The Oxford Medical Curriculum
Aims of the Medical School
Oxford offers two courses in medicine, both leading to the same qualification, Bachelor of Medicine and Surgery (BM, BCh). The courses aim to produce clinicians with a good grounding not only in basic clinical and scientific knowledge, but also with strongly-developed skills of self-directed learning, critical appraisal of published research evidence, and an understanding of how new data and techniques may be applied to clinical practice. The intention is to produce clinical practitioners who have the skills, knowledge, understanding and enthusiasm to keep up to date with the best in clinical practice and research throughout their professional careers.
1. THE SIX YEAR COURSE
This course is divided into two stages: a pre-clinical course (3 years) including an honours BA degree; and clinical medicine (3 years).
(a) Years one to three: THE PRE-CLINICAL SCIENCES
i. Entry qualifications (intake: 150 places)
A level qualifications (or equivalent)
3 A Levels are required. These must include
Chemistry with either Maths, Physics or Biology
At most colleges the typical conditional offer is AAA.
If you don’t have Maths, Biology and Physics at A Level you must have GSCEs in these subjects (at grade C or above) or in Maths and Dual Award Combined Sciences.
5 Highers plus advanced Highers or CSYS are required. These must include
an advanced higher (or CSYS) in Chemistry and
a Higher in Biology and/or Maths and/or Physics.
AAAAA/B is the typical offer.
If you don’t have Maths, Biology and Physics at Higher Level you must have Intermediate 2 or standard grade (Credit) in these subjects.
At least 38-40 points are required. Subjects studied must include:
Chemistry at Higher Level
A second science subject from Group 4 in place of a Group 6 subject.
The second science subject and/or Maths at Higher Level.
A score of 7 should be obtained in all subjects taken at Higher Level.
Graduates with a degree in non-biological sciences (including humanities) are welcome to apply. Graduates may complete this course in five years by omitting the BA degree. Graduates with a bioscience degree may prefer to apply for the shorter four year course.
ii. The Pre-clinical Course with BA degree
The first five terms introduce students to the fundamental aspects of the structure and function of the healthy body, and to the basic mechanisms underlying disease. Students learn the principles of medical sociology and of psychology for medicine and consider the experimental evidence that supports our scientific understanding. Students learn about scientific method, experimental techniques, and data interpretation; and become increasingly critical of what they read in books and learn in lectures.
Attention to clinical significance is encouraged by the Patient/Doctor course. In this course, students interview patients in general practice and hospital settings. Clinical supervisors help them to apply their scientific learning to clinical problems, and to consider the social and psychological context of health and illness.
For each system of the body, students study development and structure, and physiology and pharmacology in a co-ordinated way, to develop an integrated understanding of how the body works. They also learn about the regulatory roles of the nervous and endocrine systems. Studying molecular and cell biology, and the biochemistry of metabolism enables students to understand the materials of which the body is made and the properties and interactions of cells and tissues. Students study the structure and function of the brain and some fundamental aspects of psychology. They learn about disease processes, infection and cancer, and see the effects of illness on patients and their relatives. They learn about the immune system and also about modern genetics and its developing importance in medicine.
The curriculum is divided into a core, which all undergraduates are expected to know at a basic level, and a wider syllabus from which students may choose to follow their own interests to a large extent.
A unique aspect of the Oxford Course is the Final Honours School (FHS) which aims to develop interpretative and critical skills and leads to an Honours BA. Most medical students choose a degree in Physiological Sciences though some elect to take the Philosophy, Psychology and Physiology (PPP) degree which involves an additional year of study. Exceptionally students can take other degrees, including Arts degrees. A research project forms the major part of the final honours school.
Students are expected to become fully accustomed to working from research papers, and primary sources in the literature, and are encouraged to think both critically and creatively (for instance, to propose their own hypotheses and test them against the published results). They gain an in-depth knowledge and understanding in some areas of biomedical science of their choosing, and improve their technical ability both at the bench and in the use of computers to handle and present experimental results and to search scientific databases. Students also learn to express themselves clearly and effectively both on paper and orally. Many of these skills are not restricted to medicine and should prove valuable irrespective of the students’ career choice after graduation.
