MBBS Stage 5 Handbook

Newcastle University Faculty of Medical Sciences, 2010/2011

General enquiries regarding Stage 5 should go to:

mbbs-support@ncl.ac.uk

Enquiries regarding assessment should go to:

mbbs-assessmentenq@ncl.ac.uk Updated information from the Medical Student Office and downloadable forms can be obtained online through the Learning Support Environment (LSE) at: https://mbbs.ncl.ac.uk/

Contents
MBBS Stage 5 Handbook .............................................................................................................. 1 Calendar for Stage 5 2010/2011 ............................................................................................... 4 Term Dates ........................................................................................................................... 4 Attendance and Key Dates ................................................................................................... 4 Examination Dates ................................................................................................................ 4 Preface ...................................................................................................................................... 5 Key Information for Stage 5 .................................................................................................. 5 Stage 5 Handbook ................................................................................................................ 6 Learning Outcomes for Stage 5 ................................................................................................ 7 Assessing Outcomes ............................................................................................................ 7 Curriculum Content ................................................................................................................... 9 Stage 5 Senior Rotations ...................................................................................................... 9 Teaching, Learning and Assessment ...................................................................................... 10 Self-Study & Time Management ......................................................................................... 10 Stage 5 MBBS: Student Assessment ................................................................................. 12 Structure of Assessment in Stage 5 ................................................................................... 12 Determination of Outcomes for Clinical and Communication Skills and Knowledge and Critical Thought .................................................................................................................. 14 Determination of Outcome for Professional Behaviour ...................................................... 17 Examination Arrangements................................................................................................. 19 Final Outcome of Stage 5 Examination .............................................................................. 19 Resit Examination ............................................................................................................... 21 Prizes .................................................................................................................................. 21 Student Progress and Achievement ........................................................................................ 22 Attendance and Submission Requirements ........................................................................ 22 Student Support and Guidance ............................................................................................... 23 Communications and General Information ......................................................................... 23 Finances .............................................................................................................................. 23 Financial Hardship .............................................................................................................. 24 Academic and Pastoral Support ......................................................................................... 24 Re-allocation to a Base Unit ............................................................................................... 26 Re-allocation in Clinical Attachments ................................................................................. 26 Conduct in Assessments .................................................................................................... 26 Conduct on clinical attachments ......................................................................................... 26 Consent Issues on Clinical Attachments ............................................................................ 27 Your Health and Welfare on Clinical Attachments .............................................................. 27 Medical Students, the Law and Clinical Attachments ......................................................... 28 Learning Resources ................................................................................................................ 32 Learning Resources ............................................................................................................ 32 Learning Resource Environment ........................................................................................ 32 Annex 1: Core Presentations .................................................................................................. 34 Annex 2: Assessment.............................................................................................................. 40 Ethics Assignment SSC4 ................................................................................................. 40 OSCE .................................................................................................................................. 40 MOSLER ............................................................................................................................. 40 Annex 3: Control of Infection ................................................................................................... 41 Annex 4: Career Development in Medicine............................................................................. 42 Where can you obtain advice and guidance about your career? ....................................... 42 Who can help? .................................................................................................................... 43 Annex 5: Course Directors ...................................................................................................... 46 Annex 6: Prizes ....................................................................................................................... 47

Calendar for Stage 5 2010/2011

Term Dates
Begin Autumn Spring Summer 31/08/10 04/01/11 03/05/11 End 17/12/10 15/04/11 17/06/11

Attendance and Key Dates

Introduction to Stage 5 As advised by your Base Unit Senior Rotations 1-4 12 weeks Medical School 31/08/10 02/09/10 03/09/10 06/09/10 26/11/10

National Applications Process to fill Foundation Programmes for August 2011 commences in September 2010. See www.foundationprogramme.nhs.uk/pages/home Foundation Application Workshops see annex 4 Student Elective photographic and SSC Poster Prizes Evening Preparing for Practice Christmas Vacation Hospital-based Practice 3 weeks 2 weeks 16 weeks HBP and 1 reading week as advised by your Base Unit 2 weeks 1 week 4 weeks 03/12/2010

29/11/10 17/12/10 20/12/10 03/01/11 04/01/11 13/05/11

Easter Vacation Reading Week Assessment Pass List Published Congregations

18/04/11 29/04/11 16/05/11 20/05/11 23/05/11 17/06/11 15/06/11 04/07/11 09/07/11 (provisional dates)

F1 Shadowing Course

As advised by your Foundation School

Examination Dates
The following dates are provisional; a final timetable will be published in due course. Examination 1 Examination 2 Examination 3 Examination 4 OSCE Written Paper 1 Written Paper 2 MOSLER 03/06/11 08/06/11 09/06/11 14/06/11

Details of the OSCE and MOSLER are provided in Annex 2 of this handbook.

Preface
Welcome to Stage 5 of the MBBS degree programme.
Stage 5 is the final year of the MBBS programme. In Stage 5 you will undertake a series of senior rotations which will provide teaching and learning environments and experiences which will enable you to consolidate your clinical knowledge and skills, and develop further your attitudes to colleagues, medical, nursing and ancillary staff as well as patients and their relatives and in doing so fully achieve the terminal learning outcomes defined for the programme. To assist you in this aim you will be expected to become active members of clinical teams, shadow Foundation Programme Trainees, and learn the practical aspects of being a Foundation Programme Trainee. Following final examinations in June 2011, there will be a Foundation Programme Shadowing Course as advised by your allocated foundation school. The shadowing course takes place before F1 jobs start in August 2011 to help your transition from student to doctor.

Key Information for Stage 5

Entry to Stage 5 of the MBBS course is dependent upon successful completion of the Stage 4 examination. The teaching takes place in hospital, general practice, and a variety of community settings and you will be taught by a range of health care professionals. All clinical teaching is considered compulsory and consistent poor attendance is taken to reflect an unsatisfactory attitude which may result in deferment or, in extreme cases, termination of studies. Throughout Stage 5 you are attached to one of the four clinical Base Units and as such it is important that you gain familiarity with the local arrangements within your Base Unit as quickly as possible. You should be mindful of the fact that the Stage 5 experience will be different both between Base Units and also within Base Units. However the curriculum has been designed such that irrespective of your location in Stage 5, you will be provided with teaching and learning opportunities which will enable you to achieve the learning outcomes defined for this stage of the programme. In addition, all assessments in Stage 5 will be equivalent, irrespective of the Base Unit. To ensure that you have the appropriate clinical experience to enable you to meet the outcomes of the Final Year, and therefore adequately prepare you for F1, you will be required to adopt a more flexible pattern of working than in previous Stages of the programme. As such there may be a need for you to undertake a shift pattern of working. This does not mean that you will be expected to routinely work night shifts but that working patterns in addition to a standard 9-5 day may operate in some rotations and at some sites. Furthermore, unlike Stages 1-4, throughout Stage 5, Wednesday afternoon will be part of your working week. For information relating to the applications process to fill the Foundation Programmes commencing in August 2011, you are referred to the Northern Deanery website http://mypimd.ncl.ac.uk/PIMDDev/pimd-home/foundation-programme and the Foundation School website www.foundationprogramme.nhs.uk/pages/home For advice on student visas and guidance on student visa renewal, please contact the University Visa Advisers by email on visa@ncl.ac.uk see www.ncl.ac.uk/students/progress/visa/ For information about visas and Foundation Training, see the Foundation Programme website www.foundationprogramme.nhs.uk

Elective Photograph and SSC Poster Prizes Evening

The Faculty invites all Final Year students to the Elective Photograph and SSC Poster Prizes evening on Friday 3 December 2010 at 6.00 in the Boardroom, Medical School. This is a really pleasant social event which provides a rare opportunity for final year students to meet. The

elective photographs and a selection of posters are displayed and the prizes are presented by an eminent guest speaker. Light refreshments are served!

Learning Agreement
You are reminded of the MBBS Learning agreement which you are required to read and acknowledge at the beginning of each academic year. See LSE, admin tab/miscellaneous.

Stage 5 Handbook
This Handbook provides you with: an overview of the year, but details of the components of the course are given in individual Study Guides and Log Books. information about Stage 5 including learning and assessment strategies. It is also intended to help guide your behaviour when dealing with patients and their relatives, as well as other health care workers. It also provides you with advice to protect you from potential dangers in clinical settings (e.g. Hepatitis B). information relevant to your Base Unit.

Learning Outcomes for Stage 5

On successful completion of Stage 5 you will have achieved the terminal learning outcomes of the MBBS degree programme. Detailed rotation-specific learning outcomes and their relationship to the terminal learning outcomes are given in the individual study guides provided for each component of the Stage 5 programme. In summary these are as follows:

Clinical and Communication Skills

Elicit a comprehensive medical history and undertake a thorough physical examination of a wide variety of patients, young and old; Organise and present information gathered from patients in a clear and logical manner; Communicate information and ideas to patients and their relatives, their peers, and medical staff and other carers; Undertake a variety of practical procedures; Construct differential diagnoses and management plans to include investigations and treatment.

Knowledge and Critical Thought

Demonstrate knowledge and understanding of : common acute and chronic medical and surgical conditions in hospital and community settings and their management; common acute and chronic conditions in womens health and their management; common acute and chronic conditions in child health and their management; common acute and chronic disorders of mental health and their management; common conditions in general practice and their management; Demonstrate an awareness of the need for the continuing development of those attitudes favourable to the practice of medicine, including an awareness of the moral, ethical and legal responsibilities Demonstrate proficiency in decision making, and clinical reasoning and judgement.

