Specialties

• WHOLE PERSON
  • The Whole Person
  • The Medical Patient
  • The Surgical Patient
  • The Community Patient
• CARDIORESPIRATORY
  • Cardiovascular System
  • Respiratory System
  • Haematology
• METABOLISM
  • Gastrointestinal System
  • Renal and Urinary System
  • Endocrine System
• HUMAN DEVELOPMENT
  • Obstetrics and Gynaecology
  • Child Health
  • Sexual Health and HIV
• BRAIN AND BEHAVIOUR
  • Neuroscience
  • Psychiatry
  • Ophthalmology
  • Head and Neck (ENT)
• LOCOMOTOR
  • Musculoskeletal System
  • Health Care of the Elderly
  • Dermatology

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WHOLE PERSON: The Whole Person

Index

• General Outcomes for the Whole Person

• General Outcomes for the Whole Person
  • TD 16: PROVIDE IMMEDIATE CARE IN MEDICAL EMERGENCIES
    • Basic Life Support
      1. Provide immediate care in medical emergencies (click to see list) (YR5intro)
  • Medical knowledge: ANATOMY (TD 8.1)
    • Surface Anatomy - General
      1. Be able to describe basic surface anatomy, especially that relevant to general clinical examination and diagnosis
      2. Describe the body's organ systems and their location and relationship to the body's surface and skeleton
      3. Describe basic surface anatomy especially that relevant to general clinical examination and diagnosis
    • Anatomical Positions, Planes and Movements
      1. Know the accepted anatomical language with regard to anatomical planes
      2. Understand the following anatomical planes: Axial; Transverse; Horizontal; Sagittal; Coronal (GEP/BB)
      3. Use the basic language of anatomical directions and movements (superior, inferior, anterior, posterior, proximal, distal, pronation etc)
      4. Can name the different types of tissue and identify their major functions:
      5. Understand and use the basic language of anatomical directions and movements (superior, inferior, anterior, posterior, proximal, distal etc)
      6. Can describe the relevant skin and fascia
      7. Can describe the relevant, deep fascia, compartments (FM1)
      8. Can describe the relevant muscle groups and movements (FM1)
    • Epithelia and Glands
      1. Recognise the various epithelial cell types in photomicrographs and predict their function from their structure (FM1, GEP/M&P)
      2. Understand and master the use of the system for classifying different types of lining epithelia based on number of layers and shape of cells on the surface (FM1)
      3. Recognise glandular tissue in photomicrographs, identify the gland type and its likely function (FM1)
      4. Understand and master the use of the system for classifying different types of lining epithelia based on number of layers and shape of cells. (GEP/M&P)
      5. Recognise the mucous and serous membranes in photomicrographs and be able to identify different structural components found in each of these complex tissues (FM1)
      6. Recognise, name and understand the function of different components of the basement membrane. (FM1, GEP/M&P)
      7. Recognise glandular tissue in photomicrographs, indentify the gland type and its likely function. (GEP/M&P)
      8. Recognise the basement membrane and list its function (GEP/M&P)
    • Muscles, Nerves and Connective Tissue
      1. Recognise the different types of connective tissue in photomicrographs (FM1)
      2. Recognise nervous tissue and be able to distinguish neural and glial components (FM1)
      3. Identify common cell types found in connective tissues (FM1)
      4. Show understanding of how different cell types within nervous tissue and the organisation of the tissue contribute to its functions (FM1)
      5. Understand differences in the make-up of the extracellular matrix between various connective tissues and how types are differently organised (FM1)
      6. Relate organisation of different types of connective tissue to their function (FM1)
      7. Recognise different types of muscle and different components of muscle tissue in photomicrographs (FM1)
    • Histology
      1. Describe the categorisation, main structural features and functions of the connective tissues. (FM1)
      2. Describe the different cell types found in mature connective tissue. (FM1)
      3. Relate the composition of extracellular matrix components to the functional requirements of the various connective tissues. (FM1)
      4. Compare and contrast the structure and functions of the two types of adipose tissue. (FM1)
    • Bones and Joints
      1. Can describe the axial and appendicular skeleton (FM1)
      2. Can classify the different types of joints (FM1)
      3. Classify the different types of joints
    • Skin and Tissues
      1. For each of the various types of epithelial tissue, can outline its structural characteristics, functional capabilities, cellular specialisations and be able to give an example of a body site where it would be located. (FM1)
      2. Can name the various types of glands, relate their structure to their function, and give an example of where each might be found in the body. (FM1)
      3. Can describe the basic structure of a mucosa and a serosa, and predict their functions from the different types of epithelial cell found on their surface. (FM1)
    • Bones, Muscles and Ligaments of the Pelvis
      1. Identify the individual bones of the pelvis
      2. Describe the main ligamentous attachments of the bony pelvis
      3. Indicate the relationship of the foramina and notches to the passage of nerves, blood vessels and muscles
      4. Outline the consequences of injuries to the pelvic floor leading to prolapse of the pelvic viscera
    • Pelvic Viscera and Perineum
      1. Have knowledge of the organs of the pelvis
      2. Have knowledge of the organs of the pelvis. (GEP/HD, HD1)
      3. Understand the structure of the pelvic viscera in the male (GEP/HD, HD1)
      4. Describe the urogenital triangle and its pouches
      5. Describe the contents of the perineal pouches in the male and female
    • Female Pelvis and Reproductive System
      1. Identify the major structures (external and internal) of the female pelvis; describe the functional anatomical relationships between these structures
      2. Have knowledge of the organs of the pelvis. (GEP/HD, HD1)
      3. Outline the development of the reproductive system (GEP/HD, HD1)
      4. Describe the micro-anatomy of the internal genitalia
      5. Understand pelvic measurements used in obstetrics
      6. Understand the structure of female reproductive organs (GEP/HD, HD1)
    • Male Pelvis and Reproductive System
      1. Have knowledge of the organs of the pelvis. (GEP/HD, HD1)
      2. Outline the development of the reproductive system (GEP/HD, HD1)
      3. Describe the descent of the testes and the development of the inguinal canal (GEP/HD, HD1)
      4. Describe the micro-anatomy of the internal genitalia
      5. Identify the major structures (external and internal) of the male pelvis; describe the functional anatomical relationships between these structures
    • Surface Anatomy of the Pelvis
      1. Recognise the main differences between the male and female pelvis
    • Renal System and Urinary Tract
      1. Understand the descent of the ureters through the pelvis and the position of the bladder and urethra in the male and female (GEP/HD, HD1)
    • The Pectoral Region, Breasts and Mammary Glands
      1. Describe the anatomy and micro-anatomy of the breast
      2. Describe the development of the breast at puberty
    • General Outcomes for Embryology
      1. Understand the difference between embryonic and fetal periods of development and the clinical significance to organ development and growth (GEP/HD, HD1)
      2. Describe the major developmental steps of the human embryo between the time of implantation and 8-weeks gestation including the development of the face and heart
      3. Highlights of week 4, to include the closure of the neural tube, folding of the embryo, the pharyngeal arches and the beginnings of the limbs. (GEP/HD, HD1)
      4. Identify the major structures which are unique to the development of the embryo
      5. Know the highlights of Week 4 including closure of the neural tube, folding of the embryo, the pharyngeal arches and the beginnings of the limbs
      6. Know the highlights of week 5 including the growth of the head, heart and kidneys
      7. Know the highlights of week 6 including progress of the development of the limbs and the heart and start of spontaneous movements
      8. Know the highlights of week 7 including the importance of cell death to shape the limbs and face and the growth and development of the gut
      9. Know the highlights of week 8 including bone formation and more of the development of the gut
    • Anatomy of the Nervous System - General
      1. Explain the structural and the functional divisions of the nervous system (FM1)
      2. Can explain the broad structure and function of the central nervous system (FM1)
      3. Relate CNS anatomy to structures viewed in MRI, CT and X-Rays (GEP/BB)
      4. Can explain the broad structure and function of the peripheral nervous system (FM1)
      5. Can explain the broad structure and function of the somatic nervous system (FM1)
      6. Can explain the broad structure and function of the autonomic nervous system (FM1)
  • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • Homeostasis
      1. Be able to apply the principles of homeostasis to one human physiological system, from: body temperature; or blood glucose concentration; or body fluid volume. (FM1)
      2. Be able to apply the principles of homeostasis to one human physiological system - body temperature; blood glucose concentration; body fluid volume
      3. Be able to define homeostasis in relation to the physiological systems (FM1)
      4. Be able to discuss the contribution of negative feedback, positive feedback and positive feedforward to the process of body homeostasis. (FM1)
      5. Be able to discuss the contribution of negative feedback, positive feedback and positive feed-forward to the process of body homeostasis
    • Acid-Base Balance
      1. Be able to define the term buffer system and explain how it resists changes in pH
      2. Be able to state the normal pH and hydrogen concentration of human blood plasma and the ranges compatible with life
      3. Be able to cite a common clinical example of acid-base becoming unbalanced
    • Body Fluids
      1. Be able to describe the distribution of body fluids within the body and the composition of intracellular and extracellular fluids. (FM1)
      2. Be able to describe how water moves between different compartments of the body. (FM1)
      3. Be able to discuss the contribution of ion pumps to the regulation of cell volume. (FM1)
      4. Be able to discuss fluid balance and the role of the kidney in regulating blood osmolality and volume. (FM1)
      5. State general disorders of fluid balance. (FM1)
    • Physiology of Growth and Puberty
      1. Describe the regulation of normal growth (GEP/HD, HD1)
      2. Understand the normal physiological and anatomical changes at puberty (GEP/HD, HD1)
      3. Identify the stages of puberty in boys and girls (GEP/HD, HD1)
      4. Understand the relationships between growth and the onset of puberty (GEP/HD, HD1)
      5. Understand the techniques of measuring children of all ages and be able to plot and interpret measurements on a growth chart (GEP/HD, HD1)
      6. Understand the biological features influencing normal growth patterns (GEP/HD, HD1)
    • Male Reproductive Physiology
      1. Describe the normal process of oogenesis and spermatogenesis
    • Female Reproductive Physiology
      1. Describe the normal process of oogenesis and spermatogenesis
      2. Understand the normal process of ovulation
      3. Understand that ovarian and menstrual cycles are closely linked
    • The Hormones of Reproduction
      1. Understand the principles of sensitivity and specificity of analytical methods
      2. Recognise testing anomalies
      3. Explain the importance of the structure of glycoproteins
      4. Outline the role of the main glycoproteins involved in reproductive physiology incuding maternal recognition and maintainance of pregnancy
      5. Understand the changes in levels of the main glycoproteins at the menopause
      6. Recognise that molecules can be produced ectopically
    • General Outcomes for Nervous System Physiology
      1. What are the membrane properties essential for excitability? Including an introduction to resting and action potentials and voltage-gated ion channels
      2. Describe how sensory nerve endings transduce and encode stimuli with examples including peripheral stretch (mechano) and thermoreceptors
      3. Be able to describe the biophysical requirements for action potentials to take place
      4. Why everything depends on the Na-pump
      5. Be able to discuss the principle characteristics of an action potential
      6. What is the basic mechanism of local anaesthetics (an example of pharmacological manipulation of excitability)
      7. Describe what is meant by threshold, sub-threshold and supra-threshold responses, and how a neuronal dendritic tree can integrate many synaptic inputs, taking the spinal a-motor neuron as an example
      8. Have an understanding of the importance of saltatory nerve conduction for activities of daily life
      9. Describe a synapse and the role of both excitatory and inhibitory neurotransmitters with examples
      10. Why is pre-synaptic Ca2+ important?
      11. Understand the concept of a ligand-gated receptor
      12. What are the membrane properties essential for excitability? Including an introduction to resting and action potentials, and voltage-gated ion channels.
