nm0445: just for those who [0.3] perhaps were the far side of the room [0.3] 
when i was er introducing myself in the sort of round robin there [0.5] er i'll 
just say A [0.3] who i am and [0.6] quite why i'm [0.2] standing up here [0.3] 
talking to you [0.6] and perhaps quite what i may be able to tell you [1.0] er 
my name's namex [0.6] i'm a senior lecturer in medical education [0.7] and [0.
2] i spend [0.3] half of my time [0.4] at namex Medical School [0.4] running [0.
2] the clinical element [0.3] of phase two [0.4] of the four year [0.3] 
accelerated [0.2] graduate entry course [0.6] and pretty much [0.8] the focus 
of what i'll be talking about in the next half hour or so [1.0] but the other 
half of my time [0.2] i'm a paediatrician at University Hospitals namex and 
namex N-H-S Trust [0.5] er doing general paediatrics with a special interest in 
food allergy [0.4] so that's kind of who i am [0.5] and what i do [5.0] what 
i've [0.4] really been asked to do [0.3] is [1.2] to try and [0.3] give you an 
overview [0.3] of [0.8] the phase two [0.3] of our course [1.0] perhaps [0.2] 
for those of you who are particularly [0.4] new to this enterprise it might be 
worth just [0.3] very 
briefly [0.3] mentioning phase one of the course [0.3] and how they fit 
together [0.2] would that be useful for people [0.3] 
nf0446: yes [0.2] 
nm0445: yeah [1.6] as hopefully you're aware [0.6] this is a [0.2] four year [0.
3] accelerated [0.4] graduate entry [0.6] medical school [1.1] and [0.3] we are 
[0.6] the only [0.4] pure graduate entry medical school [0.4] at the moment [0.
7] er although there are a number of graduate entry streams [0.5] that operate 
either [0.6] fairly well integrated to school leaver streams [0.2] or 
relatively as separate entities just within the same school [0.3] in other 
places [0.9] and [0.4] compared [0.5] to [0.8] other graduate entry streams and 
they're slowly coming online round the country [0.6] er [0.5] we are [0.3] 
probably [0.2] the narrowest in terms of the sorts of graduates [0.3] we take 
in that we accept [0.4] biomedical [0.3] science [0.2] graduates [1.1] there is 
a separate stream that's just started off [0.3] at namex this summer [0.3] 
which is obviously following a fairly similar course and certainly with the 
same assessments [0.2] which 
is taking [0.3] healthcare [0.2] science [0.2] graduates [0.7] but we here are 
only currently taking biomedical science graduates [1.2] we can discuss over 
coffee afterwards if that's a good thing or a bad thing or or whatever but [0.
2] that's [0.3] who we currently get in [1.6] er [0.4] so for instance you 
could get into ours [0.2] with [0.2] biochemistry [0.5] genetics physiology 
those kind of things as first degrees [0.2] but we wouldn't let you in [0.5] 
with a physiotherapy degree [0.4] or with a pure [0.4] chemistry degree [0.4] 
or a pure physics degree [1.1] so we're taking a relatively narrow tranche of 
students [1.4] we're giving them a four year course [0.8] as opposed to the 
five year [0.2] course er that [0.3] runs for the school [0.4] leavers at 
Easter [0.7] and [0.3] all [0.2] the time we've chopped off the course [0.2] is 
chopped off the early [0.4] part of the course [1.3] the school [0.2] leavers 
who go to namex do five years [0.3] they do [0.2] two-and-a-half years of phase 
one [0.5] two-and-a-half years of phase two [1.3] broadly speaking [0.6] phase 
one is university based [0.3] and broadly preclinical [1.0] and phase two [0.3] 
is pretty 
much hospital based [0.4] and broadly clinical [0.7] having said that [0.3] as 
i'm sure you're aware [0.3] everybody integrated their courses years ago so 
we're not actually allowed to use those labels [0.4] but in terms of 
understanding [0.2] where the students are and what they're doing [0.2] that's 
broadly the case although clearly there was clinical exposure [0.2] from the 
beginning within phase one [1.6] phase one [0.4] is modular [0.5] mainly 
systems based modules but also a number of [0.3] er social science based 
modules and [0.3] health policy and other such such modules [0.5] and [1.0] the 
[0.3] students that come here [0.3] broadly [0.4] miss [0.2] the basic [0.2] 
science modules [0.4] because the presumption is that we've collected a stream 
of people [0.2] who have [1.0] either that to a great depth or the ability [0.
3] to [0.4] get up to that level relatively rapidly [1.3] as an interesting 
aside [0.5] irrespective [0.4] of your first degree [0.7] you do the same 
course [0.7] so we don't run all modules and we chop and change depending on 
where people's strengths and weaknesses are [0.2] they all do the same stuff [0.
6] 
they all miss out [0.2] the same modules from phase one [2.6] as a sort of 
reaction to that or perhaps a way of of dealing with that a lot of phase one [0.
4] is based around [0.4] group learning [0.9] and [0.6] the groups are 
deliberately structured [0.5] to have a range of [1.1] students with a range of 
first degrees [0.3] so hopefully as they go through phase one [0.7] if they 
operate nicely within their groups the strengths of those individuals [0.2] 
will help the group [0.4] and the balance between the groups [0.6] should [0.2] 
help hopefully ensure that [1.1] er [1.0] perhaps that works well perhaps in 
some groups that doesn't there's a lot of dynamic [0.3] industry going on there 
[2.1] after they've done [0.2] that [0.2] eighteen months of phase one [0.2] 
shortened from two-and-a-half years [0.3] they come into phase two [0.4] which 
is in effect the full-time [0.2] clinical placements [1.8] that's pretty much 
all i planned to say about phase one [0.4] because that's not the main topic of 
what i'm talking about here [0.8] but can i just pause for a second just in 
case there is anything that [0.2] people want 
clarification [0.3] bearing in mind i'm not the phase one coordinator and it's 
not my prime role but if there is anything [0.4] that [0.9] that people will al-
, be always be desperate to know or that doesn't make sense of what i've just 
said [3.6] okay [0.2] thank you very much so i'll [0.2] i'll [1.3] carry on 
with with perhaps the sort of main meat of what i was going to say [1.5] what 
i'm hoping to do [0.6] is [0.4] tell you why [0.2] the clinical course [0.3] at 
namex Medical School is arranged in the way it is [0.4] because as will become 
[0.7] fairly clear [0.3] fairly quickly [0.7] unless [0.2] you're a recent 
namex graduate [0.2] it will be [0.9] fundamentally different [0.8] from [0.2] 
the majority [0.2] of medical courses running [0.2] in the U-K at present [0.6] 
it is an unusual model [1.3] some would say it's quite a brave and dynamic 
model some would say that causes some problems but we'll go through that in a 
bit more detail [0.4] but it is different [0.8] and i think that's important [2.
