School of Medicine

MB ChB Programme – Years 3 & 4 SSC Guidelines

for Students and Supervisors

INTRODUCTION

In the Manchester curriculum, students acquire a common core of knowledge and skills through problem-based learning and the clinical skills program, both of which run through the 'main modules'. These modules alternate with Student Selected Components. These guidelines are for the four Year 3-4 SSCs. The guidelines for Year 4 Project Options are in a separate document.

The overall objectives of SSCs

The SSCs allow students to

extend their education in depth and breadth from personally defined objectives

acquire in depth knowledge and skills about a specialty or aspect of medicine

relate in depth knowledge and skills to a specific case, which may be medical issues or problems relating to a patient, a patient group, a family, a community or health care service

critically appraise published research and understand research methodology

constantly question and be self-critical

communicate clearly in writing

focus on the long term intellectual and attitudinal demands of a professional life.

RANGE AND CHOICE OF SSCs IN THE MANCHESTER REGION

The Manchester Region refers to the area covered by the ManchesterMedicalSchool. It includes the DistrictGeneralHospitals, the Primary Care Centres and the communities linked to the4 teaching sectors (Central, Salford, South and Preston). The University of Manchester has a formal contract with supervisors in the Manchester Region affiliated to the ManchesterMedicalSchool.

The MedLea System contains lists of all SSC placements and supervisors. These lists are updated by each of the 4 teaching sectors, the School of Primary Care and the medical school (for disciplines which are not evenly distributed across the sectors such as oncology, infectious diseases and dermatology). The scope of SSCs is large and influenced by the interests, resources and individual enthusiasms of supervisors. Recruitment for new SSC placements is an ongoing sector activity. Supervisors (both in primary care and in hospitals) are also encouraged to be flexible in negotiating learning opportunities with students.

Well before the start of an SSC, students will be asked to choose a number of possible options from the availability lists in MedLea before an announced cut-off date. After that date, the choices will be processed so that each student is allocated one of their chosen SSCs. Every attempt will be made to accommodate student’s choice with the SSCs available and within the logistics of delivering SSCs. When their SSC placement is confirmed, students have the responsibility of contacting their supervisor and arranging to meet them on or before the first day of the SSC. By discussing the student's portfolio of past experience with them, supervisors may be able to help students in setting appropriate objectives.

During Years 3 and 4, students are required to do a minimum of one SSC in a DistrictGeneralHospitaland one in the Community. The available choices in MedLea will reflect this. Students must avoid doing more than one SSC in the same subject. However interested one is in a particular specialty, the undergraduate years are not the time for focusing on one particular specialty.

To avoid potential conflict of interest in supervision and assessment:

  • students should not do SSCs in situations where a close relative is working
  • the supervisor must not be a close relativeor spouse.

COMMUNITY SSCs

Students are encouraged to think more broadly about opportunities for SSCs in the Community, including topics related to Disability or Culture, the Arts and Sports. Suggestions for topics can be found on the Community Based Medical Education Unit (CBME) website:

If they are having difficulties with planning, students should seek assistance early on from the Community Based Medical Education Unit (CBME).

SSCs CANNOT BE DONE OVERSEAS
exceptby Students on the European Optionprogramme
SSCs OUTSIDE THE MANCHESTER REGION BUT IN THE UK
The only situation in which an SSC can be undertaken outside the Manchester Region but within the UK is if a particular educational resource relevant to year 3-4 stage of the course is totally unavailable in this region. There is virtually no topic which cannot be pursued in Manchester. For example, spending time working in a mountain rescue team is not an appropriate introduction to medicine in the community, and is something that would be more appropriate to the elective period.
If a student wishes to do an SSC outside Manchester, written application must be made to the Hospital Dean at least 8 weeks before the start of the SSC. The application must include:
1.an explanation about the relevance to year 3-4 of the course
2.clear evidence about the lack of relevant resources in Manchester
3.written confirmation that the proposed supervisor understands and accepts that no SIFT monies or other funding can be allocated by the University of Manchester for this SSC placement

SSCs FOR EUROPEAN OPTION STUDENTS

Students on the ‘European Option’ may normally, with permission from the Hospital Dean and their language tutor, undertake one SSC of the four available in Years 3 & 4 in a European country where the language that they are studying is spoken. Students must satisfy both the intended learning outcomes for UK SSCs and confirm that the SSC will be undertaken wholly in the language being studied as part of the European Option. The SSC report must be completed in the language that the student is studying. As with SSCs in the UK, students must make all arrangements themselves.

The “European Option SSC” cannot replace the UK Community SSC, which must be undertaken in the Manchester area.

THE SSC LEARNING CONTRACT

Supervisors are encouraged to help students

  • think in broad terms about developing their understanding and attitudes
  • think HOW their learning objectives could reasonably contribute to developing their moral reasoning and medical understanding
  • stretch learning outside the core curriculum

Students should NOT be confined to working ONLY with health professionals or writing about clinical cases. Supervisors should discuss the student’s achievements to date and plans about future SSCs.

