Medical school in the United Kingdom

For introductory information about medical schools and information about medical schools in other countries see: Medical school.

In the United Kingdom, medical school generally refers to a department within a university which is involved in the education of future medical practitioners. All leading British medical schools are in the government sector and their core purpose is to train doctors on behalf of the National Health Service.

Admissions

In the United Kingdom students generally commence their medical studies without any preliminary higher education, typically at the age of eighteen or nineteen. This contrasts with the U.S. system, where a preliminary bachelor's degree is required for entry to medical school. Entry to British medical schools is very competitive. Courses last five or six years. The medical education itself takes five years, consisting of an aggregate of 2 years of preclinical training in an academic environment and three years of clinical training at a teaching hospital; the way these two elements are integrated varies between medical schools and is currently in a state of flux. Medical schools and teaching hospitals are closely integrated. The overall course of study is extended to six years if an intercalated degree is taken (see below for details).

After successful completion of clinical training a student graduates as a Bachelor of Medicine and Surgery, usually abbreviated as 'MBChB' (at the universities of Aberdeen, Birmingham, Bristol, Dundee, Edinburgh, Glasgow, Leeds, Leicester, Liverpool, Keele, Manchester, Sheffield, and Warwick). It is also abbreviated as 'MBBS' for the universities of UEA, HYMS, London, and Newcastle; 'MBBCh' for Cardiff and Swansea; 'BMBCh' for Oxford, 'BMBS' for University of Nottingham, Peninsula Medical School and Brighton-Sussex, 'BM' for Southampton, and 'MBBChir' for Cambridge. Queen's University Belfast gives the degree of 'MBBChBAO' (BAO is Bachelor of the Art of Obstetrics). The Bute Medical School (University of St Andrews) offers a pre-clinical BSc or BSc(Hons) with subsequent entry to Manchester or Keele for Clinical Teaching, and a Manchester MBChB (it is sometimes possible for entrants to negotiate transfer to another medical school for clinical training, such as Glasgow or Dundee).

Applications for entry into medical school (in common with other university courses) are made through the Universities and Colleges Admissions Service. UCAS generally allows students to apply for up to five places at different universities, however applicants for medical school may use only four of these places for medical courses; the remaining one must be left blank or be used to apply for non-medical courses, with many students applying for courses in biomedical science, medical genetics etc. as insurance options. Most UK medical schools now also require applicants to sit additional entrance tests such as the United Kingdom Clinical Aptitude Test (required by 23 universities) and the BioMedical Admissions Test (required by 6 universities).

Other primary medical qualifications registrable with the General Medical Council exist in the UK, some of which have only recently become defunct, and many people in the UK still practising medicine have these qualifications. These include the 'LMSSA' (the licentiate in Medicine and Surgery of the Society of Apothecaries), the 'LRCP, MRCS' (conjoint diploma of the London Royal Colleges) and the 'LRCPE, LRCSE, LRCPSG' (the 'Scottish Triple Diploma', given by the Royal Colleges in Glasgow and Edinburgh).

Course structure

The delivery of medical education is divided into two distinct methods, utilised to different extents by each medical school. It should be noted that these teaching methods feature most heavily in the first two years of medical school, after which clinical teaching predominates; and this will vary between hospitals, an aspect that is often overlooked during application to medical school.

Problem-based learning (PBL)

PBL in the UK is conducted in small groups of around 10 students with an academic or clinical tutor (or facilitator). This involves student led study of a series of clinical or ethical scenarios, where the students select which areas of study to pursue in their own time. In keeping with the ethos of self directed learning, during sessions it encourages a shift in power from an academic tutor to the student leader of a PBL group. PBL was introduced into the UK medical school curricula in response to the 1993 GMC report, 'Tomorrow's Doctors'. that criticised the amount of unecessary scientific knowledge irrelevant to clinical practice that medical students were required to learn. This coincided with the creation of the new UK medical schools which heavily adopted PBL teaching, as well as Manchester medical school which adopted a new curriculum in 1994. One exception to this is Brighton and Sussex medical school which, although it is one of the newest medical schools in the UK, places less emphasis on Problem-based learning and students there are more exposed to a traditional lecture-intensive based approach with some PBL incorporated in small-group work.

