different <pause dur="0.8"/> from <pause dur="0.2"/> the majority <pause dur="0.2"/> of medical courses running <pause dur="0.2"/> in the U-K at present <pause dur="0.6"/> it is an unusual model <pause dur="1.3"/> some would say it's quite a brave and dynamic model some would say that causes some problems but we'll go through that in a bit more detail <pause dur="0.4"/> but it is different <pause dur="0.8"/> and i think that's important <pause dur="2.3"/> having <pause dur="0.4"/> started on that i'll then hopefully give you enough information so at least you know the structure <pause dur="0.2"/> and how it's

put together <pause dur="0.6"/> and then <trunc>o</trunc> <pause dur="0.3"/> we'll lead on to a period of discussion <pause dur="0.3"/> which hopefully will bring out some of the issues <pause dur="0.2"/> that <gap reason="name" extent="1 word"/> was mentioning at the beginning <pause dur="0.3"/> about learning styles <pause dur="0.3"/> and about self-directed learning <pause dur="0.4"/> and <pause dur="0.3"/> the sorts of students <pause dur="0.4"/> who find our course a good way <pause dur="0.6"/> of doing things and the sorts of students that struggle <pause dur="0.7"/> and hopefully that'll come <trunc>u</trunc> <pause dur="0.4"/> up in discussion a bit <pause dur="3.0"/> i'll also <pause dur="0.7"/> try and underline some of the challenges <pause dur="0.2"/> that this particular way of doing things gives us <pause dur="0.2"/> which may or may not be a little bit different <pause dur="0.2"/> from <pause dur="0.8"/> other medical courses <pause dur="3.7"/><kinesic desc="changes slide" iterated="n"/> going right back to the beginning <pause dur="1.8"/> there is a stated philosophy <pause dur="0.2"/> for our curriculum <pause dur="0.6"/> which broadly is the sort of thing that's come out of the G-M-C anyway and broadly <pause dur="0.2"/> is the sort of the thing <pause dur="0.2"/> that the majority of medical schools will <trunc>sta</trunc> state that they're trying to do <pause dur="0.4"/> but i think as will become clear <pause dur="0.4"/> # perhaps <pause dur="0.2"/> the curriculum we are running here has really bitten the bullet and actually tried to

develop <pause dur="0.5"/> on the basis of these principles <pause dur="1.3"/> being <pause dur="0.2"/> that doctors must be lifelong learners the sort of thing that gets thrown out on many many occasions <pause dur="0.7"/> but perhaps <pause dur="0.2"/> it does mean something perhaps there's something we can do about that in the course <pause dur="1.2"/> and <pause dur="0.8"/> it's stated that our curriculum is designed <pause dur="0.2"/> to help students take charge of their own learning <pause dur="3.0"/> and <pause dur="0.6"/> that phase one <pause dur="0.3"/> which is broadly <pause dur="0.2"/> group work <pause dur="0.3"/> with a variety of levels of support <pause dur="0.6"/> is <pause dur="0.2"/> a preparation <pause dur="0.5"/> for the self-directed learning that they will have to do <pause dur="0.4"/> if they're going to <trunc>s</trunc> be successful in phase two of the course <pause dur="0.6"/> in the clinical environments <pause dur="4.5"/><kinesic desc="changes slide" iterated="n"/> the majority <pause dur="0.4"/> of us who are medically qualified in this room will have gone <pause dur="0.7"/> to a variety of medical schools if you graduated <pause dur="0.3"/> from the U-K in the last ten to fifteen years you will have done <pause dur="0.4"/> an integrated course of some sort <pause dur="0.2"/> probably <pause dur="0.3"/> although there were examples of of people holding on to even older models <pause dur="0.7"/> # <pause dur="1.3"/> but <pause dur="0.5"/> you will probably <pause dur="0.3"/> have had a course

which attempted <pause dur="0.3"/> to teach you <pause dur="0.5"/> a lot of different things <pause dur="0.9"/> that was <pause dur="0.5"/> loaded with content <pause dur="0.2"/> to <pause dur="0.2"/> # up to a point <pause dur="1.7"/> and <pause dur="1.0"/> tried <pause dur="0.2"/> to gain experience for the students over a number of specialties <pause dur="0.9"/> certainly <pause dur="0.5"/> i remember as a student having my fortnight in E-N-T <pause dur="0.7"/> and i remember learning not very much there <pause dur="0.9"/> certainly as a year we were shuffled through <pause dur="0.7"/> in phases of our clinical course <pause dur="0.2"/> a lot of brief <pause dur="0.2"/> clinical experiences <pause dur="0.4"/> in relatively large groups <pause dur="0.7"/> where <pause dur="0.3"/> the teachers didn't particularly know us <pause dur="0.3"/> because we were coming on so quickly <pause dur="0.7"/> and <pause dur="0.5"/> it very much felt we were being given a sort of cycle of teaching <pause dur="0.4"/> on a rapid basis and in a fortnight <pause dur="0.4"/> it's actually relatively easy to just miss the point and not get anything out of it <pause dur="1.1"/> and <pause dur="1.2"/> with the increasing subspecialization of hospital medicine <pause dur="0.5"/> this was a trend that was continuing and continuing <pause dur="0.6"/> it was no longer good enough to spend send students to general medicine <pause dur="0.4"/> you had to spend send them <pause dur="0.2"/> to <pause dur="0.2"/> chest medicine <pause dur="0.2"/> and cardiology <pause dur="0.7"/> and

gastroenterology <pause dur="0.8"/> and <pause dur="0.4"/> as divisions <pause dur="0.2"/> and <pause dur="0.2"/> more and more subdivisions <pause dur="0.2"/> appeared <pause dur="0.3"/> the tendency was to cut courses into smaller more smaller segments <pause dur="0.2"/> trying to gain <pause dur="0.2"/> the breadth of experience for the students <pause dur="0.2"/> by rushing them round all the specialties <pause dur="3.1"/> one of the upshots of this was that something that's always said about U-K medical education is it runs on an apprenticeship model <pause dur="0.9"/> and that almost certainly broadly is not true <pause dur="1.3"/> # and certainly the model of rushing everybody round in groups of six or eight <pause dur="0.5"/> briefly through a <trunc>n</trunc> <trunc>l</trunc> a large number of short clinical experiences <pause dur="0.4"/> gave little chance <pause dur="0.2"/> for the students to get to know the teachers the teachers to get to know the students <pause dur="0.3"/> and <pause dur="0.2"/> the students to model themselves on the teachers in any <pause dur="0.2"/> meaningful way <pause dur="0.4"/> which would be the elements if apprenticeship was going to actually work as a concept <pause dur="3.4"/> there was also <pause dur="0.4"/> little opportunity <pause dur="0.2"/> for self-directed learning <pause dur="1.0"/> on your timetable you were shuffled off to E-N-T <pause dur="0.4"/> got to

learn a bit of E-N-T <pause dur="0.8"/> a few seminars packing some information in <pause dur="0.5"/> not a lot of opportunity <pause dur="0.2"/> for students to work out where they are <pause dur="0.2"/> what they're doing <pause dur="0.2"/> where their strengths are where their weaknesses are where they need to be working <pause dur="4.0"/><kinesic desc="changes slide" iterated="n"/> on the basis of this <pause dur="0.5"/> the <pause dur="0.2"/> new <gap reason="name" extent="1 word"/> curriculum which has subsequently <pause dur="0.2"/> become <pause dur="0.3"/> the <gap reason="name" extent="2 words"/> curriculum which is the curriculum we follow <pause dur="3.4"/> was made up of <pause dur="0.8"/> what perhaps are a series of relatively <pause dur="0.7"/> old ideas <pause dur="0.7"/> rather unusually <pause dur="0.2"/> for a medical course <pause dur="0.2"/> it was made very very explicit <pause dur="0.5"/> exactly what the learning outcomes for the whole clinical course were <pause dur="0.8"/> so there was a book <pause dur="0.7"/> it's there i should have brought a copy with me to wave at you actually but if you haven't otherwise seen it it's The Objectives of Phase Two Curriculum <pause dur="0.5"/> and <pause dur="0.4"/> if you want a copy if you can get in touch with us we can send you it <pause dur="0.5"/> # <pause dur="0.2"/> and it shows <pause dur="0.2"/> everything <pause dur="0.3"/> in a list <pause dur="0.2"/> that we expect of the students <pause dur="0.6"/> and <pause dur="0.3"/> it's based on the competencies required of a new P-R-H-O which is what