3] having [0.4] started on that i'll then hopefully give you enough information 
so at least you know the structure [0.2] and how it's 
put together [0.6] and then o-, [0.3] we'll lead on to a period of discussion 
[0.3] which hopefully will bring out some of the issues [0.2] that namex was 
mentioning at the beginning [0.3] about learning styles [0.3] and about self-
directed learning [0.4] and [0.3] the sorts of students [0.4] who find our 
course a good way [0.6] of doing things and the sorts of students that struggle 
[0.7] and hopefully that'll come u-, [0.4] up in discussion a bit [3.0] i'll 
also [0.7] try and underline some of the challenges [0.2] that this particular 
way of doing things gives us [0.2] which may or may not be a little bit 
different [0.2] from [0.8] other medical courses [3.7] going right back to the 
beginning [1.8] there is a stated philosophy [0.2] for our curriculum [0.6] 
which broadly is the sort of thing that's come out of the G-M-C anyway and 
broadly [0.2] is the sort of the thing [0.2] that the majority of medical 
schools will sta-, state that they're trying to do [0.4] but i think as will 
become clear [0.4] er perhaps [0.2] the curriculum we are running here has 
really bitten the bullet and actually tried to 
develop [0.5] on the basis of these principles [1.3] being [0.2] that doctors 
must be lifelong learners the sort of thing that gets thrown out on many many 
occasions [0.7] but perhaps [0.2] it does mean something perhaps there's 
something we can do about that in the course [1.2] and [0.8] it's stated that 
our curriculum is designed [0.2] to help students take charge of their own 
learning [3.0] and [0.6] that phase one [0.3] which is broadly [0.2] group work 
[0.3] with a variety of levels of support [0.6] is [0.2] a preparation [0.5] 
for the self-directed learning that they will have to do [0.4] if they're going 
to s-, be successful in phase two of the course [0.6] in the clinical 
environments [4.5] the majority [0.4] of us who are medically qualified in this 
room will have gone [0.7] to a variety of medical schools if you graduated [0.
3] from the U-K in the last ten to fifteen years you will have done [0.4] an 
integrated course of some sort [0.2] probably [0.3] although there were 
examples of of people holding on to even older models [0.7] er [1.3] but [0.5] 
you will probably [0.3] have had a course 
which attempted [0.3] to teach you [0.5] a lot of different things [0.9] that 
was [0.5] loaded with content [0.2] to [0.2] er up to a point [1.7] and [1.0] 
tried [0.2] to gain experience for the students over a number of specialties [0.
9] certainly [0.5] i remember as a student having my fortnight in E-N-T [0.7] 
and i remember learning not very much there [0.9] certainly as a year we were 
shuffled through [0.7] in phases of our clinical course [0.2] a lot of brief [0.
2] clinical experiences [0.4] in relatively large groups [0.7] where [0.3] the 
teachers didn't particularly know us [0.3] because we were coming on so quickly 
[0.7] and [0.5] it very much felt we were being given a sort of cycle of 
teaching [0.4] on a rapid basis and in a fortnight [0.4] it's actually 
relatively easy to just miss the point and not get anything out of it [1.1] and 
[1.2] with the increasing subspecialization of hospital medicine [0.5] this was 
a trend that was continuing and continuing [0.6] it was no longer good enough 
to spend send students to general medicine [0.4] you had to spend send them [0.
2] to [0.2] chest medicine [0.2] and cardiology [0.7] and 
gastroenterology [0.8] and [0.4] as divisions [0.2] and [0.2] more and more 
subdivisions [0.2] appeared [0.3] the tendency was to cut courses into smaller 
more smaller segments [0.2] trying to gain [0.2] the breadth of experience for 
the students [0.2] by rushing them round all the specialties [3.1] one of the 
upshots of this was that something that's always said about U-K medical 
education is it runs on an apprenticeship model [0.9] and that almost certainly 
broadly is not true [1.3] er and certainly the model of rushing everybody round 
in groups of six or eight [0.5] briefly through a n-, l-, a large number of 
short clinical experiences [0.4] gave little chance [0.2] for the students to 
get to know the teachers the teachers to get to know the students [0.3] and [0.
2] the students to model themselves on the teachers in any [0.2] meaningful way 
[0.4] which would be the elements if apprenticeship was going to actually work 
as a concept [3.4] there was also [0.4] little opportunity [0.2] for self-
directed learning [1.0] on your timetable you were shuffled off to E-N-T [0.4] 
got to 
learn a bit of E-N-T [0.8] a few seminars packing some information in [0.5] not 
a lot of opportunity [0.2] for students to work out where they are [0.2] what 
they're doing [0.2] where their strengths are where their weaknesses are where 
they need to be working [4.0] on the basis of this [0.5] the [0.2] new namex 
curriculum which has subsequently [0.2] become [0.3] the namex curriculum which 
is the curriculum we follow [3.4] was made up of [0.8] what perhaps are a 
series of relatively [0.7] old ideas [0.7] rather unusually [0.2] for a medical 
course [0.2] it was made very very explicit [0.5] exactly what the learning 
outcomes for the whole clinical course were [0.8] so there was a book [0.7] 
it's there i should have brought a copy with me to wave at you actually but if 
you haven't otherwise seen it it's The Objectives of Phase Two Curriculum [0.5] 
and [0.4] if you want a copy if you can get in touch with us we can send you it 
[0.5] er [0.2] and it shows [0.2] everything [0.3] in a list [0.2] that we 
expect of the students [0.6] and [0.3] it's based on the competencies required 
of a new P-R-H-O which is what 
the G-M-C tell us we should be doing [0.6] but [0.4] we are [0.3] completely 
explicit [0.3] on paper [0.2] there it is [0.2] this is what they've got to 
learn they've got two-and-a-half years to learn it [0.5] and it's listed [0.3] 
and the assessments are based on that document and therefore [0.3] if they know 
what's in there they should pass [0.2] in theory [4.0] there was also a move [0.
9] from [0.4] away a very strong move away from lots and lots of short 
attachments [0.7] and this is perhaps [0.9] the boldest [0.2] part [0.3] of [0.
2] the phase two curriculum that we operate here [0.7] in that instead [0.4] of 
[1.0] taking the students in groups round lots of short attachments [0.8] we [0.
2] attach them currently in pairs although that may need to go up to threes at 
some point with expanding numbers [1.0] of students [0.3] to two consultants [1.
1] in hospital [0.2] for the hospital attachments [0.5] and therefore we attach 
them at a ratio [0.3] of one to one [1.7] two students two consultants [0.5] 
and [0.3] we give them eight weeks [0.6] to get on and do something useful [0.
6] so we're using long attachments [1.0] where a small number of students [0.2] 
are 
attached to an equal number of consultants [2.2] the argument being [0.7] that 
that gives [0.2] time [0.3] for the students to know learners [0.2] the sorry 
learners to know the teachers teachers to know the learners [0.7] for them [0.
