Bachelor of Medicine, Bachelor of Surgery (Graduate Entry)

This centres on the knowledge of the structure, function and development of the normal human body at all levels of organisation, from molecular and cellular to the whole individual. It encompasses the knowledge of the causes and consequences of disease, injury and abnormal development; and of evidence-based strategies for treatment and prevention of disease. This module will largely be delivered through Problem-Based Learning (PBL), an educational technique that involves student learning in small-group tutorials. In all, students spend five hours per week in PBL tutorials.

In Years 3 and 4, the aim is not only to continue to build an understanding of pathophysiology and relevant basic biomedical science but to promote effective reasoning and decision-making in everyday clinical settings. While students will continue to take a high level of responsibility for their own learning, they will be guided by well-defined educational outcomes and will be supervised by a range of Clinical Supervisors who will be specifically contracted to provide teaching, supervision and mentoring. Over time, students will have increasing exposure to disease processes and particularly to the diagnosis of illness and to disease management.

Clinical Skills covers the skills required by a doctor for direct patient contact, including consultation and communication skills, practical clinical skills and procedures, and emergency care - and to constructive interaction with other health professionals. Practicals relevant to the basic sciences will centre on anatomical teaching, which students will learn through surface anatomy on live humans, anatomical models, plastinated anatomical specimens, prosected specimens and through medical imaging. Clinical skills are largely taught in a 'Clinical Skills Resource Unit' on the UL campus, while Anatomical Skills are largely taught in a 'Anatomical Skills Resource Unit' on campus. Clinical Skills are taught twice a week for two hours. Anatomical Skills sessions take place once a week for two hours.

In Years 3 & 4, the teaching of clinical skills will build on what students have already been taught in Years 1 & 2. However, clinical skills teaching in the latter years will largely involve real patients, encountered in 'real-life' clinical settings such as the GP surgery, the hospital bedside, the operating theatre and the out-patient clinic. In addition, each of the clinical disciplines will deliver a full half-day each week of formal clinical skills teaching that is relevant to that discipline. For example, examination of the foetal heart will be taught during the clinical placement in Obstetrics & Gynaecology while students will acquire Advanced Life Support (ALS) skills during their clinical placement in Surgery & Related Disciplines.

The Professional Competencies module embeds the generic skills, attitudes and behaviours that help doctors successfully manage several issues in professional life. The module spans the four years in the School. 

The programme is developed from the Irish Medical Council's "Guide to Professional Conduct and Ethics for Registered Medical Practitioners", 8th edition 2019, and it is based on its "Three Pillars of Professionalism" – Partnership, Practice, and Performance.

Partnership

Quality patient care depends on working closely with patients, colleagues and other health professionals. Students learn the importance of trust as a critical professional quality. The module imbues the importance of excellent communication, respect for patient autonomy, confidentiality and consent. Partnership studies teach interprofessional communication, conflict resolution, healthcare resource utilisation, leadership and management. Social partnership studies teach understanding diversity, distributive justice, health economics, advocacy, social and community healthcare and public health and occupational medicine. Over the four years, students learn these competencies from the beginning, through the Early Patient Contact Programme, Problem Based Learning, formal lectures, group assignments, written reflections and student-selected modules.  

Practice

The elements of good professional practice include Health Law and Ethics, Self-Care, Health Psychology, Record keeping, and Informatics. The module focuses on the values and behaviours that support good patient care. Students learn patient centred care through high-quality consultation by listening to patients, by understanding their values and preferences.  Health and Illness are studied in the broader context of family, culture and society and explores community, political and economic influences.

Performance

Performance studies teach safe practice, taking in: systems analysis, error, human factors, situation awareness, quality development, risk management, complaints, open disclosure, health care governance and poor professional performance. Self-care and self-management are emphasised from early on to control stress and avoid "burn-out". Safe prescribing is also taught throughout the module. Students learn research methods and ethics, clinical audit, critical appraisal and biostatistics to practice evidence-based medicine. Students employ these skills in Year 4, completing a project of either original research, clinical audit or a scientific literature review.

The Professional Competencies module is integrated from the beginning of the course and is relevant to all medical disciplines for the professional life of doctors.

The first two years of the course are structured around Problem-Based Learning (PBL). This is backed up by a small number of lectures. There will also be structured clinical skills teaching and anatomical skills teaching. Teaching in the Professional Competencies takes the form of lectures, tutorials, workshops and seminars on topics such as psychology, public health, health law and ethics and medical sociology. All sessions are focused towards the topic of the week and exploring it from different perspectives including the scientific, sociological, public health, legal and patient experience. This means that everything you learn is done in the context in which you will use it when you practise as a doctor.