      13. Why everything depends on the Na-pump
      14. What is the basic mechanism of local anaesthetics (an example of pharmacological manipulation of excitability)?
      15. Describe a synapse and the role of both excitatory and inhibitory neurotransmitters with examples
      16. Why is pre-synaptic Ca2+ important?
      17. Understand the concept of a ligand-gated receptor
    • Neuropharmacology
      1. Be able to explain how neurotransmitters can produce electrical changes by activating / inhibiting receptors in the post-synaptic cell (FM1)
      2. Be able to outline the role of G-proteins in coupling a hormone/NT receptor complex to a) adenylate cyclase; b) hydrolysis of inositol phospholipids (FM1)
      3. By means of simple diagrams and suitable examples, be able to describe the properties of the receptor-regulated ion channels and the neurotransmitters which activate them (FM1)
      4. Describe the major neurotransmitter systems in the central and peripheral nervous systems (FM1)
      5. Describe the role of protein kinases in transmitting the intracellular effects of second messengers (FM1)
      6. Explain how an action potential is initiated by the summation of synaptic inputs (FM1)
    • Autonomic Nervous System
      1. Compare and contrast the SNS and ANS (FM1)
      2. Draw labelled diagrams to show the general arrangement of motor and somatic reflexes. (FM1)
      3. Name the divisions of the ANS, and describe the segmental organisation of the sympathetic and parasympathetic nervous systems. (FM1)
      4. Draw a series of labelled diagrams to show the arrangement of nerve fibres in the divisions of the ANS at the anatomical and neurochemical and receptor levels, (FM1)
      5. Describe how the adrenal medulla acts as a modified post-ganglionic cell. (FM1)
      6. Briefly describe how the enteric nervous system can control gut function. (FM1)
    • Gastrointestinal Physiology - General
      1. Analyse how the gut handles carbohydrate
      2. Describe the hormonal control of blood glucose
    • Function of the GI Tract
      1. Distinguish between the handling of simple and complex carbohydrates
    • Muscle Function and the Neuromuscular Junction
      1. Know the anatomy, physiology and pharmacology relating to the neuromuscular junction (LOC1)
    • Adaptation of Fetus to Neonate - General
      1. Understand the circulatory changes at birth and the neonatal transitional circulation (GEP/HD, HD1)
      2. Highlights of week 4, to include the closure of the neural tube, folding of the embryo, the pharyngeal arches and the beginnings of the limbs. (GEP/HD, HD1)
      3. Understand the changes in pulmonary physiology at birth
      4. Understand the changes in pulmonary physiology at birth (GEP/HD, HD1)
      5. Describe the basic metabolic adaptations which take place in the neonate
      6. Describe the basic metabolic adaptations which take place in the neonate (GEP/HD, HD1)
    • Physiology of Ageing - General
      1. Outline the patterns of body and organ growth during normal human development
      2. Explain how age, metabolic rate, weight and surface area change during normal human development
      3. Briefly outline the patterns of disease noted in human development and diseases of premature ageing
    • Physiology of Pregnancy - General
      1. Describe the physiological changes in preparation for lactation
    • Labour, Delivery and Puerperium (inc. Lactation)
      1. Describe the nature and control of processes associated with lactation
  • Medical knowledge: BIOCHEMISTRY (inc. Metabolism) (TD 8.3)
    • Biochemistry - General
      1. Be able to define and describe with examples, the volume of distribution, clearance and elimination half life (GEP/BB)
      2. To define and explain drug absorption (GEP/BB)
      3. 1. To describe the extracellular architecture 
      4. 2. To appecriate the key components that make up most of the ECM including 
      5. 2. To appecriate the key components that make up most of the ECM including 
      6. 1. collagen
      7. 1. collagen
      8. 2. proteoglycans
      9. 2. proteoglycans
      10. 3. To appreciate the mechanism that allow cells to adhere and move through the extracellular matrix
      11. 3. To appreciate the mechanism that allow cells to adhere and move through the extracellular matrix
      12. 4. To describe how loss of cell ahesion can lead to diseases
      13. 4. To describe how loss of cell ahesion can lead to diseases
    • Acid-Base Balance
      1. Be able to define the term buffer system and explain how it resists changes in pH (FM1)
      2. Understand the basic physiological principles behind acid base balance.
      3. Be able to state the normal pH and hydrogen concentration of human blood plasma and the ranges compatible with life. (FM1)
      4. Understand the relationship between respiratory and metabolic control of acidaemia
      5. List causes of a normal and high anion gap.
      6. Describe common causes of lactic acidosis.
    • Amino Acids
      1. Be able to cite a common clinical example of acid base becoming unbalanced. (FM1)
  • Medical knowledge: CELL BIOLOGY (TD 8.4)
    • Cell and Tissue Structure
      1. Describe different types of cell to cell (intercellular) communication (FM1)
      2. Identify the organelles and ultrastructural features of cells; describe organisation and functions of the following and, where applicable, relate to human disease (FM1)
      3. Understand the functions of the principal components of the extracellular matrix and relate to cell function and disease (FM1)
      4. Describe the steps and components in a simple intracellular pathway (FM1)
      5. nucleus; mitochondrion; endoplasmic reticulum (rough and smooth); Golgi complex; lyosomes; peroxisomes; cytoskeleton; plasma membrane (FM1)
      6. Discuss the structure and function of inter-cellular connections in relation to tissue function eg adherens junctions, tight junctions, gap junctions, desmosomes, synapses and relate to disease (FM1)
      7. Understand how signals may activate different responses in cells (FM1)
      8. Relate the specialised structure of the cell surface (microvilli, cilia, pseudopodia) to the functions of the tissues and cells concerned (FM1)
      9. How intracellular signals can act as molecular switches via phosphorylation (FM1)
      10. Explain the different types of intracellular and cell surface receptors (FM1)
      11. Understand the importance of cell communication in physiological and pathophysiological conditions. (FM1)
    • Proteins
      1. Understand the role of the ribosome in mRNA translation; how and where, including co-translational translocation of membrane and secreted peptides at the ER (FM1)
      2. Outline the common structural features of the amino-acids and the roles of their side chains in protein structure and function (FM1)
      3. Describe the structure of proteins and the stabilising forces of the a-helix, b-pleated sheet and collagen triple helix (FM1)
      4. Comprehend the problems of protein folding in vivo and the role of molecular chaperones in dealing with this (FM1)
      5. Explain how post translational modifications can be important for stability and modulation of function (FM1)
    • Enzymes
      1. Define the following terms in relation to enzyme catalysis: substrate specificity; active site; activation energy; cofactor and co-enzyme; proenzyme. (FM1)
      2. Explain the effects on enzyme catalysis of changes in temperature and pH. Distinguish between competitive and non-competitive inhibition, giving a physiological example of each. (FM1)
      3. Enzyme activity assays
      4. Define the term isoenzymes and their value in diagnostic enzymology. (FM1)
    • Membrane Function
      1. Be able to describe the function of membrane proteins (FM1)
      2. Understand the functions of biological membranes and associated proteins including adhesion, transport and communication
      3. Distinguish between passive diffusion, facilitated diffusion, secondary active transport, and active transport giving examples of each in human tissues (FM1)
      4. Understand the composition and architecture of biological membranes (FM1)
      5. Relate specialisations of the plasma membrane to its function (FM1)
      6. Describe how deficiencies in folding, trafficking and function of the CFTR protein cause cystic fibrosis (FM1)
      7. To appecriate the key components that make up most of the ECM including collagen and proteoglycans, (FM1)
      8. To describe how loss of cell ahesion can lead to diseases (FM1)
      9. To appreciate the mechanism that allow cells to adhere and move through the extracellular matrix (FM1)
    • Lipids and Membranes
      1. Distinguish between essential and non-essential fatty acids and understand their importance as energy stores and as precursors of membrane lipids and paracrines (FM1)
      2. Explain the following terms in relation to enzyme catalysis: substrate specificity; active site; activation energy; cofactor and co-enzyme; proenzyme. (FM1)
      3. Describe the physiological functions of cholesterol: as a component of biological membranes and as a precursor for steroid and bile salt synthesis (FM1)
    • Biological Energy
      1. Define the principal energy stores in human cells (FM1)
      2. Describe the principal biological roles of ATP in relation to biosynthesis reactions, transport and motility (FM1)
      3. Describe the principal mechanisms of energy generation within the cell and distinguish between ATP generation through substrate level phosphorylation and via the proton motive force (FM1)
      4. Explain the significance of B-group vitamins in terms of coenzyme structure and function (FM1)
    • Cell Differentiation and Cell Death
      1. Define programmed cell death (FM1)
      2. Explain the difference between stem cells and differentiated cells (FM1)
      3. Visualisation of cell behaviour including movement, cell division and death
      4. Describe the role of stem cells in cancer (FM1)
      5. Explain the changes that occur with ageing at the cellular and tissue levels (FM1)
    • Sugars and Polysaccharides
      1. Distinguish between the terms monosaccharide, disaccharide and polysaccharide and name a physiologically important example of each group (FM1)
      2. Define the terms: glycosidic bond; sugar esterification (phosphates + sulphates); amino sugar, giving a physiologically relevant example of each one (FM1)
      3. Define the mechanism and biological importance of protein glycosylation (FM1)
      4. Outline the structures and biological roles of glycogen, heparin, proteoglycan and bacterial lipo-polysaccharide (FM1)
  • Medical knowledge: MOLECULAR BIOLOGY and GENETICS (TD 8.5, 8.6)
    • Chromosomal Genetics
      1. Describe the normal human karyotype and common methods used to identify individual chromosomes; explain benign copy-number-variation
      2. Define the terms used to denote variation in chromosome number: haploid, diploid, polyploid, aneuploid, monosomy, trisomy; list common aneuploidy syndromes, incidence, clinical picture and methods for pre-natal diagnosis
      3. Explain the three causes of Down's syndrome phenotype: classical trisomy 21; 14:21 Robertsonian translocation and somatic mosaicism
      4. Define the terms used to denote variation in chromosome structure: deletion; duplication; inversion; translocation; ring chromosome. Explain the importance of acquired chromosomal changes in cancer
      5. Define the functions of the X and Y chromosomes and the significance of Lyonisation in females
    • Genetics - General Outcomes
      1. What? The type of alteration of genetic material: molecular and cytogenetic, and subdivisions. (CSP3)
      2. How is pre-natal diagnosis and PGD performed
      3. Evaluate the contribution of genetic and environmental factors to normal human variation and to disease
      4. To be able to define the differences between monogenic and complex genetic diseases (CSP3)
      5. PCR and its uses in pre-natal diagnosis / pre-implantation genetic diagnosis
      6. How? (type of molecular biological consequence) (CSP3)
      7. Describe, with examples, the different patterns of inheritance of single gene disorders
      8. Evaluate the likelihood of genotype specific drugs / therapies
      9. Describe the basic principles of Mendelian inheritance and understand the difference between monogenic, multigenic and multifactorial disorders
      10. To have some knowledge of the methods used to map genes causing complex genetic diseases, for example the basics of linkage analyses and association studies (CSP3)
      11. Use of high density single nucelotide polymorphism (SNP) arrays of disease gene mapping and cancer diagnostics
      12. Where? (which cells are affected) (CSP3)
      13. Understand the basic principles of population genetics with reference to allele frequencies and Hardy-Weinberg equilibrium (FM1)
      14. Understand the role of cytogenetics and molecular genetics in clinical diagnosis
      15. Think about the ethical issues with respect to personal genome sequencing
      16. Old and new sequencing: how to sequence your genome for £2000
      17. To know some examples of complex gene traits where new genes have been mapped and what has been found and why it is important (CSP3)
      18. Who? (patterns of inheritance) (CSP3)
      19. Explain how genetic variation contributes to common disease (FM1)
      20. When? (at what point is the disease visible) (CSP3)
      21. These questions are applied to the following diseases in differing amounts of detail: Duchenne muscular dystrophy, Haemophilia A, X-linnked severe combined immune deficiency disorder, congenital deafness, Retinitis pigmentosa, Chondroplasia punctata, Hypophosphataemic rickets, Cystic fibrosis, Tay-Sachs, Haemachromatosis, Phenylketonuria,.Huntingdons disease, Achondroplasia, polycystic kidney, Fragile X mental retardation, Alzheimer’s disease, Down’s syndrome, Acquired uniparental disomy, Reigar syndrome, Preaxial polydactyly (CSP3)