Professional Behaviour
Demonstrate a responsible and professional manner in dealings with patients, their relatives, and professionals both within the hospital and community Demonstrate a problem-orientated, self motivated learning style Demonstrate self-awareness to the extent of recognising ones own limitations and knowing when to seek help Demonstrate an ability to cope with uncertainty, stress and setback To demonstrate a desire for intellectual rigour and the development of a capacity for selfaudit and reflection

Assessing Outcomes
A range of assessment instruments or modes of examination are used to assess your competency in each of the three essential domains. Through this process it is possible to

develop an overall profile indicative of your strengths and weaknesses which can be used to advise and manage future effort. Evaluation of your attainment is conducted through a process of 'assessment-to-standard'. A description of the formal assessment process used in Stage 5 can be found in the section on 'Teaching, Learning and Assessment' in this Handbook.

Curriculum Content

Stage 5 Senior Rotations

The Senior Rotations for Stage 5 are listed below: Child Health Mental Health Primary Care Womens Health Preparing for Practice Hospital Based Practice 3 weeks 3 weeks 3 weeks 3 weeks 3 weeks 16 weeks

These attachments emphasise the importance of hospital, primary care and community medicine, and address the overall themes of care and management. In the first 12 weeks of Semester 1, the rotations are organised into four three week blocks as shown in the diagram above. All students undertake Preparing for Practice in the last 3 weeks of Semester 1. Hospital-based Practice takes place in the first 16 weeks of Semester 2. Information about your sequence of rotations will be provided by the Base Unit Office. Detailed information relating to each Senior Rotation is provided in the relevant Study Guide. All Study Guides for Stage 5 are distributed to students as appropriate. Loss of the folder or individual Study Guides is the students responsibility. All Study Guides are available via the Learning Support Environment (LSE); it is possible to print individual Guides.

Student Selected Components

Two assignments have to be submitted during Stage 5. SSC3 - Elective Report - see Elective Study Guide for detail SSC4 Ethics Assignment - see Annex 2 for detail These assignments are assessed and form part of the Stage 5 Examination

Core presentations, conditions and cases

The core presentations and their corresponding core conditions are given in Annex 1. The presentations and conditions reinforce the patient centred nature of the curriculum and guide the core knowledge and skills which you should have acquired on graduation. The cases are used to focus and integrate your learning.

Teaching, Learning and Assessment

Teaching delivery and learning process
Within the framework of each rotation, content is defined in the Study Guides and may be introduced through various teaching methods both plenary and small group. This can then be extended through experience, practice and self-study. The choice of method is linked explicitly to the educational objectives and the learning outcomes. Examples of methods used for developing knowledge and understanding include: Small group tutorials and seminars, to provide opportunities for interaction, discussion and clarification in support of learning selected areas; Small group clinical teaching, for experiential learning in hospital and community care settings; Guided self-study, supported by provision of targets and direction in Study Guides. Examples of methods used in support of skills training include: Video and role play, to teach communication skills and develop attitudes and promote reflective practice; Clinical skills training in small groups in clinical attachments in hospital and community settings. Other methods serve a unifying role and help promote development of personal attributes, time management and self-reliance: Clinical attachments in hospital and community settings for the senior rotations provide opportunities to integrate, consolidate and apply knowledge, skills and attitudes accumulated from all other course components; Seminars, to allow discussion and debate; Logbooks (see below).

Self-Study & Time Management

By Stage 5, you are expected to manage your time efficiently and to ensure that the required reading and experience for Stage 5 is completed to schedule. It is your responsibility to ensure you are meeting the learning outcomes specified in the Study Guides: in-course assessment and appraisal will help you to monitor your progress. The Study Guides should be used to assist in planning learning. The Phase II Study Skills Handbook should be used to help optimise your learning opportunities in each Senior Rotation.

Logbooks
As part of your personal and professional development throughout Stage 5 you will be required to maintain a Logbook which is provided as a separate document for each component of Stage 5. The Logbooks provide you with a structured approach to your learning through allowing recording of your own experiences and performance. During Stage 5 it is your responsibility to ensure that you not only appraise and log your own performance but receive formative feedback from clinical supervisors, colleagues and other members of the health care team. You will be required to provide your Assessor with access to the relevant Logbook during your summative assessment of professionalism.

Log Book

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Each Logbook has the following sections: Rotation Log this provides a list of rotation specific outcomes/competencies which you should complete/achieve during the rotation. You are expected to complete this log as you progress though each rotation/component of Stage 5. The Log forms an essential record of your achievement of the rotation outcomes which you will be required to produce as evidence during your end of rotation summative assessment of professionalism. Record of Achievement of Rotation Competencies Some of the Logbook Outcomes are marked with a flag. These are competencies which will be assessed during the rotation. Evidence of having achieved these competencies is required for your end of rotation summative assessment of professionalism. In addition to the formal recording of rotation outcomes within the Logbook you should also keep a record of your appraisal and assessment forms and a patient/learning diary

Appraisal and Assessment

Appraisal of your Clinical and Communication Skills, and your Knowledge and Critical Thought using the Formative Clinical Encounter Appraisal Forms Appraisal of your attainment of outcomes relating to Professional Behaviour using the Formative Appraisal of Professionalism forms Copies of your summative assessment forms, either Clinical Encounter or Professionalism, will be retained in this section

Patient records, Activities log and critical incident log

Patient diary sheets on which you should record basic information about patients you have seen and the triggers for learning that these have generated. These sheets are not intended to contain full case reports but to act as an aide memoire as to the range of patients you have seen and the knowledge about their conditions that was triggered. Clinical and learning activities log in which you should record additional clinical or educational opportunities of which you have availed yourself. These should be sessions beyond those scheduled and timetabled for all students. This section can be used as evidence of self motivation and enthusiasm. Critical incident sheets which can be used to record key events in your clinical training which have allowed you to define valuable learning outcomes or which have significantly altered your perspective Any Case Reports which you are asked to write will be retained in this section Additional pages and formative appraisal forms may either be downloaded from the Learning Support Environment (LSE) or may be obtained from your Base Unit Office. It is your responsibility to ensure that all sections of your Logbook are kept up to date and safe. In addition, you should maintain the e-Portfolio to which you have been introduced in Stages 1 to 4. In particular, you should use this record to reflect accounts of critical incidents which have affected you in a particular way, as well as continuing to accumulate evidence towards your completion of personal development outcomes. This approach to learning will prepare you for the mandatory use of portfolios in your postgraduate training and for professional revalidation exercises.

Reflection on personal performance

Reflective practice means thinking through what you have done or seen, then deciding what worked well and what didn't work out and why this might have been the case. From that you can decide what you need to develop, change or improve. You can then make this an objective in your clinical work. Try and spend a few minutes a day jotting down your thoughts in this way. There is evidence that this form of activity is how the best doctors learn clinical medicine, as they are more prepared for the unexpected and unplanned experiences they come across.

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Stage 5 MBBS: Student Assessment

Assessment in Stage 5
Assessment in Stage 5 comprises in-course assessment of all components of Stage 5, assessment of Elective Report and Ethics Assignment (SSCs 3 and 4 respectively) and an end of Stage 5 Examination.

Modes of Assessment
The learning outcomes for Stage 5 are defined in terms of Clinical and Communication Skills (Skills), Knowledge and Critical Thought (Knowledge) and Professional Behaviour (Professionalism). Different modes of examination and different assessment instruments are used to assess student competency with the choice of question type/mode matched carefully to the outcome being assessed. The following modes of assessment may be used to assess Clinical and Communication Skills : Free-text examination questions, Multi-station Objective Structured Clinical Examinations (OSCE), Multi-station Objective Structured Long Examination Record (MOSLER) and in-course assessments/assignments The following modes of assessment may be used to assess Knowledge and Critical Thought: Extended Matching Item questions (EMI), MOSLER, Data interpretation/problem solving questions and in-course assessments/assignments The following mode of assessment is used to assess Professional Behaviour: In-course assessments/assignments, These various instruments are used both individually, as part of continuous assessment (e.g. in-course assessments) or in combination for the end of Stage 5 assessment.

Formative Appraisal
You have been provided with a Logbook to help you record and reflect on your progress towards the learning and personal development outcomes of the programme. Formative appraisal forms for each component of Stage 5 are provided in the Logbook. You are advised to take the opportunity to participate in formative appraisal as often as is appropriate and practicable and to retain all completed formative appraisal forms in your Logbook. This will provide you with a permanent record of the feedback given on your strengths and weaknesses and allow you to monitor and reflect on your own progress. You will encounter two types of formative appraisal in Stage 5: Appraisal of your Skills and your Knowledge using the Formative Clinical Encounter Appraisal Forms Appraisal of your attainment of outcomes relating to your Professionalism using the Formative Appraisal of Professionalism forms Further information relating to formative appraisal can be found in the Logbook.

Structure of Assessment in Stage 5

On the first occasion of examination (normally June), or any subsequent occasion following a further year of study (normally the following June), the Stage 5 MBBS Examination comprises:

In-course Assessments/Assignments
Child Health: in-course assessment

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Mental Health: in-course assessment Primary Care: in-course assessment Womens Health: in-course assessment Preparation for Practice: in-course assessment Hospital-based Practice: in-course assessment x2 SSC3 Elective Report: in-course assignment SSC4 Ethics Assignment: in-course assignment Details of the in-course assessments are provided in the relevant Study Guides

Challenges to Clinical In-Course Assessment Grades

If a student believes that they have reasonable grounds on which to challenge a grade, they should refer to the Challenges to Clinical In-Course Assessment Grades Procedure which can be found in the Assessment section of the LSE. Details of the Elective Report and Ethics Assignment are provided in the Elective Study Guide and Annex 2 of this Handbook respectively. You are reminded that individual assessment episodes (in-course assessments/assignments and examinations) may contribute to more than one of the assessment domains, Skills, Knowledge and Professionalism.