the G-M-C tell us we should be doing <pause dur="0.6"/> but <pause dur="0.4"/> we are <pause dur="0.3"/> completely explicit <pause dur="0.3"/> on paper <pause dur="0.2"/> there it is <pause dur="0.2"/> this is what they've got to learn they've got two-and-a-half years to learn it <pause dur="0.5"/> and it's listed <pause dur="0.3"/> and the assessments are based on that document and therefore <pause dur="0.3"/> if they know what's in there they should pass <pause dur="0.2"/> in theory <pause dur="4.0"/> there was also a move <pause dur="0.9"/> from <pause dur="0.4"/> away a very strong move away from lots and lots of short attachments <pause dur="0.7"/> and this is perhaps <pause dur="0.9"/> the boldest <pause dur="0.2"/> part <pause dur="0.3"/> of <pause dur="0.2"/> the phase two curriculum that we operate here <pause dur="0.7"/> in that instead <pause dur="0.4"/> of <pause dur="1.0"/> taking the students in groups round lots of short attachments <pause dur="0.8"/> we <pause dur="0.2"/> attach them currently in pairs although that may need to go up to threes at some point with expanding numbers <pause dur="1.0"/> of students <pause dur="0.3"/> to two consultants <pause dur="1.1"/> in hospital <pause dur="0.2"/> for the hospital attachments <pause dur="0.5"/> and therefore we attach them at a ratio <pause dur="0.3"/> of one to one <pause dur="1.7"/> two students two consultants <pause dur="0.5"/> and <pause dur="0.3"/> we give them eight weeks <pause dur="0.6"/> to get on and do something useful <pause dur="0.6"/> so we're using long attachments <pause dur="1.0"/> where a small number of students <pause dur="0.2"/> are

attached to an equal number of consultants <pause dur="2.2"/> the argument being <pause dur="0.7"/> that that gives <pause dur="0.2"/> time <pause dur="0.3"/> for the students to know learners <pause dur="0.2"/> the sorry learners to know the teachers teachers to know the learners <pause dur="0.7"/> for them <pause dur="0.2"/> to actually plan what learning's going to take <pause dur="0.5"/> be undertaken during that eight weeks for them to implement that <pause dur="0.2"/> for some degree of apprenticeship or <unclear>wardling</unclear> or that kind of thing to go on <pause dur="0.8"/> and also <pause dur="0.2"/> for at the end of the process hopefully the teacher to be able to say something sensible <pause dur="0.2"/> about the student <pause dur="0.2"/> having known them for <pause dur="0.4"/> a period of time and not just had them rush around with the group for two weeks <pause dur="0.8"/> <vocal desc="clears throat" iterated="n"/> <pause dur="1.3"/> those of you <pause dur="0.4"/> who are good at quick maths will realize <pause dur="0.4"/> that if we've got two-and-a-half years and they're being attached in blocks of eight weeks <pause dur="0.5"/> you don't actually <pause dur="0.2"/> get that many eight week blocks <pause dur="0.8"/> and indeed in total <pause dur="0.3"/> in addition to the medical elective which is still within the curriculum <pause dur="0.9"/> they have twelve <pause dur="0.3"/> eight week blocks <pause dur="1.1"/> now there were certain

elements <pause dur="0.7"/> that were felt to be tangibly different that had to be taught as a specialty block <pause dur="0.7"/> and those <pause dur="0.3"/> are <pause dur="0.2"/> psychiatry <pause dur="1.0"/> clinical methods <pause dur="0.5"/> obs and gynae <pause dur="0.8"/> and child health <pause dur="1.6"/> and they are taught as eight week blocks <pause dur="1.5"/> everything else <pause dur="0.8"/> is taught <pause dur="0.2"/> in the remaining <pause dur="0.8"/> now we're just down to eight <pause dur="0.5"/> eight week blocks <pause dur="0.7"/> and once i get into the sort of <pause dur="0.7"/> the <pause dur="0.6"/> descriptions of how those are actually worked out we can talk a bit more about those in detail <pause dur="4.4"/><kinesic desc="changes slide" iterated="n"/> these <pause dur="1.7"/> what actually goes on <pause dur="0.6"/> in these eight week blocks <pause dur="0.8"/> has varied to a degree over time <pause dur="0.7"/> from the inception to curriculum <pause dur="0.4"/> to where we are now <pause dur="1.5"/> the original notion was <pause dur="0.6"/> that if you gave a good student to teacher ratio <pause dur="0.5"/> and you gave them <pause dur="0.7"/> eight <pause dur="0.2"/> long attachment blocks <pause dur="0.5"/> almost on a random basis <pause dur="0.6"/> and you told them what they needed to learn <pause dur="0.4"/> then lots of good learning would go on <pause dur="1.7"/> and <pause dur="0.2"/> that didn't work very well <pause dur="0.9"/> because <pause dur="1.0"/> the students could really have <pause dur="0.4"/> a very <pause dur="1.3"/> very different sequence of attachments <pause dur="0.3"/> and could for

instance spend an awful lot of time with dermatologists <pause dur="0.6"/> and no time at all <pause dur="0.3"/> with certain other <pause dur="0.3"/> important areas <pause dur="0.8"/> so <pause dur="0.6"/> after a while efforts were made <pause dur="0.2"/> to <pause dur="0.7"/> take <pause dur="0.4"/> them through some sort of sequence <pause dur="0.6"/> where <pause dur="0.2"/> where <pause dur="0.2"/> there were <pause dur="0.6"/> surgically labelled eight week blocks and medically labelled eight week blocks <pause dur="0.2"/> some of which were more specialist than others <pause dur="0.6"/> and this culminated in there actually then being an extra specialist block invented which was kind of a rehab block <pause dur="0.3"/> which goes under the <pause dur="0.2"/> unedifying title of Geri-ortho <pause dur="0.3"/> because it's # elderly care physician and an orthopaedic surgeon <pause dur="1.1"/> so having gone from this very <pause dur="0.3"/> out of the grey superrandomness great things will happen <pause dur="0.5"/> an increasing amount of structure was put in <pause dur="0.4"/> and this is before we got started at this end this is very much at the <gap reason="name" extent="1 word"/> end <pause dur="1.1"/> and <pause dur="0.4"/> as the numbers have become more pressured <pause dur="0.8"/> the elements of structure that are in there <pause dur="0.2"/> have actually started to creak a little bit at the edges and look a

little bit <pause dur="0.4"/> # <pause dur="0.2"/> suspect <pause dur="3.7"/><kinesic desc="changes slide" iterated="n"/> so this is what it looks like <pause dur="0.5"/> # <pause dur="0.9"/> that is <pause dur="0.5"/> the timeline <pause dur="1.0"/> from left to right <pause dur="0.2"/> of the phase two curriculum <pause dur="2.2"/> with the various elements <pause dur="2.7"/> they start off <pause dur="1.6"/> with a junior <pause dur="0.3"/> period <pause dur="1.5"/> they have an exam <pause dur="0.6"/> and they go into a senior period <pause dur="1.8"/><kinesic desc="changes slide" iterated="n"/> and within the junior and senior periods <pause dur="0.3"/> there are <pause dur="0.2"/> big blocks of general <pause dur="0.2"/> clinical education <pause dur="0.8"/> within the junior <pause dur="0.4"/> they have four <pause dur="0.8"/> eight week blocks <pause dur="1.0"/> and within the senior they have a further four <pause dur="2.9"/> the specialties are <pause dur="0.4"/> also <pause dur="0.8"/> there <kinesic desc="indicates point on slide" iterated="n"/><pause dur="0.7"/> Clinical Method <pause dur="0.4"/> and Psychiatry <pause dur="0.4"/> coming in <pause dur="1.4"/> for the most junior students <pause dur="0.6"/> Child Health and Obs and Gynae <pause dur="0.2"/> coming in for the more senior <pause dur="4.4"/><kinesic desc="changes slide" iterated="n"/> going back to <pause dur="0.2"/> the general clinical education blocks because i think these are the most interesting <pause dur="1.8"/> i've already said <pause dur="0.9"/> that at the beginning <pause dur="0.9"/> there was very little structure as to how these were organized <pause dur="3.0"/> we are <pause dur="0.2"/> at the moment looking at that <pause dur="0.2"/> quite active plan <pause dur="0.6"/> because <pause dur="0.4"/> there still isn't that much structure <pause dur="0.7"/> to it <pause dur="1.1"/> because <pause dur="0.2"/> at the moment <pause dur="1.2"/>

there is actually the last block they get block twelve they get a bit of choice <pause dur="1.4"/> as to what they do which is a nice thing <pause dur="0.5"/> but that means our four and four eight blocks are now down to seven <pause dur="1.6"/> one of those is the so-called Geri-ortho <pause dur="0.2"/> which gets us down to six <pause dur="1.2"/> and of the remainder <pause dur="0.8"/> i've lost some in my maths somewhere <pause dur="0.7"/> i've remembered <trunc>clini</trunc> </u><u who="nf0447" trans="overlap"> <gap reason="inaudible" extent="1 sec"/> yes </u><u who="nm0445" trans="overlap"> <unclear># just that</unclear> <pause dur="0.6"/> <unclear>you see</unclear> <pause dur="0.2"/> # <pause dur="0.4"/> there is also one of those senior blocks is <trunc>tau</trunc> is taken up with the some generic teaching <pause dur="0.3"/> and a little bit of choice which is something called the clinical special study module <pause dur="0.4"/> so that gets us down to five blocks <pause dur="1.3"/> now at the moment <pause dur="0.8"/> the general clinical education that isn't geri-ortho <pause dur="0.4"/> is arranged to either be specialist medicine sorry general medicine <pause dur="0.6"/> or <trunc>spe</trunc> <pause dur="0.2"/> or general surgery <pause dur="0.4"/> or specialist medicine <pause dur="0.2"/> which is divided into specialist medicine one and specialist medicine two <pause dur="0.4"/> or specialist surgery one and specialist surgery two <pause dur="1.4"/> so <pause dur="1.0"/> three medical <pause dur="0.5"/> three surgical <pause dur="0.7"/> types of blocks