Studies have shown that students believe that PBL increases the educational effect of self study and their clinical inference ability, and although studies are conflicting, one showed that UK PRHO graduates believed that they were better at dealing with uncertainty and knowing their personal limits. Students feel less detached from clincal medicine through PBL and thus this may increase their enthusiasm for learning.

Criticisms include, that current Medical SpRs and consultants have suggested that PBL can promote incomplete learning and educational blind spots; particularly in anatomy and basic medical sciences, due to ultimate decision making within the PBL group resting with the students. This has also brought into question whether the lack of anatomical knowledge adequately prepares graduates for surgery, or negatively affects enthusiasm to enter certain specialties; including academic medicine, surgery, pathology and microbiology.

Noteably, universities that pioneered successful Problem-based-learning such as University of Montreal or McMaster are themselves prestigous institutions that hold worldwide reputations for clinical and academic excellence, taking the top few percent of worldwide graduate applicants. PBL can be considered to be more suitable to teaching of graduate medicine, whos students may benefit from the maturity of an existing degree and previous experience of self directed learning, and perhaps unsuitable for less able students and undergraduates.

Although all universities have adoped PBL due to GMC recommendations, the UK universities that place a high emphasis on PBL include Hull-York medical school, Keele medical school, Peninsula medical school, and Manchester medical school.

Traditional or Lecture-based learning (LBL)

LBL learning consists of information delivered mainly through large lectures or seminars. This was the predominant method of delivering medical education prior to the introduction of PBL, hence the label 'traditional'. Emphasis is placed on factual knowledge in the traditionally pre-clinical components of medicine - physiology, pharmacology, anatomy and biochemistry as well as covering communication skills, ethics and law etc through separate teaching.

Key points in support of LBL include that students gain the opportunity to interact with leading clinicians and academics, whereas PBL tutors may be either underused, or have no medical experience at all. LBL is argued to produce graduates that are capable of practicing across a wide range of medicine, not just key pathologies that are concentrated on by a 'dumbed down' curriculum.

LBL has been criticised for 'spoon feeding' students and thus not preparing them for future continued medical education, which is by necessity, self directed. It also overloads students with information that may not be relevant to their first years in clinical practice.

Significantly, despite the introduction of PBL learning on a UK wide scale, meta-analyses have suggested that PBL education produces graduates with no better factual or clinical knowledge than students from a traditional course, despite in some cases the graduates' belief that they are, questioning whether PBL learning is merely a popular trend. It is accepted by many that although PBL may feature too heavily in certain medical schools at the expense of other medical subjects, PBL itself is a useful tool to facilitate medical education, provided it is not seen as an 'all or nothing' education.

Traditional Pre-Clinical/Clinical or Integrated

Another division of medical curricula is on the basis of whether they belong to the traditional pre-clinical/clinical type, where theoretical teaching (pre-clinical, i.e. biochemistry, physiology etc.) is delivered completely separately from the clinical teaching in years 3-5. This approach in its pure form now exists at only 3 universities, Oxford, Cambridge and St Andrews. The other type, an integrated course introduces clinical interaction from the first year, as well as placing emphasis on clinical skills and ethics. The teaching method of LBL is associated with the traditional course and PBL is associated with the integrated course.

In practice, all other medical schools have adopted the integrated approach, although to differing extents. Universities that lean more towards the traditional course include Imperial College London and University College London; universities that lean more towards a fully integrated course include Machester and Peninsula.

Support for the traditional course includes that it achieves a basic scientific foundation from which to build clinical knowledge upon in later years. However it is criticised for producing graduates with inferior communication skills and making transition into the clinical environment more difficult in year 3 or 4. Support for the integrated course includes that by allowing patient interaction early, the course produces students who are more at ease with communicting with patients and better developed interpersonal skills. Criticisms include, questioning whether students in the first year have a place in the healthcare environment, when actual clinical knowledge may be virtually nil. Also, the ability of PBL produce graduates with adequate knowledge for clinical practice has been questioned, as detailed in the section above.