By the end of the SSC, students should be able to:

1)explain their reason for choosing the SSC

2)reflect on how she/heworked with health care professionals other than doctors

3)demonstrate that her/his specific objectives for the SSC were achieved

4)demonstrate an in-depth understanding of one clinically relevant subject, including appropriate allied issues, such as public health aspects, prevention, epidemiology, treatment options and future development

5)relate in-depth understanding of the above subject to the specific 'case' that was studied.

6)produce a word-processed report on a chosen 'case'

LEARNING OBJECTIVES

The student must

  • contact the supervisor before the starting date of the SSC, to know where to go and how to meet during the first two days of the SSC.
  • at the first meeting with the supervisor, discuss what she/he wants to achieve and how to do this during the SSC. A blank Timetable during the SSC (Form 2) is provided at the back of these Guidelines for the student to complete with the supervisor.
  • summarise the discussion with the supervisor in the Learning objectives and self assessment form (Form 3). This must be signed by the supervisor and be appended to the written report.
  • arrange and meet with the supervisor at least once a week throughout the SSC.
  • review own progress at regular intervals, discuss with the supervisor and complete Reviewing and recording professional development through the Year 3/4 SSCs, Part 1 and Part 2 (Form 4).

Components of the Learning Objectives
Specific Learning Objectives / In discussion with the supervisor, the student must set some specific learning objectives for this SSC. It is worth spending some time thinking about what objectives to set and whether they are achievable in 4 weeks. The main mistakes people make in setting objectives are (1) to make them too general, and (2) to make them impossible to achieve.
Students should think about the objectives in terms of the following:
1 knowledge and understanding of disease and its management, including public health aspects, prevention, epidemiology and aspects of clinical management.
2 clinical skills - the student may wish to learn and practice specific skills and become proficient in them (eg. intubation).
3 developing attitudes appropriate to the field of study and the medical profession.
4 working with a range of health care professionals.
5 exploration of ethical, legal and moral issues.
6 appreciation of areas of difficulty and uncertainty; exploration of future research and clinical development needs.
7 understanding clinical audit
8 understanding provision and delivery of health care.
Learning methods / - the methods the student will use and experience/resources that will need to be tapped to achieve the above objectives. The student will have to be proactive and must not expect to be spoon fed. Wherever possible, real medical issues or problems rather than abstract theory should be studied. After the first week, the supervisor should discuss the student's progress and the learning opportunities available. The supervisor should be informed early on if the student's learning expectations are not being met so that the situation may be rectified.
Timetable / - a timetable of fixed and variable sessions.

CORE SKILLS

The SSCs are good opportunities to practice and to learn new skills. The following are the core skills for which students might wish to gain more practice during each SSC. Students should think about which ones are most appropriate.

Core Theme: Heart, Lungs & Blood
History skills
Take an appropriate history
Take history from carer/relative/3rd party
Examination skills
Respiratory examination
Cardiovascular examination
Lymph node examination
Assessment of hydration/volume
Procedural skills
Perform ECG
Peripheral venous cannulation, fixation, blood sampling
Care of the unconscious patient
Basic airway management
Endotracheal intubation
Emergency defibrillation
Peak flow measurement
Arterial puncture
Intercostal drainage/aspiration of pneumothorax
Pleural Aspiration
Assist in theatre
Use nebuliser
Use bronchodilator inhaler
Interpret chest radiograph
Interpret ECG
Core Theme: Family and Children
History Skills
Take history from carer/relative/3rd party
Take appropriate history
Build rapport by history taking from child/parent
Take sexual history
Examination skills
Approach to examination of children
Breast examination
Inguinal examination
Testicular examination
Procedural skills
Vaginal examination including speculum
Cervical smear and swab
Swab cervix, urethra and vagina
Swab male urethra / Core Theme: Nutrition, Metabolism & Excretion
History skills
Take an appropriate history
Take history from carer/relative/3rd party
Examination skills
Rectal examination
Abdominal examination
Neck examination including thyroid
Procedural skills
Measurement of blood glucose
Arterial puncture
Urethral catheterisation (male and female)
Nasogastric intubation
Assist in theatre
Interpret abdominal examination
Core Theme: Mind and Movement
History Skills
Take appropriate history
Take substance abuse history
Communicate with mentally ill people
Examination Skills
Conscious level: assessment
Mental state examination
Cognitive assessment
Assess suicide risk
Neurological examination
Locomotor examination
Functional status assessment
Procedural Skills
Fracture immobilisation
Lumbar puncture
Interpret locomotor radiographs
Management Skills
Disabled patient: assess rehabilitation needs
Discuss psychological disorders with the family
Judge point of referral to specialised services
Integrated Skills
To be able to assimilate history and examination in forming a differential diagnosis,
commenting on aetiology, management and prognosis.

WRITTEN REPORT

Students are required to hand in two copies of their written report:

one copy to the supervisor and

another copy to the Hospital Dean's office.

They must be handed in by the last day of the SSC.