available <pause dur="0.5"/> five slots in which to do it <pause dur="1.0"/> basically means <pause dur="0.2"/> that not all students do all types of blocks <pause dur="1.8"/> which and in addition to that <pause dur="0.2"/> they can do <pause dur="1.3"/> any of those blocks <pause dur="0.3"/> in either junior <pause dur="0.4"/> or senior <pause dur="0.8"/> which actually means <pause dur="0.3"/> that <pause dur="0.4"/> one particular group of teachers could have one group of students <pause dur="0.2"/> who were brand new to the clinical course <pause dur="0.2"/> for one <trunc>w</trunc> eight weeks <pause dur="0.3"/> and the next eight weeks they might have some that have just finished <pause dur="1.3"/> which may keep their life interesting <pause dur="0.3"/> but it also means <pause dur="0.3"/> that we can't <pause dur="0.2"/> put together <pause dur="0.5"/> teaching partnerships with consultants <pause dur="0.2"/> that are particularly suitable <pause dur="1.0"/> for students at the beginning of the course <pause dur="0.2"/> or particularly suitable for students at the end of the course <pause dur="0.3"/> because at the moment <pause dur="0.6"/> they could undertake them at any point in the course <pause dur="3.6"/> the other thing to say about this is i've already said <pause dur="0.9"/> that <pause dur="1.5"/> one of the problems was the number of specialties students had to rush through <pause dur="1.7"/> now clearly on this <trunc>m</trunc> model <pause dur="0.7"/> they are only going to get exposed <pause dur="0.2"/> to

five plus an optional <pause dur="0.2"/> six different <pause dur="0.3"/> things <pause dur="1.2"/> they're not all going to get E-N-T <pause dur="0.8"/> although there are E-N-T surgeons in both the partnerships as some will know <pause dur="0.4"/> they're not all going to get opthalmology <pause dur="1.1"/> they are going to get some general medicine but they're not all going to get cardiology respiratory medicine gastroenterology <pause dur="1.5"/> and this is one of the fundamental things to understand about this way of delivering our curriculum <pause dur="0.7"/> that <pause dur="0.4"/> we are <pause dur="0.2"/> not aiming <pause dur="0.2"/> to fulfil <pause dur="0.2"/> their learning needs by rushing them round a bunch of specialists <pause dur="0.2"/> who happen to have specialist knowledge in particular areas <pause dur="0.8"/> we are looking <pause dur="0.2"/> to address their learning needs <pause dur="0.5"/> by giving them a list of what they need to learn and putting them in a series <pause dur="0.2"/> of clinical situations <pause dur="0.5"/> where there are opportunities <pause dur="2.7"/> but <pause dur="1.0"/> if they just sit back and wait for it to wash over them <pause dur="0.9"/> they are not going to meet everything by a long shot <pause dur="1.7"/> they <pause dur="0.5"/> not only are encouraged to take control of their learning <pause dur="0.4"/> but if they don't they're

not going to do very well <pause dur="2.7"/> do people see what i'm saying about that <pause dur="0.4"/> that it is quite <pause dur="0.5"/> a radical and different way of looking at things <pause dur="0.8"/> and it's a <trunc>w</trunc> <pause dur="0.6"/> way that <pause dur="0.3"/> some of the students get and some of them don't <pause dur="1.1"/> a lot of them say oh well we were never taught such and such <pause dur="1.0"/> they might be coming to you <unclear>today</unclear> you know we <pause dur="0.3"/> we we've not done E-N-T <pause dur="0.6"/> so i don't know it <pause dur="0.3"/> so i'm not prepared to think about it <pause dur="1.0"/> is that something that people have come across in their practice oh we we didn't we didn't do that <pause dur="0.4"/> we didn't do head and neck <pause dur="0.9"/> yeah <pause dur="1.0"/> we just don't do it <pause dur="0.8"/> it's not important can't matter <pause dur="2.1"/> i think in discussion we can talk a little bit more about <pause dur="0.3"/> how different <trunc>stu</trunc> types of students cope with this <pause dur="0.9"/> but that <pause dur="0.4"/> is the theory of what we do <pause dur="0.2"/> and how it's actually practically arranged <pause dur="1.6"/> the specialist blocks are much more like your <pause dur="0.2"/> traditional <pause dur="0.6"/> blocks <pause dur="0.2"/> you know eight weeks of obs and gynae eight weeks of psychiatry <pause dur="0.6"/> # <pause dur="1.1"/> although interestingly these are our most pressured

blocks in terms of finding new <pause dur="0.3"/> new placements for increasing student numbers <pause dur="0.8"/> up to a point we are protected in the general clinical education <pause dur="0.2"/> block end <pause dur="0.4"/> because as far as our curriculum's concerned we could send them to nearly anybody <pause dur="0.6"/> although actually there's probably <pause dur="0.3"/> some sort of <pause dur="0.3"/> moral compulsion on us to actually send them to reasonably good people in reasonably good combinations in a reasonably good order <pause dur="0.9"/> but there's no compulsion for us to find X number <pause dur="0.5"/> of <pause dur="0.8"/> opthalmologists or X number <pause dur="0.2"/> of <pause dur="0.2"/> E-N-T surgeons <pause dur="2.2"/> the elective still exists and it comes just after <pause dur="0.3"/> phase one and they've done Intermediate Clinical Examination <pause dur="1.1"/> just as an aside <pause dur="0.2"/> # <pause dur="1.7"/> medical student electives <pause dur="0.2"/> are a very interesting beast <pause dur="0.3"/> they've been around since the seventies <pause dur="1.1"/> we are <pause dur="0.8"/> # in effect although we're not <pause dur="0.2"/> officially a new medical school because we're set up with <gap reason="name" extent="1 word"/> <pause dur="0.9"/> but we're certainly a university <pause dur="0.2"/> that is new to having medical students around <pause dur="0.6"/> and quite sensibly are asking lots of

sensible questions about <pause dur="0.3"/> safety security supervision <pause dur="0.4"/> # <pause dur="0.2"/> consistency of marking <pause dur="0.3"/> # <pause dur="0.6"/> institutional <pause dur="0.2"/> responsibility all that kind of thing about the medical student elective <pause dur="0.7"/> which are all the sorts of questions <pause dur="0.2"/> that actually all the other medical schools should probably be asking themselves anyway <pause dur="0.5"/> so who knows what's going to happen with that <pause dur="0.2"/> but watch this space <pause dur="0.4"/> we are currently in the process of getting a legal opinion as to quite where we stand and all that <pause dur="1.4"/> but anyway <pause dur="2.1"/> there are two summative assessments the intermediate clinical exam and the final professional exam <pause dur="0.4"/> which come between <pause dur="0.2"/> junior and senior <pause dur="0.4"/> and then <pause dur="0.9"/> after senior <pause dur="0.7"/> and <pause dur="0.7"/> if people are particularly interested in those we can chat afterwards about quite how they're structured <pause dur="0.7"/> but broadly <pause dur="1.0"/> the intermediate clinical exam <pause dur="0.4"/> is a version <pause dur="0.3"/> of the <trunc>s</trunc> assessments you are doing <pause dur="0.3"/> within <pause dur="0.2"/> clinical methods of the observed consultation type assessments <pause dur="0.4"/> and final professional exam <pause dur="0.3"/> is the same again <pause dur="0.2"/> only at a

slightly higher level <pause dur="0.3"/> plus <pause dur="0.2"/> a written paper <pause dur="4.3"/><kinesic desc="changes slide" iterated="n"/> we've got a number of challenges at the moment in the system <pause dur="0.7"/> i've already <pause dur="0.7"/> said <pause dur="0.2"/> that <pause dur="0.2"/> capacity is a challenge <pause dur="0.2"/> # <pause dur="1.0"/> it's a challenge up and down the country i think # <pause dur="0.6"/> we're trying to run a medical school on a population of about eight-hundred-thousand which is not a desperately large <pause dur="0.3"/> population to try and run a relatively large medical school <pause dur="0.6"/> but capacity although it is a particular local problem is also a national issue as there are new medical schools popping up all over the place <pause dur="0.5"/> # <trunc>pu</trunc> <pause dur="0.3"/> taking up those pools of population that the other medical schools use to feed students who <pause dur="0.2"/> on an in <unclear>creeping</unclear> basis and keep their courses running <pause dur="0.9"/> but there are also the specific challenges of areas like <pause dur="0.2"/> child health for instance <pause dur="0.4"/> # <pause dur="0.6"/> which are problematic <pause dur="0.3"/> not because of availability of teachers <pause dur="0.2"/> particularly <pause dur="0.3"/> but the availability <pause dur="0.3"/> of <pause dur="0.3"/> young children <pause dur="0.7"/> because there aren't enough children <pause dur="0.7"/> or there aren't as many children as there used to be