2] to actually plan what learning's going to take [0.5] be undertaken during 
that eight weeks for them to implement that [0.2] for some degree of 
apprenticeship or wardling or that kind of thing to go on [0.8] and also [0.2] 
for at the end of the process hopefully the teacher to be able to say something 
sensible [0.2] about the student [0.2] having known them for [0.4] a period of 
time and not just had them rush around with the group for two weeks [0.8] [1.3] 
those of you [0.4] who are good at quick maths will realize [0.4] that if we've 
got two-and-a-half years and they're being attached in blocks of eight weeks [0.
5] you don't actually [0.2] get that many eight week blocks [0.8] and indeed in 
total [0.3] in addition to the medical elective which is still within the 
curriculum [0.9] they have twelve [0.3] eight week blocks [1.1] now there were 
certain 
elements [0.7] that were felt to be tangibly different that had to be taught as 
a specialty block [0.7] and those [0.3] are [0.2] psychiatry [1.0] clinical 
methods [0.5] obs and gynae [0.8] and child health [1.6] and they are taught as 
eight week blocks [1.5] everything else [0.8] is taught [0.2] in the remaining 
[0.8] now we're just down to eight [0.5] eight week blocks [0.7] and once i get 
into the sort of [0.7] the [0.6] descriptions of how those are actually worked 
out we can talk a bit more about those in detail [4.4] these [1.7] what 
actually goes on [0.6] in these eight week blocks [0.8] has varied to a degree 
over time [0.7] from the inception to curriculum [0.4] to where we are now [1.
5] the original notion was [0.6] that if you gave a good student to teacher 
ratio [0.5] and you gave them [0.7] eight [0.2] long attachment blocks [0.5] 
almost on a random basis [0.6] and you told them what they needed to learn [0.
4] then lots of good learning would go on [1.7] and [0.2] that didn't work very 
well [0.9] because [1.0] the students could really have [0.4] a very [1.3] very 
different sequence of attachments [0.3] and could for 
instance spend an awful lot of time with dermatologists [0.6] and no time at 
all [0.3] with certain other [0.3] important areas [0.8] so [0.6] after a while 
efforts were made [0.2] to [0.7] take [0.4] them through some sort of sequence 
[0.6] where [0.2] where [0.2] there were [0.6] surgically labelled eight week 
blocks and medically labelled eight week blocks [0.2] some of which were more 
specialist than others [0.6] and this culminated in there actually then being 
an extra specialist block invented which was kind of a rehab block [0.3] which 
goes under the [0.2] unedifying title of Geri-ortho [0.3] because it's er 
elderly care physician and an orthopaedic surgeon [1.1] so having gone from 
this very [0.3] out of the grey superrandomness great things will happen [0.5] 
an increasing amount of structure was put in [0.4] and this is before we got 
started at this end this is very much at the namex end [1.1] and [0.4] as the 
numbers have become more pressured [0.8] the elements of structure that are in 
there [0.2] have actually started to creak a little bit at the edges and look a 
little bit [0.4] er [0.2] suspect [3.7] so this is what it looks like [0.5] er 
[0.9] that is [0.5] the timeline [1.0] from left to right [0.2] of the phase 
two curriculum [2.2] with the various elements [2.7] they start off [1.6] with 
a junior [0.3] period [1.5] they have an exam [0.6] and they go into a senior 
period [1.8] and within the junior and senior periods [0.3] there are [0.2] big 
blocks of general [0.2] clinical education [0.8] within the junior [0.4] they 
have four [0.8] eight week blocks [1.0] and within the senior they have a 
further four [2.9] the specialties are [0.4] also [0.8] there [0.7] Clinical 
Method [0.4] and Psychiatry [0.4] coming in [1.4] for the most junior students 
[0.6] Child Health and Obs and Gynae [0.2] coming in for the more senior [4.4] 
going back to [0.2] the general clinical education blocks because i think these 
are the most interesting [1.8] i've already said [0.9] that at the beginning [0.
9] there was very little structure as to how these were organized [3.0] we are 
[0.2] at the moment looking at that [0.2] quite active plan [0.6] because [0.4] 
there still isn't that much structure [0.7] to it [1.1] because [0.2] at the 
moment [1.2] 
there is actually the last block they get block twelve they get a bit of choice 
[1.4] as to what they do which is a nice thing [0.5] but that means our four 
and four eight blocks are now down to seven [1.6] one of those is the so-called 
Geri-ortho [0.2] which gets us down to six [1.2] and of the remainder [0.8] 
i've lost some in my maths somewhere [0.7] i've remembered clini-, 
nf0447: yes 
nm0445: er just that [0.6] you see [0.2] er [0.4] there is also one of those 
senior blocks is tau-, is taken up with the some generic teaching [0.3] and a 
little bit of choice which is something called the clinical special study 
module [0.4] so that gets us down to five blocks [1.3] now at the moment [0.8] 
the general clinical education that isn't geri-ortho [0.4] is arranged to 
either be specialist medicine sorry general medicine [0.6] or spe-, [0.2] or 
general surgery [0.4] or specialist medicine [0.2] which is divided into 
specialist medicine one and specialist medicine two [0.4] or specialist surgery 
one and specialist surgery two [1.4] so [1.0] three medical [0.5] three 
surgical [0.7] types of blocks 
available [0.5] five slots in which to do it [1.0] basically means [0.2] that 
not all students do all types of blocks [1.8] which and in addition to that [0.
2] they can do [1.3] any of those blocks [0.3] in either junior [0.4] or senior 
[0.8] which actually means [0.3] that [0.4] one particular group of teachers 
could have one group of students [0.2] who were brand new to the clinical 
course [0.2] for one w-, eight weeks [0.3] and the next eight weeks they might 
have some that have just finished [1.3] which may keep their life interesting 
[0.3] but it also means [0.3] that we can't [0.2] put together [0.5] teaching 
partnerships with consultants [0.2] that are particularly suitable [1.0] for 
students at the beginning of the course [0.2] or particularly suitable for 
students at the end of the course [0.3] because at the moment [0.6] they could 
undertake them at any point in the course [3.6] the other thing to say about 
this is i've already said [0.9] that [1.5] one of the problems was the number 
of specialties students had to rush through [1.7] now clearly on this m-, model 
[0.7] they are only going to get exposed [0.2] to 
five plus an optional [0.2] six different [0.3] things [1.2] they're not all 
going to get E-N-T [0.8] although there are E-N-T surgeons in both the 
partnerships as some will know [0.4] they're not all going to get opthalmology 
[1.1] they are going to get some general medicine but they're not all going to 
get cardiology respiratory medicine gastroenterology [1.5] and this is one of 
the fundamental things to understand about this way of delivering our 
curriculum [0.7] that [0.4] we are [0.2] not aiming [0.2] to fulfil [0.2] their 
learning needs by rushing them round a bunch of specialists [0.2] who happen to 
have specialist knowledge in particular areas [0.8] we are looking [0.2] to 
address their learning needs [0.5] by giving them a list of what they need to 
learn and putting them in a series [0.2] of clinical situations [0.5] where 
there are opportunities [2.7] but [1.0] if they just sit back and wait for it 
to wash over them [0.9] they are not going to meet everything by a long shot [1.
