LECTURE

Learning Experiences and Assessmentin the First 2 Years of the Medical Course
at King’s College London School of Medicine
Despo Papachristodoulou

Department of Biochemistry, King’s College London School of Medicine, London, UK(Received for publication on April 16, 2010)(Revised for publication on May 25, 2010)(Accepted for publication on June 17, 2010)

The medical curriculum at King’s College London School of Medicine is a 5 year course; an extended program (6 years) and a graduate entry program (4 years) are also available. The first
2 years of the curriculum comprise phases 1 and 2. The curriculum consists of core material
that is common to all students and student-selected components (students undertake threesuch components in the first 2 years). Phase 1 lasts 12 weeks and students learn the principles
of tissue and organ structure and function. They are also introduced to the practice of medicine (concepts of health, communication, ethics, inter-professional education and medicine in
the community). Phase 2 consists of 36 weekly clinical scenarios that place basic medical science in a clinical context. Phase 2 covers cardiovascular, respiratory, gastrointestinal, renal
and musculoskeletal systems; nutrition; endocrinology; head and neck anatomy; neuroscience;
genetics; and infections. Teaching continues in primary care and in the hospitals and includes
basic and advanced life support. Learning experiences include lectures, tutorials, practicalclasses, dissection and prosection, communication skills, e-learning, student-led sessions andprimary care and hospital visits. Assessment consists of in-course assessment (e.g., presentations, tests and essays) and end-of-year examinations which consist of written papers and an
objective structured clinical examination at the end of year 2. The main strengths of the program include the scenario format of learning and the practice of medicine early on. The difficulties arise mainly from the large numbers of students (420 per year). (Keio J Med 59 (4) : 140－145, December 2010)

Keywords: clinical scenario, learning methods, assessment, student-selected components, virtual campus

Introduction
King’s College London School of Medicine is locatedat three main hospitals: Guy’s, King’s and St Thomas’
and a number of associated district general hospitals inLondon, Kent and West and East Sussex (Fig. 1).
The standard medical degree program (MBBS) is a
5-year program and consists of five phases. There is progression from studying basic medical science to clinicalskills and medical practice. In addition, we have a 4 year

graduate/professional entry program (GPEP) for a small
number of mature students, and a 6-year extended medical degree program (EMDP) for students of high academic ability from poorly performing schools in theLondon area. The curriculum consists of core material,
which is common to all students, and student-selectedcomponents (SSCs), which vary in format
The first two phases are mainly taught at Guy’s campus. Phases 1 and 2 consist of the first 2 years in thestandard program and cover basic medical science withPresented at the 1648th meeting of The Keio Medical Society in Tokyo, December 11, 2009.
Reprint requests to: Despo Papachristodoulou MSc, PhD, Department of Biochemistry (Henriette Raphael House room 1.13), King’s College London, Guy’sCampus, London, SE1 1UL, UK, E-mail: despo.papachristodoulou@kcl.ac.uk
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Keio J Med 2010; 59 (4): 140－145

141tal basic science needed to prepare the students for phase2, which contains 36 scenarios of basic medical science
integrated into a clinical context.
Outcomes for Phases 1 and 2

Fig. 1 The three main hospitals are shown in white and theassociated district hospitals in black

On completion of phase 1, students should be able to:• Act as independent learners• Understand basic scientific language and the role ofscience in medicine• Have basic communication skills• Perform basic statistical tests on medically relevantdata.
On completion of phase 2, students should, in addition tophase 1, be able to:• Appreciate the integration of science and clinicalmedicine with epidemiology, public health sciences,medical sociology and psychology in the understanding of illness and health• Apply ethical principles to medical situations• Demonstrate a knowledge of basic science in the defined core areas covered• Show development of appropriate attitudes for thestudy of medicine• Perform simple clinical skills including communication skills• Work constructively with students in related healthprofessions.
Content of Phases 1 and 2Fig. 2 Numbers of students in the standard 5 year program, thegraduate/professional entry program (GPEP) and the extended
medical degree program (EMDP). Also shown are the additional
34 graduates from Oxford and Cambridge who enter at phase 3.

some integrated clinical practice. The next two phases
consist of years 3 and 4 and they include attachments inclinical areas in the main hospitals and the associateddistrict general hospitals. In phase 5 students act ashouse officers in their clinical attachments (Fig. 2).
We also offer a year of intercalated BSc study, usually
between phases 2 and 3, in many areas, including anatomy, neurosciences, imaging, psychology, medical ethics
and law, translational medicine and global health. The
main body of this lecture program will cover the learning experiences and methods of assessment in the first
2 years or phases of the standard program.
The First Two Phases
Phase 1 starts at the beginning of the academic year in
September and lasts 12 weeks. It provides the fundamen-

Students receive information on learning and study
skills in the first week and course booklets with learning
objectives for every session. All the information is alsoavailable electronically on the ‘virtual campus,’ which is
our electronic information and communication vehicle
for students and staff of the School. The students experience a wide range of learning methods during the program.
Phase 1 provides a platform of knowledge, skills andattitudes that will enable students to progress to the clinical scenario-based part of the course that constitutes therest of year 1 and all of year 2.
The areas covered in phase 1 are:
• The principles of tissue structure and function• Cellular and molecular biology• Metabolism• Tissue and organ structure and the organisation andfunction of the cardiovascular, respiratory, gastrointestinal, renal, musculoskeletal, nervous and immunesystems• An introduction to the practice of medicine, including:• Concepts of health and illness• The place of medicine in society• Communication in medicine

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Fig. 3 Example of one of the scenarios on the cardiovascular system (CVS).
GP; general practice.