out there and they're in better health <pause dur="0.5"/> so <pause dur="0.7"/> we need to think perhaps more radically about how addressing some of those issues <pause dur="0.4"/> or perhaps we should just cancel the immunization programme and then we'll get # <pause dur="0.3"/><vocal desc="laughter" iterated="y" n="ss" dur="1"/> much iller <pause dur="0.2"/> and # <pause dur="0.3"/> we could teach our students much better <pause dur="3.1"/><vocal desc="laughter" iterated="y" n="ss" dur="1"/> there is a challege here <pause dur="1.5"/> though that's much more inherent to the structure of our course <pause dur="0.5"/> about the quality <pause dur="0.3"/> of experience they get <pause dur="1.6"/> clearly <pause dur="1.4"/> they get <pause dur="0.3"/> a <pause dur="0.2"/> hopefully <pause dur="0.5"/> deeper <pause dur="1.3"/> more personal experience <pause dur="0.2"/> within their eight week attachments <pause dur="0.5"/> but they don't get the breadth of the specialty experience <pause dur="0.4"/> that other medical students get up and down the country <pause dur="0.3"/> and that is a direct trade-off <pause dur="1.3"/> but we have to look <pause dur="0.5"/> about whether there are particular things that they struggle to get <pause dur="0.7"/> whether there are particular skills <pause dur="0.2"/> particularly like <pause dur="0.7"/> ophthalmoscopy <pause dur="0.2"/> or E-N-T examination i keep using those as examples <pause dur="0.4"/> # <pause dur="0.4"/> that we have to put in structurally in another way <pause dur="0.2"/> to bridge

certain gaps <pause dur="0.9"/> but up to a point that's a direct trade-off if we're going to give them long attachments at a low ratio <pause dur="0.8"/> they are never ever ever going to get round everything <pause dur="0.8"/> but then <pause dur="1.0"/> the majority of medical schools <pause dur="0.6"/> are <pause dur="0.4"/> doing the same thing in a much softer way we've just taken the big bold step <pause dur="0.2"/> perhaps <pause dur="1.4"/> there is an issue of equity <pause dur="0.9"/> in <pause dur="0.4"/> that <pause dur="0.2"/> if you've only got five allocated general clinical education attachments <pause dur="0.6"/> if you get two bad ones <pause dur="0.3"/> that's a pretty big proportion of your course <pause dur="1.2"/> and also if you get two that are pretty similar <pause dur="0.8"/> although <pause dur="0.4"/> all patients have abdomens chests ears <pause dur="0.2"/> eyes mostly <pause dur="0.4"/> # <pause dur="0.3"/> and therefore <pause dur="0.2"/> there is <pause dur="0.2"/> always stuff to examine and always <pause dur="0.3"/> # <pause dur="0.5"/> people to take histories from and all that kind of thing <pause dur="0.7"/> certainly students feel if they spend too much time with <pause dur="0.3"/> a particular type <pause dur="0.3"/> of doctor <pause dur="0.5"/> that they've had an unequal experience <pause dur="1.7"/> and <pause dur="0.4"/> there are also particular quality issues <pause dur="0.3"/> around attaching students in very small numbers to a huge pool of

teachers <pause dur="0.7"/> at a very small ratio <pause dur="0.8"/> clearly <pause dur="0.6"/> in the perfect world <pause dur="0.2"/> that's a very high quality experience <pause dur="0.5"/> the <trunc>stude</trunc> the learner <pause dur="0.2"/> and the teacher <pause dur="0.3"/> get to sit together <pause dur="0.3"/> think <pause dur="0.3"/> plan be very individual be very observant give direct feedback et cetera et cetera <pause dur="1.1"/> but it also means <pause dur="0.4"/> it's much harder for us to <trunc>u</trunc> <pause dur="0.3"/> us to survey quality in a way we could in a much more organized teaching programme <pause dur="0.6"/> such that we could be observing the session specialty X is providing <pause dur="0.4"/> or <pause dur="0.2"/> reviewing <pause dur="0.4"/> a specialty at a given time in a <trunc>d</trunc> <pause dur="0.2"/> given way <pause dur="1.0"/> whereas we've got our students scattered over a huge number of <trunc>lo</trunc> of teachers <pause dur="0.6"/> and those teachers <pause dur="0.2"/> are going to vary and there's a big question of how we <trunc>m</trunc> <pause dur="0.2"/> feed back to them in a meaningful way <pause dur="0.5"/> in a way that the students are happy with <pause dur="0.6"/> that doesn't bring their confidentiality that allows them to be # honest <pause dur="0.6"/> and also <pause dur="0.4"/> # <pause dur="1.1"/> issues <pause dur="0.2"/> about <pause dur="0.3"/> how we give support to such a big diverse group <pause dur="1.0"/> because <pause dur="0.2"/> they are teaching in such small groups scattered all over the

place <pause dur="5.5"/><kinesic desc="changes slide" iterated="n"/> the new directions <pause dur="0.8"/> really <pause dur="0.7"/> # <pause dur="1.0"/> was just to say that <pause dur="1.6"/> we are currently looking at doing a number of things <trunc>wi</trunc> <pause dur="0.4"/> with <pause dur="0.2"/> the way we organize phase two <pause dur="0.6"/> which have some relevance to <pause dur="1.3"/> certainly a lot of relevance to what the students might be saying to you but probably won't affect clinical methods that much <pause dur="0.8"/> we are aiming <pause dur="0.5"/> to rearrange <pause dur="0.7"/> the <pause dur="0.5"/> general clinical attachments such that <pause dur="0.4"/> some are specified to being done <pause dur="0.2"/> in the junior phase and some are specified to be done in the senior phase <pause dur="0.7"/> this allows us to put together more challenging partnerships for more experienced students <pause dur="0.2"/> and it allows us to put together attachments <pause dur="0.3"/> that are <pause dur="0.5"/> more introductory <pause dur="0.2"/> for more junior students <pause dur="1.9"/> we are also <pause dur="0.4"/> looking <pause dur="0.2"/> to iron out some of the anomalies in the system that we've inherited <pause dur="0.3"/> from <gap reason="name" extent="1 word"/> in that <pause dur="0.2"/> to give an example <pause dur="0.6"/> there is currently <pause dur="0.2"/> a <pause dur="0.4"/> general <pause dur="0.2"/> surgery attachment on the general surgical list <pause dur="0.3"/> which is paediatric <pause dur="0.2"/> surgery <pause dur="0.3"/> and maxillofacial surgery <pause dur="0.6"/> which is a combination i think sounds

pretty specialized <pause dur="0.8"/><vocal desc="laughter" iterated="y" n="ss" dur="1"/> i don't know about you <pause dur="1.5"/> # <pause dur="1.9"/> we are also looking <pause dur="0.3"/> at rearranging what the orthopaedic surgeons are up to <pause dur="0.3"/> and drawing in <pause dur="0.5"/> # more anaesthetists which is partly an <trunc>un</trunc> underutilized area but i don't think that's of too much <pause dur="0.3"/> # <pause dur="1.7"/> # importance to yourselves <pause dur="2.5"/><kinesic desc="changes slide" iterated="n"/> # <pause dur="1.0"/> what our aim <pause dur="1.2"/> throughout <pause dur="1.0"/> is <pause dur="1.0"/> to get the students to <pause dur="1.0"/> do <pause dur="0.5"/> basically these things take history <pause dur="0.3"/> examine the patient <pause dur="0.3"/> problem solve <pause dur="0.8"/> explain and manage <pause dur="0.5"/> and behave professionally throughout <pause dur="0.9"/> and you can actually learn to do that in a whole number of different settings <pause dur="2.2"/> and they should do that in the context of common clinical presentations <pause dur="0.2"/> and uncommon <pause dur="0.2"/> but serious situations <pause dur="0.6"/> which is one of the ways we justify <pause dur="1.2"/> not rushing around <pause dur="0.4"/> all these specialty experiences <pause dur="2.7"/> do people want to talk about any depth of clinical assessments or shall we just <pause dur="0.3"/> break for a moment and have a chat more about learning styles and things like that 'cause i think that's possibly more useful <pause dur="2.8"/> yeah <pause dur="2.0"/> can i take