Standard Setting & Criteria of Performance

In line with GMC recommendations, and in order to secure standards and provide evidence that students have achieved a particular outcome, absolute performance criteria are defined for all assessments. For continuous assessments (e.g. ESR Summative Clinical Encounter assessment), your progress is measured against explicit criterion-referenced statements specified for either each grade M, S, B and U or for Acceptable and Unacceptable. These are provided in the Stage 5 Logbook. For all objective, structured modes of assessment (e.g. EMI, OSCE) your progress is measured according to pre-determined cut-off points on the scoring scale, i.e. a cut-off score is determined which equates to Merit (M), Satisfactory (S), Borderline (B) and Unsatisfactory (U). The MBBS Assessment Standards Board is responsible for determining the cut-off scores for each assessment. The Board comprises a panel of academic staff who are familiar with the assessment methods, the stage of the students development, and who are experts in the related fields of the assessment. The methods used are judgmental. For written papers and unobserved OSCE stations, the method used (known as the Modified Anghoff) involves a process in which the Board determines for each question the number of items it would expect students in each grade category (i.e. M, S, B and U) to score correctly. Estimates are averaged over Board members and summed over questions to create a standard (cut-off) score for the test. For the observed OSCE stations the Borderline method is used to determine the standard (cut-off) score for each station. This is based on the mean score of those candidates deemed by the examiners, in their global assessment of performance, to be Borderline. When a question has been used before, the Board is aided in its deliberations by having previous relevant performance data to help inform its judgement. Once determined, and validated by actual performance, the cut-off (standard) scores stay the same on each subsequent application of the test. Clearly the cut-off scores will vary from test to test, so that they are not published until the time of the test. In order to pass the OSCE examination you must attain at least a Pass in 10 out of the 15 OSCE stations.

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Determination of Outcomes for Clinical and Communication Skills and Knowledge and Critical Thought
You are assessed by: Summative Clinical Encounter assessment in all components of Stage 5 except Preparation for Practice Unseen examination in the End of Stage Examination. Assessment Child Health: in-course assessment Mental Health: in-course assessment Primary Care: in-course assessment Womens Health: in-course assessment Hospital-based Practice: in-course assessment 1 Hospital-based Practice: in-course assessment 2 Skills Y Y Y Y Y Y Knowledge Y Y Y Y Y Y

End of Stage Examination

For each assessment episode you are graded according to the M, S, B and U grading scheme such that at the end of the year you will have a final overall grade (M, S, B or U) for both Skills and Knowledge. In order to determine a final outcome for Skills and Knowledge, a combination of grade averaging and Look-Up Tables (see below) are used. To average grades, each grade will be converted to a numerical score (M=4, S=3, B=2, U=1) and average calculated and the number converted back to a grade using the following thresholds (M>3.54, S>2.54, B>1.54, U1.54).

Clinical and Communication Skills

The grades awarded for each in-course assessment/assignment are averaged to give an overall In-Course Grade. The grades achieved for the OSCE, MOSLER and written components of the End of Stage Examination are combined to give a final score out of 24, on the basis of:

OSCE

MOSLER

12

12

S B

9 6

9 6

14

The final aggregate score for each candidate is then re-expressed as a single letter grade, the Clinical Skills Grade according to the scale: M = score of 21 or more S = score of 17 to 20 B = score of 10 to 16 U = score of 9 or less The In-Course Grade is then combined with the Clinical Skills Grade using Look-Up Table 1 to give the carried forward result, Clinical Practical Grade. LOOK-UP TABLE 1 Clinical Skills Grade M M M M S S S S B B B B U U U U In-Course Grade M S B U M S B U M S B U M S B U End of Stage Skills Grade M M S B S S S B B B B B B B U U

Knowledge and Critical Thought

The grades awarded for each in-course assessment/assignment are averaged to give an overall In-Course Grade. The grades achieved for the MOSLER and Written Paper components of the End of Stage Examination are combined using Look-Up Table 2 below to give the Examination Grade: LOOK-UP TABLE 2 Written Paper Grade M M MOSLER Grade M S Examination Grade M M

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M M S S S S B B B B U U U U

B U M S B U M S B U M S B U

S B S S S B S B B B B B U U

The Examination grade is combined with the In-Course Grade using Look-up Table 3 to give the End of Stage Knowledge Grade

LOOK-UP TABLE 3 Examination Grade M M M M S S S S B B B B U U U U In-course Grade M S B U M S B U M S B U M S B U End of Stage Knowledge Grade M M S B S S S B S B B B B B U U

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Determination of Outcome for Professional Behaviour

Your Professionalism will be assessed throughout Stage 5 as follows: Assessment Episode Child Health: professionalism assessment Mental Health: professionalism assessment Primary Care: professionalism assessment Womens Health: professionalism assessment Preparation for Practice: professionalism assessment Hospital-based Practice: professionalism assessment 1 Hospital-based Practice: professionalism assessment 2 SSC3 Elective Report: in-course assignment SSC4 Ethics Assignment: incourse assignment Professionalism y y y y y y y y y
combined to give a single in-course assignment professionalism grade

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For each assessment episode a students achievement of Professionalism is assessed and a student is graded either Acceptable or Unacceptable. As such, a student will not complete Stage 5 with a final overall grade in Professionalism, but will be required to be in good standing with respect to Professionalism i.e. to be Fit to Practise to complete the End of Stage Examinations and graduate. To be in good standing with respect to Professionalism means that a student: Has been graded Acceptable for each in-course assessment/assignment as described above or If graded Unacceptable for one or more in-course assessment has satisfied the requirements of any agreed remediation plan associated with an Unacceptable grade(s). Is not under consideration by the Faculty of Medical Sciences Fitness to Practise procedure.

Summative Assessment of Professionalism

The possible grades for the Summative Assessment of Professionalism (Professional Behaviour domain) are as follows: Completion of Rotation Outcomes Womens Health Child Health Mental Health Primary Health P4P HBP 1 HBP 2 Ethics and Elective A or U A or U A or U A or U A or U A or U A or U Professionalism A or U A or U A or U A or U A or U A or U A or U A or U

Completion of rotation outcomes U grades are remediable and would be changed to A grades once satisfactory Professional Behaviour U grades are non-remediable and would stand * Attendance does not feed into the Professional Behaviour domain. Problems in this area would be dealt with under the University regulations for Unsatisfactory Progress A single non-remediated U grade for Completion of Rotation Outcomes in any rotation would mean a student could not progress to finals and would be required to retake Stage 5 as a final attempt. Three or more U grades for Professional Behaviour would mean a student could not progress to finals and would be required to resit the whole stage again as a final attempt A student having attained two U grades in Professional Behaviour could therefore graduate in good standing. The issues which led to the U grades would have been highlighted under Areas for Consideration on the Professionalism form and should have been addressed through subsequent rotations. Where an incident leading to a U grade in professionalism in any rotation is sufficiently serious, a student may be referred to either the University Disciplinary Procedure or the Fitness to Practise Procedure.

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Attendance
A students attendance will be recorded via Section 3 on the Summative Assessment of Professionalism forms during each rotation. The possible grades for this are as follows: Attendance Womens Health Child Health Mental Health Primary Health P4P HBP 1 HBP 2 A or U A or U A or U A or U A or U A or U A or U

One U grade awarded in this section would mean automatic referral to the Base Unit SubDean. This grade could not be remediated, however, should subsequent investigation reveal a valid reason (extenuating circumstance) to account for an attendance problem the Sub-Dean would have the discretion to amend this grade. 2 U grades in this section across rotations would result in a written warning regarding attendance and strict monitoring of the student to be introduced in accordance with the University progress regulations 3 U grades in this section across rotations would result in referral by the Director of Studies to the University Concessions Committee with a recommendation that the student should defer taking finals.

Examination Arrangements
Examination timetables will be posted on the Stage 5 Examinations notice board in the Medical School and the Learning Support Environment (LSE). You are responsible for familiarising yourself with these schedules. You should also make sure that you are aware of the location of the examination and that you allow yourself sufficient travel time to ensure that you do not arrive late. Late arrivals at an examination will only be permitted entry in the first half-hour of written examinations and the first ten minutes of clinical examinations and will not be permitted extra time to complete the exam. You are responsible for maintaining the anonymity of your Candidate Number and may be required to produce the card on all occasions of assessment. Replacement cards can only be obtained from the Medical Student Office (Medical School) where a charge of 1.00 will be made. Use of the correct Candidate Number is essential and is your responsibility.

Final Outcome of Stage 5 Examination

If on completion of Stage 5 you are carrying at least a grade S in each of the Skills and Knowledge assessment domains and are in good standing with respect to Professionalism, you will be deemed to have passed the Stage 5 (Final Qualifying) Examination. If on completion of Stage 5 you are carrying a grade of U or B in one or both of the Skills and Knowledge assessment domains, you will be deemed to have failed the Stage 5 (Final Qualifying) Examination. If on completion of Stage 5 you are not in good standing with respect to Professionalism, you will be deemed to have failed the Stage 5 (Final Qualifying) Examination.