      22. Gene therapy: the characteristics of a particular genetic disease that render gene therapy likely or unlikely to be successful. (CSP3)
    • Genetic Variation
      1. Appreciate how much genetic variation we have: both rare and common variants (FM1)
      2. Understand how prenatal diagnosis and PGD can be performed (FM1)
      3. Discuss how DNA polymorphisms can be detected and how they may be used to identify individuals (FM1)
      4. Appreciate how genetic variation may determine treatment options (FM1)
      5. Think about the ethical issues with respect to personal genome sequencing (FM1)
    • Inheritance and Mutation
      1. Describe the different types of gene mutation and their consequences (FM1)
      2. Review the types of genetic mutation and how they affect the organism (FM1)
      3. Review the types of chromosomal mutations (FM1)
      4. Describe, with examples, the different patterns of inheritance of single gene disorders (FM1)
      5. Review the causes of genetic mutations (FM1)
      6. Describe how mutations in different genes can result in the same clinical disorder
      7. Define the following terms in relation to human genetics and disease: homozygous; heterozygous; proband; sibling; recessive; dominant; co-dominant; penetrance; anticipation; imprinting phenotype; genotype; allele (FM1)
    • The Genome and Drug Discovery
      1. Be able to describe the main approaches and tools used to identify genes for common disease and drug response and safety
      2. Be able to give some examples of where genetic makeup affects drug effectiveness and safety; understand how this may contribute to drug discover
      3. Understand some of the ethical issues around genetic data and potential risks to the individual
    • Genetics of Autoimmune Disease
      1. Understand how genetic risk variants predisposing to human disease can be identified (CSP3)
      2. Understand the spectrum of risk variants (common, rare, SNPs, structural variants) (CSP3)
      3. Understand risk variants for selected chronic immune disease eg Type 1 Diabetes, Coeliac Disease, Crohn's Disease (CSP3)
      4. Role of HLA variants and immune disease risk: coeliac disease, ankylosing spondylitis as examples (CSP3)
      5. Role of new technologies: exome and whole genome sequencing. (CSP3)
      6. Taking risk variants forward for patient benefit: diagnosis, prognosis, new therapeutics (CSP3)
    • Genetics of Antibiotic Resistance
      1. Be able to describe the key features of plasmids, insertion sequences, transposons and integrons and understand their role in mobility of antibiotic resistance genes. (CSP3)
      2. Be able to understand the differences between bacterial and eukaryotic genes (CSP3)
      3. Be able to outline the mechanism of transfer of DNA between bacterial cells; conjungation, transformation and transduction (CSP3)
      4. Know the major biochemical mechanisms of resistance - destruction of drug, modification of drug, drug impermeability or efflux, target modification, target bypass (CSP3)
      5. Understand that resistance can disseminate by spread of resistant strains, spread of mobile genetic elements and spread of resistance genes (CSP3)
      6. Understand the potential sources of antibiotic resistance genes and the significance of horizontal gene transfer in the evolution and spread of antibiotic resistance among pathogenic bacteria (CSP3)
    • The Human Genome
      1. Describe in outline the structure and organisation of the human genome
      2. Describe the structure and organisation of the human genome. (FM1)
      3. Understand the differences between coding and non-coding the DNA-sequences, introns and exons, control elements, pseudogenes, and repetitive sequences (FM1)
      4. Compare the different ways in which we can access the human genome
    • Epigenetics
      1. Define the term epigenetics (FM1)
      2. Describe the role of epigenetic marks in controlling gene expression (FM1)
      3. Understand the extent to which epigenetics impacts on human disease (FM1)
    • Protein Synthesis
      1. Outline the key features of the genetic code (FM1)
      2. What are the essential RNA species for translation (FM1)
      3. Describe the events and regulation in the ribosome cycle of protein synthesis (FM1)
      4. Describe the structural changes undergone by a newly synthesised polypeptide in order to constitute a biologically active protein in the appropriate site (post-translational modifications / targeting and sorting) (FM1)
      5. How does viral and bacterial interference effect protein translation (FM1)
      6. Know that antibiotics are used to target ribosomes (FM1)
      7. Outline protein synthesis defects in inherited disease (FM1)
    • Cell Division and its Control
      1. Describe the main features of the cell cycle (FM1)
      2. Describe the main mechanisms and biological functions of mitosis and meiosis (FM1)
      3. Discuss the role of genes in co-ordinating the cell cycle (FM1)
      4. Give examples of human diseases associated with mutations in these genes (FM1)
      5. Explain how some chemotherapeutic drugs may inhibit cell division in cancer cells (FM1)
    • Forensic Molecular Pathology
      1. Appreciate the difference in requirements when analysing DNA for medical and criminal justice purposes
      2. Gain an understanding of what is meant by a DNA Profile
      3. Learn about how different parts of the human genome provide molecular tools that are used for intelligence and crime-fighting purposes
    • DNA Structure and Synthesis
      1. Describe, using simple diagrams, the structure of DNA and its organisation into nucleosomes, chromatin and chromosomes (FM1)
      2. Outline the mechanism of DNA replication (synthesis) and describe how some antibiotics interfere in this process (FM1)
      3. Explain the very low level of mistakes in the DNA replication process (FM1)
      4. Outline methods of DNA repair with examples of inherited DNA repair defects (FM1)
    • Control of Gene Expression
      1. Understand the basic processes involved in eukaryotic gene expression
      2. Describe, with examples, the various levels at which eukaryotic gene expression can be controlled
      3. Discuss the interaction of protein factors and DNA regulatory elements in the control of transcription in eukaryotic cells
      4. Know how drugs / hormones can influence gene expression
    • RNA Structure and Synthesis
      1. Describe the Central Dogma and the basic structure of a gene (FM1)
      2. Describe the process of transcription and explain the function of RNA polymerase (FM1)
      3. Explain what a promoter is and its role in transcription (FM1)
      4. How is RNA modified before leaving the nucleus? (FM1)
      5. Describe the different types of RNA and their role in translation (FM1)
      6. Describe how antibiotics can interfere in the process of transcription (FM1)
  • Medical knowledge: PATHOLOGY (TD 8.7)
    • General Pathology
      1. Describe how the basic tissue types are organised in the skin and the colon
      2. The graduate will be able to apply to medical practice biomedical scientific principles, method and knowledge relating to: (click to see list): TD 8 a-g (YR5intro)
      3. Describe the types of investigations that can provide tissue for histological analysis, and discuss the clinical value of such analysis (FM1)
      4. Describe the morphological changes undergone by cancer cells as seen in a photomicrograph (FM1)
  • Medical knowledge: CANCER
    • Pathology of Cancer
      1. Give a brief classification of benign and malignant tumours based on origin of cell and morphological features (FM1)
    • General
      1. Revise the principles of cancer biology ()
      2. 3. To know the hallmarks of cancer and describe the alterations in physiology that collectively result in malignant growth (FM1)
      3. Understand the steps in the cancer patient pathway ()
      4. Identify and describe the key features of metastasis (FM1)
      5. Understand the concept of red flags in cancer diagnosis and the cancer referral process ()
      6. Describe the purpose of the MDT and the role of the individuals within it ()
      7. Have a basic knowledge of grading and staging tumours (FM1)
      8. Understand the general principles of cancer treatment: surgery, radiotherapy, chemotherapy, targeted and biological therapy. ()
      9. Appreciate the role of the immune system in cancer ()
      10. Understand the part research plays in the cancer patient pathway ()
      11. Appreciate the implications of living with and beyond cancer ()
      12. Develop insight into the patient experience of cancer ()
    • Neoplasia
      1. Identify and compare the major pathological features of benign and malignant neoplasms (FM1)
      2. Define the terms: tumour, neoplasm, benign, malignant, histogenesis, differentiation, metastasis (FM1)
      3. Describe the principles of cancer diagnosis and the classification of malignant neoplasms
      4. Identify and compare the behaviour between benign and malignant neoplasms (FM1)
      5. To be able to describe the pathological features of carcinomas (FM1)
      6. List the aetiological agents that have been linked to the development of some malignant neoplasms (FM1)
      7. Give a brief classification of benign and malignant neoplasms according to their cell of origin (histogenesis) (FM1)
      8. Define the term paraneoplastic syndrome and give some examples (FM1)
      9. List aetiological agents that have been linked to the development of some malignant neoplasms
    • Cancer and Genetic Disease
      1. Describe the genetic changes that occur in oncogenes (FM1)
      2. Describe the processes of spontaneous and carcinogenic DNA damage (FM1)
      3. Describe the role of gain of function mutations in oncogenes and loss of function mutations in tumour suppressor genes in cancer initiation and progression (FM1)
  • Medical knowledge: IMMUNOLOGY and INFLAMMATION (TD 8.8)
    • Immunology - General Outcomes
      1. Indicate the development of the immune system, including the function of lymphocytes
      2. Indicate the development of the immune system, including the function of lymphocytes. (GEP/HD, HD1)
      3. Identify patients at risk of immunodeficiency (CSP3)
      4. Understand cytokines and their function (FM1)
      5. 1. To understand that immunology is related to disease including infections, autoimmunity and allergy (hypersensitivity). (FM1)
      6. Appreciate the key concept that cytokines are very beneficial molecules in small localised controlled doses, but are extremely harmful molecules in high prolonged and systemic doses (FM1)
      7. Identify clinical features suggestive of deficiency of Non-specific defences; Neutrophils; Antibody; T-Lymphocytes ('combined') deficiencies (CSP3)
      8. Be aware of the main players in the immune system including lymphocytes (T-cells, B cells and NK cells), myeloid cells (macrophages and granulocytes), dendritic cells and antibodies (FM1)
      9. Know that the immune system is an agent of harm in the modern age (FM1)
      10. Understand principles of management of immune deficient patients (CSP3)
      11. Appreciate that communication between cells is critical (FM1)
      12. Explain the immunological processes enabling protection against disease to take place. (GEP/HD, HD1)
      13. List features of the following primary immunodeficiency syndromes: Common variable immune deficiency, X-linked agammaglobulinaemia, Di George syndrome, Severe combined immune deficiency, chronic granulomatous disease, Classical complement pathway deficiency, Lytic sequence deficiencies, Chediak-Higashi syndrome, Wiskott-Aldrich syndrome. (CSP3)
      14. Distinguish the features of the following conditions: conjunctivitis/rhinitis/sinusitis, asthma, atopic dermatitis, aspirin sensitivity, oral allergy syndrome, other food allergy, latex allergy, drug allergy, erythema multiforme and Stevens-Johnson syndrome (CSP3)
      15. Realise the importance of long term immunological memory (FM1)
      16. List the features of the following secondary immunodeficiency syndromes: neutropenia, Chronic lymphocytic leukaemia, splenectomy, AIDS, Immunodeficiency due to immunosuppression. (CSP3)
      17. Match these tests to their diagnostic indications: total IgE, specific IgE, tryptase, C3, C4, C1q, C2, anti-C1q antibodies, D-dimers, C1 esterase inhibitor, cryoglobulins, skin-prick tests, patch tests (CSP3)
    • The Immune Response in Health
      1. Know that many pathogens invade the spaces between cells eg extra-cellular bacteria (FM1)
      2. List the physical defence barrier components of the innate immune system (skin etc), and link them with the mechanisms by which they are breached (CSP3)
      3. Know how bacteria are eliminated using the humoral immune response (FM1)
      4. Know what an antibody is (FM1)
      5. Know how phagocytes (eg neutrophils) interplay with antibodies (FM1)
      6. Understand complement and know its function (FM1)
    • Recognition and Response to Antigens
      1. Understand that some pathogens live inside cells - this includes all viruses, or bacteria such as TB
      2. Know the meaning of the term antigen (FM1)
      3. Know how the immune system recognises antigens (FM1)
      4. How are these eliminated by the cell-mediated immune response including macrophages, cytotoxic T cells, NK cells and yd cells
      5. List the cellular components of the innate immune system: macrophages / monocytes; neutrophils; eosinophils; basophils / mast cells; and link them with their antigen T receptors (where known: TLRs, NOD) (CSP3)
      6. Appreciate that innate immune cells recognise a limited array of microbial structures using pattern recognition receptors. (FM1)
      7. Introduce the idea that TCRs and BCRs are made with random antigen recognition capacities (FM1)
      8. State how phagocytes move and kill (together with defects), and state the structures and molecules that they interact with: endothelial cells, adhesion molecules, matrix (CSP3)