some guidance from the chair </u><pause dur="0.9"/> <u who="nm0448" trans="pause"> yeah <pause dur="0.4"/> let's <trunc>t</trunc> talk about <pause dur="1.1"/> the the the what what the ethos of <pause dur="0.4"/> <gap reason="name" extent="1 word"/> Medical School is in relation <pause dur="1.3"/> to # is it a problem based <pause dur="0.2"/> learning school </u><u who="nm0445" trans="overlap"> sure </u><u who="nm0448" trans="overlap"> or is it <pause dur="0.9"/> ethos is it self-directed learning </u><pause dur="0.3"/> <u who="nm0445" trans="pause"> okay <pause dur="3.7"/> i think i'll kind of lead on to that if that's all right <pause dur="0.5"/> by <pause dur="1.7"/> sort of just outlining <pause dur="1.6"/> what seems to happen <pause dur="0.5"/> when we put students through this kind of system <pause dur="3.5"/> i've already said that it's very <pause dur="0.2"/> reliant <pause dur="0.5"/> on <pause dur="0.2"/> or it's it's very much based on self-directed learning <pause dur="0.5"/> and therefore <pause dur="0.8"/> for them to get the most out of these long eight week attachments they actually have to have at least some insight <pause dur="0.6"/> as to what they've already done <pause dur="1.4"/> what they've never done at all <pause dur="0.4"/> what they're good at and what they're bad at <pause dur="1.7"/> and they also <pause dur="0.2"/> have to have the ability to have a sensible discussion <pause dur="1.0"/> with <pause dur="0.4"/> their <trunc>c</trunc> <pause dur="0.5"/> clinical teacher <pause dur="0.3"/> about those areas <pause dur="2.3"/> broadly <pause dur="2.5"/> the top tranche of students <pause dur="0.3"/>

thrive on this <pause dur="1.1"/> but then good students thrive no matter what you do to them basically <pause dur="0.4"/> they'll always pick out the best learning opportunity and get on with it <pause dur="1.0"/> i think the next <pause dur="0.7"/> kind of quartile probably <pause dur="0.2"/> to <pause dur="0.2"/> probably the <pause dur="0.3"/> # <pause dur="0.4"/> second and third <pause dur="0.2"/> quartile <pause dur="1.4"/> take a while to get their head round all of this <pause dur="0.5"/> but when they do <pause dur="0.6"/> i think they do quite well and i think they probably do better <pause dur="0.6"/> than <pause dur="0.2"/> if we were very structured with them <pause dur="1.2"/> i think the lower quartile <pause dur="0.6"/> flounder <pause dur="1.1"/> and <pause dur="1.2"/> they do so much much more <pause dur="0.7"/> than in much <trunc>struc</trunc> more structured courses or at least they are seen <pause dur="0.2"/> to flounder much much more <pause dur="0.3"/> it's more obvious <pause dur="0.4"/> and i can't actually tell you whether actually <pause dur="1.1"/> putting them through structure that actually just hides the fact they're floundering <pause dur="0.8"/> or whether it actually gives them enough structure to help them get on with things <pause dur="0.5"/> but i think one of the challenges we have to look at is <pause dur="0.2"/> how we deal <pause dur="0.4"/> with <pause dur="0.2"/> students who are <pause dur="0.3"/> struggling <pause dur="0.3"/> with the insight and <pause dur="0.5"/> the self <pause dur="0.2"/> you know who haven't

cottoned on to the self-directed nature <pause dur="1.4"/> i think one of the things <pause dur="1.1"/> which <pause dur="0.6"/> is quite important in <pause dur="0.5"/> in understanding how things operate <pause dur="0.4"/> is <pause dur="1.3"/> the way the course was cut down to four years <pause dur="0.4"/> was to a large degree <pause dur="0.9"/> based on the presumption <pause dur="0.3"/> that these guys are graduates which is true <pause dur="0.2"/> it's not a presumption it's a it's a truth <pause dur="0.2"/> but the presumption <pause dur="0.2"/> that graduates come to us as accomplished adult learners <pause dur="2.0"/> and <pause dur="1.4"/> i don't know <pause dur="0.6"/> if that's entirely true or it certainly doesn't seem to be the whole story <pause dur="0.8"/> we undoubtedly <pause dur="0.2"/> have <pause dur="0.3"/> a lot of people coming to us <pause dur="0.2"/> who are <pause dur="0.2"/> mature <pause dur="0.8"/> efficient effective adult learners <pause dur="0.7"/> who have learned that in their first degree or in the work they've done since or whatever <pause dur="0.4"/> and we undoubtedly have some very very effective learners on our course <pause dur="0.2"/> far more so than you'd expect with a school leavers' group <pause dur="1.6"/> but i think our spectrum is much wider <pause dur="0.5"/> and my personal opinion i don't have any data to back this up at all <pause dur="0.4"/> but it seems to ring true whenever i talk to other

teachers <pause dur="0.2"/> is we have <pause dur="0.2"/> also <pause dur="0.4"/> a group of people who've gone straight from school <pause dur="0.2"/> straight to first degree <pause dur="0.3"/> have had a very spoon fed first degree as many science degrees appear to be nowadays <pause dur="0.3"/> who actually <pause dur="0.3"/> are more dependent <pause dur="1.2"/> learners <pause dur="0.2"/> than the majority of school leavers <pause dur="1.2"/> so <pause dur="0.4"/> the presumption <pause dur="0.2"/> that we can <pause dur="0.4"/> let our wonderful adult learners loose on the learning material and let them get on with it <pause dur="0.2"/> is perhaps a bit naive for some groups <pause dur="0.4"/> and i think <pause dur="0.4"/> we do have this <trunc>h</trunc> <pause dur="0.5"/> # <pause dur="0.3"/> i think <pause dur="0.2"/> <trunc>s</trunc> school leaver populations are more homogenous i think we've got an enormous breadth <pause dur="0.2"/> of <pause dur="0.2"/> maturity and learning ability <pause dur="0.3"/> far far wider <pause dur="0.3"/> than the school leavers' group <pause dur="0.3"/> but i think that also actually goes much lower <pause dur="0.2"/> in terms of <pause dur="0.3"/> ability to learn <pause dur="0.3"/> than <pause dur="0.6"/> the school leaver group <pause dur="1.0"/> # <pause dur="0.2"/> and i think that's quite a challenge <pause dur="1.6"/> is that something that <pause dur="0.5"/> rings true in the students that you've been seeing </u><pause dur="3.4"/> <u who="nf0449" trans="pause"> can i ask you do they have # a sort of individual mentor a personal <pause dur="0.7"/> sort of # <pause dur="0.3"/>

tutor or somebody <trunc>tha</trunc> who can actually help them appraise where they are <pause dur="0.5"/> you know # during this stage or do they have to keep doing it with their <pause dur="0.3"/> at the beginning of their new each block with <pause dur="0.2"/> # whoever's sort of <pause dur="0.4"/> you know sort of <gap reason="inaudible" extent="1 sec"/></u><u who="nm0445" trans="overlap"> they do not have a consistent <pause dur="0.2"/> block a block mentor </u><u who="nf0449" trans="pause"> right </u><pause dur="0.8"/> <u who="nm0445" trans="pause"> they <pause dur="0.2"/> who carries them through the core course <pause dur="1.2"/> this as an idea has been <pause dur="0.3"/> muted <pause dur="0.9"/> # <pause dur="2.0"/> there are <pause dur="0.2"/> a number of practical considerations but there's also <pause dur="1.5"/> quite who that person would be and whether <pause dur="1.0"/> we genuinely have <trunc>two-hun</trunc> well <pause dur="0.4"/> if they didn't have more than one student at a time <pause dur="0.3"/> four-hundred-plus <pause dur="0.6"/> useful active quality mentors out there <pause dur="0.6"/> but no it's very much <pause dur="0.4"/> they they have <pause dur="0.5"/> a formative feedback process which informs them at the end of each block <pause dur="0.6"/> and we collate that <pause dur="0.3"/> and for those in trouble <pause dur="0.8"/> we can <pause dur="0.2"/> act as that kind of person collating their information <pause dur="0.7"/> # <pause dur="0.2"/> but <pause dur="0.3"/> we do not

have an individual who's taking an individual eye on that <pause dur="0.2"/> individual's progress <pause dur="0.4"/> no </u><pause dur="3.6"/> <u who="nf0450" trans="pause"> <trunc>i</trunc> if a student # <pause dur="0.3"/> decided that they weren't learning very much in their attachment </u><u who="nm0445" trans="overlap"> yes </u><u who="nf0450" trans="overlap"> let's say the consultant was not a particularly <pause dur="0.5"/> good teacher say if it's the <trunc>en</trunc> <pause dur="0.5"/> chest clinic </u><pause dur="0.3"/> <u who="nm0445" trans="pause"> yeah </u><u who="nf0450" trans="latching"> are they allowed to <pause dur="0.6"/> to <pause dur="0.2"/> to discuss with the consultant that they could go to the say the eye clinic <pause dur="0.4"/> are they allowed </u><u who="nm0445" trans="overlap"> sure </u><u who="nf0450" trans="overlap"> to <pause dur="0.3"/> move around a little bit </u><pause dur="0.5"/> <u who="nm0445" trans="pause"> yeah i mean they are not <pause dur="0.2"/> limited <pause dur="0.4"/> to <pause dur="0.5"/> the <pause dur="0.2"/> learning <pause dur="0.5"/> opportunities that are strictly within <pause dur="0.2"/> that partnership <pause dur="0.9"/> i think it's important <pause dur="0.3"/> that <pause dur="1.1"/> they have a <pause dur="0.5"/> a discussion <pause dur="0.2"/> and that we should be encouraging them to do <pause dur="0.3"/> about what other opportunities are around <pause dur="1.1"/> clearly <pause dur="0.8"/> the <trunc>o</trunc> there is a