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If you are presenting for examination on the first occasion and are carrying the grade M in one of the Skills and Knowledge assessment domains (and are in good standing with respect to Professionalism), you will be deemed to have passed the Stage 5 (Final Qualifying) Examination with Merit. If you are presenting for examination on the first occasion and are carrying the grade M in both the Skills and Knowledge assessment domains (and are in good standing with respect to Professionalism), you will be deemed to have passed the Stage 5 (Final Qualifying) Examination with Distinction. For information about Exit Awards please refer to the MBBS Degree Programme Handbook. For information about the Leave of Absence Policy please refer to the MBBS Degree Programme Handbook

Academic Rating & the Award of Honours

To be eligible for the award of MBBS with Honours, you must fulfil three criteria: You must achieve a Pass with Distinction in the Stage 5 (Final Qualifying) Examination You must achieve an academic rating of at least 27 You must not have achieved a U grade in the Professionalism domain in either of the two incourse assignments for the Stage (the Elective Report and the Ethics Assignment) The Academic Rating is a cumulative measure of a students overall performance in the Examinations for all Stages 1, 2 3 & 4. On completion of any Stage examination on the first occasion of examination, a candidate will be classified as having: Passed with Distinction Passed with Merit Passed Failed For each of the Stage 1, Stage 2, Stage 3 and Stage 4 Examinations, these classifications are awarded a score that contributes towards the Academic Rating as follows: Stage 1 Pass with Distinction Pass with Merit Pass Fail 4 3 2 1 Stage 2 8 6 4 2 *Phase I 12 9 6 3 Stage 3 12 9 6 3 Stage 4 16 12 8 4 Academic Rating 40 30 20 10

* Refers to Phase I of the Accelerated Programme Candidates who did not take Phase I at either Newcastle or DUQC, will be eligible for the award of Honours with an Academic Rating of 18.

Notification of Results
The assessment programme is monitored by a number of External Examiners, who attend the Institution for the OSCE and the MOSLER examinations. In addition they look at a sample of student work undertaken throughout the year and attend the Meeting of Examiners following completion of the assessment programme.

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Following the completion of the Meeting of Examiners, a Pass list will be posted on the Stage 5 Examinations notice board in the Medical School and on the LSE. If your name does not appear on the list you must make an appointment to see the appropriate Curriculum Officer on the date(s) given.

Resit Examination
Students failing the Stage 5 (Final Qualifying) Examination will normally be expected to undertake Stage 5 for a second time before completing the Stage 5 (Final Qualifying) examination for the second and final time. It should be noted that a choice of Base Unit for this repeat year may not be guaranteed. Students resitting the Stage 5 (Final Qualifying) Examination will be required to take the following unseen examinations: Written papers OSCE MOSLER You will not be required to resubmit the Elective assignments, but will be required to undertake a new Ethics Assignment during the year.

Prizes
Philipson Scholarships
Awarded to 2 students who obtain the highest marks in the Final MBBS and tenable for one year. The Scholarships are awarded, on the recommendation of the Board of Examiners, to the undergraduates who shall obtain the highest marks at the Stage 5 Examination in any one academic year. The Scholarships will only be awarded if in the Examiners' opinion the marks are of a sufficiently high standard. The successful candidates will be designated 'The Philipson Scholarships of the Degree of Bachelor of Medicine'.

Mona MacNaughton Prize

The prize is known as the Mona MacNaughton Prize, and is awarded annually on the recommendation of the Board of Examiners, to the undergraduate student who obtains the highest marks in the Stage 5 Examination. The prize is only awarded if, in the Examiners opinion, the marks are of a sufficiently high standard. There are a number of other prizes which students are encouraged to compete for (see annex 7). Full information is also available on the Learning Support Environment or by contacting Richard Wales, email: r.wales@ncl.ac.uk, telephone 0191 222 5160

Other Student Achievements

The Faculty is aware that students sometimes have significant achievements, for example winning an external prize or bursary, presenting a poster at a conference etc. etc. We would strongly encourage students to let us know of such achievements so that we can duly record them on your students record and congratulate your success! A form to report an achievement is available on the LSE see Admin Tab/Forms.

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Student Progress and Achievement

Attendance and Submission Requirements
Logbooks
The maintenance of your Logbooks may be taken into account as follows: if the Director of Medical Studies or University Concessions Committee need to consider your progress if you are referred to the Base Unit Sub-Dean as a consequence of being awarded an Unacceptable grade as part of the summative assessment of your professionalism

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Student Support and Guidance

Communications and General Information
During Stage 5, the Base Unit Office is your primary centre for information and enquiries for all matters. You must keep the Base Unit Office informed of any change of address or telephone number. This is essential during the clinical course as you are required to travel between hospitals and General Practices, and cannot always be contacted via your attachment. Failure to keep the Base Unit Office informed may result in you not receiving important information as your local address will always be treated as the primary point of contact in Phase II. In addition to notifying the Base Unit you should you must notify the Medical Student Office of all changes to your local and home addresses, telephone numbers and change of name. You can do this by using the change of address form on the Learning Support Environment or you can log on to the Student Self Service Portal, S3P at any time during the year and update your details. (The exception to this is a change of name which still needs to be processed by the Medical Student Office). The primary route for communication will be by e-mail, and it is essential that you check your email regularly and inform the Base Unit Office if you are not included in the mailing lists. It is essential that you use your ncl.ac.uk email address since the Medical Student Office and Base Unit Office will not use any other email address to contact you. It is therefore ESSENTIAL that students who studied at DUQC in Phase I use their ncl.ac.uk email address otherwise they will miss vital information which will not be sent to their Durham email address. If you experience any problems with your ncl.ac.uk email address, please contact your Base Unit Office without delay. In addition you should check the Base Unit notice boards for new and important information which cannot be distributed to individual students. You are referred to Annex 6 of this handbook for information relating to communication with your Base Unit Office.

Finances
Student Loans
All student loan instalments will be paid directly into your bank account. If you do not receive expected payment please contact the University Finance Office, Kings Gate, NE1 7RU telephone number 0191 222 6496. Financial assistance with travel There is some assistance available within the Faculty for travel during Stage 5. Payment of a travel bursary is intended only as a contribution to the expense you incur whilst undertaking your studies. However, some LEAs will also make a contribution for travel, which is often a larger amount than that provided by the Faculty. You should contact your own LEA to confirm whether this applies to you. If you make a claim through your LEA you will not be able to claim from the Faculty All medical students including self funded and International students are eligible for support from the Student Travel Bursary, and you will be required to complete a claim form at the start of Stage 5 to apply. The Bursaries available are as follows: Northumbria Base Unit - 155.00 Tees Base Unit - 255.00 Tyne Base Unit No bursary available Wear Base Unit - 155.00

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The application deadline for the Medical School Travel Bursary is FRIDAY 24TH SEPTEMBER 2010. Payments will be made directly into your bank account. A small number of you may be entitled to claim travel expenses from the NHS Bursary Students Grants Unit. Those of you in this position will not be entitled to claim the travel bursary from the Faculty. This is to maximise the amount of money available within the Facultys Student Travel Fund, and this money is used to help students struggling financially with their travel. If you have already received a contribution towards your expenses from the Faculty prior to making a claim from the Student Grants Unit, you will be asked to return the former. You should be aware that the remuneration in respect of travel via the NHS Bursary Scheme is greatly in excess of that which can be provided by the Faculty. A small amount of money is also available to further assist students, who may be experiencing financial hardship, with their travel expenses. Students who wish to apply to this travel fund should do so by writing a letter, addressed to the Director of Medical Studies, giving any necessary information regarding their need for further financial assistance. It must be noted that it may not be possible to grant every request for further help, but the Faculty will endeavour to help as many students as possible.

Financial Hardship
The CIA Roberts Bursary Scheme is money from a bequest to assist medical students in case of severe financial hardship. Applications are invited in February of each year and further information is available on the LSE (see admin tab, bursaries and prizes) In addition, the University Student Wellbeing Service can offer discretionary financial support. Further information can be found at: www.ncl.ac.uk/financial-support

Academic and Pastoral Support

Network of support
The main aim of the Student Support and Guidance system is to ensure that you can access appropriate help when and if you need it. You are encouraged to think of a network of support. To remind you, this includes: Informal support e.g. from family and friends, peer parents and fellow students Base Unit staff e.g. Pastoral Tutor lead, who can allocate you a personal tutor Undergraduate or other Education tutor Base Unit office: can direct you to members of staff with a pastoral role Base Unit Sub-Dean Medical School staff e.g. Curriculum Officer e.g. Senior Tutor for Student Support and Guidance, Study Skills Advice, Careers Advice, Referral to Occupational Health University Services e.g. Student Wellbeing Service

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Your Personal/ PastoralTutor

Personal/ Pastoral Tutors are available to listen to you and talk with you about any personal or other difficulties which might require support and/or referral. The Pastoral Tutor lead can allocate you a tutor if you need some pastoral support, whether for a specific issue or for a longer period of time.

Curriculum Officers
If you are experiencing any issues or problems that are impacting on your performance and progress you should contact your Base Unit Sub-Dean. Such issues might include long-term health problems, bereavement, family problems, study skills problems, leave of absence, uncertainty about medicine as a career, intercalation. You may, at some point, be referred to a Curriculum Officer in the Medical School, usually the Senior Tutor for Student Support and Guidance. o The Senior Tutor for Student Support and Guidance is Dr Rosie Stacy, email: rosie.stacy@ncl.ac.uk . Dr Stacy is available at two surgery sessions each week, which are usually held on Wednesday and Friday afternoons. Students make an appointment to attend a surgery session by contacting the Medical Student Office: telephone 222 5260 or e-mail mbbs-support@ncl.ac.uk. Where there is a possibility of your health impacting on your studies you will be referred to the Occupational Health service so that we can have an assessment of the issues and your needs. If you need the support of University welfare agencies, for example for counselling, you can be advised on where the most convenient service would be based.