The immediate post-graduation period

After graduation medical students enter paid employment, but they are still a year away from obtaining full registration with the General Medical Council. During this year trainees are legally only able to work in certain highly supervised jobs, as a Foundation House Officer 1 (FHO1), and cannot legally practise independently.

A new medical graduate's first job will be as a Foundation House Officer (FHO), during which they will complete the first year of Foundation Training. Although by this time, they have graduated from the university, it is the responsibility of the medical school they attended to supervise this year until they are fully registered with the General Medical Council. Therefore, the first year of the Foundation Programme forms the final year of medical school.

Students in their final year will begin the process of applying for jobs. The new system (implemented by the NHS Modernising Medical Careers) involves a simplified application process without interviews based on a matching scheme - students rank their preferred Foundation Schools (which often comprise a catchment area of two or three cities), and are ranked based on the answers given on their application form, the resulting correlation of scores determines which job the student will get when they graduate. The graduates will embark on a new-style foundation programme consisting of two years (much like the previous PRHO (Pre-registration house officer) and SHO (Senior house officer) years) which focus on the seven principles of the MMC training ethos: trainee centred, competency assessed, service based, quality assured, flexible, coached, and structured & streamlined.

The Multi-Deanery Application Process (MDAP) system, which was used for applications to the Foundation Programme in some areas in 2006, came under much criticism within the medical student press (Student BMJ) and at medical student conferences such as the one held by the BMA in March 2006 where there was dissatisfaction with the way London students had been treated. It has also been suggested in letters to The Times that some medical students have lied on their MDAP forms.

The MDAP system was replaced by the Medical Training Application Service (MTAS) system in 2007 which dealt with applications for the Foundation Programme but failed to handle applications for specialty training appointments.

Graduate Entry Programmes

Recently several four year graduate entry schemes have been introduced which cover a similar range and depth of knowledge to the undergraduate scheme but at a more intensive pace. The accelerated pace is largely in the pre-clinical phase of the medical programme, with the GMC mandating a minimum number of clinical hours in the clinical phase of medical degrees.

These courses have a limited number of spaces and include some funding after the first year, so competition is very high. Some sources report in the region of 60 applicants for each place as these courses have become more widely known. Until relatively recently, people over thirty were strongly discouraged from applying. Entrance to these programmes usually involves sitting a competitive selection test. The most common entry examinations are the GAMSAT (Graduate Australian Medical Schools Admissions Test [1] or MSAT (Medical Schools Admissions Test) [2]. Some schools may use existing entrance examinations that school leavers are also usually required to take e.g. UKCAT or BMAT (see above).

The admissions criteria for these graduate entry programmes vary between universities - some universities require the applicant's first degree to be in a science-related discipline, whereas others will accept a degree in any subject as sufficient evidence of academic ability.

For detailed advice about entrance to medical school as a graduate or mature student in the UK, visit the Medschools Online website or the good 'Mature FAQ' on graduate programmes. Medical forums and sites such as [3] and this are also helpful.

The following 15 Universities will be offering four year graduate entry programmes to Medicine for entry in September 2007:

University of Birmingham
University of Bristol
University of Cambridge (candidate may offer BMAT)
University of Keele (require GAMSAT)
King's College, University of London (require MSAT)
University of Leicester (require UKCAT)
University of Liverpool
University of Newcastle (require UKCAT)
University of Nottingham (require GAMSAT)
University of Oxford (require UKCAT)
Barts and The London, Queen Mary's School of Medicine and Dentistry, University of London (require MSAT)
University of Southampton (require UKCAT)
St George's, University of London (require GAMSAT)
University of Wales, Swansea (require GAMSAT)
University of Warwick (require UKCAT)

Imperial College London, will offer graduate entry medicine from September 2008 onwards, requiring the UKCAT.

