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seem to be well appreciated and covered to a reasonable depth.

The Metabolism module is delivered in parallel with Biological Molecules in Semester 1. This covers the range of whole-body and cellular metabolic principles, including endocrinological ones. Introductory sessions are on meta- bolic rate, respiratory quotient and temperature regula- tion and on energy balance and dietary considerations. We then have the basics of cellular metabolism before reverting to whole-body consideration of hormones and endocrine control of metabolism with an emphasis on diabetes, starvation and the control of calcuim metabo- lism and growth. There has been a considerable reduction in emphasis on cellular metabolism. We deal with the rudiments only of bioenergetics, of carbohydrate and lipid structure and metabolism including glycogen, and with the citric acid cycle and simple ideas of cellular respiration and oxidative phosphorylation. There is a small amount on nitrogen metabolism and the urea cycle (relating to starvation) but nothing on metabolism of specific amino acids or on the pentose phosphate pathway, for example. In relation to whole-body concepts, this module does not attempt to grapple with lipoprotein metabolism or with steroids and cholesterol metabolism which will be picked up in later modules,

The Process Continues... Clearly, the debate will continue. We are about to embark on the second year of the course and will need to review content and delivery when we see how the various mod- ules develop. However, I have no doubt that we have made a very positive step and the response of the students bears this out. They certainly seem less overwhelmed and more attuned with the biochemistry and it will be interesting to see how many opt for the biochemical science skills options towards the end of their second year.

PII: S0307-4412 (96)00041-6

The Manchester Medical Programme

KEITH BURDETT

Department of Biochemistry and Molecular Biology, School of Biological Sciences, University of Manchester, Manchester M13 9PL, U.K.

Introduction As a result of changes in the organisation of the School of Biological Sciences in Manchester, combined with pres- sures to radically revise the teaching offered to under- graduate medical and dental students, moves were initiated in 1991 that culminated in the new programme being launched in September 1994. The first year has now been completed and the collected view of students, staff and external examiners are known to be favourable.

New programme The new programme is integrated and problem-based. Each week groups of 14 students study one case that is in essence a 'patient on paper'. They identify the issues they need to study and, with the minimum of didactic help from tutors, devise their study pattern for the week. Students are required to study subjects that are relevant to the case ranging from the molecular to the whole body levels of organisation for the biosciences, and from the individual to the community for the behavioural sciences. No part of the course carries a label such as Biochemistry: the learning is integrated so all aspects of structure and function must be addressed.

Lectures are reduced to a maximum of four per week. Those that do take place are not always of the chalk-and- board variety that typify much of university education. As students become more confident, lecture theatre events become genuinely more interactive. Practical classes that develop skills or extend knowledge arise directly from cases being studied at the time. Informatics and communi- cation skills are two threads running through the whole course, including the clinical years 3, 4 and 5 that are currently being totally redesigned. Clinicians have been involved in the design and implementation of the first 2 years. Basic medical scientists will be involved in years 3, 4 and 5 to achieve vertical integration in the course. The inevitable staff development required is one major benefit of the new programme.

Overall theme The first two years are divided in to four semesters each with an overarching theme: (1) Nutrition and Metabolism, (2) Cardiorespiratory Fitness, (3) Abilities and Disabil- ities, (4) Life Cycle.

The themes arose out of an analysis of The Health of the Nation document published in 1992 and their implemen- tation was the responsibility, in 1992, of four interdiscipli- nary Semester Design Teams that reported to a Management Group. The course is owned by the Facul- ties of Medicine and Biological Sciences, rather than indi- vidual departments or disciplines. The four themes will re-occur in years 3 and 4 as students learn clinical manage- ment and study real patients.

Apart from the major effort needed to devise suitable cases and supplementary activities in laboratories, lecture theatres and computer rooms, a great deal of effort has been put into assessment. Summative assessment is by examination at the end of each semester. The examina- tions seek to test the whole course, ie knowledge-base. problem-solving and practical skills, communication and group work. Students who need to resit examinations do so for both semesters in August.