7] they [0.5] not only are encouraged to take control of their learning [0.4] 
but if they don't they're 
not going to do very well [2.7] do people see what i'm saying about that [0.4] 
that it is quite [0.5] a radical and different way of looking at things [0.8] 
and it's a w-, [0.6] way that [0.3] some of the students get and some of them 
don't [1.1] a lot of them say oh well we were never taught such and such [1.0] 
they might be coming to you today you know we [0.3] we we've not done E-N-T [0.
6] so i don't know it [0.3] so i'm not prepared to think about it [1.0] is that 
something that people have come across in their practice oh we we didn't we 
didn't do that [0.4] we didn't do head and neck [0.9] yeah [1.0] we just don't 
do it [0.8] it's not important can't matter [2.1] i think in discussion we can 
talk a little bit more about [0.3] how different stu-, types of students cope 
with this [0.9] but that [0.4] is the theory of what we do [0.2] and how it's 
actually practically arranged [1.6] the specialist blocks are much more like 
your [0.2] traditional [0.6] blocks [0.2] you know eight weeks of obs and gynae 
eight weeks of psychiatry [0.6] er [1.1] although interestingly these are our 
most pressured 
blocks in terms of finding new [0.3] new placements for increasing student 
numbers [0.8] up to a point we are protected in the general clinical education 
[0.2] block end [0.4] because as far as our curriculum's concerned we could 
send them to nearly anybody [0.6] although actually there's probably [0.3] some 
sort of [0.3] moral compulsion on us to actually send them to reasonably good 
people in reasonably good combinations in a reasonably good order [0.9] but 
there's no compulsion for us to find X number [0.5] of [0.8] opthalmologists or 
X number [0.2] of [0.2] E-N-T surgeons [2.2] the elective still exists and it 
comes just after [0.3] phase one and they've done Intermediate Clinical 
Examination [1.1] just as an aside [0.2] er [1.7] medical student electives [0.
2] are a very interesting beast [0.3] they've been around since the seventies 
[1.1] we are [0.8] er in effect although we're not [0.2] officially a new 
medical school because we're set up with namex [0.9] but we're certainly a 
university [0.2] that is new to having medical students around [0.6] and quite 
sensibly are asking lots of 
sensible questions about [0.3] safety security supervision [0.4] er [0.2] 
consistency of marking [0.3] er [0.6] institutional [0.2] responsibility all 
that kind of thing about the medical student elective [0.7] which are all the 
sorts of questions [0.2] that actually all the other medical schools should 
probably be asking themselves anyway [0.5] so who knows what's going to happen 
with that [0.2] but watch this space [0.4] we are currently in the process of 
getting a legal opinion as to quite where we stand and all that [1.4] but 
anyway [2.1] there are two summative assessments the intermediate clinical exam 
and the final professional exam [0.4] which come between [0.2] junior and 
senior [0.4] and then [0.9] after senior [0.7] and [0.7] if people are 
particularly interested in those we can chat afterwards about quite how they're 
structured [0.7] but broadly [1.0] the intermediate clinical exam [0.4] is a 
version [0.3] of the s-, assessments you are doing [0.3] within [0.2] clinical 
methods of the observed consultation type assessments [0.4] and final 
professional exam [0.3] is the same again [0.2] only at a 
slightly higher level [0.3] plus [0.2] a written paper [4.3] we've got a number 
of challenges at the moment in the system [0.7] i've already [0.7] said [0.2] 
that [0.2] capacity is a challenge [0.2] er [1.0] it's a challenge up and down 
the country i think er [0.6] we're trying to run a medical school on a 
population of about eight-hundred-thousand which is not a desperately large [0.
3] population to try and run a relatively large medical school [0.6] but 
capacity although it is a particular local problem is also a national issue as 
there are new medical schools popping up all over the place [0.5] er pu-, [0.3] 
taking up those pools of population that the other medical schools use to feed 
students who [0.2] on an in creeping basis and keep their courses running [0.9] 
but there are also the specific challenges of areas like [0.2] child health for 
instance [0.4] er [0.6] which are problematic [0.3] not because of availability 
of teachers [0.2] particularly [0.3] but the availability [0.3] of [0.3] young 
children [0.7] because there aren't enough children [0.7] or there aren't as 
many children as there used to be 
out there and they're in better health [0.5] so [0.7] we need to think perhaps 
more radically about how addressing some of those issues [0.4] or perhaps we 
should just cancel the immunization programme and then we'll get er [0.3] 
[laughter] much iller [0.2] and er [0.3] we could teach our students much 
better [3.1] [laughter] there is a challege here [1.5] though that's much more 
inherent to the structure of our course [0.5] about the quality [0.3] of 
experience they get [1.6] clearly [1.4] they get [0.3] a [0.2] hopefully [0.5] 
deeper [1.3] more personal experience [0.2] within their eight week attachments 
[0.5] but they don't get the breadth of the specialty experience [0.4] that 
other medical students get up and down the country [0.3] and that is a direct 
trade-off [1.3] but we have to look [0.5] about whether there are particular 
things that they struggle to get [0.7] whether there are particular skills [0.
2] particularly like [0.7] ophthalmoscopy [0.2] or E-N-T examination i keep 
using those as examples [0.4] er [0.4] that we have to put in structurally in 
another way [0.2] to bridge 
certain gaps [0.9] but up to a point that's a direct trade-off if we're going 
to give them long attachments at a low ratio [0.8] they are never ever ever 
going to get round everything [0.8] but then [1.0] the majority of medical 
schools [0.6] are [0.4] doing the same thing in a much softer way we've just 
taken the big bold step [0.2] perhaps [1.4] there is an issue of equity [0.9] 
in [0.4] that [0.2] if you've only got five allocated general clinical 
education attachments [0.6] if you get two bad ones [0.3] that's a pretty big 
proportion of your course [1.2] and also if you get two that are pretty similar 
[0.8] although [0.4] all patients have abdomens chests ears [0.2] eyes mostly 
[0.4] er [0.3] and therefore [0.2] there is [0.2] always stuff to examine and 
always [0.3] er [0.5] people to take histories from and all that kind of thing 
[0.7] certainly students feel if they spend too much time with [0.3] a 
particular type [0.3] of doctor [0.5] that they've had an unequal experience [1.