Other Curriculum Officers in the Medical School include The Director of Medical Studies, Dr Bradley, who you may be required to see for specific areas of concern such as disciplinary or fitness to practice issues.

University Services
Newcastle University provides a range of service to help you. The following services are particularly relevant, but do look at the University website to see the whole range. Student Wellbeing Service. Information and contact details for the network of University support agencies are given on www.ncl.ac.uk/students/wellbeing The Counselling and Mental Health Support Service is part of the Student Wellbeing Service. Many undergraduate medical students use the counselling service at some point to help them through a particularly difficult time. Students can make arrangements to do this directly and in complete confidence. As well as counsellors, there are mental health advisors and student wellbeing advisors, who can help with problems such as anxiety. Disability Support. This service assists with long term needs such as extra time in examinations for students with dyslexia, but will also offer help for a range of other issues including short-term impairment. Student Advice Centre. This provides advice on many practical matters, including finance, accommodation, visa applications. You contact the Centre directly as indicated on the webpage. Careers advice. General careers advice is available for students who wish to leave medicine and change direction. The Writing Development Centre. Level 2 Robinson Library. This offers advice, guidance and tuition for students who wish to improve their writing skills for study or employment purposes. It covers problems planning and structuring assignments, using sources in writing without plagiarism, writing CVs and cover letters and using grammar and

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punctuation accurately. You can visit the Centre to book an appointment. A drop-in service is also available. Maths and Statistics help. This is available from the Robinson Library. Maths-Aid provides workshops, a drop-in centre and help with teaching materials.

Re-allocation to a Base Unit

The Faculty recognises that students circumstances may change during the course of Stage 5. Any student who, as a consequence of personal circumstances, wishes to be allocated to a different Base Unit must make an appointment to discuss their request with the Director of Medical Studies. Any re-allocation will only be made between rotations and only if a similar pattern is available elsewhere.

Re-allocation in Clinical Attachments

Students who wish to change to their hospital or group allocation, must make an appointment to see the Base Unit Sub-Dean to provide the reason for such a request. Requests will be considered on a case by case basis. Swapping attachments without the permission of the Base Unit Sub-Dean is not permitted under any circumstances.

Conduct in Assessments
The Regulations and Examination Conventions of the University and the Faculty govern all assessments (in-course and unseen written examinations). ). Students should also be familiar with the Universitys Rules Governing the Conduct of Examinations, available at www.ncl.ac.uk/examinations/RULES.htm As a Stage 5 student you need to be aware that you: are required to bring your smart card to ALL examinations are required to bring the relevant Log Book to each in-course assessment of your professionalism. should not bring bottled water or any other refreshments to any clinical examination

In-course assessments
In-course assessment grades are awarded based on the academic and clinical judgement of the assessor, who will give feedback on your performance on the appropriate assessment form. You will be asked to sign the assessment form. This is to indicate that you have received the feedback provided.

Conduct on clinical attachments

During your clinical attachments you are expected to maintain a high standard of behaviour. You must respect patients and their relatives, and conduct yourselves in an appropriate manner in your relationships with medical, nursing and paramedical staff. When working on the wards you must be suitably dressed. Some guidelines on conduct are given below

Punctuality
You must arrive at all clinics, ward rounds and general practices on time. If late arrival is anticipated please try to inform the relevant teacher or practice in advance. In teaching sessions late arrival of students is discourteous and disruptive to other students, and for this reason latecomers may be refused admission to teaching sessions.

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Behaviour
You must be courteous to patients and the general public at all times. You should also be considerate to medical, nursing and para-medical staff.

Consent Issues on Clinical Attachments

Patients are fully at liberty to decline student involvement to any extent, without prejudice to their care or treatment. Any hospital or Primary Care setting where clinical teaching takes place should give patients an explanation of the importance of clinical teaching and an outline of what it might involve. The following procedures should be followed to ensure patients are fully informed of a students presence: Written information about the presence of medical students should be given to patients in advance wherever possible. The information should state the likely role the student(s) may play, including access to notes if appropriate. Written information should be supplemented by notices in areas used by the patients. Patients should be reminded of the presence and role of students by staff at the time of their clinic appointment or admission. Verbal consent should be gained prior to the clinical encounter, ideally by someone other than the student. Whilst verbal consent is valid and wholly appropriate for most situations, it may be necessary to gain consent in writing in certain situations, namely where intimate examination is proposed, either with a conscious patient or under anaesthesia. If a patient is unable to give informed consent due to their mental or conscious state, or the physical effects of their problem, consent should be sought from a relative if possible. If it is not possible to gain consent, involving the patient in teaching is still acceptable if the clinician believes it to be appropriate. Written consent must be obtained for any recordings or data used for teaching purposes from which the patient can be identified; oral consent is sufficient for recordings from which the patient cannot be identified. You are referred to the document Consent for involvement in Teaching/Medical Education for detailed information relating to consent issues for undergraduate medical students.

Your Health and Welfare on Clinical Attachments

Occupational Health
An occupational health service for medical students is provided by the Occupational Health Service Worklife & Wellbeing Centre, Newcastle General Hospital, Newcastle upon Tyne Hospitals Foundation Trust. Telephone: 0191 2821188 Fax: 0191 2821199 It is your responsibility to ensure that your occupational health records are complete and up to date by:complying with all requests from the Occupational Health Directorate to provide proof of your immunisation status for Polio, Tetanus, Varicella (Chicken Pox), Diptheria, Measles, Mumps, Rubella and TB. undergoing routine testing in accordance with the Medical Schools Council protocol on blood borne viruses (Hep B, Hep C and HIV) (www.medschools.ac.uk/AboutUs/Projects/Documents/BBVsGuidanceFeb2008.pdf

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notifying Occupational Health if you have any reason to believe your immunisation status or BBV status may have changed If you decline screening or test positive for a BBV you will fully supported in continuing on the course and will be counselled on the implications and restrictions regarding the organisation and delivery of your clinical training. (Detailed information relating to control of infection, personal hygiene & illness, needlestick injuries, and blood borne virus infections is included in Annex 3 of this handbook). However, if you have not been given appropriate health clearance by Occupational Health simply because you have failed to provide information and/or undergo routine testing without discussing this with Occupational Health, you may be restricted from the wards and unable to complete your clinical attachments. In addition, individual Trusts have their own policy in respect of Occupational Health procedures, and you may be required to augment the immunisations listed above and/or to complete an Occupational Health questionnaire before attending a Trust for the first time. You may also find that some Trusts will require you to attend their Occupational Health Department on your first day. Should you sustain a needlestick injury or work related accident or develop a health problem which is impacting on your studies please contact the Occupational Health Department for advice and support.

Venesection
You will be expected to help on wards with taking blood samples from patients. Ensure that you take care with venesection and report any "needle-stick" injuries immediately as outlined in the control of infection section. It is essential for your own health to check you have had hepatitis B immunisation and have seroconverted.

Medical Students, the Law and Clinical Attachments

The Medical Act 1983
By virtue of section 47 of the Medical Act 1983, an appointment as a physician, surgeon or other medical officer can only be held by a person fully registered with the General Medical Council. Persons with provisional or limited registration may be deemed to be fully registered to the extent permitted by sub-sections 15(3) and 22 (7) of that Act. Students are excluded from these provisions. Authorities are liable in law for the acts and omissions of students they admit to their premises4.

Conditions governing students' clinical work

To ensure that the interests of patients, Authorities and Trusts are safeguarded, the Department and the profession have agreed on the conditions under which students may undertake clinical work. All medical, nursing, midwifery, pharmacy and radiography staff, and in particular staff responsible for patient care in units where students will be present, should be familiar with these conditions which must also be fully understood by the students themselves. The admission of a medical student to the premises of a Health Authority or a Trust is subject to the prior written approval of that body. Only "bona fide medical students" may have access to patients and take part in any clinical procedure involving patients, including all forms of clinical examination, even under supervision. Students must be readily identifiable as such, e.g. wear a suitable lapel badge.

Students must in no circumstance:

Initiate, alter or stop the treatment of a patient on their own diagnosis; both diagnosis and treatment must be confirmed by the registered medical practitioner supervising them; Prescribe, request radiological examinations or other diagnostic investigations, or order blood to be cross-matched. If students complete an order form for any of these purposes

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it must then be signed by the registered medical practitioner supervising them before it is executed; Take any part in obtaining or witnessing the signature by or on behalf of a patient on a form of consent to treatment; Take a history from, examine or undertake a procedure on a patient unless his/her prior informed consent has been obtained. If it is not practicable to obtain specific consent, the student must seek authorisation in advance from a supervising registered practitioner. This will apply in the case of those patients unable, for whatever reason, to make a decision on consent. Exceptionally, this may include some anaesthetised patients, though normally such consent should have been sought from the patient in advance. A student acting in an emergency eg, a cardiac arrest, has the same rights and responsibilities as any other citizen.

Conditions for medical students on attachment

The consultant to whom the medical student is attached will determine the degree of supervision required, will provide such supervision personally, or will arrange for its provision by one or more identified registered medical practitioners.

Medical Student Assistants/Locums

Those students in their final year may act as Assistants/Locums.