Aim of the written report

The aim of the written report is for the student

to enhance her/his written communication skills

to be able to concisely and effectively summarise a specific case (which may be a patient, a family, a community or a health care service)

to demonstrate depth of understanding regarding:

  • underlying pathophysiology or pathological processes
  • rationale underpinning investigations and management
  • current management and how it might be improved in the future
  • multidisciplinary team work, and the roles and contributions of different health care professionals
  • public health aspects including epidemiology and prevention

to relate this in-depth understanding of the above issues and relevant references to the case

Requirements of the written report

The report must:

be word-processed with font size 10 or greater, text in double line spacing and pages numbered consecutively

Word count must be included in bottom right hand corner of the cover page

be 2000 – 5000 words excluding references (with text in double line spacing).

Reports which exceed 6000 words will be penalised by awarding a lower grade and will not be considered for a final grade 'Excellent'

be organised into logical sections

include 10 - 20 relevant references, and preferably not textbooks, listed in The Uniform Requirements styles (Harvard and Vancouver) found at

bound or presented in a folder or file

submitted before the specified deadline. Reports submitted late will be awarded an ‘unsatisfactory’ grade except where mitigating circumstances have been accepted. Possible mitigating circumstances ( include

  • significant illness or injury
  • the death or critical illness of a close family member
  • family crises or major financial problems leading to acute stress
  • absence for jury service or maternity, paternity or adoption leave

ASSESSMENT

Assessment domains

The supervisor will assess the following:

  1. Attendance
  2. Work habits and performance

Student and supervisor must meet in the last week of the SSC for an appraisal and assessment of how far the student achieved the objectives of the SSC. However, the supervisor must inform the Hospital Dean early on if there are concerns about a student’s attendance, attitude or behaviour so that attempts may be made to remedy the situation before the end of the SSC.

  1. Written report

The written report will be assessed by the Supervisor. It will also be assessed by another Assessor when a student is awarded an ‘Unsatisfactory’ by the supervisor.

Supervisors’ should complete the online assessment forms provided by MedLea (Form 5). MedLea (Medical Learning) is the name for the bespoke e-learning system that has been developed to support student learning. Some functions of MedLea have been designed specifically for tutors. For example, tutors are able to see the same information as students but also have access to electronic assessment sheets.

MedLea is accessible from any Internet connection (ie it can be accessed from the University campus, a Hospital Teaching site, a General Practice placement or from ‘home’). To gain access to the MedLea log on page require a username and password. To obtain this, supervisors should contact the administrator in their Sector who will in turninform the MedLea team. The MedLea team will thereafter correspond directly with the supervisor to provide a username and password. The MedLea Help email is

Assessment criteria

The following are the assessment criteria for the 3 domains.

Domain / Assessment criteria
1. Attendance and punctuality / ≥80% of the SSC period is ‘satisfactory’. The grade 'unsatisfactory' will be awarded if attendance is less than the minimum requirement of 80%
2. Work habits and performance / • Ability to identify own strengths and weaknesses and confront issues of concern
• Motivation, enthusiasm and active participation
• Seek and take advantage of available learning opportunities and resources
• Application of knowledge and skills
• Exploration of ethical, legal and moral issues
• Working with health care professionals other than doctors
• Achievement of specific learning objectives
3. Written report / Presentation and structure
word processed with font size 10 or greater and double-spaced
word count 2000-5000 excluding references
Note: an excessively long report will be penalised by awarding a lower grade and will not be awarded 'excellent'
organised into logical sections
tables and figures used appropriately
Abstract/Summary
maximum 200 words
clear and accurate summary of the content
Content
concise description of a specific case
understanding of a medical topic related to the case (which may be issues such as disease mechanism, public health aspects, prevention, epidemiology, treatment options and future development relating to a patient or group of patients, a family, a community or a health care service)
understanding illustrated through clear explanations and analyses
available information appraised critically and interpreted correctly
Use of literature
10-20 references and preferably not textbooks
appropriate range and pertinent to the topic
cited accurately and in a consistent style

Assessment grades for each of the three domains

The grades for each of the domains are shown below.

Domain / Grade
1. Attendance / unsatisfactory (<80% of PO period) / satisfactory (≥80% of PO period)
2. Work habits & performance / unsatisfactory / cause for concern / average / above average / excellent
3. Written report / unsatisfactory / cause for concern / average / above average / excellent

Grade definitions for Domain 2 - Work habits & performance and Domain 3 - Written report

Grade / Unsatisfactory / Cause for concern / Average / Above average / Excellent
Definition / • lacks motivation
• fails to respond to guidance and advice
• poor time management and poor organisation of basic tasks
• gross deficiencies in practical output
• written work inadequate, inaccurate with many omissions / • performance and output below average / • satisfactory on most of the criteria listed / • performance and output above average / • performance outstanding over a range of tasks
• highly motivated
• well organised, systematic approach
• thinks logically
• written work exceptionally good on the criteria listed

Guidance to Supervisors for awarding grades