• Medical consultation• The healthcare team
• An introduction to the disciplines shown below:• Medical ethics• Medical statistics• Professional skills.
Some of the topics such as communication skills andethics are studied with students of other health programs
as part of the inter-professional education program(IPE). Students meet patients in the community throughout phase 1.
Phase 2 runs for a year and a half and allows the promotion of understanding of normal structure and function and their interrelationships. It also continues to extend training in professionalism (communication skills,attitudes and behaviours) as well as teaching basic clinical skills. It consists of 36 clinical scenarios that employ
a variety of learning styles, including:• Lectures• Small group teaching• Workshops• Student-led learning• Student presentations• Clinical attachments in hospital and community settings.
The Clinical Scenarios
Each clinical problem is introduced by a clinician andis used as a focus for learning the background basic
medical, behavioural and epidemiological science needed to understand the clinical situation. Each scenario iscompleted in approximately 1 week and ends with asumming up session reviewing the important learning issues in the context of the clinical setting. The scenarios
cover the following areas:• Cardiovascular and respiratory systems• Gastrointestinal and renal systems• Metabolism and nutrition• Musculoskeletal system• Endocrinology• Fertility and reproduction• Head and neck anatomy• Neuroscience• Genetics• Infections.
Scenario titles often include a patient name and condition, which may seem a frivolous approach, but our students tell us that it helps them to remember the topics.
Below are a few examples of the scenario titles and thearea to which they belong:• Sanjay’s malaise: is it influenza? (respiratory)• Wilma’s woeful wrist (musculoskeletal)• Diana’s diarrhoea (gastrointestinal)• Sheila’s sore shoulder (musculoskeletal)• Donna has diabetes (endocrinology).
Figure 3 shows an example of a typical scenario taking place in 1 week.
Learning Methods in Years 1 and 2• We give about eight 1-hour lectures per week to thewhole year of about 420 students and provide themwith paper handouts and PowerPoint presentations

Keio J Med 2010; 59 (4): 140－145

on the virtual campus in advance.
• We hold 1-hour tutorial classes for 12-14 students on
average 1-3 times a week.
• We hold laboratory practical classes in physiology,biochemistry and histology for 50-60 students at atime.
• We carry out dissection of cadavers and prosection
in supervised groups of about 10 students. The dissecting room is open for private study and there is anadditional voluntary weekly session with academicstaff.
• We hold problem-solving workshops with groups of30-60 students.
• We teach communication skills with simulated patients in small groups of 2-12 students.
• We also have an online tutorial facility through thevirtual campus. Students can ask questions on academic matters which are answered by the appropriate member of staff. They can also comment on any
part of the course.
• We organise primary care and hospital visits for thestudents so that they see selected patients at generalpractice (GP) and in the patients’ homes and theyalso visit patients in hospital.
In year 1 we organise four GP sessions where thethemes are ‘why do people go to the doctor?’ and ‘what
happens during the consultation?’ Students attend inpairs. The theme of the hospital visits is the process ofadmission and discharge. Students again attend in pairs
and they also attend three seminars in groups of 12.
There is a clinical symposium and students are asked tomake presentations about their community and hospital
medicine experiences
In year 2 there are two themes: eliciting a medical history and access to healthcare. For each theme wehold a symposium and workshops and visit a generalpractice and a hospital.
• We encourage self-directed learning, particularly inthe clinical skills centre where students can improvetheir practical skills.
• We organise a system of peer-led problem-basedlearning, whereby year-4 student volunteers facilitate problem-based learning sessions for year-2 student volunteers.
• Year-2 students can attend post-mortem examinations in the hospitals in groups of five students• We have a great variety of student-selected components (SSCs) in the course.
In year 1, students learn together in groups of six witha supervisor. In this way we introduce supported selflearning linked to developing oral presentation and poster skills and report writing. In year 2, students undertake
two SSCs, one per term. One day per week is set aside
for these SSCs and no core teaching is scheduled. A
wide choice of scientific, medical and humanities projects are included as well as learning a foreign language.