7] and [0.4] there are also particular quality issues [0.3] around attaching 
students in very small numbers to a huge pool of 
teachers [0.7] at a very small ratio [0.8] clearly [0.6] in the perfect world 
[0.2] that's a very high quality experience [0.5] the stude-, the learner [0.2] 
and the teacher [0.3] get to sit together [0.3] think [0.3] plan be very 
individual be very observant give direct feedback et cetera et cetera [1.1] but 
it also means [0.4] it's much harder for us to u-, [0.3] us to survey quality 
in a way we could in a much more organized teaching programme [0.6] such that 
we could be observing the session specialty X is providing [0.4] or [0.2] 
reviewing [0.4] a specialty at a given time in a d-, [0.2] given way [1.0] 
whereas we've got our students scattered over a huge number of lo-, of teachers 
[0.6] and those teachers [0.2] are going to vary and there's a big question of 
how we m-, [0.2] feed back to them in a meaningful way [0.5] in a way that the 
students are happy with [0.6] that doesn't bring their confidentiality that 
allows them to be er honest [0.6] and also [0.4] er [1.1] issues [0.2] about [0.
3] how we give support to such a big diverse group [1.0] because [0.2] they are 
teaching in such small groups scattered all over the 
place [5.5] the new directions [0.8] really [0.7] er [1.0] was just to say that 
[1.6] we are currently looking at doing a number of things wi-, [0.4] with [0.
2] the way we organize phase two [0.6] which have some relevance to [1.3] 
certainly a lot of relevance to what the students might be saying to you but 
probably won't affect clinical methods that much [0.8] we are aiming [0.5] to 
rearrange [0.7] the [0.5] general clinical attachments such that [0.4] some are 
specified to being done [0.2] in the junior phase and some are specified to be 
done in the senior phase [0.7] this allows us to put together more challenging 
partnerships for more experienced students [0.2] and it allows us to put 
together attachments [0.3] that are [0.5] more introductory [0.2] for more 
junior students [1.9] we are also [0.4] looking [0.2] to iron out some of the 
anomalies in the system that we've inherited [0.3] from namex in that [0.2] to 
give an example [0.6] there is currently [0.2] a [0.4] general [0.2] surgery 
attachment on the general surgical list [0.3] which is paediatric [0.2] surgery 
[0.3] and maxillofacial surgery [0.6] which is a combination i think sounds 
pretty specialized [0.8] [laughter] i don't know about you [1.5] er [1.9] we 
are also looking [0.3] at rearranging what the orthopaedic surgeons are up to 
[0.3] and drawing in [0.5] er more anaesthetists which is partly an un-, 
underutilized area but i don't think that's of too much [0.3] er [1.7] er 
importance to yourselves [2.5] er [1.0] what our aim [1.2] throughout [1.0] is 
[1.0] to get the students to [1.0] do [0.5] basically these things take history 
[0.3] examine the patient [0.3] problem solve [0.8] explain and manage [0.5] 
and behave professionally throughout [0.9] and you can actually learn to do 
that in a whole number of different settings [2.2] and they should do that in 
the context of common clinical presentations [0.2] and uncommon [0.2] but 
serious situations [0.6] which is one of the ways we justify [1.2] not rushing 
around [0.4] all these specialty experiences [2.7] do people want to talk about 
any depth of clinical assessments or shall we just [0.3] break for a moment and 
have a chat more about learning styles and things like that 'cause i think 
that's possibly more useful [2.8] yeah [2.0] can i take 
some guidance from the chair [0.9] 
nm0448: yeah [0.4] let's t-, talk about [1.1] the the the what what the ethos 
of [0.4] namex Medical School is in relation [1.3] to er is it a problem based 
[0.2] learning school 
nm0445: sure 
nm0448: or is it [0.9] ethos is it self-directed learning [0.3] 
nm0445: okay [3.7] i think i'll kind of lead on to that if that's all right [0.
5] by [1.7] sort of just outlining [1.6] what seems to happen [0.5] when we put 
students through this kind of system [3.5] i've already said that it's very [0.
2] reliant [0.5] on [0.2] or it's it's very much based on self-directed 
learning [0.5] and therefore [0.8] for them to get the most out of these long 
eight week attachments they actually have to have at least some insight [0.6] 
as to what they've already done [1.4] what they've never done at all [0.4] what 
they're good at and what they're bad at [1.7] and they also [0.2] have to have 
the ability to have a sensible discussion [1.0] with [0.4] their c-, [0.5] 
clinical teacher [0.3] about those areas [2.3] broadly [2.5] the top tranche of 
students [0.3] 
thrive on this [1.1] but then good students thrive no matter what you do to 
them basically [0.4] they'll always pick out the best learning opportunity and 
get on with it [1.0] i think the next [0.7] kind of quartile probably [0.2] to 
[0.2] probably the [0.3] er [0.4] second and third [0.2] quartile [1.4] take a 
while to get their head round all of this [0.5] but when they do [0.6] i think 
they do quite well and i think they probably do better [0.6] than [0.2] if we 
were very structured with them [1.2] i think the lower quartile [0.6] flounder 
[1.1] and [1.2] they do so much much more [0.7] than in much struc-, more 
structured courses or at least they are seen [0.2] to flounder much much more 
[0.3] it's more obvious [0.4] and i can't actually tell you whether actually [1.
1] putting them through structure that actually just hides the fact they're 
floundering [0.8] or whether it actually gives them enough structure to help 
them get on with things [0.5] but i think one of the challenges we have to look 
at is [0.2] how we deal [0.4] with [0.2] students who are [0.3] struggling [0.
3] with the insight and [0.5] the self [0.2] you know who haven't 
cottoned on to the self-directed nature [1.4] i think one of the things [1.1] 
which [0.6] is quite important in [0.5] in understanding how things operate [0.
4] is [1.3] the way the course was cut down to four years [0.4] was to a large 
degree [0.9] based on the presumption [0.3] that these guys are graduates which 
is true [0.2] it's not a presumption it's a it's a truth [0.2] but the 
presumption [0.2] that graduates come to us as accomplished adult learners [2.
0] and [1.4] i don't know [0.6] if that's entirely true or it certainly doesn't 
seem to be the whole story [0.8] we undoubtedly [0.2] have [0.3] a lot of 
people coming to us [0.2] who are [0.2] mature [0.8] efficient effective adult 
learners [0.7] who have learned that in their first degree or in the work 
they've done since or whatever [0.4] and we undoubtedly have some very very 
effective learners on our course [0.2] far more so than you'd expect with a 
school leavers' group [1.6] but i think our spectrum is much wider [0.5] and my 
personal opinion i don't have any data to back this up at all [0.4] but it 
seems to ring true whenever i talk to other 
teachers [0.2] is we have [0.2] also [0.4] a group of people who've gone 
straight from school [0.2] straight to first degree [0.3] have had a very spoon 
fed first degree as many science degrees appear to be nowadays [0.3] who 
actually [0.3] are more dependent [1.2] learners [0.2] than the majority of 
school leavers [1.2] so [0.4] the presumption [0.2] that we can [0.4] let our 
wonderful adult learners loose on the learning material and let them get on 
with it [0.2] is perhaps a bit naive for some groups [0.4] and i think [0.4] we 
do have this h-, [0.5] er [0.3] i think [0.2] s-, school leaver populations are 
more homogenous i think we've got an enormous breadth [0.2] of [0.2] maturity 
and learning ability [0.3] far far wider [0.3] than the school leavers' group 
[0.3] but i think that also actually goes much lower [0.2] in terms of [0.3] 
ability to learn [0.3] than [0.6] the school leaver group [1.0] er [0.2] and i 
think that's quite a challenge [1.6] is that something that [0.5] rings true in 
the students that you've been seeing [3.4] 
nf0449: can i ask you do they have er a sort of individual mentor a personal [0.