      9. What is the MHC and its role in presenting antigens in a form that T cells can see.
      10. Understand the importance of distinguishing self from non-self (FM1)
      11. Understand how T and B cells recognise antigens and how the diversity of antigen recognition receptors on these cells is generated. (FM1)
      12. List the cells of the adaptive immune system (B-cells, different kinds of T-cells etc), and state the roles they play. List the different classes of antibody (CSP3)
      13. Be familiar with the basic structure of an antibody molecule. (FM1)
      14. Distinguish between Th1 and Th2 responses and list the cytokines involved in each stating the cells that secrete them (CSP3)
      15. Understand the role of antigen presentation and the structure and function of major histocompatability complex (MHC) molecules. (FM1)
      16. Delineate the mechanism of septic shock (CSP3)
    • Hypersensitivity and Allergy
      1. Mostly revision: definitions of allergy, atopy, types of hypersensitivity, activation of mast cells, anaphylaxis, anaphylactoid reactions, scromboid and the antigens that provoke them (CSP3)
      2. Urticaria: description, and the different causes (allergic, infections, autoimmune, cold, cholinergic/adrenergic, physical, exercise, hormonal, haematinic deficiency) and treatment (CSP3)
      3. Angioedema: description, causes (allergic, inherited, acquired C1 esterase deficiency, ACE inhibitors, idiopathic) and treatment (CSP3)
    • Transplantation and Immunosupressive Therapy
      1. List the meanings of autograft, isograft, allograft and xenograft. (CSP3)
      2. Understand the role of Class 1 and Class II HLA molecules in presenting antigen to CD8 and CD4 T-lymphocytes respectively, and the ability of foreign Class I and II HLA (or xenogeneic equivalent) to directly activate some CD8 and CD4 T-lymphocytes. (CSP3)
      3. Understand and know the timing of the terms: Hyperacute rejection (mediated by antibodies against Graft HLA molecules + complement), Accelerated rejection (mediated by presensitised T-lymphocytes), Acute rejection mediated by T-lymphcytes, and chronic rejection (uncertain mechanisms). (CSP3)
      4. Know the role of IL2 and IFNy in promoting T-lymphocyte reactivity, and of IL4 and 6 in producing anti-graft antibodies. (CSP3)
      5. Understand the role of recipient antibody screening, and of cross matching in prevention of hyper-acute rejection. (CSP3)
      6. Understand that bone marrow transplant carries the additional risk of Graft-versus-Host. (CSP3)
    • Communication between Immune Cells and Tissues
      1. Know that Th1 cells drive cell-mediated immunity (FM1)
      2. Know that Th2 cells drive humoral immunity (FM1)
      3. Know that Th17 cells drive responses to extracellular bacteria (FM1)
      4. Know that T-reg cells retrain immune responses (FM1)
      5. Know that memory T-cells remember our infection history (FM1)
      6. Appreciate that CD4 or helper T-cells orchestrate adaptive immun responses (FM1)
  • Medical knowledge: MICROBIOLOGY and INFECTION (TD 8.9)
    • General Outcomes for Microbiology
      1. Be able to distinguish between the different groups of pathogens (FM1)
      2. List the basic characteristics of viruses and the criteria by which they are classfied (FM1)
      3. Outline the structure of bacteria, emphasising differences from eukaryotic cells (FM1)
      4. Describe the structure of viruses, defining the terms: capsid; capsomeres; genome; nucleocapsid, envelope (FM1)
      5. Describe how bacteria can be classified on the basis of staining properties and morphology (FM1)
      6. Describe how viruses replicate (FM1)
      7. List those parts of the body which should be sterile and those which have a normal flora (FM1)
    • Antivirals and Viral Infections
      1. Know the concept of inhibition of virus specific enzymatic activities (FM1)
      2. List the stages in the viral replication cycle from virus entry into the cell to virus release
      3. Innate and acquired defences against infections (CSP3)
      4. How to inhibit cellular factors important for virus replication (FM1)
      5. Define humoral and cellular immunity (CSP3)
      6. List the drugs that can inhibit each stage of the viral life cycle
      7. What are the treatment strategies and treatment side effects for selected viral infections (FM1)
      8. Iatrogenic and non-iatrogenic causes of immunosuppression (CSP3)
      9. List the stages of the influenza life cycle that can be inhibited by drugs and the drugs concerned
      10. Lists organism causing disease in the immunocompromised host (CSP3)
      11. Outline clinical evaluation and diagnostic procedures (CSP3)
      12. Principles of therapy in the immunocompromised host (CSP3)
    • Antimicrobials and Bacterial Infections
      1. List innate and acquired defences against infection in man. (CSP3)
      2. Describe the principle of selective toxicity (FM1)
      3. Define humoral and cellular immunity. (CSP3)
      4. Describe the structure and function of targets in microbes that differ from their counterparts in the host (FM1)
      5. List iatrogenic and non-iatrogenic causes of immunosuppression. (CSP3)
      6. List organisms causing disease in the immunocompromised host relating these to the immunological defect particularly associated with infection by a particular organism. (CSP3)
      7. Outline the clinical evaluation and diagnostic procedures used when investigating the febrile immunosuppressed patient. (CSP3)
      8. Understand the mechanisms and implications of inherent and acquired antimicrobial resistance in bacteria (FM1)
      9. List principles of therapy in the immunocompromised host. (CSP3)
      10. List preventive measures employed against infection in known immunosuppressed hosts. (CSP3)
    • Pathogenesis
      1. Describe portals of entry of pathogens and their adherence mechanisms (FM1)
      2. Discuss major infectious disease problems; case studies of bacteria; lessons from history (public health, pathology, pathogenesis)
      3. For viruses, list their mechanisms of persistence, and explain their harmful effects (killing cells, alter functions of cells, giant cell formation, malignant change, hypersensitivity) (FM1)
      4. For bacteria, list their mechanisms of persistence, describe how they make you ill, and how they survive the host response (involving stress, stealth, scavenging, striking back) (FM1)
      5. Describe how pathogens are disseminated through host organs and how they exit from the host (FM1)
    • Terminology used in Microbiology
      1. Be familiar with terminology relating to helminth and protozoal diseases
      2. Define the terms pathogen; commensal; opportunistic pathogen; carriage; colonisation resistance; virulence (FM1)
    • Retroviruses
      1. List the three sets of genes in retroviruses (Gag, Pol, Env), their order and what they encode (CSP3)
      2. Draw the retroviral life cycle, naming the enzymes involved (CSP3)
      3. List the retroviruses that cause disease in humans and the diseases they cause (CSP3)
      4. Account for HTLV1 causation of Adult T-cell Leukaemia and Myelopathy, including Tax gene; describe these conditions and their treatment (CSP3)
      5. Describe Human Endogenous Retroviruses (CSP3)
    • Sources of Infection and Routes of Transmission
      1. Define the terms: incidence; prevalence; endemic; epidemic; pandemic (FM1)
      2. Discuss how pathogens are transmitted (FM1)
      3. Discuss methods of controlling infectious diseases (prevention, immunisation, treatment) and the significance of herd immunity. (FM1)
    • General Outcomes for HIV and AIDS
      1. List the phases of the HIV replication cycle that can be inhibited by drug treatment
  • Medical knowledge: PHARMACOLOGY (TD 8.10)
    • Drug Receptor Interactions
      1. Define the terms: agonist, antagonist, EC50, efficacy and potency
      2. Describe how the volume distribution of a drug is calculated and the factors that affect the distribution of a drug in the body (FM1)
      3. Describe the four major classes of receptors (FM1)
      4. Describe, with a clinical example, the characteristics of competitive antagonism
      5. Describe how drug activity can be modified by changes in receptor interactions (FM1)
      6. Distinguish competitive antagonism from non-competitive and physiological antagonism
    • Safe Prescribing and Drug Administration
      1. Define and identify the steps involved in Drug reconciliation (CSP3)
      2. Understand unit conversion and be able to express percentage concentrations (CSP3)
      3. By using suitable drug examples discuss the advantages and disadvantages of the following routes of administration: oral, intravenous; intramuscular; subcutaneous; sublingual; rectal; transdermal; inhalation
      4. Focus main learning about drugs ie pharmacology / prescribing (BRAINS&AIMS) around the top 100 Drugs you are most likely to prescribe as a junior doctor
      5. Define the 10 principles of safe prescribing (CSP3)
      6. Recall and describe what BRAINS&AIMS stands for and use the format when presenting a drug.
      7. Describe the main routes of drug administration (FM1)
      8. Identify the routes of administration that lead to 1st pass metabolism and how this contributes to the activity of a drug (FM1)
      9. Calculate weight-related doses (CSP3)
      10. Learn about key features of other drugs eg interesting mechanisms that help understand underlying physiology; dangerous drugs that may have been prescribed by someone else and affect your patients
      11. Define in which patients this is needed and where it should be documented (CSP3)
      12. Recognise how phase I and phase II reactions contribute to the drugs elimination (FM1)
      13. Calculate IV flow rates for drug infusions (CSP3)
      14. Know how to record Allergy status (CSP3)
      15. Keep a portfolio of all the drugs you have learnt about / seen being used in a patient; it takes a long time to build up a good knowledge base so start now and keep revising and building; accept minor modifications if the list changes over time
      16. Describe how dosage regimes affect the activity of a drug (FM1)
      17. Understand the risks involved after seeing a video of a medication incident (CSP3)
      18. Manage the above through a series of worked examples (CSP3)
      19. Recognise the factors that affect drug interactions (FM1)
      20. Understand the principles of prescribing (CSP3)
      21. Guidelines and policies for antimicrobial prescribing in general (CSP3)
    • Drug Interactions
      1. Define pharmacodynamic interactions ie what drugs do to the body.
      2. Know how to avoid harmful (adverse) interactions
      3. Know how to identify potential or actual interactions by looking up in Appendix I in the BNF and learning common and important interactions by understanding the mechanisms
      4. Know key drugs that modify pharmacokinetic processes
      5. Use beneficial interactions
      6. Give examples of antimicrobial side effects and interactions (CSP3)
    • Evidence Based Pharmacology
      1. Be able to describe the levels of evidence and recommendations for drug therapeutic strategies
      2. Be aware of the various milestones and pitfalls in drug development (FM1)
      3. Be able to describe, discuss and assess harm:benefit ratio
      4. Be able to define the following: Randomised trial; double blind; multi-centre; placebo-controlled; cohort study; case control study; systematic review/meta-analysis; case-series; risk:benefit ratio; phase 1,2,3,4 trials
      5. Understand the limitations of using information from clinical trials eg extrapolating results to individual patients
      6. Use evidence obtained from studies to guide drug selection
      7. Use sources such as BNF, NICE Guidelines, Clinical Evidence, Cochrane Database, medical journals, PubMed to guide drug selection
    • Pharmacological Principles - General
      1. Know what is meant by the term selective toxicity and distinguish between an antibiotic and antimicrobial agent (CSP3)
      2. Discuss selectivity of drug actions
      3. List sites of action of antimicrobials with examples (CSP3)
      4. Relate how being weak acids or weak bases influences a drugs activity
      5. List mechanisms of resistance and factors predisposing to increased resistance (CSP3)
      6. Describe the forces used between a drug and its receptors
      7. Know about the increasing importance of antifungals in medicine and some examples of these agents (CSP3)
      8. Compare efficacy and potency
    • Pharmacokinetics and Pharmacodynamics
      1. Describe drug binding sites giving examples of both site and drug that attaches to it.
      2. Discuss selectivity of drug action
      3. Be able to define pharmacokinetics and pharmacodyamics (GEP/BB)
      4. Distinguish and define pharmacokinetics /pharmacodynamics; liberation; absorption; volume of distribution; distribution; exretion; metabolism; clearance; half life
      5. Understand what is meant by structure-action relationships
      6. Distinguish and define half life; narrow / wide therapeutic window; zero order kinetics; first order kinetics; peak levels; trough levels; bioavailability; loading dose, maintenance dose