limitation in that as the numbers go up <pause dur="1.1"/> there will be <trunc>s</trunc> <pause dur="0.2"/> perhaps students already sitting in the thing that they want to go to <pause dur="0.7"/> which is a limitation <pause dur="0.5"/> but <pause dur="0.7"/> as long as they are with their clinical tutors enough that that clinical tutor can make a reasonable assessment of them <pause dur="0.4"/> and as long as they've negotiated their learning needs enough that that clinical tutor knows <pause dur="0.2"/> that they're actually off being <pause dur="0.6"/> useful and off <pause dur="0.4"/> by addressing their learning needs rather than <pause dur="0.3"/> have just vanished home for the night </u><pause dur="0.4"/> <u who="nf0450" trans="pause"> mm </u><u who="nm0445" trans="overlap"> or whatever <pause dur="0.3"/> then that's absolutely fine <pause dur="1.3"/> but we get on slightly <pause dur="0.2"/> to the population issue <pause dur="0.3"/> in that <pause dur="0.3"/> you know effectively we're working off one big trust into <pause dur="0.2"/> medium to small trusts <pause dur="0.2"/> and perhaps a little bit in one <unclear>further</unclear> trust <pause dur="0.5"/> and <pause dur="1.0"/> there are partnerships in lots of specialties <pause dur="0.2"/> and i'm quite happy for them to go off and sit in the eye clinic i think that would be great <pause dur="0.4"/> but they may well

find that there's somebody already there </u><pause dur="0.5"/> <u who="nf0450" trans="pause"> mm </u><u who="nm0445" trans="latching"> # <pause dur="0.3"/> and i think <pause dur="0.8"/> as numbers of students nationally increase <pause dur="0.4"/> i think a lot of learning historically went on in these opportunistic fashions <pause dur="0.4"/> because there were lots of little learning opportunities sitting all round the place underutilized <pause dur="0.6"/> think what we're doing now is utilizing more and more and more of them <pause dur="0.3"/> so there's less and less scope for that kind of thing to go on <pause dur="0.2"/> unfortunately <pause dur="0.4"/> but we would encourage it and we'd be quite happy with it </u><pause dur="0.4"/> <u who="nf0450" trans="pause"> okay </u><pause dur="1.1"/> <u who="nm0451" trans="pause"> how is it looked at <pause dur="0.7"/> with the <pause dur="0.3"/> specialist blocks as to <pause dur="0.6"/> you know who are the good teachers and what qualifies <pause dur="0.5"/> somebody 'cause it's just <pause dur="0.9"/> the example that's been given there if if there's <pause dur="0.2"/> poor teaching occurring </u><u who="nm0445" trans="overlap"> sure </u><pause dur="0.3"/> <u who="nm0451" trans="pause"> in an area <pause dur="0.7"/> through becoming a general practitioner or consultant in whatever <pause dur="0.4"/>

doesn't <pause dur="0.3"/> mean that you're good </u><u who="nm0445" trans="overlap"> sure </u><pause dur="0.4"/> <u who="nm0451" trans="pause"> teacher how does <pause dur="0.4"/> how does would that be sorted out <pause dur="0.5"/> and <pause dur="0.4"/> the other <pause dur="0.2"/> a kind of another part of that is <pause dur="0.6"/> a kind of <pause dur="0.2"/> convergence in it or or ethos in relation to teaching i i notice that with students who <unclear>at a mentors'</unclear> interview <pause dur="0.8"/> you know a differing <pause dur="0.6"/> ethos which seems <pause dur="0.6"/> you know varies from block to block </u><pause dur="2.2"/> <u who="nm0445" trans="pause"> to <pause dur="0.4"/> sort of look at your <trunc>f</trunc> <pause dur="0.4"/> first point <pause dur="0.9"/> if i'm entirely honest with you <pause dur="1.1"/> the biggest problem with quality <pause dur="0.2"/> we've got here is actually capacity <pause dur="0.9"/> because we are struggling <pause dur="0.4"/> to find enough teachers <pause dur="0.7"/> which means <pause dur="0.6"/> # <pause dur="0.9"/> the bottom line of a poor attachment is we shouldn't be using it <pause dur="1.2"/> but our current situation if i'm quite honest with you <pause dur="0.4"/> is <pause dur="0.2"/> you'd have to be pretty bad actually for us not to use <pause dur="0.8"/><vocal desc="laughter" iterated="y" n="ss" dur="1"/> an attachment <pause dur="0.3"/> because we are <pause dur="0.2"/> so short across the board </u><u who="nm0451" trans="latching"> right </u><pause dur="0.6"/> <u who="nm0445" trans="pause"> # <pause dur="1.0"/> and <pause dur="1.1"/> i would like to think that that is a temporary capacity building phase <pause dur="0.2"/> that we will get <trunc>in</trunc> <pause dur="0.3"/> get <pause dur="0.5"/>

beyond <pause dur="0.4"/> that will allow us that flexibility <pause dur="0.2"/> and obviously <pause dur="0.6"/> at lesser levels <pause dur="0.2"/> there is supporting those individual teachers and things like that <pause dur="0.4"/> and i think we've been relatively slow about getting <pause dur="0.3"/> the central course's structure support going at <pause dur="0.8"/> this end and i think that's something we ought to be <pause dur="0.2"/> or i ought to be thinking of <pause dur="1.0"/> # <pause dur="0.8"/> we <pause dur="0.4"/> do have we're in the middle of revamping the process by which we get <pause dur="0.2"/> get feedback to them because that's <pause dur="0.4"/> going to become all electronic and we are <pause dur="0.6"/> in discussions with the trust about how <pause dur="0.2"/> to best feed back <pause dur="0.2"/> that back to them <pause dur="0.5"/> because again one of the things that's slightly unusual about this is <pause dur="0.3"/> there is no <pause dur="1.0"/> head of medicine who is particularly interested in the medicine feedback <pause dur="1.4"/> these are individual teachers <pause dur="0.4"/> and <pause dur="0.7"/> it's trying to give meaningful feedback to them in a way that's useful and helpful <pause dur="1.0"/> rather than trying to give feedback to a whole department who can then reallocate the resources or change how we do the teaching <pause dur="0.8"/> # <pause dur="0.6"/>

which does make it quite challenging <pause dur="2.3"/> your second point has gone from my mind entirely <pause dur="0.2"/><vocal desc="laughter" iterated="y" n="ss" dur="1"/> what was it </u><u who="nm0451" trans="overlap"> it <trunc>w</trunc> it was the <pause dur="0.7"/> different <pause dur="0.6"/> # i suppose the ethos seems different in in between varying blocks so <pause dur="0.4"/> you know one example springs to mind in the way that the histories are taken <pause dur="0.7"/> # <pause dur="0.6"/> it it it seems that <pause dur="0.3"/> you know part of <pause dur="0.4"/> well i don't know whether anyone else has noticed it but part of the one we <pause dur="0.5"/> we're <pause dur="0.3"/> approaching things in one way <pause dur="1.5"/> which <pause dur="0.2"/> is <pause dur="0.3"/> directly opposite to i think it's the old <pause dur="0.4"/> by rote <pause dur="0.4"/> way of taking the history <pause dur="0.3"/> <trunc>i</trunc> <pause dur="0.2"/> in another block they're occurring at the same time </u><pause dur="0.9"/> <u who="nm0445" trans="pause"> so <pause dur="1.5"/> by blocks you mean the other teaching blocks that <unclear>med</unclear> </u><u who="nm0451" trans="overlap"> yes </u><u who="nm0445" trans="overlap"> students have come through </u><u who="nm0451" trans="overlap"> yes </u><u who="nm0445" trans="overlap">

before # they meet you or whatever </u><u who="nm0451" trans="overlap"> yes <pause dur="0.6"/> before before </u><u who="nm0445" trans="overlap"> # <pause dur="1.6"/> i think that's the reality of clinical <pause dur="1.0"/> medicine teaching up to a point <pause dur="0.4"/> and we <pause dur="0.2"/> when we talk to the clinical teachers in all the specialties <pause dur="0.3"/> and when we train examiners in all of that kind of thing <pause dur="0.2"/> we are training on <pause dur="0.4"/> the <pause dur="0.6"/> # basically the <gap reason="name" extent="1 word"/> assessment package in terms of </u><u who="nm0451" trans="latching"> right </u><u who="nm0445" trans="overlap"> the examinations for ICE and the final professional exam <pause dur="0.5"/> # <pause dur="0.4"/> when we meet <pause dur="0.4"/> with teachers which we've not done as much as we need to yet we're talking through the <pause dur="0.5"/> same issues </u><u who="nm0451" trans="overlap"> right </u><u who="nm0445" trans="overlap"> here <pause dur="0.3"/> but i think we've a large number to get through to <pause dur="0.3"/> and <pause dur="0.2"/> probably a large number who we'll struggle <pause dur="0.4"/> to get the message across to </u><u who="nm0451" trans="latching"> <unclear>that's not clear</unclear> to me 'cause i thought they'd all done it <pause dur="0.2"/> so that <pause dur="0.7"/> that's more clear if they

