Medical school in the United Kingdom Information

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 state-funded and their core purpose is to train doctors on behalf of the National Health Service. Courses generally last Four to six years: two years of pre-clinical training in an academic environment and two to three years clinical training at a teaching hospital and in community settings. Medical schools and teaching hospitals are closely integrated. The course of study is extended to six years if an intercalated degree is taken in a related subject.

In the United Kingdom students generally begin medical school after secondary education. This contrasts with the US and Canadian (outside Quebec) systems, where a bachelors degree is required for entry to medical school. Entry to British medical schools is very competitive.

Applications for entry into medical school (in common with other university courses) are made through the Universities and Colleges Admissions Service (UCAS). UCAS allows four applications per applicant for medicine, as opposed to the usual five. The remaining one can either be left blank, or be used to apply for a non-medical course.

Most UK medical schools now also require applicants to sit additional entrance tests such as the Universities Clinical Aptitude Test (UCAT) (required by 26 universities) and the BioMedical Admissions Test (BMAT) (required by 5 universities).

The number of available medical school places had risen by 3,500 since 1998. There are national quotas imposed on the number of places for students on medicine and dentistry courses in the UK as much of the training needs to occur in a healthcare setting. In 2016, places at medical school were offered through the clearing process for the first time, with St Georges, University of London opening up places on its five-year medical degree undergraduate course.

The UCAS personal statement gives applicants the opportunity to write about why they are suitable for medicine. Personal statements are reviewed by university admission boards and applicants scoring highly in tests and with a good personal statement will be called to interview.

Interviews for medicine differ between individual universities. The majority of medical school interview applicants using either a Traditional interview or the Multiple Mini Interview (MMI) formats. Oxford and Cambridge medical schools have their own distinct way of interviewing with focus on science questions and other medical schools also use group tasks to assess applicants. Edinburgh is unique in not requiring an interview of any kind for UK school leavers.

The traditional medical interview consists of 2–4 interviewers sat across a table from the candidate. Interviewers take turns to ask the candidate set questions and rate their responses on a Likert scale. Interviews last between 15–30 minutes. Questions cover a range of desirable criteria that future doctors should possess.

Developed at McMaster University Medical School in Canada in 2004, the MMI format assesses candidates as they cycle through a selection of mini interview stations similar to the medical school OSCE. 1-2 interviewers assess candidates at each station and each station is focussed on a particular skill desirable of a doctor. Criteria assessed at individual stations may include:

After successful completion of clinical training a student graduates as a Bachelor of Medicine, Bachelor of Surgery, abbreviated as

Broadly speaking, undergraduate medical education in the United Kingdom may be thought of along two continuums:

These two can be combined in different ways to form different course types, and in reality few medical schools are at the extremes of either axis but occupy a middle ground.

Problem-based learning (PBL) is a principle based on the educational philosophy of the French educationalist Célestin Freinet in the 1920s, and is used in many subject areas including medicine. It was first developed in relation to medical education at McMaster University Medical School in the late 1960s,. It was introduced to the UK by Manchester University. It refers to a whole process, and not merely to a specific event (the PBL tutorial).

In the UK, the focus is on a PBL-tutorial which is conducted in small groups of around 8–10 students (although this varies with seniority and between medical school) with a tutor (or facilitator) who usually comes from either a clinical or academic background, depending on the level of the course. There is an academic, clinical or ethical scenario, where the students select which areas of study to pursue in their own time. Academics at Maastricht University developed seven steps of what should happen in the PBL process:

In keeping with the ethos of self-directed learning, during sessions it encourages a shift in power from an academic tutor to the students in a PBL group. However, it will be seen that lectures, tutorials and clinical teaching sessions can play a part in problem-based learning - but the emphasis is on the student to decide how these will enable them to fulfil their learning objectives, rather than passively absorb all information.

The introduction of PBL in the UK coincided with a General Medical Council report in 2003, Tomorrows Doctors, which recommended an increased proportion of learning should be student-centred and self-directed. This encouraged medical schools to adopt PBL, however some medical schools have adopted other methods to increase self-directed learning, whilst others (notably Oxford and Cambridge) have always had a high proportion of student-centred and self-directed learning, and have therefore not introduced PBL. Manchester Medical School adopted a new PBL curriculum in 1994, and were followed by Liverpool Medical School and Glasgow Medical School. The Norwich Medical School, at the University of East Anglia also uses a PBL based curriculum. Some of the UK medical schools created since that time have adopted problem based learning. Brighton and Sussex Medical School has a lecture-based approach supported by small-group and self-directed work. Similarly, Imperial College London employs mostly lecture-based teaching but uses supplementary teaching methods such as PBL to deliver a more rounded education.

Tomorrows Doctors also criticised the amount of unnecessary scientific knowledge irrelevant to clinical practice that medical students were required to learn, meaning that the curricula were altered in other ways around the same time that PBL was introduced in the UK. One study criticising problem-based learning found that some medical specialist registrars and consultants believe 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., although the purposeful reduction in anatomy teaching within all medical curricula which occurred following Tomorrows Doctors may be in part to blame for reduced anatomical knowledge, rather than it being due to PBL.

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 clinical medicine through PBL and thus this may increase their enthusiasm for learning.

Notably, universities that pioneered successful Problem-based-learning such as University of Montreal or McMaster are themselves prestigious 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, whose 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.

Lecture-based learning (LBL) consists of information delivered mainly through large lectures or seminars. This had been the predominant method of delivering pre-clinical medical education at many UK medical schools prior to the introduction of Tomorrows Doctors. Teaching is delivered via large teaching events at which several hundred students may be present, which guides learning. Students are encouraged to do their own reading between lectures as the lectures will only cover the main points.

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