      7. Compare and contrast routes of drug administration
      8. Define absorption and the various mechanisms
      9. Understand what is meant by pharmacokinetics
      10. Describe various methods of drug formulation resulting in its liberation
      11. Discuss the factors influencing pharmacokinetics
      12. Understand how and where drugs act - give examples
    • Adverse Drug Reactions
      1. Define adverse drug reactions (ADRs) (CSP3)
      2. Be able to inform the patient of common and serious adverse effects and advise them on what to do.
      3. To understand the side-effects and how newer drugs can reduce side effects (LOC2)
      4. To understand the side-effects and how newer drugs can reduce side effects (GEP/M&P)
      5. Be able to prevent adverse drug reactions (ADR's). Using the BNF, learn common and serious ADRs for key drugs prescribed by FY1's; avoid harmful interactions; use prophylaxis if necessary; be aware of susceptible patients; use the appropriate dose regimen
      6. Know and identify which patients / patient groups have increased susceptibility to adverse effects of certain drugs (A SAD GAP - Age, Sex, Diseases, Genetic, Altered Physiology, pregnancy); take necessary precautions, avoid such drugs or adjust doses
      7. Know how to classify adverse drug reactions using DOTS - Dose - dependent (Type A); independent (Type b); Time dependent; Independent; Susceptible patients
      8. Know how to diagnose an adverse drug reaction (ADR) and be able to differentiate a suspected ADR from known common and serious ADRs
      9. Know how to treat adverse drug reactions (ADR): stop drug; supportive and /or specific treatments if indicated eg for anaphylaxis
      10. Know which adverse reactions (ADRs) to report and how.
    • Drug Absorption and Elimination
      1. Define the term apparent volume of distribution and discuss why drugs have different values for this; explain pre-systemic (first pass) metabolism
      2. Briefly describe the ways in which drugs are eliminated from the body
    • Synaptic Transmission
      1. Review the various types of receptors (FM1)
      2. Describe how the action potential is propagated down a myelinated and unmyelinated axon
      3. Recall how synapses integrate excitatory and inhibitory signals (FM1)
      4. Be able to explain how changes in axon diameter and myelination affect the conduction velocity of axons (FM1)
      5. Recall how 2nd messengers transduce for GPCRs
      6. Describe how the action potential is converted into a chemical signal at the synapse (FM1)
      7. Describe how sensory information is integrated and a motor response initiated if appropriate (FM1)
      8. Explain why pre-synaptic calcium is important for chemical transmission (FM1)
      9. Compare the effects of excitatory and inhibitory neurotransmitters on the post-synaptic membrane potential (FM1)
    • Prescribing for the Elderly
      1. Outline how the body composition and organ metabolic changes impact on pharmacology
  • Medical knowledge: CLINICAL FEATURES of DISEASE (TD 8 b)
    • Tropical Haematological Disorders
      1. Know the common presentations of neglected tropical disease: viral, protozoal, helminth and bacterial
  • Medical knowledge: SOCIOLOGY (TD 10 a-e)
    • Health Inequality
      1. Understand key concepts like class, relative poverty and social exclusion.
      2. Apply social science principles, method and knowledge to medical practice (click to see list) (YR5intro)
      3. Understand and describe what is meant by class, relative poverty and social exclusion.
      4. Describe the relationship between social structure and health.
      5. Describe the key ways in which social structure and health are related.
      6. Review key explanations for health inequalities.
      7. Offer valid explanations for the existence of noted health inequalities.
      8. Outline policy and interventions aimed at reducing health inequality
      9. Outline the implications of inequality for health policy and medical practice.
    • Older People, Illness and Society
      1. Describe changes in the demographics of ageing.
      2. Summarise the changing demographics of ageing (GEP/HD, HD1)
      3. Outline the differences between biological and social ageing.
      4. Describe different experiences of later life.
      5. Define ageism and age discrimination.
      6. Discuss the health and health care needs of older people
    • Gender and Health
      1. Describe the changing relationship between social structure and gender.
      2. Describe the changing relationship between social structure and gender.
      3. Be aware of differential patterns of morbidity and mortality related to gender. Consider different causes for these patterns.
      4. Be aware of differential patterns of morbidity and mortality related to gender.
      5. Consider different causes for these patterns.
      6. Outline the implication of considerations related to gender on medical provision.
      7. Discuss key health concerns for men and women.
      8. Outline implications for healthcare.
    • Diversity
      1. Critically appraise the research on inequality in health related to race (GEP/HSPH, HSPH2)
      2. Define the historical antecedents, theory, distribution, cause, prevention, management and evidence base. (GEP/HSPH, HSPH2)
      3. Know how to define ethnicity, culture, and racism (GEP/HSPH, HSPH2)
    • Death and Dying
      1. Outline current trends in life expectancy
      2. Explore definitions and experiences of dying including the good death
      3. Examine different dying trajectories and the role of palliative medicine
      4. Demonstrate an understanding of the processes involved in normal grief and bereavement
      5. Discuss experiences of health professionals working with dying patients and their relatives
    • Stigma
      1. Can define the concepts of "stigma" and "labelling"
      2. Outline the processes by which medicine is involved in social control
      3. Can describe the relationship between stigma and illness
      4. Outline the processes in producing changes in patterns of behaviour
      5. Consider the experience of stigmatised illness
      6. Discuss three different approaches to the idea of risk
      7. Can appreciate implications for healthcare
      8. Define the concept of labelling, and describe three major effects of chronic illness
    • Health beliefs and Behaviour
      1. To be aware of the importance of health beliefs. (HSPH2)
      2. To be able to describe factors that influence health beliefs. (HSPH2)
      3. To understand how health beliefs influence behaviour. (HSPH2)
      4. To have familiarity with common health belief models
    • Healthcare for Refugees and Asylum Seekers
      1. Define who qualifies as a refugee under the Geneva Refugee Convention.
      2. Explain why the UK accepts asylum seekers.
      3. List common barriers to healthcare faced by this group in the UK.
      4. Describe common physical and mental health problems in this patient group.
      5. Explain the role of the health care worker and common challenges with this group.
    • General Topics
      1. Know the component disciplines which comprise the system
      2. Understand implications of the debate on the role of the doctor. ()
    • Child Poverty and Health
      1. Understand the extent of child poverty in the UK
      2. Identify the main social changes that have affected the family
      3. Review the relationship between poverty and ill-health in children
      4. Describe how families can affect the cause, course and outcome of illness
      5. Understand the value of examining health from a life course perspective
      6. Describe the Barker hypothesis and its implications for health
    • Chronic Illness and disability
      1. Describe the prevalence of chronic illness and the impact it has on healthcare.
      2. Describe the difference between impairment and disability.
      3. Understand responses to being diagnosed with chronic illness including biographical disruption.
      4. Outline current health policy regarding chronic illness.
    • Ethnicity and Health
      1. Know how to define Ethnicity, Culture and Racism.
      2. Identify patterns of ill-health in relation to ethnicity.
      3. Review and discuss key explanations for ethnic health differences.
      4. Describe the principles of culturally competent health care practice
    • Social support
      1. The nature of social support including social isolation, network size, and perceived and received functional support (emotional support, practical support, informational support).
      2. The role of social support as a protective/risk factor for mortality, as well as mental health, cardiovascular, immune, and endocrine end-points (including incidence, course, prognosis, recovery).
      3. The two dominant hypotheses linking social support and health: the stress buffering hypothesis and the direct effects hypothesis.
      4. Potential psychological, physiological, and behavioural mechanisms by which social support might influence physical and mental health.
      5. The importance of taking a social history addressing familial, occupational, and recreational aspects of the patient's personal life which have the potential to be clinically significant.
    • Self Management
      1. Understand the patient's role in managing their illness.
      2. Review the effectiveness of self-management using behavioural interventions as examples.
    • Chronic Illness and Disability
      1. Explain how people typically cope with developing a chronic illness and their adaptation strategies.
    • Health across the life course
      1. Explain the meaning of ‘health’ (FM1)
  • Medical knowledge: EPIDEMIOLOGY
    • Obesity
      1. Consider obesity and diabetes as both an individual and a public health problem. (PH3)
      2. Understand how several screening methods can be combined into a single screening test. (PH3)
      3. Assess the screening performance of a multi-marker screening test (e.g. the Quadruple test). (PH3)
      4. Recognise the major determinants of obesity and diabetes. (PH3)
      5. Understand why cholesterol and blood pressure measurement are poor screening tests for cardiovascular disease. (PH3)
      6. Understand approaches in the prevention of obesity and diabetes, and appropriate public health policy. (PH3)
    • Trials & Research
      1. Describe the essential structure of cohort and case-control studies.
      2. Explain the Bradford Hill criteria for causality and give examples of each.
      3. Understand the properties of the Gaussian distribution. (GEP/HSPH, GEP/HSPH, HSPH2)
      4. To know the strengths and weaknesses of different study designs, and choose the most appropriate to answer specific questions. (PH3)
      5. Recognise the link between epidemiological research and determination of causal mechanisms of disease. (PH3)
      6. Interpret ‘means’, ‘standard deviations’ and ‘standard errors’.
      7. Be able to calculate and interpret risks, odds, rates and their ratios and differences. (HSPH2)
      8. Understand the difference between standard deviation and standard error. (GEP/HSPH, GEP/HSPH, HSPH2)
      9. To know the reasons for randomisation and blindness in trials. (PH3)
      10. Identify potential biases in case-control and cohort studies.
      11. Know the deductive and inferential process of discovering the causes of disease. (PH3)
      12. Interpet ‘medians’ and ‘interquartile ranges’.
      13. Understand the nature of bias.
      14. Apply these to breast cancer epidemiology and aetiology and thence to its prevention. (PH3)
      15. Be able to describe and interpret confidence intervals for relative risks and odds ratios (HSPH2)
      16. Detail when each of case-control, cohort and randomised controlled trials are appropriate research studies.
      17. To distinguish intention-to-treat and on-treatment analyses. (PH3)
      18. Explain the basic characteristics of a Normal Distribution.
      19. Explain how confounding occurs.
      20. Be aware of the impact of sample size on uncertainty. (GEP/HSPH, HSPH2)
      21. To appreciate the superiority of crossover trials when feasible. (PH3)
      22. Interpret unadjusted and adjusted results and be able to explain when each is valid.
      23. Be able to give examples of important case-control and cohort studies.
      24. Define a reference range.
      25. To recognise that P<5% is statistically significant only when testing a prior hypothesis. (PH3)
      26. Be aware of the relationship between P values and confidence intervals. (GEP/HSPH, HSPH2)
      27. Have practical experience of calculating risks, odds, rates and their ratios. (HSPH2)
      28. To know that different causes of a disease usually interact multiplicatively. (PH3)
    • Cancer epidemiology
      1. Recognise that risk of cancer generally becomes high only after prolonged (decades) exposure to a carcinogen but falls within a few years of removing the exposure. (PH3)
      2. Understand why some cancers do well (high 5 year survival) and others do not. (PH3)
      3. Understand why "debulking" cancers does not materially prolong survival. (PH3)
      4. Recognise that cancer is monoclonal and is a multistage process and hence has many causes. (PH3)
      5. Recognise that carcinogens have no threshold. (PH3)
      6. Know the major causes of cancer. (PH3)
      7. Understand the concept of over-diagnosis. (PH3)
      8. Appreciate why some cancers are becoming less common and others more so. (PH3)
    • Pandemics
      1. Pandemic Influenza: 1918 pandemic; virology of infectious disease; emerging viral infections; pandemics past and future
    • Hepatitis
      1. Know that the two major liver killers are alcohol consumption and the Hepatitis C virus. (PH3)
      2. Understand how to calculate alcohol units. (PH3)
      3. Know the different types of public health interventions. (PH3)
      4. Know that the two major liver killers can be eliminated by public health interventions but that there are political challenges. (PH3)
    • Malnutrition and other Nutritional Deficiencies
      1. Understand the importance of different nutrients in disease causation. (PH3)
      2. Understand the factors influencing the development of public health policy in relation to nutrition. (PH3)
      3. Recognise the key factors that influence nutrition policy (advocates,individuals and government). (PH3)
    • Drugs, Medicine and Safety
      1. Understand the outline history of drug development in the UK throughout the twentieth and into the twenty-first century.
      2. Describe efforts to standardise and regulate medicines in the UK, including the Therapeutic Substances Act (1925), the Penicillin Act (1942), and the Medicines Act (1968) which remain the basis of contemporary legislation.