Medical students in general practice and the community

Remember that when you are in the community you are acting as an 'ambassador' for the Medical School. In particular, the relationship between a patient, GP, or other primary health care professionals, does not normally include a third party. You are therefore in a privileged position, which requires some sensitivity, for example in dress and behaviour. Make sure you take your stethoscope and diagnostic kit (if you have one) with you. Patients may ask to be seen without a student being present more often than in a hospital setting, although on the whole people are very happy to contribute to medical education as long as their consent is sought, and their dignity and confidentiality is respected. All those involved in the teaching have a days work to do, and may have planned well ahead to fit their routine work around teaching. Furthermore, many patients will have given up their own time to attend the surgery for teaching purposes. Please therefore be punctual and if you are unavoidably detained, or are unable to attend, inform the practice as soon as possible. It is also your responsibility to inform the Base Unit Office before 10.00 am if you are absent on any particular day.

Medical Students and Inappropriate Patients

Although patients are entitled to expect that you will maintain complete confidentiality there may be some patients you encounter where it may not be appropriate for you to be involved in their care and treatment. These may include Members of staff of the Medical School and Hospital Trusts Medical Students Families of the above In most cases patients will be able to indicate their own wishes about the involvement of medical students in their care. Particular difficulties may arise with children, or those unable to give permission. In the case of children the permission of the parents should be sought. In the case of adults whose competence is questioned the permission should be sought from the relevant family member.

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Difficult Consultations and Difficult Times

During your Senior Rotation attachments, when you are functioning more independently, you may encounter patients, for instance when interviewing in out-patients or a GP surgery, or when clerking on the wards, who are angry or aggressive, emotionally distressed, or who have problems such as impaired hearing. All these factors make communication more difficult. The following notes are general guidelines of how to handle some of these situations. You are advised to read and reflect on them before you start the attachments.

Angry Patients
Being ill, or having a relative who is ill, can make people frustrated and angry. Acute grief is often also accompanied by anger, classically directed at doctors or nurses. Remember the following: It is the patient or relative who is angry, not you. Angry people are often also frightened people. Don't leave the anger unexplored. Acknowledge it - something as obvious as 'You seem to be very angry' is amazingly effective! - encourage the person to talk about the problem, and show your willingness to listen. Try not to interrupt a verbal outburst. Don't contradict or behave in a threatening way. The main aim is to break the cycle of anger and aggression, to reduce the threat of harm to anyone, and to create a calm atmosphere. If there is a physical threat, keep a safe distance. Body language can be important - don't stand with arms folded in an aggressive posture or jab your finger at the patient; keep your posture 'open'; positioning yourself slightly lower than the patient may help, for instance sitting down. Try and help find a solution to the patient's problem if appropriate e.g. finding out why they have been kept waiting for so long, but do not make promises that can't be kept. Always report the incident to a senior colleague.

Emotionally Distressed Patients

People who are physically ill are also often emotionally distressed as well. Unfortunately this is not always recognised or acknowledged, besides which some people may feel they have to put a brave face on things - 'I didn't want to make a fuss; the staff are all so busy'. Perhaps because medical students are not seen as being part of 'the system', or are perceived as having more time, patients sometimes unburden their feelings to them. A few points to guide you should this happen: There is nothing wrong with a patient unburdening their feelings, and you do not have to feel that you have to provide a solution. Allowing ventilation of feelings may in itself be therapeutic. Recognise the signs - silence, body language, changes in speech, manner and so on - and respond to the cues. Saying something like 'You seem very upset is often all that is required. Try and avoid 'blocking' things, for instance by changing the subject or attempting to 'jolly' the patient along. Demonstrating empathy should be a part of every consultation, not least when the patient is distressed. This is about indicating to the patient that you are trying to understand their feelings and experience. Simple things like maintaining eye contact and statements like 'That must have been very upsetting for you' are very effective. Touch is also a powerful means of communication that we use to express a whole range of emotions, including empathy. A gentle touch on the arm, or squeezing a hand, substitutes for a thousand words. If, however, you feel uncomfortable about using touch it is probably better not to do it.

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If you can't think of anything to say, don't say anything! Or to put it another way: 'Don't just do something - sit there' Silence is a powerful tool in communication if used appropriately. Again, always report such an encounter to a senior colleague. The patient might require further support.

Challenging Communication Problems

These include people: With impaired hearing With learning difficulties With speech problems, for instance after a stroke, or the frail elderly, and Whose first language is not English Such patients often find themselves part of a vicious spiral of social isolation: the person struggles to make his/herself understood; this creates embarrassment, frustration or annoyance; others withdraw or avoid contact; the person feels rejected and misunderstood. You have already covered aspects of communication in some of these situations, for example impaired hearing, people with learning difficulties, and working with interpreters, earlier in the curriculum, e.g. Stage 4 Challenging Communications, but here are a few general principles: Take your time and try not to show impatience, however frustrating the situation is, thus demonstrating respect for the other person. It is not always the case that the louder we speak, the more easily the other person will understand (the caricature of the Englishman on holiday in a foreign country!). If it is necessary to speak louder, for instance with someone with impaired hearing, a loud conversational voice will often suffice with one's face in full view of the patient. Avoid the 'does he take sugar?' approach of talking over a patient. Don't make assumptions about what the person is trying to say. Check that you have heard correctly by feeding back to them what you have understood. Similarly, don't make assumptions about what they have heard and understood. Check their understanding by asking them to feed back to you. Don't offer meaningless reassurance or platitudes (Don't worry - we'll take care of everything for you') as a substitute for effective communication. Consider using other forms of communication such as pictures and written words.

Difficult times for students

It is important to recognise and acknowledge your own feelings in response to a patient's emotions or a difficult consultation. It may be helpful to 'debrief' by talking things through with another person. During each attachment there may be events that occur which cause you distress (e.g. unexpected death, child abuse, domestic violence, stillbirth, intimidation, harassment). Discussion with other members of the clinical team or peers can be very helpful. Students who perceive that the event has had a more profound effect on them are encouraged to discuss it initially with their supervising consultant or the Course Director, as they are likely to be most familiar with the clinical details. Any difficult issues can be discussed with a Curriculum Officer.

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Learning Resources
Learning Resources
Students reading for the degree MBBS are considered self-motivated, and identifying and retrieving the appropriate learning resources useful in reaching particular learning objectives is largely a self-directed activity. However, Study Guides give a lead and provide advice and initial guidance as to the range of learning resources available. You are also referred to: the Walton Library (5th Floor, Catherine Cookson Building, Medical School), and the Robinson Library (main University Library); the Medical Computing Centre (Ground and 5th Floor, Catherine Cookson Building, Medical School); the library and IT faculties in your Base Unit

Learning Resource Environment

See https://mbbs.ncl.ac.uk/ The Learning Support environment is still available to you in Stage 5 and is now being increasingly used by Base Units to upload Base Unit specific information. The LSE Focus Group meets monthly and would welcome your ideas and suggestions for improvement. Please email mbbs-support@ncl.ac.uk Similarly, if you experience any technical difficulties in accessing the LSE please contact mbbs-support@ncl.ac.uk

Library Services for Stage 5 Students NHS Libraries

All NHS libraries can provide you with borrowing rights, a place to study and access to the internet, however resources and opening hours will vary. For more information on these services, you should contact the hospital or Trust librarian. There is an electronic list of these, Guide to Medical Learning Resources in the North East and North Cumbria at: www.ncl.ac.uk/library/walton/nhs/libraries.php

Walton Library Contacts

www.ncl.ac.uk/library/contact/library_contacts/

Services from Newcastle University

Your library membership at Newcastle University remains active throughout your placement. You are still able to borrow books and use the library as before, however for many of you it will no longer be possible to come in and use the library. For this reason, there are a number of services in place to help you with access to resources remotely.

Your patron record

You will be able to check the catalogue, manage your patron record, renew and reserve items over the internet just as you did when you were based on campus. These functions are available through the library catalogue at: http://sparky.ncl.ac.uk/F

Electronic journals and databases

You can continue to access databases and electronic journals via the Newcastle University library website as usual at:

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www.ncl.ac.uk/library There may be a few e-journals or databases which may not be accessed off-campus, or require you to use the RAS service. If you encounter these, instructions and help can be found at: www.ncl.ac.uk/library/resources/databases www.ncl.ac.uk/library/resources/ejs/fulltext.php You should continue to use your Athens username and password.

Additional services
These services are subsidised, but there is a charge to the user. You can purchase the service tokens from Reader Services at the Robinson Library. Information about these services and the forms you will need to use are available at: www.ncl.ac.uk/library/services

Postal loans
This service will allow you to borrow books from Newcastle University libraries. It costs 3.00 per loan. To obtain a postal loan, check that it is available on the University Library catalogue: www.ncl.ac.uk/library/services/for/distance_learning/postal_loan.php

Article photocopy request

This is for articles in journals which ARE held at Newcastle University Library. It costs 6p per sheet. Fill in and sign the online form, print it out and post it to the address on the bottom of the form. The article will be delivered to the address you nominate on the form. This photocopy is then yours to keep. www.ncl.ac.uk/library/walton/services/store_requests/photocopies.php

Inter-library loan
This is for books or articles in journals which are NOT held at Newcastle University Library. See www.ncl.ac.uk/library/services/lending/ill

Delays and problems

Sometimes books which you request may be on loan, or there may be a delay in posting items out to you. You will be informed immediately of any delays or problems via your Newcastle University email. You are advised to check this regularly.

The Library will be happy to answer any comments or queries you may have. You can phone on: Robinson Library0191 222 7662(fax 0191 222 6235) Walton Library 0191 222 7550 (fax 0191 222 8102) Or email us at: Lib-readerservices@ncl.ac.uk (Robinson Library) Lib-walton-rs@ncl.ac.uk (Walton Library)

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Annex 1: Core Presentations

The presentations and conditions presented below represent those defined for the MBBS Degree Programme.

