Experiential learning (learning in the workplace) is central to the educational experience in Year 4. You will experience a variety of clinical environments to develop breadth of knowledge and practice. You will be taught to adapt the skills and concepts acquired in Year 3 in these new areas through observation and deliberate practice. You will achieve this by attendance where appropriate: At ward rounds, operating sessions, outpatient clinics, MDT meetings, Tier 2 clinics, nursing homes and community clinics delivered by allied healthcare professionals. You will be required to demonstrate increasing independence in clinical environments by actively seeking out opportunistic learning experiences. You will provide evidence of these activities through the clinical placement logbooks.

In Year 4 there are two rotations, each comprising 4 Clinical Placement Blocks of 4 weeks:

Specialty Rotation A	Specialty Rotation B
Children’s Health	Neurology and Special Senses*
Women’s Health	Mental Health
General Practice	Ageing and Complex Health
Cancer Skin and Infection*	Musculoskeletal Health

Two of the above blocks will consist of shorter duration placements (1 or 2 weeks) to ensure you are exposed to all the necessary subject areas:

*Dermatology/ Infectious Diseases/ Oncology/ Breast

*Neurology / ENT / Ophthalmology

What you can expect from a placement

• You will be notified in advance of your placements in order for you to make arrangements for travel.
• You will be allocated a Clinical Placement Supervisor whose responsibility it is to meet with you and to supervise your placement. Your supervisor is trained and will be required to sign you off at the end of each placement and give you feedback. If they are unavailable for any reason the programme requires that the placement ensures a deputy supervisor is available.
• You will have a placement specific induction and orientation.
• You will be provided with a placement specific timetable.
• You will be provided with Patient Assessment and core skills teaching relevant to the block.
• You will be provided with the opportunity to attend ward rounds, clinics, theatres and other sessions relevant to the placement.

These are the specifications for each placement. These have been defined and agreed by the MBChB programme and our NHS partners. You will be asked to complete an evaluation of each placement and the feedback you provide will be used to improve those placements. Please give honest, constructive feedback and suggestions for improvement.

What we expect from you in a placement

• We expect you to attend all clinical sessions that have been organised for you. Please note not all of these will appear as timetabled events on your 1med timetable.
• We expect you to attend all teaching sessions and complete the preparatory work.
• We expect you to notify us if you are absent and provide a reason with evidence for this in a timely manner.
• We expect you to achieve a satisfactory sign-off for every clinical placement.
• We expect you to complete a logbook demonstrating at least the minimum requirements of your clinical learning as you move through the placements.
• We expect you to dress appropriately, attend on time and behave in a professional manner at ALL times.

Please also note: Students are all expected to be registered with a GP at their term time address. In the event that you are placed for a block at the GP surgery where you are registered you should advise the community administrator at your Clinical Education Campus as soon as possible (see: Contacts). It is best practice to keep your work and personal contact with General Practice separate whenever this is feasible. Your personal data at your registered GP remains confidential.

What constitutes a ‘Satisfactory’ grade in a SINGLE Year 4 Clinical Placement Block?

We want this process to be as fair as possible. Any decisions should be made on the basis of evidence that you provide. The electronic logbook has been created to support you to achieve this. It is your responsibility to show your supervisor how you have performed in the placement.

Your supervisor will make an assessment based upon:

• The entries in your logbook and your attainment of the minimum requirements.
• Their experience of working with and teaching you.
• The clinical teams’ experience of working with and teaching you.

This is the process by which you will be assessed throughout your medical career until you are a Consultant or General Practitioner.

If you fail a placement we will meet with you to discuss this further and agree objectives for the subsequent Block. We will ask your next supervisor to make a judgement on whether you have addressed any issues identified previously and met these agreed objectives.

As you move into Year 4 the criteria for assessing engagement in clinical learning will reflect your growing independence as senior medical students. You will be expected to provide evidence of your engagement in the Clinical Placement Block through the following criteria:

1. Full attendance within placement at the following mandatory teaching and learning activities:

• Induction,
• Patient Assessment Teaching,
• Themed Case Discussions,
• Secondary Component Learning,
• Placement sign-off meeting with the Clinical Placement Supervisor.

(Evidence of attendance for the first four activities is usually collected through sign off on each student’s iPad within the 1MedForms (E-form) software. For these activities it is your responsibility to ensure that the “teaching and learning” E-form is signed by the tutor to demonstrate attendance).

2. Engagement in learning provided by evidence in your logbook of:

• A minimum of 1 Presentation of Patient Assessment  per week,
• NB On one occasion across single specialty 4-week Blocks (Women’s Health, Child Heath, GP, Ageing and Complex Health, MSK) an ‘enhanced’ Presentation of Patient Assessment must be performed where a case is presented to a senior doctor,
• A minimum of 3 x Patient Assessments per week,

Your supervisor should sign off your form by the final day of the placement. If this cannot be completed due to the supervisor being unavailable, the supervisor’s deputy should sign this off. In case of any difficulties, the CEC Year Lead will assess the student’s logbook to determine a grade and submit the form. The latest possible date for submission of a form post-placement is 5 working days. After this date, the student’s placement will be considered unsatisfactory.

What constitutes an overall ‘Satisfactory grade’ in the Clinical Placement Blocks ACROSS the Year?

A satisfactory grade within each Block, or in the event of an unsatisfactory grade, the meeting of agreed objectives in the Block subsequent to the unsatisfactory one.

PLUS

• Evidence of completion of all Year 4 UPSAs and Prescribing and Medicine Safety (PMS) Skills assessments.
• No concerns regarding your overall attendance and/or engagement as assessed by clinical supervisors and faculty at your CEC.

What happens if you fail 1 or more Clinical Placements or do not complete your UPSAs and/ or Prescribing and Medicine Safety (PMS) assessments by Block 8:

The picture below outlines the consequences of not passing your clinical block placements. This may affect your ability to go on your elective or progress to year 5 if you do not meet the requirements outlined above. Please read the  Progression requirements from year 4 to 5 in conjunction with  this information.

Mitigating circumstances can be applied for a block failure. If accepted they will not change the outcome of that placement nor educational requirements to remediate, but if there is consequent failure of remediation it will determine whether Clinical Placements in a repeat year will be at 1st or 2nd attempt. For details of this is applied please visit the Year 4 Progression Page.

 

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