haven't </u><pause dur="0.5"/> <u who="nm0445" trans="pause"> all done </u><pause dur="0.4"/> <u who="nm0451" trans="pause"> the LAP assessment <unclear>thing</unclear> </u><pause dur="0.5"/> <u who="nm0445" trans="pause"> # </u><pause dur="0.4"/><u who="nm0451" trans="pause"> all gone through the package </u><pause dur="0.3"/> <u who="nm0445" trans="pause"> not all the teachers no no </u><u who="nm0451" trans="overlap"> yes that makes sense </u><u who="nm0445" trans="overlap"> only <pause dur="0.5"/> of those who are not doing clinical methods </u><pause dur="0.5"/> <u who="nm0451" trans="pause"> yeah </u><pause dur="0.5"/> <u who="nm0445" trans="pause"> the only ones who have been through it are the trained examiners </u><u who="nm0451" trans="overlap"> right </u><pause dur="0.5"/> <u who="nm0445" trans="pause"> yes <pause dur="0.7"/> yeah </u><pause dur="1.1"/> <u who="nf0452" trans="pause"> can i just ask <pause dur="0.2"/><vocal desc="clears throat" iterated="n"/> just thinking about this it's obviously a very very new idea and to for most of us who are trained in a traditional way it's so different <pause dur="0.6"/> i wondered whether there are any plans to as these cohorts of doctors come out to follow them up long term <pause dur="0.4"/> and see what happens

and to see </u><u who="nm0445" trans="overlap"> sure </u><pause dur="0.3"/> <u who="nf0452" trans="pause"> because it might be five years down the line there are obviously <pause dur="0.7"/> these <pause dur="0.2"/> group of doctors are much much better at some things but much much worse at others and it'd be very interesting to see what happens throughout their careers and see <pause dur="0.6"/> if tinkering with the course is for the good or the bad </u><pause dur="0.9"/> <u who="nm0445" trans="pause"> i # <pause dur="0.6"/> there's a whole number of of issues there </u><pause dur="0.2"/> <u who="nf0452" trans="pause"> mm </u><u who="nm0445" trans="latching"> up to a point that <pause dur="0.3"/> job <pause dur="0.5"/> is probably best done with with <gap reason="name" extent="1 word"/> <pause dur="0.4"/> who invented the thing and who have got the school leavers <pause dur="0.7"/> who are <pause dur="0.3"/> up to a point the more comparable group </u><pause dur="0.2"/> <u who="nf0452" trans="pause"> mm </u><pause dur="0.6"/> <u who="nm0445" trans="pause"> we of course have got an extra level of complexity <pause dur="0.3"/> in that we've got <pause dur="0.3"/> a new type of entrant <pause dur="0.6"/> and <pause dur="0.3"/> you can argue it as many ways as you like <pause dur="0.3"/> you know perhaps they're more positive and committed because they've already done something else or financially it's a bigger <trunc>in</trunc> <pause dur="0.3"/> you know

investment <pause dur="0.4"/> they could have gone off and you know but they've they've gone back into education so perhaps they're more committed </u><pause dur="0.3"/> <u who="nf0452" trans="pause"> although <trunc>ac</trunc> </u><u who="nm0445" trans="overlap"> equally you could argue that </u><u who="nf0452" trans="latching"> i think my year at medical school about five per cent of the course were postgraduates </u><u who="nm0445" trans="latching"> yeah </u><pause dur="0.2"/> <u who="nf0452" trans="pause"> actually taken in so </u><u who="nm0445" trans="overlap"> yeah </u><pause dur="0.2"/> <u who="nf0452" trans="pause"> you you sort of <pause dur="0.6"/> got some some <gap reason="inaudible due to overlap" extent="1 sec"/> there </u><u who="nm0445" trans="overlap"> yeah <pause dur="0.5"/> # but i think there are lots of reasons why our bunch could be better or worse <pause dur="0.7"/> # because of that aspect as well </u><u who="nf0452" trans="latching"> mm </u><u who="nm0445" trans="latching"> # but i think that's <pause dur="0.4"/> the point you make is a good one i think that's one thing to do <pause dur="0.3"/> i think as well in terms of different intake streams we actually are <trunc>mol</trunc> are almost running a natural experiment </u><u who="nf0452" trans="latching"> mm </u><u who="nm0445" trans="latching"> in that we've got <pause dur="0.7"/> ICE and <trunc>s</trunc> final professional exams are identical summative assessments <pause dur="0.4"/>

and fairly shortly going through them we'll have school leavers <pause dur="0.2"/> biomedical science graduates and healthcare science graduates </u><u who="nf0452" trans="latching"> mm </u><pause dur="0.6"/> <u who="nm0445" trans="pause"> going through the same key points who will then go out into careers probably <pause dur="0.3"/> the majority within a relatively local <pause dur="0.3"/> geographical area <pause dur="0.8"/> and i think it would be <pause dur="0.6"/> an absolute crime if we didn't at least <pause dur="0.6"/> you know <pause dur="0.2"/> have a reasonable look at <pause dur="0.8"/> at what's happening and how the numbers shape up </u><pause dur="0.3"/> <u who="nf0452" trans="pause"> mm </u><pause dur="8.9"/> <u who="nm0445" trans="pause"> perhaps <pause dur="0.4"/> just to <pause dur="0.3"/> move on to to just cover one more thing <pause dur="0.3"/> which was <pause dur="0.3"/> # <pause dur="0.9"/> to make sense of this session a little bit for those # <pause dur="1.0"/> who weren't in the session i i gave for the # <pause dur="0.5"/> the local <pause dur="0.2"/> G-P senior lecturers and lecturers <pause dur="1.0"/> we talked through similar issues and then went on to a discussion

and one of the things we discussed <pause dur="0.5"/> up to a point was the problem based learning <pause dur="0.7"/> # <pause dur="0.5"/> which is something that came up in discussion then <pause dur="0.9"/> # <pause dur="0.8"/> because <pause dur="0.5"/> a lot of people are throwing the phrase problem based learning around and you'll have heard about problem based <pause dur="0.2"/> medical courses <pause dur="0.5"/> yes <pause dur="0.4"/> have you heard anybody say that this is a problem based course <pause dur="3.1"/> no <pause dur="1.9"/> good 'cause it isn't <pause dur="0.6"/><vocal desc="laugh" iterated="n"/><pause dur="1.4"/> i want to say a few well i've been asked to say a few words i'm quite delighted to say a few words <vocal desc="laughter" iterated="y" n="ss" dur="1"/> i'll get the <trunc>phras</trunc> phraseology right <pause dur="0.5"/> about problem based learning because <pause dur="0.9"/> if you're not aware of it there is a <pause dur="0.8"/> # <pause dur="0.3"/> movement within medical education <pause dur="0.4"/> called the problem based learning <pause dur="0.8"/> movement or whatever <pause dur="0.6"/> it's quite old now it started in the late sixties # <pause dur="0.2"/> in Canada it's also up and running <pause dur="0.4"/> in the Netherlands in Maastricht <pause dur="0.5"/> and <pause dur="0.2"/> an increasing number of medical schools in the last five years or so <pause dur="0.2"/> have taken up <pause dur="0.4"/> this as their <pause dur="0.4"/> # <pause dur="0.2"/> mantra in the U-K <pause dur="1.1"/> and <pause dur="0.9"/> to various degrees of popularity <pause dur="1.1"/> # <pause dur="1.5"/> i don't want to talk about it too much because it's not

what we do <pause dur="0.5"/> but i think <trunc>i</trunc> <pause dur="0.2"/> # it's worth making a point of clarification because <pause dur="0.6"/> a lot of our <pause dur="0.5"/> teaching <pause dur="0.8"/> in phase one <pause dur="0.2"/> is a group teaching <pause dur="1.2"/> a lot of the group teaching is based around clinical problems <pause dur="0.7"/> and because of that <pause dur="0.3"/> a lot of people <pause dur="0.3"/> think <pause dur="0.2"/> that we're a problem based curriculum <pause dur="1.4"/> but we're not <pause dur="0.4"/> and perhaps if i try and explain the difference <pause dur="0.5"/> # <pause dur="0.2"/> it'll at least clarify things in if you're having that conversation with somebody later <pause dur="3.1"/> teaching around clinical problems there's absolutely nothing new about it <pause dur="0.9"/> people have sat and discussed on ward rounds and after ward rounds clinical problems and used it as teaching material and effectively what we are doing <pause dur="0.3"/> is an extension of that <pause dur="0.2"/> we're simply <pause dur="0.2"/> trying to make stuff clinically relevant <pause dur="0.4"/> and using <pause dur="0.3"/> patient type problems to try and <pause dur="0.4"/> bring out the clinical relevance <pause dur="0.2"/> and also try and bring out some of the family