The BA in Physiological Sciences is under revision and may be modified in style. Currently it includes:
either four 'options' or three ‘options’ and a dissertation. The options available might typically include:
iii. Principles of Clinical Anatomy
This course, at the end of the third year, is designed to teach students about the clinically important aspects of anatomy that will be of immediate use during the clinical training.
iv. Learning styles
Lectures, seminars and practical classes are offered during the morning sessions, with afternoons being set aside for private study. Students attend personal tutorials (an average of two per week) individually or in groups of up to four, for which they are expected to prepare work during the afternoon private-study sessions. Undergraduates are encouraged to read widely around and beyond the core curriculum for themselves, and will be expected to present their work in tutorials. Tutorials and most seminars are problem-based, to encourage understanding of the core material and discourage rote learning. Tutorials encourage students to follow their own interests in the medical literature, perhaps with an exploration of relevant current research, and credit is given in examinations for breadth of reading and consideration of experimental evidence.
Throughout the course students’ performance is assessed informally during college tutorials and this helps students and tutors identify strengths and weaknesses. Practical classes are formally assessed and each subject is assessed by a three-hour written paper. There are four of these papers at the end of the first year and towards the end of the second year. A dissertation forms a major part of the BA examination at the end of the third year.
The Pre-Clinical Course not only provides students with the knowledge and understanding required to make a start in clinical medicine, but also provides an understanding of science and of scientific method that prepares students for a world where medical practice is rapidly evolving. It enables students to make their own distinctive contributions to that evolution.
(b) Years four to six: CLINICAL MEDICINE
i. Entry qualifications (intake 113 places, rising to 130 in 2004)
The Clinical School will admit and consider applications only from HEFCE quota pre-clinical students (i.e. students who have been admitted against a nationally set medical student quota at a UK University). The admissions procedure is competitive and the applications are welcome from those students who have completed their pre-clinical studies at any UK medical school. Students who have completed their pre-clinical studies in Oxford must compete with those from other schools for a place on the Oxford clinical course, but the joint admission process ensures that suitably qualified Oxford students will be allocated a clinical place in a London school or Cambridge if not in Oxford. The following university qualifications are required:
University of Oxford: First BM Examination and a Second Public Examination (normally the Honour School of Physiological Sciences) for the BA degree.
University of Cambridge: Second MB examinations (in Anatomy, Physiology, Biochemistry, Medical Genetics, Pharmacology, Population Sciences, and Pathology (Psychology is not required)), and who have passed the Tripos examinations for the BA degree.
Other UK universities: a course of study in the medical sciences which shall have included the subjects of the First B.M. Examination at Oxford1 and which in the opinion of the divisional board adequately qualifies the candidate to take the course; and an approved Honours degree in Science or in Arts.
Students who decide to do a research degree in Oxford or elsewhere before starting the clinical course must complete their thesis before they begin their clinical training. There is no spare time in the clinical course for completing theses.
ii. Year 4 (First Clinical Year)
Year 4 provides clinical skills training: students learn the skills needed to communicate with patients, obtain a medical history, examine the principal systems and perform simple procedures. By the end of Year 4 students should be able to:
Learning takes place during GP attachments and medical and surgical attachments both in Oxford and local district general hospitals (Banbury, Northampton, Reading and Swindon). Students work with actors to develop communication skills and are introduced to the issues surrounding medical law and ethics through small group work. Students are encouraged to pursue their own interests in 4-weeks of "Special Study". The School offers a portfolio of modules that include opportunities to study humanities such as ethics, theology, philosophy, history of medicine, literature or a foreign language, or to pursue a scientific interest in depth.
Many final year medical students complete our “Medical Education module” and these trained students teach and support new clinical students who have just started to work on the wards.
iii. Year 5 (Second Clinical Year)
During this year, students develop their clinical skills and knowledge through specialty rotations. Students rotate through specialist attachments for periods of between two and eight weeks (depending on the specialty). These attachments are: orthopaedics, accident and emergency and musculo-skeletal medicine; psychiatry; obstetrics and gynaecology; public health medicine; primary care; clinical geratology; palliative medicine; neurology (including neurosurgery); ophthalmology; ear, nose and throat surgery (ENT).
iv. Year 6 (Third Clinical Year)
Year 6 fosters self-directed study and focuses on consolidating the skills and attitudes required of a pre-registration house-officer (PRHO). The aim is a seamless transition from the final year through to the pre-registration year. Students learn to:
· formulate a management plan after considering the differential diagnosis and reaching a diagnosis
· explain diagnosis and management to patient and colleagues
· keep clear and accurate hospital records
· explain principles of drug therapy
· explain the steps involved in breaking bad news and obtaining informed consent
· perform (under supervision) routine tasks, such as admitting/discharging patients, writing a prescription, and presenting cases
The year starts with a six month General Clinical Skills Course, during which students return to general medicine and surgery, both in Oxford and at District General hospitals. This course aims to consolidate their clinical skills and concentrates on strategies for treatment and management. The last six months is devoted to vocational skills and opportunities for special study. During this period, students prepare for their first pre-registration house officer post by shadowing the PRHO who they will be replacing on qualification and by completing a course preparing them for practice as a PRHO. Further opportunities for self-directed study are provided throughout the course, including the 3000-word essay, a ten-week elective and programme of special study modules.