Special study modules In line with new courses elsewhere, The Manchester Pro- gramme has core options. The special study modules in Semester 2, 3 and 4 last for 2 weeks and represent an opportunity to work on some chosen area in depth. The

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modules can be library, laboratory, clinic or community based. The emphasis throughout the course is on adult learning and that means presenting the students with the opportunity to learn and not to be force-fed. Interestingly, a significant portion of the special study modules titles selected from the list offered, involved basic science topics that more traditionally educated students would have been expected to avoid.

Student opinion Student opinion expressed in the middle and at the end of each semester shows that if there is a choice in the context of a clinically relevant backdrop, students will enthusi- astically and effectively study the basic medical sciences. Our external examiners commented that the quality of answers they were hearing at vivas was as good as on traditional courses.

After a first attempt we have learned what is needed to improve the course. However the majority of our 330 medical and dental undergraduates of the class of 1994 are keen to enter year 2, and in addition, to support the class of 1995 as they in turn accept that the responsibility for learning basic medical sciences is theirs.

PII: S0307-4412 (96)00042-8

The New Medical Curriculum at Liverpool University

JOHN SMITH

Department of Biochemistry, University of Liverpool, Liverpool L69 3BX, UK

Introduction The course will be one in which didactic teaching will be substantially reduced, being replaced by small group work, directed self-learning activities and earlier clinical contact. It has been divided into three phases: phase 1, an introduction to the principles of medical practice, and to the learning environment of the medical school, including the early acquisition of basic clinical, resuscitation and communication skills; phase 2, 3 years of problem-based learning in small groups with extensive, integrated clinical experience, special study modules, elective experience and the opportunity to intercalate; phase 3, intensive apprentice-based clinical experience with half-day release to theoretical teaching reflecting the needs of the modern health service.

Four themes run across the course acknowledging the changing roles of doctors: (i) structure and function in health and disease, (ii) individuals groups and society, (iii) professional values and ethics, and (iv) public health and epidemiology. The biochemistry in the course is part of theme (i) and the intention is that this theme will consti- tute perhaps threequarters of the content of year 1, but

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continuing on a declining basis throughout the entire course. The theme, however, will be taught on an inte- grated basis with the other traditional preclinical sciences, and both such didactic teaching as remains and the work in small groups will be set in clinical contexts.

The detailed content of the curriculum is being developed by members of the faculty and members of the Biochemistry department have been involved in all the modules produced so far. In practice, the department has traditionally taught only in the first year of the old curric- ulum, and has provided simply a basic biochemistry course as a platform on which the detailed knowledge required by clinical situations can be built. The expectation is that the interest of the department will now extend further in time into the curriculum, and more closely into areas of direct clinical relevance.

Phase 1 Phase 1 learning will be constructed around problem- based themes, each one lasting a fortnight. Each of the themes, which will have loose clinical connections, is designed to trigger directed self-learning across a range of topics. The focus will be predominantly on the basic sciences (modular and cellular biology, anatomy and phys- iology), but basic concepts in other areas (statistics, path- ology, epidemiology and public health, pharmacology, behavioural science) will also be introduced in an inte- grated manner. Although the subjects chosen as topics for learning will have clinical relevance, the natural history, pathology, diagnosis and management of specific diseases are not on the agenda for phase 1, and problem solving will also be deferred until phase 2.

The timetable will include structured teaching elements to supplement the relevant self-learning objectives. They will include lectures, supervised practical classes and ses- sions in the clinical laboratory; each fortnight may include up to eight lectures, three practical classes and four clinical skill sessionsmall pertinent to the topics under discussion. The rest of the time is for self-learning. This will receive direction via three small group sessions (six students per group) supervised by a 'non-expert' medi- ator, on a system related to that of the University of Limburg. 'Expert' guidance will be provided to the tutors and subsequently to the students by means of study guides, which are currently being produced.

Phase 2 Phase 2, which occupies 3 years involves two journeys through a chronological life cycle from 'birth' (concep- tion) to death, incorporating a further forty clinical scenarios. These will again be investigated using primarily directed self-learning, but with progressively reduced direction. The first cycle will concentrate on the normal situation, whilst the second will focus on the disease state, including its clinical management. In terms of content, there will be core areas which it is considered that all students should be familiar with, but there will also be timetabled breaks in the course to allow for 'special study