Core Presentations
Ankle / leg swelling

Core Conditions
Cardiac failure, Liver disease, nephrotic syndrome Venous thromboembolism (any) Idiopathic oedema or lymphoedema Musculoskeletal conditions Cellulitis Acute abdomen or peritonitis Biliary colic or cholecystitis Ectopic pregnancy GORD or Peptic ulcer Irritable Bowel Syndrome/constipation Intra-abdominal cancer Fluid, fat, foetus, flatus, faeces Hernias Intra-abdominal malignancy 1o or 2 o Ovarian cyst (benign or malignant) Crohns disease Mechanical back pain OA Osteoporosis Cancer (any manifestation, metastases)

Abdominal pain

Abdominal mass / swelling

Back pain

e.g.

bone

Bowel habit [abnormal / change in]

Inflammatory bowel disease GI cancer [colon] GI infection [gastroenteritis] Irritable Bowel Syndrome and simple constipation Systemic causes as example of broad differential eg thyroid and adverse drug reactions Benign and malignant Anxiety Asthma Cardiac failure COPD Lung cancer (any manifestation) Pneumonia Pulmonary embolus Stridor Depression Diabetes mellitus Cancer any organ

Breast lump Breathlessness

Change in appetite and body weight

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Thyroid disorders Eating disorders Chest pain and pleurisy Angina, MI and aortic stenosis Non cardiac chest pain and anxiety GORD Pneumonia Pulmonary embolus Shock-cardiac, hypovolaemic, haemorrhagic including ectopic pregnancy, septic including peritonitis, adrenal insufficiency Diabetes mellitus hypo or hyper Epilepsy Myocardial infarction and cardiac arrythmias Pulmonary embolus Stroke Syncope and orthostatic hypotension Adverse drug reaction Infection (any bacterial or cerebral) Dementia Cerebral such as epilepsy or stroke Metabolic (eg diabetes, renal, electrolyte disturbance, thyroid, hypoxia, hypercapnia) Cardiac and circulatory such as shock Respiratory: Asthma, COPD, Lung cancer Infective; Pneumonia, bronchitis, TB, RSV Bronchiectasis and fibrosing alveolitis Cardiac: pulmonary oedema and mitral stenosis Misc other; GORD, post-nasal drip Adverse drug reaction e.g. ACE-I Prostate disorders Myelopathy [any cause] Pelvic mass UTI Orthostatic hypotension: any cause including adverse drug reaction, cardio-inhibitory syncope, autonomic neuropathy etc Psychiatric: anxiety Neurological: stroke, Parkinsons disease, myelopathy, MS Vestibular disorders [any] Metabolic Alcohol misuse (any manifestation) GI cancer oesophageal, gastric GORD including stricture Peptic ulcer Functional dyspepsia Benign and malignant oesophagus and oropharynx strictures of

Collapse

Confusion / Disorientation/Delirium

Cough

Difficult micturition and dysuria

Dizziness, syncope and falls (overlaps with collapse)

Dyspepsia

Dysphagia

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Achalasia, Stroke and motor neurone disease Fever Haematological disorder Systemic Infection [any cause] UTI OA Parkinsonism or Parkinsons disease Myelopathy [any cause or site], Radiculopathy or neuropathy E.g. sciatica / diabetic neuropathy Stroke and space occupying lesion Peripheral vascular disease Lung cancer (any manifestation) Pneumonia and acute bronchitis Pulmonary embolus Alcohol misuse (any manifestation) GORD or Peptic ulcer Cirrhosis (any cause) UTI, stones and cancer Meningitis Migraine and stress headache Stroke Giant cell arteritis Sinusitis and TMJ syndromes Noise induced and trauma Presbyacusis Cancer throat or lung Smoking, functional dysphonia Pelvic mass [any] Stroke UTI Pneumonia Systemic Infection [any cause] UTI Hernias ( including inguinal) Parkinsonism or Parkinsons disease Essential tremor Adverse drug reaction Eczema or Psoriasis Haematological disorder (incl. anaemia) Cholestasis Adverse drug reaction Alcohol misuse (any manifestation) Gallstones Liver disease [any] Metastatic or pancreatic cancer

Gait disturbance

Haemoptysis

Haematemesis and Melaena

Haematuria Headache

Hearing loss Hoarseness Urinary incontinence

Infection [symptoms of]

Inguinal swelling Involuntary movements [including tremor] Itch

Jaundice

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Joint pain Joint swelling

OA RA OA RA UTI and stones Haematological disorder (including anaemia) Lung cancer [any manifestation] Infections eg EBV and TB Delirium Dementia Stroke Menorrhagia Anxiety Depression Mania Alcohol misuse (any manifestation) Biliary colic or cholecystitis GI cancer GI infection [gastroenteritis] GORD or Peptic ulcer Migraine Pancreatitis Pregnancy Mechanical back pain OA Lymph gland enlargement Thyroid disorder Salivary gland enlargement [any cause]

Loin pain Lymphadenopathy

Memory problems

Menstrual / Menopausal symptoms Mood disturbance

Nausea and vomiting

Neck pain Neck swelling

Normal pregnancy Nutritional disorders Pallor Palpitations Obesity Undernutrition [any cause] Haematological disorder anaemia)and Menorrhagia Anxiety Thyroid disorder Arrythmias Myelopathy [any cause or site], Radiculopathy or neuropathy E.g. sciatica / diabetic neuropathy/Guillan Barre Carpal tunnel syndrome Anxiety Delirium Epilepsy Psychosis Stroke (including

Paraesthesiae

Perceptual abnormalities

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Photophobia Polyuria Rectal blood loss

Migraine Meningitis Diabetes GI cancer Haemorrhoids [bleeding p.r.] IBS Pelvic disease (PID, endometriosis) Psychosexual problems Adrenal insufficiency [e.g. acute illness in steroid dependent patients] Hypovolaemia (any cause) Haemorrhage [any site) Myocardial Infarction Peritonitis and sepsis (from any cause) Pulmonary embolus Adverse drug reaction Eczema or Psoriasis Leg ulcer [arterial or venous] Benign mole / melanoma BCC / SCC Lung cancer [any manifestation] COPD Depression Parkinsonism Stroke Alcohol misuse (any manifestation) Diabetes mellitus and hypercalcaemia Delirium Dementia Depression Psychosis Any cause of shock Any renal cause Prostate disorders Diabetes mellitus Stroke Red eye (any cause) Visual failure (cataract, glaucoma or agerelated macular degeneration) Myelopathy,radiculopathy or peripheral neuropathy OA RA Stroke Thyroid disorders

Sexual intercourse, painful

Shock

Skin rashes and ulcers

Skin lesions, pigmented Skin lesions, non-pigmented nodules Sleep disturbance Speech problems [dysphasia, dysarthria, dysphonia] Substance misuse [viz alcohol] Thirst Thought abnormalities

Urine, reduced output

Visual problems [including loss, field defect, diplopia, squint]

Weakness [of muscles]

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Weight loss

Depression COPD CCF Cancer Endocrine diabetes and thyrotoxicosis Asthma Difference between wheeze and stridor Cardiac Failure

Wheeze

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Annex 2: Assessment
Ethics Assignment SSC4
The Ethics Assignment is the Student Selected Component in Stage 5.

OSCE
This is an objective and structured clinical examination. All candidates are tested on the same material, making comparisons more valid. Objectivity is assured by using detailed rating scales that define the correct performance of the task. Students are tested in as realistic a manner as is possible. Both real patients and simulated patients are used. Where simulated patients are involved, they are briefed on the role they have to play. To examine certain practical procedures, mannequins and simulators may be used. The marking schedule is designed to provide an objective assessment of the students competence. Marks are assigned to various components of the clinical/practical skills being tested and the weighting given to each has been agreed in advance. The facility to award discretionary marks is provided at some stations for fluency and appropriateness of approach; at others marks may be deducted where the candidate says or does something which is clearly dangerous or inappropriate. As the examination cannot start until every examiner, patient, simulated patient and candidate is in place, punctuality is essential, and latecomers may not be permitted to sit the examination. The OSCE will be held in at least seven centres Each student will be examined on the same set of clinical scenarios and assessed against the same standard criteria.

MOSLER
The MOSLER will be held in a number of centres. All students will be examined on four 20 minute clinical scenarios and may expect to meet a subject from any of the rotations in the final year. The scenarios may involve real patients, simulated patients or role players and each one will be examined by a single examiner. Further details of the MOSLER will be released prior to the examination.

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Annex 3: Control of Infection

Please refer to guidance on the Learning Support Environment (Admin tab/policies)/ This purpose of this guidance is to provide some essential advice, applicable to whichever hospital you may attend, on important issues related to infection control. Further information will be given by Base Units, including advice on the relevant Dress Code which students MUST comply with. Control of infection in hospitals is becoming increasingly important. Not only are there implications for individual patients should they become infected, but there may be major financial implications as well; it can be very expensive to deal with large outbreaks of infection. In addition infection control problems attract the interest of the news media and may have medico-legal implications. For this reason you should read this information carefully and remember the principles laid down when you begin clinical work in hospitals. Individual control of infection policies will vary from one hospital to another and students MUST follow the guidance and advice given at Base Unit and site induction.

Follow-up action on return from electives

Students who have experienced clinical symptoms or exposure whilst on elective MUST make an appointment with the Occupational Health Service on their return. Contact details: Occupational Health Service, Worklife & Wellbeing Centre, Newcastle General Hospital, Newcastle upon Tyne Hospitals Foundation Trust. Telephone: 0191 2821188 Fax: 0191 2821199 Students who have spent time in tropical areas may benefit from a screening for tropical disease on their return. Some infections acquired abroad may present after an appreciable latent period on returning to UK. Students with any significant symptomatology, or in need of advice should contact the Occupational Health Service.