7] sort of er [0.3] 
tutor or somebody tha-, who can actually help them appraise where they are [0.
5] you know er during this stage or do they have to keep doing it with their [0.
3] at the beginning of their new each block with [0.2] er whoever's sort of [0.
4] you know sort of 
nm0445: they do not have a consistent [0.2] block a block mentor 
nf0449: right [0.8] 
nm0445: they [0.2] who carries them through the core course [1.2] this as an 
idea has been [0.3] muted [0.9] er [2.0] there are [0.2] a number of practical 
considerations but there's also [1.5] quite who that person would be and 
whether [1.0] we genuinely have two-hun well [0.4] if they didn't have more 
than one student at a time [0.3] four-hundred-plus [0.6] useful active quality 
mentors out there [0.6] but no it's very much [0.4] they they have [0.5] a 
formative feedback process which informs them at the end of each block [0.6] 
and we collate that [0.3] and for those in trouble [0.8] we can [0.2] act as 
that kind of person collating their information [0.7] er [0.2] but [0.3] we do 
not 
have an individual who's taking an individual eye on that [0.2] individual's 
progress [0.4] no [3.6] 
nf0450: i-, if a student er [0.3] decided that they weren't learning very much 
in their attachment 
nm0445: yes 
nf0450: let's say the consultant was not a particularly [0.5] good teacher say 
if it's the en-, [0.5] chest clinic [0.3] 
nm0445: yeah 
nf0450: are they allowed to [0.6] to [0.2] to discuss with the consultant that 
they could go to the say the eye clinic [0.4] are they allowed 
nm0445: sure 
nf0450: to [0.3] move around a little bit [0.5] 
nm0445: yeah i mean they are not [0.2] limited [0.4] to [0.5] the [0.2] 
learning [0.5] opportunities that are strictly within [0.2] that partnership [0.
9] i think it's important [0.3] that [1.1] they have a [0.5] a discussion [0.2] 
and that we should be encouraging them to do [0.3] about what other 
opportunities are around [1.1] clearly [0.8] the o-, there is a 
limitation in that as the numbers go up [1.1] there will be s-, [0.2] perhaps 
students already sitting in the thing that they want to go to [0.7] which is a 
limitation [0.5] but [0.7] as long as they are with their clinical tutors 
enough that that clinical tutor can make a reasonable assessment of them [0.4] 
and as long as they've negotiated their learning needs enough that that 
clinical tutor knows [0.2] that they're actually off being [0.6] useful and off 
[0.4] by addressing their learning needs rather than [0.3] have just vanished 
home for the night [0.4] 
nf0450: mm 
nm0445: or whatever [0.3] then that's absolutely fine [1.3] but we get on 
slightly [0.2] to the population issue [0.3] in that [0.3] you know effectively 
we're working off one big trust into [0.2] medium to small trusts [0.2] and 
perhaps a little bit in one further trust [0.5] and [1.0] there are 
partnerships in lots of specialties [0.2] and i'm quite happy for them to go 
off and sit in the eye clinic i think that would be great [0.4] but they may 
well 
find that there's somebody already there [0.5] 
nf0450: mm 
nm0445: er [0.3] and i think [0.8] as numbers of students nationally increase 
[0.4] i think a lot of learning historically went on in these opportunistic 
fashions [0.4] because there were lots of little learning opportunities sitting 
all round the place underutilized [0.6] think what we're doing now is utilizing 
more and more and more of them [0.3] so there's less and less scope for that 
kind of thing to go on [0.2] unfortunately [0.4] but we would encourage it and 
we'd be quite happy with it [0.4] 
nf0450: okay [1.1] 
nm0451: how is it looked at [0.7] with the [0.3] specialist blocks as to [0.6] 
you know who are the good teachers and what qualifies [0.5] somebody 'cause 
it's just [0.9] the example that's been given there if if there's [0.2] poor 
teaching occurring 
nm0445: sure [0.3] 
nm0451: in an area [0.7] through becoming a general practitioner or consultant 
in whatever [0.4] 
doesn't [0.3] mean that you're good 
nm0445: sure [0.4] 
nm0451: teacher how does [0.4] how does would that be sorted out [0.5] and [0.
4] the other [0.2] a kind of another part of that is [0.6] a kind of [0.2] 
convergence in it or or ethos in relation to teaching i i notice that with 
students who at a mentors' interview [0.8] you know a differing [0.6] ethos 
which seems [0.6] you know varies from block to block [2.2] 
nm0445: to [0.4] sort of look at your f-, [0.4] first point [0.9] if i'm 
entirely honest with you [1.1] the biggest problem with quality [0.2] we've got 
here is actually capacity [0.9] because we are struggling [0.4] to find enough 
teachers [0.7] which means [0.6] er [0.9] the bottom line of a poor attachment 
is we shouldn't be using it [1.2] but our current situation if i'm quite honest 
with you [0.4] is [0.2] you'd have to be pretty bad actually for us not to use 
[0.8] [laughter] an attachment [0.3] because we are [0.2] so short across the 
board 
nm0451: right [0.6] 
nm0445: er [1.0] and [1.1] i would like to think that that is a temporary 
capacity building phase [0.2] that we will get in-, [0.3] get [0.5] 
beyond [0.4] that will allow us that flexibility [0.2] and obviously [0.6] at 
lesser levels [0.2] there is supporting those individual teachers and things 
like that [0.4] and i think we've been relatively slow about getting [0.3] the 
central course's structure support going at [0.8] this end and i think that's 
something we ought to be [0.2] or i ought to be thinking of [1.0] er [0.8] we 
[0.4] do have we're in the middle of revamping the process by which we get [0.
2] get feedback to them because that's [0.4] going to become all electronic and 
we are [0.6] in discussions with the trust about how [0.2] to best feed back [0.