    • Routes of Spread
      1. Define the terms: incidence; prevalence; endemic; epidemic; pandemic (FM1)
      2. Discuss how pathogens are transmitted (FM1)
      3. Discuss methods of controlling infectious diseases (prevention, immunisation, treatment) and the significance of herd immunity. (FM1)
    • The Epidemiological Approach
      1. Understand how epidemiology and clinical medicine are related (HSPH2)
      2. Explain briefly the two main methods of investigation in epidemiology: the cohort study and the case-control study. (HSPH2)
      3. Describe the complementary roles of nature and nurture. (HSPH2)
      4. Describe how different methods of prevention and treatment can be combined (HSPH2)
    • Bias, Confounding and Causality
      1. Explain the Bradford Hill criteria for causality and give examples of each. (HSPH2)
      2. Understand the nature of bias. (HSPH2)
      3. Explain how confounding occurs. (HSPH2)
      4. Interpret unadjusted and adjusted results and be able to explain when each is valid. (HSPH2)
    • Randomised Controlled Trials
      1. Explain the importance of the following features of clinical trials: randomisation, controls, blinding, and placebo.
      2. Define intention to treat analysis, loss to follow-up and compliance.
      3. Explain why intention to treat analysis is often used.
      4. Interpret the results from a clinical trial and assess how applicable they are to a patient you may be treating.
      5. Explain numbers needed to treat (NNT)
      6. Explain why meta-analyses are undertaken.
    • Statistical Principles
      1. Appreciate how observational studies are designed (HSPH2)
      2. Appreciate their limitations (HSPH2)
      3. Understand the properties of the Gaussian distribution
      4. Understand the difference between standard deviation and standard error
      5. Have practical experience of calculating and interpreting ranges and confidence intervals for data with a Gaussian distribution.
      6. Understand what p-values are and be able to interpret statistical significance
      7. Be able to describe and interpret confidence intervals for relative risks and odds ratios.
      8. Be aware of the relationship between P values and confidence intervals.
      9. Be aware of the impact of sample size on uncertainty
      10. Have practical experience of calculating risks, odds, rates and their ratios.
      11. Be able to calculate and interpret risks, odds, rates and their ratios and differences.
      12. Define the terms : Randomised , primary outcome, intention to treat analysis, data and safety monitoring committee , hazard ratio, Current Controlled Trials number, ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI), refractory Angina (HSPH2)
      13. What is a confidence interval and P value? (HSPH2)
      14. Why is a critical appraisal of a trial performed and why do we ask the questions that we do? (HSPH2)
      15. Perform a critical appraisal on this paper and interpret its results. (HSPH2)
      16. Evaluate if this intervention should be adopted. (HSPH2)
    • Cohort Studies
      1. Describe the essential structure of cohort studies (HSPH2)
      2. Identify potential biases in cohort studies (HSPH2)
      3. Be able to calculate and distinguish between relative risks, absolute excess risks and attributable proportions.
      4. Interpret the results from cohort studies including survival analysis (HSPH2)
      5. Explain how confounding occurs.
    • Case-Control Studies
      1. Describe the essential structure of case-control studies including nested case-control studies. (HSPH2)
      2. Identify potential biases in case-control studies (HSPH2)
      3. Detail when each of cross-sectional, case-control, cohort and randomised controlled trials are appropriate research studies. (HSPH2)
      4. Interpret results from case-control studies and distinguish between the terms odds ratio, absolute excess risk and attributable proportion. (HSPH2)
    • Evaluating Clinical Data
      1. Interpret means, standard deviations and standard errors.
      2. Interpret medians and interquartile ranges
      3. Explain the basic characteristics of a normal distribution
      4. Define a reference range.
      5. Define and interpret p-values and confidence intervals and understand their relationship
    • Coronary Heart Disease (CHD)
      1. Know the risk of IHD and stroke in the UK now and why IHD mortality increased and then decreased over the past century. (PH3)
      2. Recognise the important modifiable and non-modifiable risk factors. (PH3)
      3. Understand the relationship with serum cholesterol and blood pressure, and which risk factors make good screening tests. (PH3)
      4. Understand the basis for a healthy diet preventing future IHD and stroke. (PH3)
      5. Know the important drugs used to prevent IHD and stroke, their efficacy alone and in combination, and the polypill concept. (PH3)
      6. Understand the clinical management of acute myocardial infarction and acute ischaemic stroke in an epidemiological context. (PH3)
    • Epidemiology of Childhealth
      1. Describe common congenital malformations, their prevalence and reasons for high prevalence in some communities. (PH3)
      2. Explain what a teratogen is, some common teratogens and their action. (PH3)
    • Accidents and Suicide
      1. To appreciate that suicide is often impulsive (spur of the moment) and can be prevented by removing the means. (PH3)
      2. To appreciate that death and disease are often better prevented by "changing the environment" rather than telling people not to do things. (PH3)
      3. To recognise the high morbidity associated with hip fracture and the ways of preventing it. (PH3)
  • Medical Knowledge: SCIENTIFIC METHOD & RESEARCH
    • General Topics
      1. Critically appraise the results of controversial research papers reported in the medical and scientific literature (FM1)
      2. Apply findings from the literature to answer questions raised by controversial research papers (FM1)
      3. Appreciate that most of the biomedical literature is generally not reproducible (FM1)
    • General Topics
      1. Understand the public health, ethical and scientific issues involved in fraudulent medical research (FM1)
  • Medical knowledge: PUBLIC HEALTH and GLOBAL HEALTH (TD 11 a-j)
    • Cancer screening
      1. Define lead time and length time bias. (PH3)
      2. Understand the difference between mortality and survival. (PH3)
      3. Understand the reason for randomisation in cancer treatment trials and when to use an intention-to-treat and an on-treatment analysis. (PH3)
      4. Know the three NHS cancer screening programmes in Britain. (PH3)
    • Public Screening Programmes
      1. Know how to calculate and interpret the three parameters of a screening test (detection rate, false-positive rate and odds of being affected given a positive test result).
      2. Recognise the trade-off between higher detection rate but higher false-positive rate.
      3. Be able to calculate and interpret the risk of being affected with a disorder for an individual based on a quantitative screening marker.
    • Cancer prevention
      1. Know the major risk factors for breast cancer. (PH3)
      2. Know the agents that have potential to prevent breast cancer. (PH3)
      3. Understand the effectiveness of tamoxifen. (PH3)
      4. Recognise the key role of HPV in cervix cancer. (PH3)
      5. Know the major types of HPV involved in disease. (PH3)
      6. Understand the merits of HPV testing vs cytology in screening. (PH3)
      7. Know the two HPV vaccines currently available, and the UK vaccination programme. (PH3)
      8. Understand the issues about who to vaccinate. (PH3)
    • Smoking
      1. Describe the smoking trends among men and women. (PH3)
      2. Know the diseases caused by smoking. (PH3)
      3. Understand the relative merits of different methods of helping people stop smoking. (PH3)
      4. To recognise that the smoking epidemic is only just beginning in developing countries. (PH3)
    • General Outcomes for Public Health
      1. Apply to medical practice the principles, method and knowledge of population health and the improvement of health and healthcare (click to see list) (YR5intro)
    • Infectious Diseases
      1. Be familiar with and understand the causes of recent infectious disease outbreaks in London (Tuberculosis; Anthrax; Hepatitis A outbreak in the orthodox jewish community)
      2. Recognise the importance of exponential growth (PH3)
      3. Distinguish organisms with and without environmental reservoirs. (PH3)
      4. Know the determinants of the risk of an infectious disease outbreak in a community. (PH3)
      5. Know the determinants of case severity. (PH3)
      6. Recognise that infectious diseases may cause chronic diseases including cancer. (PH3)
      7. Understand the nature of epidemics. (PH3)
    • Antenatal Care
      1. Describe the factors affecting the risk of having a baby with Down's syndrome. (PH3)
      2. State the major health complications associated with Down's syndrome. (PH3)
      3. Know the antenatal screening programmes available in the UK and elsewhere. (PH3)
      4. Describe a Multiple of the Median (MoM), how it is calculated and why it is useful in screening for Down's syndrome. (PH3)
      5. Be able to explain a screening test to a woman considering the test. (PH3)
      6. Explain why certain family origin groups are at greater risk of developing blood disorders such as sickle cell anaemia. (PH3)
    • Oral Health
      1. Know that the major dental diseases of caries (tooth decay); periodontal disease (gum and supporting bone); oral cancer are, in the main, preventable chronic conditions. (PH3)
      2. Know that (oral) health depends on controlling consumption of free sugars, tobacco & alcohol by having a healthy diet, brushing twice daily with fluoridated toothpaste, not smoking. (PH3)
      3. Understand that material and social deprivation are significantly associated with poor oral health, access and uptake of dental services; children and the elderly are at the forefront of disadvantage. (PH3)
    • Lifestyle and Disease
      1. Provide the major arguments supporting denial of NHS treatment from those condition was caused by their lifestyle. ()
      2. Provide the major arguments against denial of NHS treatment from such patients. ()
      3. Describe the value of prevention versus treatment and begin to apply it to all medicine for the rest of your career
      4. Understand the social context of the question. ()
      5. Explain the key driving factors behind current health policy as regards management of chronic illness.
    • Vaccination and Immunisation
      1. For the neurone in your brain that stores the word "vaccination" to synapse with the neurone that stores the term "herd immunity". (PH3)
      2. Recognise the normal immunisation programme. (GEP/HD, HD1)
      3. Be familiar with the present vaccination schedule. (PH3)
      4. Understand the dangers to the individual and the herd of not immunising
      5. Recognise that realistic levels of vaccine uptake can eliminate infectious diseases nationwide. (PH3)
      6. Recognise the ultimate objective of eliminating infectious diseases worldwide. (PH3)
      7. Recognise the importance of striving for high uptake of a vaccine. (PH3)
      8. Relate experience in the UK to worldwide programmes of protection. (GEP/HD, HD1)
      9. Appreciate that vaccines are extremely safe (despite the scare stories). (PH3)
    • Health Systems including the HNS
      1. Compare health care spending in the UK with that of other government departments and of other countries. (PH3)
      2. Understand the relative merits of cutting NHS costs by reducing numbers of beds in a hospital, reducing length of admission, closing hospitals and merging hospitals. (PH3)
      3. Know the reasons for the increasing number of admissions. (PH3)
      4. Know the reasons for the increasing cost of the NHS over time. (PH3)
    • Social Policy
      1. Understand the social context of the question. ()
  • Medical knowledge: PSYCHOLOGY (TD 9 a-g)
    • Bio-Psycho-Social Issues
      1. Outline the biopsychosocial model of disease
      2. Describe how understanding a patient's experience of illness may aid diagnosis and care
    • Psychological Therapies
      1. Describe commonly used psychological therapies and how they are used in general medicine.
      2. Describe how psychological therapies may be used to help patients cope with acute and chronic stress.
      3. Review the evidence base for the use of psychological therapies in general medicine and primary care.
    • Preparing Patients for Unpleasant Medical Proceedures
      1. Identify the need to provide psychological care for patients undergoing stressful medical procedures.
      2. Outline factors that influence patient coping.
      3. Describe the impact of anxiety on post-surgical recovery times.
      4. Demonstrate practical skills in preparing patients for unpleasant investigative and therapeutic procedures.
    • Medical Decision Making
      1. Consider the psychology of clinical decision-making. (HSPH2)
      2. Understand how expert clinicians differ from students in the ways they make decisions. (HSPH2)
      3. Appreciate the role of cognitive bias in decision-making and understand some of the factors implicated in mistakes.
    • Stress and Illness
      1. Understand common frameworks for articulating complexity (HSPH2)
      2. The role of interaction between environment and genes.
      3. The contribution of psychological factors to specific disease groups/states: e.g cardiovascular disease.
      4. Psychoneuro-immunology: the interaction of behavioural, neural, and endocrine factors and the functioning of the immune system.