In each of the first two years, the curriculum is further divided into six learning units, covering different topic areas. Areas covered by each unit include:

• Life Structure: Musculoskeletal system, Rheumatology, Orthopaedics, Trauma, Plastic Surgery, Skin and Dermatology
• Life Cycle: Reproduction and Development, Child Health (Paediatrics), Obstetrics and Gynaecology, Sexual Health, Ageing, Death
• Life Maintenance: Alimentary System, Gastroenterology, Endocrinology, Renal Medicine, Urology, Nutrition
• Life Protection: Immunology, Infection, Haematology, Oncology, Preventative Medicine, Genito- Urinary Medicine
• Life Support: Cardiology/ Cardiovascular Surgery, Respiratory Medicine, ENT
• Life Control: Nervous system, Neurology/ Neurosurgery, Vision and Ophthalmology, Psychiatry, Psychology

Module Codes and Titles (further information on each module can be found on The University's Book of Modules)

In Year 3, all students will be located in the General Practice/Primary Care setting in one of 6 Primary Care Teaching Networks (PCTNs) across Ireland for 18 weeks. For the remainder of Year 3, students will undergo hospital-based clinical training in Medicine and Surgery. Three weeks in Year 3 is devoted to the SSM.

In Year 4, students will spend 6 weeks of Clinical Training in each of Obstetrics/Gynaecology, Paediatrics and Psychiatry. They will also undertake another 6 weeks in Medicine and Related Specialties and a further 6 weeks in Surgery and Related Specialties. This will involve rotations through a number of affiliated hospitals across Ireland. Six weeks in Year 4 is devoted to the SSM.

Students that are placed in University Hospital Limerick (UHL) for their Year 3 Medicine and Surgery rotations must complete their senior cycle of Medicine and Surgery rotations in an affiliated hospital in Year 4 or vice versa. 

Module Codes and Titles (further information on each module can be found on The University's Book of Modules)

Throughout Years 3 and 4 of the programme, students are placed in clinical settings. The School currently has six affiliated teaching hospitals and six General Practice/Primary Care networks as outlined below.

In Year 3, all students will be located in the General Practice/Primary Care setting in one of the school's Primary Care Teaching Networks (PCTNs) for 18 weeks. For the remainder of Year 3, students will undergo hospital-based clinical training in Medicine and Surgery. Three weeks in Year 3 is devoted to Special Study Module (SSM).

In Year 4, students will spend 6 weeks of Clinical Training in each of Obstetrics/Gynaecology, Paediatrics and Psychiatry. They will also undertake another 6 weeks in Medicine & Related Specialities and a further 6 weeks in Surgery & Related Specialities. Six weeks in Year 4 is devoted to SSM.

All students should expect to be placed outside of Limerick at some stage during their clinical training and potentially for more than one discipline/rotation. With respect to Medicine and Surgery, all students that are placed in the Mid-Western Regional hospital network for Year 3 Medicine and Surgery rotations must complete their senior cycle of Medicine and Surgery rotations in an affiliated hospital in Year 4

GENERAL PRACTICE / PRIMARY CARE NETWORKS

1. Limerick/Mallow/Charleville
2. Clare
3. Kerry
4. South Tipperary / Mallow / Mitchelstown / Fermoy
5. South East
6. Midlands

The ‘problems’ are highly structured hypothetical clinical cases, each of which takes a week to work through. Each semester, students are divided into groups of seven or eight, each with its own tutor in a tutorial room, with PC, state of the art AV equipment and walls lined with whiteboards. The group meets with the tutor to work through the week’s case. The tutor does not act as a teacher, but as a facilitator, guiding your group through the sequence of steps which have been devised to help students learn from the clinical cases. Each step and new development in the case (such as results of investigations or details of drugs prescribed) is only given out after the group has finished discussing the previous step.

By working through the problem and hypothesising about what is wrong with the patient, the PBL group comes up with a list of learning issues that represent the key knowledge needed to understand what is happening to the patient. The group members then independently research these learning issues (also known as learning objectives) in their own time. At the next PBL tutorial, each group discusses what they have learned and the tutor distributes the next stage of the problem. The new information is discussed, new learning issues arrived at, and members again research independently.

The group report back again and the final stage of the problem is explored and the case concluded. By this time, the group is likely to have worked through:

• The original presentation of the patient (either at A&E, an outpatient clinic or a GP clinic)
• The history taken by the doctor
• The examination findings
• Any investigations ordered and their findings (e.g. Blood results, x-rays, biopsies, etc)
• The course of the patient's illness (over hours, days, weeks, months or years) and the impact of this on the patient's life
• Treatment (pharmacological, surgical, psychiatric, etc)
• The involvement of family & others close to the patient
• Any complications that might have arisen
• The outcome of the case (including rehabilitation, on-going community care, etc.)

Independent learning times are not just about reading from textbooks. During these times, you are encouraged to visit and make use of the facilities of the Anatomical Skills Education Unit and Clinical Skills Education Unit.

Staff will be on hand to provide support in whatever area you feel you need it. However, to a large extent, students in the programme will be both encouraged and expected to assume a high level of responsibility for their own learning. Students will not be ‘spoon fed’ and there is a deliberate strategy to minimise the amount of didactic teaching in the curriculum.

