The Structure Of A Medical Degree

My name is Matthew Walters, and I’m the head of the School of Medicine, Dentistry, and Nursing at the University of Glasgow. I’m going to try to contextualise it a little by talking about the curriculum that students at Glasgow University experience as they pass through those important five years. And the reason that’s important is because there are more than 30 medical schools now in the UK, and we expect prospective students to have an idea of what they’re letting themselves in for and to have reflected on the nature of the curriculum they’ll experience at each school. We hope that this knowledge helps to inform their decisions about which schools to apply to.

And it’s an important element of the interview process that we test this knowledge and we ensure that students are familiar with what lies ahead. So a few words about the curriculum at Glasgow University Medical School. The first thing to say is that it’s evolved quite significantly. Certainly if you’re an alumnus or an alumna, I suspect you probably wouldn’t recognise a great deal of the curriculum nowadays compared to what you’d experienced previously.

Over the last 8 to 10 years, we’ve made some very significant changes to the way we teach medicine at the Medical School, and this has been informed by a number of factors– firstly, some quite major restructuring within the university and also within the major health board with whom we deal, NHS Greater Glasgow and Clyde. We’ve had some new guidance from the General Medical Council in “The Shape of Tomorrow’s Doctors,” a document that’s now being replaced. But when that came out, that stimulated some changes to our curriculum. And there was a general perception in Glasgow that the medical school curriculum needed to be revised and refreshed in order better to prepare its graduates to thrive in 21st-century biomedicine.

Having made these changes, we’re now in quite a good place. We’ve been ranked consistently in the top two UK medical schools for the last couple of years, usually between Oxford and Cambridge. That’s unusual because we’re quite a big medical school. We have almost 1,500 full-time students enrolled in our five-year programme. We’ve evolved the clinical practise that we teach our students, and we’ve developed some very strong international links. And all of these elements, I think, are important things that prospective applicants should be aware of. Clearly, the biggest change that we’ve experienced in Glasgow in the last five years or so has been the opening of the Queen Elizabeth University Hospital. This is one of the largest acute hospitals in Europe.

And it’s a fabulous environment in which we can immerse our students and in which they can learn the skills they’ll need. Not only are the clinical areas new, but we’ve refurbished our teaching spaces right across our campus. And this little insert here is from the Glasgow Royal Infirmary, the new Lister building. So we’ve got some very high-quality real estate and a superb environment in which to train our medical students. It’s not just the clinical areas that have changed. We have our World Changing Glasgow programme and the Learning and Teaching Hub that’s being constructed at the moment right opposite the medical school.

That will further enhance the student experience for those first couple of years when our medical students spend most of their time on the campus and Gilmorehill before they move out to their clinical practises later on. So to address the curriculum structure in a little more detail, we have a four-phase curriculum. Phase one looks at basic medical sciences and essentially brings all of our students really up to the same page as far as their knowledge of the basic science that underpins clinical practise. That’s the main focus of phase one.

However, we also, at a very early stage in phase one, introduce our students to some clinical elements of the programme, really just to sort of whet their appetite and give them a feel for what it is they’ll be spending more time on later on during their MBChB programme. So they have some clinical experience visits. They’ll have some supervised visits to a GP practise and to a ward in order to see what a clinical environment looks like. And they’ll begin to be taught rudimentary communication skills and professionalism and some other softer elements of clinical practise with which they need to be familiar before they graduate.

Phase two, we begin to provide a little more clinical context, although we’re still based at Gilmorehill. And this is where we develop the applied clinical sciences. And the approach we take here is a hybrid approach involving not only problem-based learning and self-directed learning, as we’ve historically used in Glasgow for many years, but more recently, we’ve reintroduced the ideas of more didactic teaching, laboratories and lectures, in order to make sure our students are fully prepared and have a clear understanding of the knowledge that they’ll require. In phase three, the students are exposed to quite intensive clinical pathological teaching.

And at this stage, the focus of teaching moves from Gilmorehill and the main university campus onto clinical campuses at the Queen Elizabeth University Hospital and at the Glasgow Royal Infirmary. And that marks a very significant transition for the students. They’re moving from what were historically called the preclinical years into clinical practise. And they find themselves based for much of the time on a clinical campus, although they’re spending more of their time than not in a teaching environment, in a lecture theatre, in a laboratory, or in a teaching room. They do, however, get more clinical experience as they move through phase three. And at the end of phase three and starting phase four, they transition into a clinical environment.

And this is where they’re immersed in one of the excellent teaching hospitals that we use right across the central belt of Scotland. Students will undertake between 5 and 10-week blocks across general medicine, general surgery, obstetrics, psychiatry, surgical specialties, general practise. And they’ll rotate around for the last 2 1/2 years, essentially, of their programme. So half of the MBChB programme they spend immersed in clinical practise, rotating around clinical placements. They will return for lectures on a less frequent basis than they’d had before. So they still have that sense of community and being a class of medical students, but most of the time they spend in our excellent teaching environments in wards and hospitals right across the central belt.

And this schematic shows the relative proportions of time that students spend engaged in different educational activity throughout the five years of their programmes. You can see that we’ve retained a strong volitional element, and the student-selected components remain an important feature of our curriculum. These allow students to undertake five-week blocks of a more relaxed choice of subjects. They can identify things that are of particular interest to them, and they can spend some time during their term time studying these elements in greater detail. You can see that we’ve retained some problem-based learning and some case-based learning throughout the early phases of the curriculum, although that’s far less prominent than it used to be.

And you can see the very heavy focus on vocational skills and clinical practise that increases as the students progress from year one through through to year five. So we have a fantastic network of teaching hospitals. We have, I think, one of the very best groups of general practitioners teaching our students. And this is a very important element of the curriculum that’s achieving even greater prominence now the Scottish government is more engaged in the delivery of high-quality undergraduate teaching in general practise. But we also have a vision that extends beyond the west of Scotland. And one of the key features of our curriculum is we have two elective periods.

These are four-week blocks undertaken between year three and year four and between year four and year five, during which time our students are encouraged to experience medicine practised in a different social and cultural context. And this frequently means travel abroad. Here, for example, are a group of students. This is the first ever exchange of clinical medical students between mainland China and the UK. So these are students in Sun Yat Sen University experiencing clinical medicine practised in China. And every summer, we have a diaspora of students right across the globe who are broadening their minds, learning new skills, and bringing them back to Glasgow. So these are some of the key elements of Glasgow’s MBChB curriculum.

It’s a curriculum of which we’re very proud. And we would hope those students who are considering applying to Glasgow have some familiarity with this curriculum and are able to articulate quite clearly what it is about Glasgow’s curriculum that have caused them to put in an application to come and study in Glasgow.