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Table 1 Scenario-based curriculum: student evaluation fromend-of-year questionnaires
Presenting the basic science material in scenario format made it interesting• Strongly agree• Agree• Neutral• Disagree• Strongly disagree

59%
39%
1%
0%
1%

Table 2 Student evaluation
Presenting the basic science material in scenario format helped learning• Strongly agree• Agree• Neutral• Disagree• Strongly disagree

53%
43%2%1%1%Students can also devise their own project if they find awilling supervisor.
Evaluation of the Course
We evaluate the course using a number of methods, including student staff lunch meetings and by carrying out
a number of questionnaires at the end of each academicyear. Tables 1 and 2 show some results from the questionnaire for the academic year 2008–2009:
Assessment
Student assessment includes the end-of-year examinations and in-course assessment (ICA) during the year.
The MBBS Part 1 examination consists of two main
components that are weighted as follows:
End-of-year examinations 80%
In-course assessment 20%
The end-of-year examination consists of three units
and the in-course assessment component consists ofeight elements (Table 3).
Students must pass all three written examinations, but
one further attempt is allowed if a student fails any ofthe papers. Each paper consists of two types of questions: single best answer questions and extended matching questions. All written papers are computer marked.
In year 2, MBBS Part 2 is an examination consistingof two main components that are weighted as follows:• End-of-year examinations 82%• In-course assessment (ICA) 18%
The end-of-year examination component consists offour units and the ICA component consists of eight elements (Table 4).

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Table 3 MBBS Part 1 examination
Components of the MBBS part 1 examination% of final markEnd-of-year examination (Duration)
1. Phase 1 (3 hours)
2. Scenarios 1-7 (2 hours)
3. Scenarios 8-13 (2 hours)

Total 8034
23
23

In-course assessment
1. Mid-sessional written examination2. Clinical Presentation
3. Timed Problems (best 2 out of 3)
4. Histology sessions
5. IPE assessment

Total 2082226Scenarios 1–7 cover the cardiovascular and respiratory systems. Scenarios 8–13 cover
gastrointestinal and renal scenarios and nutrition and metabolism.

Table 4 MBBS Part 2 examination
Components of the MBBS part 2 examination% of final markEnd-of-year examination (Duration)
1. Scenarios 14-23 (3 hours)
2. Scenarios 24-32 (3 hours)
3. Scenarios 33-36 (1.5 hours)
4. OSCE

Total 822828
14
12In-course assessment
1. Clinical epidemiology and statistics critical appraisal
2. Mid-sessional examination
3. Neuropsychology assessment report
4. Neuroscience timed essay
5. Three neuroscience practicals (hearing, vision and CAL)
6. Endocrinology problem
7. Ethics short answer questions
8. Histology practicals

Total 1833
2.5
3
1
1
3
1.5

Scenarios 14–23 cover the musculoskeletal system and endocrinology. Scenarios 24–32
cover head and neck anatomy and neuroscience and scenarios 33–36 cover genetics andinfections.

Students must pass all three written papers and theOSCE in order to progress to year 3. One further attempt
is possible if a student fails one or more examinations.
The OSCE (objective structured clinical examination)
examines skills, knowledge and understanding in clinicalsituations and is a minimum competence examination. Inyear 2, we have 20 stations, 16 of which are active and 4of which are rest stations. Each station lasts 6 or 12 minutes. Each OSCE has a mixture of history taking, practical skills and communication skills including sensory
awareness and living anatomy.
Student-Selected Components (SSCs)
In year 1, groups of six students work together on aproject selected by them from an extensive list. At theend of the collaboration, the students do a poster presentation as a group which accounts for 50% of their markand write a report which accounts for the other 50% ofthe mark. The report mark is an individual mark for eachstudent.
In year 2, the assessment depends on the type of SSC.
It could be a library project marked by two examiners
independently, a written examination, e.g., for a language or a taught course, and/or an oral examination,e.g., as part of a language exam, library project or taught
course. The SSC marks do not form part of the final examination mark but a student needs to pass two out of
three in order to progress to year 3.
Strengths and Weaknesses of the Course
The best feature of the course in years 1 and 2 is thescenario format of phase 2. This is a consistent feature of
the results from all questionnaires carried out since westarted this way of teaching and learning. Since we started teaching in this way, we have not had any of the usualquestions that medical students asked previously, i.e.,Keio J Med 2010; 59 (4): 140－145‘what does this have to do with medicine?’ The relevance of basic science to medicine is made immediately
obvious in the scenarios.
Another strength of the course is the gradual integration of clinical material into basic science. The virtual
campus is one of our strong points and a feature that hasreceived praise from the General Medical Council. Students also tell us during admission interviews that one of
our attractive features compared to other medical
schools is the breadth of our SSCs. Our OSCE also consistently receives praise from external examiners for itsorganisation and the way it is conducted.
Our weaknesses are few, but we have some difficulties
such as organising such a large body of students forteaching; the process necessitates multiple rotations andsessions to cover the material. The large number of students in years 1 and 2 and the fact that we have to accommodate the standard 5 year-program students with145

the extended 6 year-program students and the accelerated 4 year-program students mean that running thiscourse is very complex and challenging.
A weakness of the scenario format is that it makes thetimetable rather inflexible; for example, if a lecturer isunavailable on a particular day, then that session is difficult to reschedule within the week of the scenario.
In summary, this article gives an overview of theteaching, learning and assessment methods in the first
2 years of the medical course at King’s College London
School of Medicine. We have not adopted an ultra-modern method of education, but I think we have struck agood balance by putting traditional methods of teaching
and learning in a clinical context aided by e-learning,
without compromising the value of basic science. We
have found that this approach works well, judging by
evaluations of the course by our students and also bystaff members and external examiners.