2] that back to them [0.5] because again one of the things that's slightly 
unusual about this is [0.3] there is no [1.0] head of medicine who is 
particularly interested in the medicine feedback [1.4] these are individual 
teachers [0.4] and [0.7] it's trying to give meaningful feedback to them in a 
way that's useful and helpful [1.0] rather than trying to give feedback to a 
whole department who can then reallocate the resources or change how we do the 
teaching [0.8] er [0.6] 
which does make it quite challenging [2.3] your second point has gone from my 
mind entirely [0.2] [laughter] what was it 
nm0451: it w-, it was the [0.7] different [0.6] er i suppose the ethos seems 
different in in between varying blocks so [0.4] you know one example springs to 
mind in the way that the histories are taken [0.7] er [0.6] it it it seems that 
[0.3] you know part of [0.4] well i don't know whether anyone else has noticed 
it but part of the one we [0.5] we're [0.3] approaching things in one way [1.5] 
which [0.2] is [0.3] directly opposite to i think it's the old [0.4] by rote [0.
4] way of taking the history [0.3] i-, [0.2] in another block they're occurring 
at the same time [0.9] 
nm0445: so [1.5] by blocks you mean the other teaching blocks that med 
nm0451: yes 
nm0445: students have come through 
nm0451: yes 
nm0445: 
before er they meet you or whatever 
nm0451: yes [0.6] before before 
nm0445: er [1.6] i think that's the reality of clinical [1.0] medicine teaching 
up to a point [0.4] and we [0.2] when we talk to the clinical teachers in all 
the specialties [0.3] and when we train examiners in all of that kind of thing 
[0.2] we are training on [0.4] the [0.6] er basically the namex assessment 
package in terms of 
nm0451: right 
nm0445: the examinations for ICE and the final professional exam [0.5] er [0.4] 
when we meet [0.4] with teachers which we've not done as much as we need to yet 
we're talking through the [0.5] same issues 
nm0451: right 
nm0445: here [0.3] but i think we've a large number to get through to [0.3] and 
[0.2] probably a large number who we'll struggle [0.4] to get the message 
across to 
nm0451: that's not clear to me 'cause i thought they'd all done it [0.2] so 
that [0.7] that's more clear if they 
haven't [0.5] 
nm0445: all done [0.4] 
nm0451: the LAP assessment thing [0.5] 
nm0445: er [0.4] 
nm0451: all gone through the package [0.3] 
nm0445: not all the teachers no no 
nm0451: yes that makes sense 
nm0445: only [0.5] of those who are not doing clinical methods [0.5] 
nm0451: yeah [0.5] 
nm0445: the only ones who have been through it are the trained examiners 
nm0451: right [0.5] 
nm0445: yes [0.7] yeah [1.1] 
nf0452: can i just ask [0.2] just thinking about this it's obviously a very 
very new idea and to for most of us who are trained in a traditional way it's 
so different [0.6] i wondered whether there are any plans to as these cohorts 
of doctors come out to follow them up long term [0.4] and see what happens 
and to see 
nm0445: sure [0.3] 
nf0452: because it might be five years down the line there are obviously [0.7] 
these [0.2] group of doctors are much much better at some things but much much 
worse at others and it'd be very interesting to see what happens throughout 
their careers and see [0.6] if tinkering with the course is for the good or the 
bad [0.9] 
nm0445: i er [0.6] there's a whole number of of issues there [0.2] 
nf0452: mm 
nm0445: up to a point that [0.3] job [0.5] is probably best done with with 
namex [0.4] who invented the thing and who have got the school leavers [0.7] 
who are [0.3] up to a point the more comparable group [0.2] 
nf0452: mm [0.6] 
nm0445: we of course have got an extra level of complexity [0.3] in that we've 
got [0.3] a new type of entrant [0.6] and [0.3] you can argue it as many ways 
as you like [0.3] you know perhaps they're more positive and committed because 
they've already done something else or financially it's a bigger in-, [0.3] you 
know 
investment [0.4] they could have gone off and you know but they've they've gone 
back into education so perhaps they're more committed [0.3] 
nf0452: although ac-, 
nm0445: equally you could argue that 
nf0452: i think my year at medical school about five per cent of the course 
were postgraduates 
nm0445: yeah [0.2] 
nf0452: actually taken in so 
nm0445: yeah [0.2] 
nf0452: you you sort of [0.6] got some some there 
nm0445: yeah [0.5] er but i think there are lots of reasons why our bunch could 
be better or worse [0.7] er because of that aspect as well 
nf0452: mm 
nm0445: er but i think that's [0.4] the point you make is a good one i think 
that's one thing to do [0.3] i think as well in terms of different intake 
streams we actually are mol-, are almost running a natural experiment 
nf0452: mm 
nm0445: in that we've got [0.7] ICE and s-, final professional exams are 
identical summative assessments [0.4] 
and fairly shortly going through them we'll have school leavers [0.2] 
biomedical science graduates and healthcare science graduates 
nf0452: mm [0.6] 
nm0445: going through the same key points who will then go out into careers 
probably [0.3] the majority within a relatively local [0.3] geographical area 
[0.8] and i think it would be [0.6] an absolute crime if we didn't at least [0.
6] you know [0.2] have a reasonable look at [0.8] at what's happening and how 
the numbers shape up [0.3] 
nf0452: mm [8.9] 
nm0445: perhaps [0.4] just to [0.3] move on to to just cover one more thing [0.
3] which was [0.3] er [0.9] to make sense of this session a little bit for 
those er [1.0] who weren't in the session i i gave for the er [0.5] the local 
[0.2] G-P senior lecturers and lecturers [1.0] we talked through similar issues 
and then went on to a discussion 
and one of the things we discussed [0.5] up to a point was the problem based 
learning [0.7] er [0.5] which is something that came up in discussion then [0.
9] er [0.8] because [0.5] a lot of people are throwing the phrase problem based 
learning around and you'll have heard about problem based [0.2] medical courses 
[0.5] yes [0.4] have you heard anybody say that this is a problem based course 
[3.1] no [1.9] good 'cause it isn't [0.6] [laugh] [1.4] i want to say a few 
well i've been asked to say a few words i'm quite delighted to say a few words 
[laughter] i'll get the phras-, phraseology right [0.5] about problem based 
learning because [0.9] if you're not aware of it there is a [0.8] er [0.3] 
movement within medical education [0.4] called the problem based learning [0.8] 
movement or whatever [0.6] it's quite old now it started in the late sixties er 
[0.2] in Canada it's also up and running [0.4] in the Netherlands in Maastricht 
[0.5] and [0.2] an increasing number of medical schools in the last five years 
or so [0.2] have taken up [0.4] this as their [0.4] er [0.2] mantra in the U-K 
[1.1] and [0.9] to various degrees of popularity [1.1] er [1.5] i don't want to 
talk about it too much because it's not 
what we do [0.5] but i think i-, [0.2] er it's worth making a point of 
clarification because [0.6] a lot of our [0.5] teaching [0.8] in phase one [0.
2] is a group teaching [1.2] a lot of the group teaching is based around 
clinical problems [0.7] and because of that [0.3] a lot of people [0.3] think 
[0.2] that we're a problem based curriculum [1.4] but we're not [0.4] and 
perhaps if i try and explain the difference [0.5] er [0.2] it'll at least 
clarify things in if you're having that conversation with somebody later [3.1] 
teaching around clinical problems there's absolutely nothing new about it [0.9] 
people have sat and discussed on ward rounds and after ward rounds clinical 
problems and used it as teaching material and effectively what we are doing [0.