dynamics psychosocial and all of those aspects <pause dur="2.2"/> separate to that <pause dur="0.3"/> in a problem based <pause dur="1.2"/> learning <pause dur="0.2"/> curriculum <pause dur="1.0"/> it's one of the few things within educational within medical education <pause dur="0.5"/> which <pause dur="0.5"/> requires a completely different way of thinking <pause dur="0.3"/> about <pause dur="0.3"/> learning <pause dur="0.4"/> and it's done in a completely different way <pause dur="0.3"/> they're put in groups <pause dur="0.8"/> and they've got a mentor <pause dur="1.0"/> and they are given clinical problems <pause dur="0.7"/> and up till now that sounds pretty similar <pause dur="1.0"/> but they are for instance given one clinical problem every month or two <pause dur="1.6"/> which is a complicated problem <pause dur="0.6"/> and as a group <pause dur="0.9"/> they have to decide <pause dur="0.2"/> on their strategy <pause dur="0.8"/> for solving that problem <pause dur="1.0"/> and they are given problems <pause dur="0.2"/> right from the beginning of their course <pause dur="0.4"/> so in week two once they've done the icebreaking exercises and everything like that <pause dur="0.3"/> they will be given <pause dur="0.2"/> their first clinical problem <pause dur="1.4"/> and as a group <pause dur="0.9"/> they have to say well to solve this clinical problem we're going to need to know this bit of anatomy we're going to need to know a bit of <pause dur="0.4"/> how this

heart works and we're going to need to know a little bit about blood and we're going to need to know a bit about this and a bit about that <pause dur="0.6"/> and they go away <pause dur="1.5"/> and they set an agenda <pause dur="0.5"/> and members of the group bring back that knowledge <pause dur="0.3"/> and use that knowledge <pause dur="0.2"/> to structure <pause dur="0.2"/> how they're going to answer that problem <pause dur="1.2"/> so they are not <pause dur="0.2"/> given a module of cardiovascular <pause dur="0.2"/> in which clinical problems are used to illustrate things <pause dur="0.6"/> they're given <pause dur="0.6"/> a series of clinical problems which are supposedly <trunc>de</trunc> designed to cover the whole curriculum <pause dur="0.7"/> but it's entirely up to the group <pause dur="0.5"/> to manage the process of finding <pause dur="0.2"/> all the information <pause dur="0.9"/> for everything <pause dur="0.5"/> the whole course in effect <pause dur="0.3"/> to bring it back to their group <pause dur="0.3"/> to assimilate it <pause dur="0.2"/> to make sense of it <pause dur="0.8"/> and <pause dur="1.2"/> to learn the material <pause dur="0.6"/> and the <pause dur="0.2"/> role of facilitator is not to provide <pause dur="0.2"/> any of that information <pause dur="0.8"/> it's to facilitate the process by which they decide and they set their agendas and they send people off and gather their knowledge <pause dur="0.3"/> and are

supposed to stop them going off on a complete red herring <pause dur="2.8"/> and i think the difference is important 'cause that is radically different from what we do <pause dur="1.6"/> and it's actually quite a well researched teaching technique and there are some good things about it and some bad things about it <pause dur="0.5"/> but one of the things that tends to happen <pause dur="0.4"/> is <pause dur="0.2"/> that people <pause dur="0.2"/> find the research in problem based learning <pause dur="0.4"/> and say it supports another style of learning <pause dur="0.7"/> where actually it's something completely different <pause dur="3.3"/> does that make sense and is that enough on that is that what you were <pause dur="0.5"/> intending </u><pause dur="0.3"/> <u who="nm0448" trans="pause"> that's very helpful thank you very much are there any questions at all for <pause dur="0.4"/> <gap reason="name" extent="1 word"/> at all on problem based # learning </u><pause dur="1.5"/> <u who="nf0450" trans="pause"> well i guess <gap reason="inaudible" extent="1 sec"/> question now is there not formal <trunc>t</trunc> anatomy teaching in phase one </u><pause dur="1.0"/> <u who="nm0445" trans="pause"> now in our phase one <pause dur="1.1"/> yes </u><pause dur="0.5"/> <u who="nf0450" trans="pause">

right </u><u who="nm0445" trans="overlap"> then for problem based learning different discussion other people </u><pause dur="0.4"/> <u who="nf0450" trans="pause"> yes </u><pause dur="0.9"/> <u who="nm0445" trans="pause"> in ours <pause dur="0.5"/> okay we there is formal anatomy <pause dur="0.2"/> teaching <pause dur="0.4"/> as part of <pause dur="0.3"/> their systems based modules <pause dur="0.6"/> so they have time in the dissection room </u><pause dur="0.5"/> <u who="nf0450" trans="pause"> yeah </u><u who="nm0445" trans="latching"> when they're doing <pause dur="0.2"/> musculoskeletal <pause dur="0.4"/> when they're doing <pause dur="0.3"/> cardiovascular <pause dur="0.2"/> when they're doing respiratory <pause dur="0.5"/> they don't have much time <pause dur="1.7"/> and it's much more <pause dur="0.5"/> illustrative <pause dur="0.6"/> than it is <pause dur="0.3"/> learning the skill of cutting up a body <pause dur="1.5"/> but they do <pause dur="0.5"/> have <pause dur="0.5"/> all of those elements formally taught <pause dur="0.3"/> within our <pause dur="0.3"/> curriculum <kinesic desc="indicates member of audience" iterated="n"/></u><pause dur="3.9"/> <u who="nm0453" trans="pause"> <gap reason="name" extent="1 word"/> can you explain a little bit further <pause dur="0.3"/> the partnerships for the general sort of clinical education rotation <pause dur="0.6"/> # for the junior rotation and the senior you called them introductory

partnerships and those <pause dur="0.3"/> more challenging partnerships <pause dur="0.5"/> and just what the difference in kind of </u><pause dur="0.3"/> <u who="nm0445" trans="pause"> at the moment <pause dur="0.5"/> there is no difference at all </u><u who="nm0453" trans="latching"> right <gap reason="inaudible" extent="1 sec"/> </u><u who="nm0445" trans="overlap"> because they're not differentiated at all <pause dur="1.0"/> at the moment <pause dur="0.8"/> any student <pause dur="0.3"/> could meet any partnership <pause dur="1.0"/> at any phase </u><pause dur="0.3"/> <u who="nm0453" trans="pause"> right </u><pause dur="0.3"/> <u who="nm0445" trans="pause"> yep <pause dur="0.3"/> so at the moment it's a bit nebulous <pause dur="0.8"/> now that offers us a couple of challenges <pause dur="1.1"/> it offers us a logistic challenge because actually we've got increasing numbers <trunc>i</trunc> and they increase in big steps </u><pause dur="0.4"/> <u who="nm0453" trans="pause"> right </u><u who="nm0445" trans="latching"> and therefore if you've got a group of partnerships that a stream would go to at one time <pause dur="0.7"/> and it could be a junior or a senior stream <pause dur="0.2"/> it takes us very <pause dur="0.2"/> makes it very difficult to plan for us because there there might be a hundred-and-thirty juniors and a hundred-and-ninety <pause dur="0.2"/>

a hundred-and-thirty seniors and a hundred-and-ninety juniors and then you know you end up juggling up all the time <pause dur="0.4"/> so there's a administrative logic to separating them <pause dur="0.9"/> but <pause dur="0.2"/> i think there's also <pause dur="0.2"/> an educational logic to separate them and make some partnerships used in the junior phase and some in the senior phase <pause dur="0.7"/> because <pause dur="0.5"/> there are certain <pause dur="0.3"/> teachers <pause dur="0.5"/> and certain combinations <pause dur="0.3"/> which might be quite difficult and challenging <pause dur="0.3"/> but if they've already done a year of clinical medicine could be very valuable <pause dur="0.6"/> so you wouldn't dare put a student who's straight you know who's only done phase one <pause dur="0.2"/> straight into this partnership <pause dur="0.3"/> but you might want to use it because there's so much to learn there <pause dur="0.3"/> and that you can make that partnership with the only medicine senior <pause dur="1.9"/> on the <pause dur="0.2"/> converse <pause dur="0.2"/> you could for instance decide that actually <pause dur="1.5"/> they ought to <trunc>tr</trunc> they all ought to meet a general surgeon in the junior <pause dur="0.8"/> therefore we will have junior partnerships that all <pause dur="0.2"/> you know <pause dur="0.2"/> one stream that all includes general surgeons or something like that <pause dur="0.6"/> but that's a development on what currently

happens because at the moment there is no differentiation at all </u><pause dur="0.2"/> <u who="nm0453" trans="pause"> thank you </u><pause dur="3.0"/> <u who="nm0448" trans="pause"> right <pause dur="0.3"/> maybe at that point give <pause dur="0.5"/> <gap reason="name" extent="1 word"/> <pause dur="0.4"/> a rest and say thank you very much for <pause dur="0.8"/> # <pause dur="1.0"/> really making phase two of the course <pause dur="0.2"/> a lot clearer <pause dur="0.7"/> because i think sometimes we can <pause dur="0.7"/> be a bit tunnel vision and just see the Clinical Methods course and <pause dur="0.2"/> forget about what else happens <pause dur="0.2"/> in phase two and that's <pause dur="0.2"/> really helpful <pause dur="0.8"/> insight thank you very much <pause dur="2.0"/> # we're going to break for <pause dur="0.2"/> coffee <pause dur="0.5"/> and can i suggest we reassemble at about twenty-five to four if that's okay it's in about fifteen minutes' time