    • Normal Behaviour and Emotional Development
      1. Apply psychological principles, method and knowledge to medical practice (click to see list) (YR5intro)
  • Clinical skills: HISTORY (TD 13 a-b)
    • Taking a History
      1. Perform a mental-state examination. (YR5intro)
      2. To appreciate the basic science behind clinical skills
      3. Take and record a patient's medical history, including family and social history, talking to relatives or other carers where appropriate. (YR5intro)
      4. Initiate consultation and establish rapport (MET3A)
      5. Identify common errors in interpreted consultations ()
      6. Take history and define the presenting complaint (MET3A, MET3A)
      7. Identify good practice in interpreted consultations ()
      8. Ascertain relevant past medical history, including drug history, allergies, family history and social history (MET3A)
      9. Discuss difficulties in taking a history and strategies that help ()
      10. Practice gaining a history and establishing rapport with a patient through a trained interpreter ()
      11. Undertake systems review (MET3A)
      12. Take a history to gain accurate and relevant information without making assumptions about sexual relations and behaviours. ()
    • General
      1. Identify clinical situations where it is appropriate to take a sexual history ()
      2. Identify the reasons for taking a sexual history ()
  • Clinical skills: PHYSICAL EXAMINATION (TD 13 c)
    • Examining the Patient
      1. Perform a full physical examination. (YR5intro)
  • Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
    • General Outcomes for Imaging
      1. Identify components of body systems and structures in several common types of medical images: ultrasound; X-Ray, CT-Scan; MRI-Scan; compared with anatomical pictures and the CAL packages
  • Clinical skills: FORMULATING A TREATMENT PLAN (TD 14 g)
    • General Principles of Patient Management
      1. Diagnose and manage clinical presentations (click to see list) (YR5intro)
    • Disease Management in the Community
      1. Provide the major arguments supporting denial of NHS treatment from those condition was caused by their lifestyle. ()
      2. Provide the major arguments against denial of NHS treatment from such patients. ()
  • Clinical skills: THERAPEUTIC PROCEDURES (TD 18 b)
    • General
      1. Carry out practical procedures safely and effectively (click to see list) (YR5intro)
      2. perform insertion of naso-gastric tube (MET3A)
  • Clinical skills: SURGERY and ANAESTHETICS (TD 14 g)
    • General Surgical Outcomes
      1. know basic theatre principles (MET3A)
  • Clinical skills: SUPPORTING PATIENTS and IDENTIFYING ABUSE and NEGLECT (TD 14 h-i)
    • General Outcomes for Integrated Health
      1. Demonstrate awareness of popular forms of Complementary and Alternative Medicine (CAM).
      2. Understand the different means of establishing evidence to support the effectiveness of complementary medicine.
      3. Appreciate arguments for and against using complementary and alternative medicine in the NHS.
    • Preventative care and Screening
      1. Describe the various definitions of prevention, health education, sexual health and health promotion
  • Clinical skills: INTERACTION WITH PATIENTS (TD 15 a-b)
    • Interacting with Patients - General
      1. Provide explanation, advice, reassurance and support. (YR5intro)
      2. Communicate effectively with patients and colleagues in a medical context (click to see list) (YR5intro)
      3. Demonstrate appropriate respect to patients in relation to dress, greetings, verbal and non-verbal behaviour
      4. Identify problems in using non-professional interpreters in consultations ()
      5. Describe a model that identifies the tasks and stages in the consultation
      6. Elicit patients’ questions, their understanding of their condition and treatment options, and their views, concerns, values and preferences. (YR5intro)
      7. Identify factors that act as barriers and enablers to communication
      8. Be able to explore the impact of ill health on a patient's life (physical, social and psychological)
      9. Discuss the role and value of attentive listening, rapport and empathy, different question styles and summarising
      10. Develop skills in observation, listening, information gathering, empathy and reflective learning
      11. Demonstrate appropriate non-verbal (eg body language) and verbal skills (eg use of silence, open and closed questions and summarising) to gather information
    • Cultural Issues
      1. Identify potential effects of culture, age, gender, ethnicity, religion, socio-economic status and environment on communication
      2. Discuss variation in social relations and the effect on communication with health-care workers
      3. Recognise the importance of not making assumptions
      4. Discuss how health beliefs affect interactions with health-care workers and services
      5. Develop skills in listening, information gathering, empathy and respect
      6. Discuss the role of health advocates in overcoming barriers to communication and enabling access to health-care
    • Non-verbal Communication
      1. Describe the importance of non-verbal communication and body language in medical encounters
  • Clinical skills: PRESCRIBING DRUGS SAFELY AND EFFECTIVELY (TD 17 a-h)
    • General Principles
      1. Prescribe drugs safely, effectively and economically (click to see list) (YR5intro)
  • Professional issues: WORKING IN TEAMS (TD 22 a-c)
    • General Outcomes for Working in Teams
      1. Understand the roles and expertise of health and social care professionals including doctors in the context of working and learning as a team as well as in policy and practice development (Yr2intro)
      2. Work with colleagues in ways that best serve the interests of patients, passing on information and handing over care
      3. To understand the role of the health care professional in managing / refer (CSP4a)
      4. Learn and work effectively within a multi-professional team (click to see list) (YR5intro)
      5. Develop effective communication skills between professionals, know how to refer a patient, and ask for advice or help from another professional; be able to make effective telephone communications; communication within a team during an emergency and give a
    • Specialist Roles
      1. Identify problems in using non-professional interpreters in consultations ()
  • Clinical skills: MANAGING INFORMATION (TD 15 c)
    • General Outcomes for Managing Information
      1. Use information effectively in a medical context (click to see list) (YR5intro)
  • Professional issues: LEARNING (TD 21 a-d)
    • Learning - General
      1. Acquire, assess, apply and integrate new knowledge, learn to adapt to changing circumstances and ensure that patients receive the highest level of professional care. (YR5intro)
      2. Gain insights in how to deal with challenging situations during patients encounters (PSYCH4)
    • Strengths and Limitations
      1. Continues to recognise limitations of current personal understanding and capabilities, identifies areas needing refreshing or extending and uses research skills to address these areas and influence own practice
      2. Recognise own personal and professional limits and seek help from colleagues and supervisors when necessary. (YR5intro)
      3. Have the ability to manage own learning needs (Yr2intro)
      4. Be able to adapt to the clinical learning environment and learn autonomously (YR3intro)
      5. Be able to identify one's own learning needs
      6. Recognise personal and professional limits and seek help from colleagues and supervisors when necessary
    • Using Information Technology (I.T.)
      1. Explain why you would search a database
      2. Be aware of the IT facilities across the College
      3. Know the difference between a citation, abstract and full text
      4. Confidently start applications on a PC, switch on; reboot; use username and password to connect to network; use mouse to point and click
      5. Recognise constituent parts of a URL address
      6. Know the structure of a bibliographic citation: author; title; source; pagination; year of publication
      7. Be able to start File Manager; confidently locate and open available software, eg, webmail, web browser, microsoft suite
      8. Know how to use internet searches to identify and explore health-related websites to identify current national guidelines relating to diabetes and obesity
      9. Carry out basics of print management - accounting for and adding print credit
      10. Be able to find and know the usefulness of a Library Database list
      11. Be informed about remote access; authentication and availability of wireless network
      12. Understand authentication (ie ATHENS personal usernames and passwords)
      13. Know the availability of three major databases for medics; have ability to find answers to problems eg using Medline, PubMed, Web of Science, Cochrane, NeLH
      14. Be aware of the need for evaluation of resources particularly web, authority, motivation, date, verification of evidence, bias etc (See BMA website - tips for professionals)
      15. Locate specific sites supporting the course; SMD Blackboard; QM Library Medical and Dental site
      16. Know how to use author, journal and subject facility; be able to apply Boolean oerators to search strategy AND/OR; be able to apply limits to search results; be able to combine search strategies
      17. Demonstrate the ability within the Web of Science, to use cited reference searching
      18. Be aware that search skills are transferable skills involving effective questioning and effective time-management
      19. Be able to display and email search results within a database
      20. Accept the need to comply with College regulations regarding IT, plagiarism and copyright
      21. Demonstrate the ability to navigate a web browser; scroll bar; back/forward/stop; home; URL box; hypertext links; bookmarks; go etc
    • Attitudes to Learning
      1. Respond constructively to the outcomes of appraisals, performance reviews and assessments. (YR5intro)
      2. Establish the foundations for lifelong learning and continuing professional development, including a professional development portfolio containing, reflections, achievements and learning needs (YR5intro)
      3. Acquire, assess, apply and integrate new knowledge and learn to adapt to changing circumstances (Yr2intro)
      4. Be able to give examples of what is and is not plagiarism; know the consequences of plagiarising and implement procedures to avoid plagiarising
    • Reflection
      1. Continually and systematically reflect on practice and, whenever necessary, translate that reflection into action, using improvement techniques and audit appropriately − for example, by critically appraising the prescribing of others. (YR5intro)
  • Professional issues: TEACHING AND MENTORING (TD 21 f)
    • Medical Students as Teachers and Mentors
      1. Function effectively as a mentor and teacher including contributing to the appraisal, assessment and review of colleagues, giving effective feedback, and taking advantage of opportunities to develop these skills (TD 21 f) (YR5intro)
  • Clinical skills: EVIDENCE BASED MEDICINE
    • Evidence Based Medicine - General
      1. Describe the type of information needed in different clinical situations ()
      2. Locate and access resources for medical professionalseg OMNI; NeLH, MEDLINE-Plus. Demonstrate the ability to find answers to problems using these resources
  • Professional issues: ETHICS and LAW (TD 20 a-g)
    • Management of Medical Information: Truth Telling & Confidentiality
      1. Explain in what respects truth-telling is important both to patient and doctor/student. ()
      2. Explain in what respects truth-telling is important both to patient and doctor/student. (CSP3)
      3. Give classical justifications for and against deception and assess the strength and weaknesses of both. ()
      4. Give classical justifications for and against deception and assess the strengh and weaknesses of both. (CSP3)
      5. Specify the potential ethico-legal consequences of lying to patients. (CSP3)
      6. Relate personal experience of deception to the concepts of rights and corresponding 'strict' duties and to the moral impropriety of professional deception. ()
      7. Describe circumstances where the duty can be relaxed. ()
      8. Describe circumstances within medicine and surgery in which it would be appropriate to be economical with the truth (CSP3)
      9. Describe circumstances within healthcare in which it would be appropriate to be 'economical' with the truth. ()
      10. Specify the moral and legal problems of respecting a patient's right not to be told the truth. (CSP3)
      11. Specify the moral and legal problems of respecting a patient's right not to be told the truth. ()
      12. Anticipate and appropriately respond to situations where patients ask you as a medical student (or doctor) to be truthful about their condition, treatment and prognosis (CSP3)
      13. Outline good policies on breaking bad news (CSP3)
    • End of Life Ethics
      1. Give arguments for and against hastening death of patients in various circumstances
      2. Outline the duties and prerogatives of doctors and the rights of competent patients in relation to the hastening of death and specify the circumstances where they apply
      3. Outline the difference between various forms of hastening death and distinguish between the ethico-legally acceptable ones from those which are unacceptable
      4. Specify the provisions of acceptable Advance Directives, action based on the rule of double effect, DNAR orders, withdrawal of life-saving treatment and non-treatment decisions
      5. Explain the role of relatives in relation to withdrawal of treatment in incompetent adults
    • Ethics in Obstetrics and Gynaecology
      1. Know about and keep to the GMC’s ethical guidance and standards including Good Medical Practice, the ‘Duties of a doctor registered with the GMC’ and supplementary ethical guidance which describe what is expected of all doctors registered with the G (YR5intro)
      2. Know and comply with GMCs ethical guidance and standards including Good Medical Practice; Duties of a Doctor Registered with the GMC, and supplementary ethical guidance which describes what is expected of all doctors registered with the GMC
      3. Understand and accept the legal, moral and ethical responsibilites involved in protecting and promoting the health of individual patients, their dependants, the public and vulnerable groups such as children, older people and people with mental illness
      4. Argue pro and con termination of pregnancy. (CSP4b)
      5. Demonstrate knowledge of laws, and systems of professional regulation through the GMC and others, relevant to medical practice, including the ability to complete relevant certificates and legal documents and liaise with the coroner or procurator fiscal wh (YR5intro)
      6. Describe the legal status of the foetus. (CSP4b)
      7. Explain the concept of personhood and describe its relation to the morality of abortion. (CSP4b)
      8. Understand some of the ethical issues around genetic data and potential risks to the individual
      9. Describe the legal conditions of lawful abortion as outlined in the Abortion Act 1967 (1990). (CSP4b)
      10. Explain the legal status of the woman and of her husband/partner regarding abortion. (CSP4b)
      11. Describe the duties and rights of the doctor in relation to abortion. (CSP4b)
      12. Outline the principles of the HFEA 1990 concerning research on embryos. (CSP4b)
      13. Identify legal and ethical issues in reproductive medicine, prenatal screening and genetic counselling. (CSP4b)
    • General Outcomes for Medical Professionalism
      1. Respect patients' rights to hold religious or other beliefs and take these into account when relevant to treatment options (Yr2intro)
      2. Specify why the privileges associated with being a medical student carry with them the responsibility to respect the rights and dignity of patients (FM1)
      3. To be aware which groups are protected by the Equality Act (HSPH2)
      4. Deal effectively with uncertainty and change. (YR5intro)
      5. Recognise the rights and the equal value of all people and how opportunities for some people may be restricted by others’ perceptions. (YR5intro)
      6. To be aware of what is meant by discrimination as defined in the Act (HSPH2)
      7. To be aware of the main tenets of the public sector equality duty and the Human Rights Act (HSPH2)
      8. Describe circumstances within healthcare in which it would be appropriate to be 'economical' with the truth. ()
      9. Demonstrate a precise knowledge of the complaints procedure ()
      10. Apply and critically analyse ethical and legal theory to ethico-legal dilemmas/issues encountered in professional practice. ()
      11. Offer leadership in ethical and legal matters in clinical practice. ()
      12. Provide education and supervision for colleagues and students in relation to ethical and legal matters. ()
    • Legal, Moral, Ethical Responsibilities of Patient Care
      1. Explain the ethico-legal importance of the duty of confidentiality. ()
      2. Describe the official history of our medical ethics. ()
      3. Outline the possible implications of breach of these duties both for the patient as well as for the student/doctor. ()