During the first two years, The Early Patient Contact Programme at UL- GEMS gives students an opportunity to interact with patients. In the first semester, students in groups of three are assigned a patient from an affiliated general practice. The majority of patients assigned to students in the programme have a chronic illness e.g. Diabetes, Cystic Fibrosis, Multiple Sclerosis and many have multiple illnesses. Some students may be assigned an expectant mother where they will monitor her progress during pregnancy and subsequently the early development of her child. Over the course of the following 24 months, students will get to know their patient as a person and how their illness and their illness experiences have affected their lives.

Students will be expected to interact with their patient in a variety of different settings e.g. the patient’s home, in the patient’s GP’s surgery and at their hospital clinic appointments. They may even accompany their patients to the operating theatre if they need surgery. The early patient contact programme helps students understand both health and illness and how each are managed from a patient’s perspective. The programme will also help students to appreciate the strengths and deficiencies of the health services and provide them with some insight into the relationships between providers and consumers of healthcare. Finally, the experiences students get on the early patient contact programme will assist them in their learning of their classroom-based subjects in particular Special Study Modules (SSMs) allow students to study in-depth areas that are of particular interest to them. In total, students undertake three SSMs, one in each of Years 2, 3 and 4. Students have a considerable choice over the subject of these projects, but the format for assessment is prescribed. Some students might choose to undertake their SSM locally and others may go abroad to complete these electives.

Special Study Modules (Electives) allow students to study in-depth areas that are of particular interest to them. In total, students undertake three SSMs, one in each of Years 2, 3 and 4. Students have a considerable choice over the subject of these projects, but the format for assessment is prescribed. Some students might choose to undertake their SSM locally and others may go abroad to complete these electives.

Interested in completing clinical electives overseas?

Students registered on the BMBS programme can opt to complete clinical electives overseas. Completing a clinical elective in North America is essential to securing a residency in the United States or Canada.

The School of Medicine has entered into formal arrangements with McMaster University and Rutgers University to provide our students with clinical electives. In addition to our formal arrangements, strong links have been forged with a number of North American medical schools to provide our students with clinical electives in a variety of specialties. Feedback from North American institutions that have enrolled UL School of Medicine students on elective programmes have commented on their clinical proficiency and exceptional medical communication skills. View further information under Partner Universities below

Students applying for an elective while on the programme are supported by members of the School of Medicine admin team, Stephane Pinson and Emmeline Searson.

Queries to MedicineElectives@ul.ie

Looking to complete an elective In Ireland from overseas?

The BMBS Incoming elective programme is facilitated through our network of overseas partners. We are happy to accommodate external students seeking elective placements over the summer months. In the case of summer elective placements the School only accommodates students from institutions that have an existing MOU with UL School of Medicine.

Queries to MedicineElectives@ul.ie

UL School of Medicine is also a member of VSLO. The AAMC Visiting Student Learning Opportunities (VSLO) programme helps medical and public health students connect with institutions offering short-term elective opportunities that can enhance their medical education. These elective opportunities include observerships, summer research programmes, clinical opportunities, away rotations, away electives, clinical rotations and visiting opportunities.

Offered by participating host institutions in the U.S. and around the world, elective opportunities are available in teaching hospitals, community clinics, and urban or rural sites and are open to preclinical, clinical, or final-year students, as determined by the host institution.

The VSLO Application Service (sometimes referred to as VSAS), which enables students to browse and apply to electives offered by host institutions.

The VSLO program includes

• A collaborative network of US and international institutions.
• Training, information and guidance for students and institutions.
• Telephone and email support to students and institutions.

The School of Medicine currently has agreements with the following institutions

• Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario
• Northern Ontario School of Medicine, Thunder Bay
• Rutgers University, New Brunswick, New Jersey, USA

Additionally, students have completed electives at the following locations

• Memorial University, St John’s, Newfoundland 
• University of Toronto, Toronto
• Lerner College of Medicine, Cleveland Clinic, Ohio 
• Memorial Sloane Kettering Clinic, New York
• Weill Cornell University, New York
• Warren Alpert at Brown University, Providence, Rhode Island
• Johns Hopkins, Baltimore
• Morristown Medical Centre, New Jersey
• University of Miami 
• Wyoming Medical Centre, Wyoming, USA

UL School of Medicine continues to expand its network of partners overseas and encourages institutions looking to develop partnerships to contact the school at MedicineInternational@ul.ie

In Ireland, the 'Internship' is the first year of medical practice following graduation from School of Medicine.  During the Intern year, medical graduates are provisionally registered with the Medical Council.  Full registration with the Medical Council follows successful completion of the Intern year.   
 
To date there have been sufficient Intern places available for all Irish/EU medical school graduates.  In line with government policy, as the number of medical graduates increases, the number of Intern places is also expected to expand.

For International students in all Irish medical schools, the future is less certain to the extent that Government policy is to advise all overseas students that for them, INTERNSHIP PLACES CANNOT BE GUARANTEED.  However, UL will do everything in its power to optimise the employment prospects and opportunities for further training for all of its students following their graduation.  For example, in the case of North American students, the School of Medicine supports students seeking elective placements in teaching centres in Canada and the US, so that students can form relationships that will later help them to secure good residency training programmes.