3] is an extension of that [0.2] we're simply [0.2] trying to make stuff 
clinically relevant [0.4] and using [0.3] patient type problems to try and [0.
4] bring out the clinical relevance [0.2] and also try and bring out some of 
the family 
dynamics psychosocial and all of those aspects [2.2] separate to that [0.3] in 
a problem based [1.2] learning [0.2] curriculum [1.0] it's one of the few 
things within educational within medical education [0.5] which [0.5] requires a 
completely different way of thinking [0.3] about [0.3] learning [0.4] and it's 
done in a completely different way [0.3] they're put in groups [0.8] and 
they've got a mentor [1.0] and they are given clinical problems [0.7] and up 
till now that sounds pretty similar [1.0] but they are for instance given one 
clinical problem every month or two [1.6] which is a complicated problem [0.6] 
and as a group [0.9] they have to decide [0.2] on their strategy [0.8] for 
solving that problem [1.0] and they are given problems [0.2] right from the 
beginning of their course [0.4] so in week two once they've done the 
icebreaking exercises and everything like that [0.3] they will be given [0.2] 
their first clinical problem [1.4] and as a group [0.9] they have to say well 
to solve this clinical problem we're going to need to know this bit of anatomy 
we're going to need to know a bit of [0.4] how this 
heart works and we're going to need to know a little bit about blood and we're 
going to need to know a bit about this and a bit about that [0.6] and they go 
away [1.5] and they set an agenda [0.5] and members of the group bring back 
that knowledge [0.3] and use that knowledge [0.2] to structure [0.2] how 
they're going to answer that problem [1.2] so they are not [0.2] given a module 
of cardiovascular [0.2] in which clinical problems are used to illustrate 
things [0.6] they're given [0.6] a series of clinical problems which are 
supposedly de-, designed to cover the whole curriculum [0.7] but it's entirely 
up to the group [0.5] to manage the process of finding [0.2] all the 
information [0.9] for everything [0.5] the whole course in effect [0.3] to 
bring it back to their group [0.3] to assimilate it [0.2] to make sense of it 
[0.8] and [1.2] to learn the material [0.6] and the [0.2] role of facilitator 
is not to provide [0.2] any of that information [0.8] it's to facilitate the 
process by which they decide and they set their agendas and they send people 
off and gather their knowledge [0.3] and are 
supposed to stop them going off on a complete red herring [2.8] and i think the 
difference is important 'cause that is radically different from what we do [1.
6] and it's actually quite a well researched teaching technique and there are 
some good things about it and some bad things about it [0.5] but one of the 
things that tends to happen [0.4] is [0.2] that people [0.2] find the research 
in problem based learning [0.4] and say it supports another style of learning 
[0.7] where actually it's something completely different [3.3] does that make 
sense and is that enough on that is that what you were [0.5] intending [0.3] 
nm0448: that's very helpful thank you very much are there any questions at all 
for [0.4] namex at all on problem based er learning [1.5] 
nf0450: well i guess question now is there not formal t-, anatomy teaching in 
phase one [1.0] 
nm0445: now in our phase one [1.1] yes [0.5] 
nf0450: 
right 
nm0445: then for problem based learning different discussion other people [0.4] 
nf0450: yes [0.9] 
nm0445: in ours [0.5] okay we there is formal anatomy [0.2] teaching [0.4] as 
part of [0.3] their systems based modules [0.6] so they have time in the 
dissection room [0.5] 
nf0450: yeah 
nm0445: when they're doing [0.2] musculoskeletal [0.4] when they're doing [0.3] 
cardiovascular [0.2] when they're doing respiratory [0.5] they don't have much 
time [1.7] and it's much more [0.5] illustrative [0.6] than it is [0.3] 
learning the skill of cutting up a body [1.5] but they do [0.5] have [0.5] all 
of those elements formally taught [0.3] within our [0.3] curriculum [3.9] 
nm0453: namex can you explain a little bit further [0.3] the partnerships for 
the general sort of clinical education rotation [0.6] er for the junior 
rotation and the senior you called them introductory 
partnerships and those [0.3] more challenging partnerships [0.5] and just what 
the difference in kind of [0.3] 
nm0445: at the moment [0.5] there is no difference at all 
nm0453: right 
nm0445: because they're not differentiated at all [1.0] at the moment [0.8] any 
student [0.3] could meet any partnership [1.0] at any phase [0.3] 
nm0453: right [0.3] 
nm0445: yep [0.3] so at the moment it's a bit nebulous [0.8] now that offers us 
a couple of challenges [1.1] it offers us a logistic challenge because actually 
we've got increasing numbers i-, and they increase in big steps [0.4] 
nm0453: right 
nm0445: and therefore if you've got a group of partnerships that a stream would 
go to at one time [0.7] and it could be a junior or a senior stream [0.2] it 
takes us very [0.2] makes it very difficult to plan for us because there there 
might be a hundred-and-thirty juniors and a hundred-and-ninety [0.2] 
a hundred-and-thirty seniors and a hundred-and-ninety juniors and then you know 
you end up juggling up all the time [0.4] so there's a administrative logic to 
separating them [0.9] but [0.2] i think there's also [0.2] an educational logic 
to separate them and make some partnerships used in the junior phase and some 
in the senior phase [0.7] because [0.5] there are certain [0.3] teachers [0.5] 
and certain combinations [0.3] which might be quite difficult and challenging 
[0.3] but if they've already done a year of clinical medicine could be very 
valuable [0.6] so you wouldn't dare put a student who's straight you know who's 
only done phase one [0.2] straight into this partnership [0.3] but you might 
want to use it because there's so much to learn there [0.3] and that you can 
make that partnership with the only medicine senior [1.9] on the [0.2] converse 
[0.2] you could for instance decide that actually [1.5] they ought to tr-, they 
all ought to meet a general surgeon in the junior [0.8] therefore we will have 
junior partnerships that all [0.2] you know [0.2] one stream that all includes 
general surgeons or something like that [0.6] but that's a development on what 
currently 
happens because at the moment there is no differentiation at all [0.2] 
nm0453: thank you [3.0] 
nm0448: right [0.3] maybe at that point give [0.5] namex [0.4] a rest and say 
thank you very much for [0.8] er [1.0] really making phase two of the course [0.
2] a lot clearer [0.7] because i think sometimes we can [0.7] be a bit tunnel 
vision and just see the Clinical Methods course and [0.2] forget about what 
else happens [0.2] in phase two and that's [0.2] really helpful [0.8] insight 
thank you very much [2.0] er we're going to break for [0.2] coffee [0.5] and 
can i suggest we reassemble at about twenty-five to four if that's okay it's in 
about fifteen minutes' time