It must be noted, however, that graduates are free to apply to the regular five/six year courses. Indeed, universities offering both graduate entry and school leaver entry courses often encourage applications to one of the two course types, depending on the graduate's educational background.

Intercalated degrees

Some medical students spend an additional year at medical school (lengthening a five year course to six years) studying for an intercalated degree. This is an extra degree awarded in addition to their medical degrees. This gives the student the opportunity to gain an extra qualification, and aids students' research and individual study skills. At the end of this intercalated year students are awarded a degree, usually a BSc, or more rarely a BA, MSc or BMedSci(Hons). Usually students complete an intercalated BSc/BA/BMedSci(Hons) the year after completing the second or third year of their medical course. Masters degrees are offered at some schools for students who have completed the fourth year of their medical course.

The way the programme is implemented varies across the country: sometimes the intercalated degree will be specifically for medical students (e.g. a supervisor-led research project culminating in a dissertation), whilst sometimes the intercalated student will complete courses offered to final year BSc or masters students. At some medical schools the intercalated degree may be undertaken in a specific subjects (e.g. Immunology, Pathology, Cardiovascular Science, Respiratory Science, Social Medicine, Management, History Of Medicine, Humanities etc), whilst at other medical schools there is a common curriculum for all intercalated students (often with some choice within it).

At many medical schools, the year is optional, and a relatively small percentage of students elect to study for it. In contrast to this, all students at University College London, Imperial College London, Bute Medical School (St Andrews), Oxford and Cambridge study for a BSc/BA in addition to their medical degrees. These five medical schools have a six-year curriculum, in which students complete a three-year pre-clinical course, which leads to a BSc or BA, followed by a three year clinical course, which in combination with the BSc or BA leads to a full medical degree. The degree awarded is BA at Oxford and Cambridge (which later becomes an MA), and BSc at the others. At these five medical schools, it is sometimes also possible to spend extra optional year(s) where one can study for an intercalated masters or doctoral degree in addition to the BSc/BA which all students receive, for example, the University of Cambridge offers an MB PhD programme of nine years total duration comprising preclinical training, the intercalated BA (see above), clinical training and within the clinical training period a PhD.

In contrast to the intercalated degrees mentioned above, there also exists a Bachelor of Medical Science degree (BMedSci). Most universities will award the unclassified degree of BMedSci to students who successfully complete their pre-clinical medical education, but who do not go on to complete the full clinical course. At Nottingham, the unclassified BMedSci degree is awarded to all students after the first three years of their course. The BMedSci at Nottingham differs from the intercalated degree in that it does not involve an extra year of study. This unclassified BMedSci should be distinguished from the BMedSci(Hons) which some medical schools offer as an intercalated programme of study, in a similar way to the BSc(Hons) courses offered (eg Sheffield University Medical School and Barts and The London School of Medicine and Dentistry). These BMedSci(Hons) courses are honours programmes, and increase the length of the course from 5 to 6 years, compared with the unclassified BMedSci offered for early exit from medical school.

Until 2003 a BMedSci degree from Newcastle involved a year of intercalation, with a year-long research project, but Newcastle no longer offers this course.

Medical student life

Most UK medical students belong to medical societies, or groups set up within the university's students' union and run by and for medical students, typically organising social events (such as Balls/Formals or drink-offs against other faculties, Law in particular), sporting events (e.g. the National Association of Medics' Sports, NAMS) and occasionally academic events.

The largest free publication in Europe for medical students is the award-winning Medical Student Newspaper. It is written and produced entirely by medical students and is distributed to the five medical schools of London.

Many students also focus on extracurricular academic activities, for example many UK schools have their own student society dedicated to improving health both within the local area through various action projects and globally, through campaigning and working abroad. Medsin is a fully student run network of healthcare students and is the UK's member of the International Federation of Medical Students' Associations. Other societies are dedicated to raising awareness about careers in surgery or other.

See also

• Medical education in the United Kingdom
• List of medical schools in the United Kingdom