      4. Provide the major arguments against denial of NHS treatment from such patients. ()
      5. Describe some unorthodox historical accounts of our medical ethics. ()
      6. Compare the local standard to acceptable standards elsewhere of information that should be offered to patients.
      7. Compare the local standard to acceptable standards elsewhere of information that should be offered to patients. ()
      8. Understand the explanatory power as well as shortcomings of the aforementioned historical theories and narratives. ()
      9. Articulate the rights of competent patients as regards refusal of medical interventions.
      10. Articulate the rights of competent patients as regards refusal of medical interventions. ()
      11. Offer a theory that can overcome the problems of the existing historiography. ()
      12. Understand the importance of getting the history of our medical ethics correct, especially vis-a-vis its possible moral implications. ()
      13. Specify the moral and legal problems of respecting a patient's right not to be told the truth. (CSP3)
      14. Specify the moral and legal problems of respecting a patient's right not to be told the truth. ()
      15. Offer leadership in ethical and legal matters in clinical practice. ()
      16. Provide education and supervision for colleagues and students in relation to ethical and legal matters. ()
    • Informed Consent
      1. Outline the legal implications of a failure to obtain valid consent when such consent should be obtained. ()
      2. Outline the legal implications of a failure to obtain valid consent when such consent should be obtained.
      3. Describe the acceptable legal standard of the information that should be offered to patients in the UK when obtaining valid consent.
      4. Explain why obtaining consent is an integral part of successful clinical relationships and the key tenets of GMC policy (FM1)
      5. Describe the acceptable legal standard of the information that should be offered to patients in the UK when obtaining valid consent. ()
      6. Compare the local standard to acceptable standards elsewhere of information that should be offered to patients.
      7. Compare the local standard to acceptable standards elsewhere of information that should be offered to patients. ()
      8. Articulate the rights of competent patients as regards refusal of medical interventions.
      9. Articulate the rights of competent patients as regards refusal of medical interventions. ()
      10. Differentiate between explicit and applied consent, indicating when each is important (FM1)
      11. Specify when consent may not or should not be obtained and how one should proceed in such cases.
      12. Specify when consent may not or should not be obtained and how one should proceed in such cases. ()
    • Misconduct, Medical Negligence and Malpractice
      1. Describe the duty of care and who has it (CSP3)
      2. Outline the legal conditions for negligence to be established (CSP3)
      3. Explain the Bolitho modification of the Bolam test (CSP3)
      4. Describe situations or res ipsa loquitur (CSP3)
      5. Explain the legal standard of evidence in negligence cases (CSP3)
    • Research Ethics
      1. Describe some classical examples of abuse in biomedical research and specify why they are abuses. (CSP3)
      2. Understand the historical context of the Declaration of Helsinki. ()
      3. Explain the change in ethics and law that has occured in the last four decades (CSP3)
      4. Outline the main principles of the Declaration. ()
      5. Outline the key international and national codes that currently regulate acceptable research (CSP3)
      6. Identify problems in the Declaration. ()
      7. Describe the work of research ethics committees and the structure of a research protocol. (CSP3)
      8. Identify common moral faults in the design of research protocols and explain why they are faults (CSP3)
      9. Describe the standards of confidentiality in relation to the publication of research outcomes (CSP3)
      10. State the circumstances in which biomedical research could be, or ought not to be, conducted on vulnerable individuals (minors and mentally incapacitated patients) (CSP3)
    • Good Medical Practice: Ethico-Legal Responsibilities of Patient Care
      1. Respect all patients, colleagues and others regardless of their age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status. G (YR5intro)
      2. Understand and accept the legal, moral and ethical responsibilities involved in protecting and promoting the health of individual patients, their dependants and the public − including vulnerable groups such as children, older people, people with learnin (YR5intro)
      3. Be polite, considerate, trustworthy and honest, act with integrity, maintain confidentiality, respect patients’ dignity and privacy, and understand the importance of appropriate consent. (YR5intro)
      4. Recognise the duty to take action if a colleague’s health, performance or conduct is putting patients at risk. (YR5intro)
      5. Describe the harm principle and the limits to autonomy (CSP3)
      6. Identify the conflict between the individual and society in the context of risk to others (CSP3)
      7. Outline the steps a doctor should take to ensure that the DVLA is informed about dangerous drivers (CSP3)
    • Ethics in Paediatrics
      1. Identify three distinct groups of minors in relation to mental capacity, consent and refusal of treatment. (CSP4b)
      2. Describe the medical law pertaining to minors and the tension reflected therein between respect for their autonomy and acting in their best interests. (CSP4b)
      3. Explain the legal concept of parental responsibility and its relevance to the consent question. (CSP4b)
      4. Explain how conflicts between the interests of minors and their guardians ought to be resolved. (CSP4b)
      5. Specify when consent may not or should not be obtained and how one should proceed in such cases.
      6. Specify when consent may not or should not be obtained and how one should proceed in such cases. ()
    • Distributive Justice: Allocation of medical Resources & Research Ethics
      1. Outline the main principles outlined in the Declaration of Helsinki.
      2. Describe the particular standard of valid consent applied in research as opposed to consent for clinical procedures.
      3. Outline the provision pertaining to Placebo-Controlled Trials (PCT).
    • Transplant Ethics
      1. Describe the causes of the organ crisis
      2. Describe the evolution of transplant ethics since 1968. (CSP4b)
      3. Argue pros and cons of a policy of implied consent (opt-out), for organ donation upon death
      4. Argue pro and con a regulated market in organs. (CSP4b)
      5. Argue pro and con a policy of implied consent (opt-out) for organ donation upon death. (CSP4b)
      6. Explain why altruistic living unrelated donation (LURD) is a legal FICTION (CSP4b)
    • Personal Accountability
      1. Outline the possible implications of breach of these duties both for the patient as well as for the student/doctor. ()
      2. Demonstrate a precise knowledge of the complaints procedure ()
    • Moral Philosophy
      1. Differentiate between ordinary autonomy and freedom of choice within social rules, and critical autonomy, which enables freedom of choice between such rules.
      2. Understand the difference between 'ethical' and 'moral'. ()
      3. Understand basic concepts of philosophical ethics. ()
      4. Describe clinical cases where non-adherence is a problem for therapeutic management; state moral arguments for discrimination on the grounds of non-adherence in the distribution of scarce medical resources.
      5. Describe different moral theories, and be able to apply them to different situations. ()
      6. Articulate moral arguments against discrimination on the grounds of non-adherence in the distribution of scarce medical resources.
      7. Explain the importance of moral arguments and their limitations. ()
      8. Summarise three moral/practical steps that should always be taken in negotiating non-adherence with patients.
      9. Understand the nature and outline the various forms of an ethical problem; identify examples of ethical problems in medicine (FM1)
      10. Give arguments for and against patients paying for their own health care if their condition has been a direct result of their lifestyle
      11. Apply and critically analyse ethical and legal theory to ethico-legal dilemmas/issues encountered in professional practice. ()
      12. Outline the major moral theories and their criteria of identifying goodness (FM1)
      13. Give examples of how each of these theories could be applied in medico-ethical decision making (FM1)
      14. Describe the shortcomings of moral theories and suggest how they could be overcome (FM1)
    • Elective
      1. Understand the sustainability of delivering healthcare in resource poor settings
      2. Be aware of the importance of local culture, language and prevalence of local diseases and determinants of health
      3. Familiarise yourself with different ethical scenarios; be able to describe an appropriate response to common ethical scenarios when working abroad
    • Ethics in Psychiatry
      1. Describe the three sections of involuntary admission as outlined in the Mental Health Act 1983 (2007).
      2. Outline the conditions that need to be met for involuntary admission.
      3. Explain the ethical-legal difference between formal and informal patients and between patients with mental illness and those who suffer from organic brain syndromes.
    • Ethics and Mental Illness
      1. Specify when consent may not or should not be obtained and how one should proceed in such cases.
      2. Specify when consent may not or should not be obtained and how one should proceed in such cases. ()
  • Professional issues: DUTIES OF A DOCTOR (TD 23 a-b)
    • Patients needs and safety
      1. Can place patients needs and safety at the centre of the care process (TD 23 a) (YR5intro)
  • Professional issues: MEDICAL FRAMEWORK IN THE UK (TD 23 c)
    • Medical Leadership and Management - General
      1. Consider why we have a national health service (FM1)
      2. Recognise the duty to take action if a colleague's health, performance or conduct is putting patients at risk (GMC) (CSP4a, GEPintro, Yr2intro, YR3intro, YR5intro)
      3. Demonstrate the ability to play various team roles including leadership; deal effectively with uncertainty and change
      4. Demonstrate awareness of the role of doctor as manager, including seeking ways to continually improve the use and prioritisation of resources (Yr2intro)
      5. Demonstrate awareness of the role of doctors as managers, including seeking ways to continually improve the use and prioritisation of resources. (YR5intro)
      6. Understand the framework in which medicine is practised in the UK including the organisation, management and regulation of healthcare provision and the structure and functions of the NHS (Yr2intro)
  • Professional issues: RISK MANAGEMENT and PATIENT SAFETY (TD 23 d)
    • Principles of Risk Management
      1. Understand and be able to perform a risk assessment (PSYCH4)
      2. Promote, monitor and maintain health and safety in the clinical setting, understanding how errors can happen in practice, applying the principles of quality assurance, clinical governance and risk management to medical practice, and understanding responsi (YR5intro)
      3. Promote, monitor and maintain health and safety in the clinical setting, understanding how errors can happen in practice and applying the principles of quality assurance, clinical governance and risk management to medical practise
      4. Place the patient's needs and safety at the centre of the care process (YR3intro)
    • Infection Control
      1. Understand the importance of, and the need to adhere to, measures to prevent the spread of infection (YR3intro)
      2. Understand the importance of, and the need to keep to, measures to prevent the spread of infection, and apply the principles of infection prevention and control. (YR5intro)
  • Professional issues: GOVERNANCE, QUALITY MATTERS and AUDIT (TD 23 e)
    • Governance and Audit - General
      1. Understand and have experience of the principles and methods of improvement, including audit, adverse incident reporting and quality improvement, and how to use the results of audit to improve practice. (YR5intro)
      2. Understand the framework in which medicine is practised in the UK, including: the organisation, management and regulation of healthcare provision;the structures, functions and priorities of the NHS; and the roles of, and relationships between, the agencie (YR5intro)
      3. Understand and have experience of the principles and methods of improvement including audit, adverse incident reporting and quality improvement and how to use the results of audit to improve practice (CSP4a)
  • Professional issues: PERSONAL ATTITUDES and SELF CARE (TD 23 f-j)
    • General Outcomes for Personal Attitudes and Self Care
      1. Recognise own personal health needs, consult and follow the advice of a suitably qualified professional, and protect patients from any risk posed by own health. (YR5intro)
      2. Respond constructively to the outcome of appraisal, performance review and assessment (Yr2intro)
    • Self Care
      1. Manage time and prioritise tasks, and work autonomously when necessary and appropriate
      2. Recognise personal health needs, consult and follow the advice of a suitably qualified professional, and protect patients from any risks posed by personal health

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