v. Learning styles
Supervised learning occurs at the bedside, on ward rounds, in tutorials, student Grand Rounds and in clinics. Practical training is provided in the Skills Centre and by courses on Basic and Advanced Life Support. Teaching is complemented by techniques such as videotaped consultations, simulated patients and role-play. During clinical attachments students are expected to present patients on ward rounds and at firm meetings, and critically appraise the medical literature related to the diagnosis and management of the cases. Tutorials and seminars are case-based.
Assessments are staged throughout the clinical years and aim to foster acquisition of clinical skills and knowledge. Oral presentations and written work evaluate ability to communicate professionally, to present ideas and to think critically. Observed clinical examinations and log-books help students to meet educational goals. Students are assigned academic tutors who provide instruction and clinical guidance throughout the course.
vii. Pastoral support
Pastoral support is provided by the Director of Clinical Studies (DCS) and his Deputy, and in addition, each clinical student is provided with a pastoral advisor, usually a clinician based in their College, whom they meet at least once per term. The clinical students' association, Osler House Club, also provides excellent peer support.
2. GRADUATE ENTRY COURSE
i. Entry requirements (intake 30 places)
The course is currently open only to bioscience graduates2 who have some understanding of biological processes, not for people with a particular subset of factual knowledge. Acceptable qualifications include degrees in the following areas: Anatomy; Biochemistry; Biology; Botany; Dentistry; Immunology; Microbiology; Neuroscience; Pathology; Pharmacology; Physiology; Plant Sciences; Psychology; Vet Science; Zoology. An updated list of acceptable subject can be found at www.medicine.ox.ac.uk.
As the course is intensive and academic in orientation, students need to demonstrate some hard evidence of real academic strength, and we look for:
· scholastic excellence (in the broadest sense);
· evidence of originality of thought or initiative;
· good comprehension and verbal reasoning;
· an ability to present ideas clearly in writing;
· an ability to handle and interpret quantitative data;
· an ability to think analytically.
Some excellent students are "late developers", and outstanding 'A'-levels or degree result (though a 2:i or better, or a GPA above 3.5 is normally expected) is not essential.
ii. The first year
The first year of the course builds on students’ bioscience background to cover most of the basic science that is needed for medicine, and also introduces essential clinical skills such as taking a clinical history and performing a physical examination. The aims of this year is to cover the core of medical science in which all medical students must be competent, to understand the application of science to clinical practice, and to gain experience in applying science and clinical skills to the process of diagnostic problem-solving.
iii. The second year
The second year builds on the basic science and clinical skills of the first year and leads to periods of more intensive clinical practice. This year offers some more clinical science training, followed by several attachments (of between f our and eight weeks) to medical and surgical firms in Oxford and in other hospitals in the region, as well as some experience in general practice. By the end of this year, students should be able to recognise common disease patterns in medicine and surgery and be capable of reaching a diagnosis of the more common illnesses. They should also be able to plan elementary clinical investigations. A nine-week clinical pathology (“Laboratory Medicine”) block is interspersed with the clinical attachments. The science teaching will continue throughout the year, and will be oriented more directly towards clinical practice. Students are expected to review clinical trials and clinical research reports, and to appraise the application of such reports to clinical practice.
iv. The third and fourth years
The final two years are fully integrated with the clinical course.
Informal assessments are held at several points during the first year, to provide feedback to students and tutors. Assessments are also held towards the end of each clinical attachment throughout the course. Formal University examinations take place at the end of the first and second years and these assessments mix written and clinical appraisal. There is in addition an element of “continuous assessment”, particularly during clinical attachments.
For specific enquiries about studying medicine see the website www.medicine.ox.ac.uk or contact:
Contact the College Admissions Office for a University Prospectus and further information about the University and Colleges at: Colleges Admissions Office, Wellington Square, Oxford OX1 2JD Tel: +44 (0)1865 270207, fax: +44 (0)1865 270708 www.admissions.ox.ac.uk/
1 Human Anatomy, Biochemistry, Pathology, Pharmacology, Physiology, Psychology for Medicine, Medical Genetics, Medical Sociology.
2 Graduates in non-science subjects may be admitted to the standard pre-clinical course without having to complete the final honour school (roughly speaking, year 3), thus completing the pre-clinical course in five terms.