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Annex 4: Career Development in Medicine

The variety of career opportunities that medicine offers can seem bewildering. Deciding on the general direction of a career (e.g. hospital as opposed to general practice) is often not difficult. Too many people, however, restrict their choice too much, without considering all the options Remember the message you do not need to decide now what you would like to do, but you do need to think about it!

The steps in choosing a career are roughly as follows: Consider the type of work you might best enjoy, or be suited to, in light of the person you are. Consider, for example; personality o o academic ability skills

aptitudes interests values key career needs o personal priorities and goals outside work life

Discover and consider all the options Decide on the broad outline Discuss with partner, friends, colleagues, consultants, others. Consider the likely career opportunities in your chosen specialty and in related specialties. Find out about the career structure and the duration and nature of training, including the need to obtain higher diplomas (MRCP, MRCGP, FRCS, etc) and the need to undertake research. Find out about regulations and procedures, such as: o o o the regulations for entry to a College examination how to apply for a place on a vocational training scheme for general practice how to prepare a curriculum vitae, apply for a post and present yourself at interview

Where can you obtain advice and guidance about your career?
It must be emphasised that the responsibility for developing your knowledge and understanding in this area falls upon you. However, there are a number of resources to help you During the Introduction to Stage 5 there will be a half day session on Foundation Applications followed by a Jobs Fair. You will also be given a Careers Self Study Pack. Foundation Application Workshops have been scheduled for late September/ early October 2010 and students may sign up to attend ONE of these sessions only. Full details can be found on the Learning Support Environment (admin tab/careers).

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During Preparation for Practice there will be a Careers Seminar session. This seminar will comprise facilitated small group discussion and interview role play. A detailed (though not comprehensive!) list of useful books, articles and websites that contain a lot of information and guidance relating to career choice can be found on the Learning Support Environment (See Admin tab/Careers). There is also a list of contact people for each specialty on the LSE. These people are willing to be emailed for information about a career in their specialty if that information is not available on college websites etc. Information from clinical placements, for example; Enjoyment why? /why not? Interest why? / why not? Environment Discussions with consultants and junior staff about a career in that specialty, or careers in general Stage 4 students will receive a series of short career lectures during CSIM3. These will cover the main specialty areas and have replaced the career forums which were not well attended. Our intention is to capture these on the ReCap system and to make these available to your year group also. The University Careers Service www.careers.ncl.ac.uk Individual clinicians you have found helpful during your education.

Who can help?

The provision of information is not difficult, but advice and guidance are often much more complex and specialised, because there are so many differences between specialties, and because training requirements frequently alter. Many people are available to help you by providing either informal or formal advice and/or guidance about your career. Who you approach will depend on the level and the degrees of specificity and complexity of advice that you are seeking. The important thing is for you to establish an Initial Contact and then follow this up by talking to others, based on his or her advice. Initial Contacts may be: Your tutor. The Clinical Tutor. These are based in the Postgraduate Teaching Centres. There is a Clinical Tutor in most Trusts outside Newcastle and one in each of the three Newcastle hospitals. The Clinical Tutors have close contact with the College (Specialty) Tutors and act as the Postgraduate Dean's representative in that Trust. If you do not know who the local Clinical Tutor is, ask at the hospital's Postgraduate Centre or contact the Northern Deanery Foundation School. (http://mypimd.ncl.ac.uk/PIMDDev/pimdhome/careers/applying-to-foundation-programme/who-can-help-me/who-can-help-me) Dr Richard Price careers lead t.r.h.price@ncl.ac.uk. Dr Rosie Stacy Senior Tutor for Student Support and Guidance rosie.stacy@ncl.ac.uk Mr Mike Wilson University Careers Counsellor with special responsibility for medicine and dentistry m.wilson1@ncl.ac.uk

The Curriculum Officers:

Professor Suzanne Cholerton (Dean of Undergraduate Studies) Dr P M Bradley (Director of Medical Studies) Professor J Spencer (Sub-Dean for Primary and Community Care) Dr R Thomson (Clinical Sub-Dean, Northumbria Base Unit)

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Professor RW Bilous (Clinical Sub-Dean, Tees Base Unit) Dr G Vance (Clinical Sub-Dean, Tyne Base Unit) Dr A Mellon (Clinical Sub-Dean, Wear Base Unit)

Foundation Programme Team at the Northern Deanery Foundation School

See mypimd.ncl.ac.uk/PIMDDev/pimd-home/foundation-programme The Dean Director is Dr Namita Kumar For all queries please approach the following in the first instance: Mrs Wendy Pearson, NDFS Business Manager 0191 2754661, email: wendy.pearson@northeast.nhs.uk Responsibilities of the Team co-ordinates the Foundation Programme Applications Process across the deanery co-ordinates the Shadowing Process facilitates the GMC provisional and full registration process monitors the quality of programmes provides policy, support and advice regarding any doctor experiencing difficulty in their training The General Practice Vocational Training Scheme mypimd.ncl.ac.uk/PIMDDev/pimdhome/general-practice/vocational-training

Other sources of advice include the local branch of the BMA and the University's Careers Advisory Service. In addition to one to one advice, they welcome medical students to any of their lunchtime workshops which cover areas such as preparation of CV's, applications, interviews. These are delivered throughout the year and details can be found on their website: www.careers.ncl.ac.uk If you are considering a career in academic medicine or research you should speak to the appropriate Head of School in the Medical School. The Postgraduate Deans are especially versed in helping with career choice, and also have a wide advisory network on which to call; in addition to the Clinical Tutors there are College Regional Advisers, College (Specialty) Tutors, Chairmen of specialty Education Committees, colleagues in the Medical School, the Regional Health Authority, general practitioners and hospital consultants. It is not difficult to plug you into the educational network.

Useful Addresses
Northern Deanery Foundation School Waterfront 4 Goldcrest Way Newcastle upon Tyne NE15 8NY email foundationprogramme@northeast.nhs.uk, telephone 0191 2754708. http://mypimd.ncl.ac.uk/PIMDDev

British Medical Association Tavistock Square WC1H 9JR

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www.bma.org.uk/ap.nsf/Content/__Home_Public British Medical Association Northern Regional Branch Old Brewery Court Sandyford Road Jesmond Newcastle upon Tyne, NE2 1XG 0191 261 7131

Newcastle University Careers Advisory Service Kings Gate Newcastle University www.careers.ncl.ac.uk/students/pages/login.asp Names and addresses of Clinical Tutors, Regional Advisers, Educational Supervisors of preregistration house officers and addresses of all the Colleges and Faculties can be obtained from the Northern Deanery Foundation School website.

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Annex 5: Course Directors

Child Health To be confirmed Mental Health To be confirmed

Primary Care Womens Health

Professor J Spencer

j.a.spencer@ncl.ac.uk

Dr K Brown

Karen.Brown@nuth.nhs.uk

Preparing for Practice

Dr S Ball

Steve.Ball@nuth.northy.nhs.uk

Hospital Based Practice

Dr S Ball

Steve.Ball@nuth.northy.nhs.uk

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Annex 6: Prizes
Prizes open to all Stages
Prize Edward Dachowski Memorial Music Fund Gibb Scholarship Subject Musical Medical Students Entry Requirements Audition Deadline Applications are invited in the Summer term Submissions are invited in the Spring term Submissions are invited in the Spring term Submissions are invited in the Spring term Submissions are invited in the Summer term Submissions are invited in the Spring term

Pathology

Essay

Luke Armstrong Prize

Pathology

Essay

Ranken Lyle Prize

Obstetrics and Gynaecology

Essay/Case Report

Rupert Kelly Prize The Sunderland Prize (Stages 3,4, and 5 only)

Schizophrenia Clinical problem seen in a real patient encounter

Essay

Case report

Prizes awarded for Stage 5 Final Examinations

Mona MacNaughton Prize Philipson Scholarship

These prizes are awarded to the students who achieve the best results in the Stage 5 Final Examinations. Students will be notified of their success in due course after their exams.

Prizes open to Stage 5 only

Prize Antony Wood Memorial Prize Charles Warrick Prize Charlton Scholarship Dickinson Scholarship Subject Radiotherapy Entry Requirements Essay Online Multi Choice Quiz, VIVA for top 4 candidates Multi Choice Exam Deadline Submissions are invited in the Summer term Applications are invited in the Summer term Applications are invited in the Summer term Applications are invited in the Summer term

Diagnostic Radiology

Clinical Medicine

Surgery

Multi Choice Exam

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Dr Isaac Bainbridge Prize Farquhar Murray Prize Goyder Memorial Scholarship Margaret Rankin Prize Wilfred Kingdon Prize

A Patient Who Changed My Practice

Essay

Submissions are invited in the Autumn term Submissions are invited in the Spring term Applications are invited in the Summer term Applications are invited in the Summer term Submissions are invited in the Spring term

Obstetrics

Essay

Clinical Medicine and Surgery

Exam

Ophthalmology

Multi Choice Exam

Psychiatry

Essay

More information about these prizes will be made available through the LSE. If you have any queries about any of the prizes please do not hesitate to contact Mr Richard Wales at the Medical Student Office (r.wales@ncl.ac.uk; 0191 222 6758). Please note that student prizes are only awarded if, in the Examiners opinion, a high enough standard is reached. As well as the prizes listed above there are also a number of external prizes, which are run by organisations such as the Royal College of Surgeons and the British Association of Dermatologists. Further information about these prizes will also be made available through the LSE.

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