Report of the Faculty Board of Clinical Medicine on amendments to the regulations for the Final Examination for the degrees of Bachelor of Medicine and Bachelor of Surgery

The FACULTY BOARD OF CLINICAL MEDICINE beg leave to report to the University as follows:

1. In this Report the Faculty Board of Clinical Medicine propose an extension of the length of the time taken to prepare for the Final M.B. Examination from two years and one term to a full three years.

2. The existing structure of the clinical course, leading to the Final M.B. Examination, has been in place since its introduction in 1975. The General Board have recently approved amendments to the examinations (see Reporter, 2003-04, pp. 92 and 846) in response to criticisms by external bodies including the General Medical Council (GMC) and the Quality Assurance Agency (QAA). As a further response, the Faculty Board have decided to instigate revisions to the core curriculum and, as a consequence, to propose extending the length of the course. These proposals were agreed in principle by the Faculty Board in the Michaelmas Term 2003; they have the support of the Faculty Board of Biology, the Medical Education Committee, the Senior Tutors' Committee, the College Directors of Studies in Clinical Medicine, clinical sub-deans in associated teaching hospitals, and the Regional Postgraduate Dean. They are also supported by current pre-registration house officers who recently undertook the clinical course.

3. The regulations set out in the Annex to this Report were approved by the Faculty Board at their meeting on 13 July 2004.

4. At two years and one term in length, the current course at Cambridge provides less clinical medical education than all other comparable courses in the UK. Clinical medicine involves the application of the biomedical and social sciences in a practical discipline in which student learning is increasingly experiential in nature. The current length of the course is no longer sufficient for the education of students seeking to practise medicine in the 21st century. The expanding knowledge base needs to be complemented by the acquisition of skills and attributes necessary for medical practice and for a greater understanding of the role of medicine in society. The need to include new areas of study within the current course has led to curriculum overload with increased student workload and stress. The current curriculum has received relatively adverse reports from both the GMC and the QAA and requires both substantial revision and a three-year time frame in order to bring it up to the standard of excellence required by these bodies, by the School of Clinical Medicine, and by the University and the Colleges. The GMC is expecting the University to have addressed the concerns of their last report at their next visit.

5. The School of Clinical Medicine is overdue in considering the impact of such changes, which have resulted in radical curricular overhaul in all other UK clinical schools. A new curriculum and the extended course is proposed to take effect from September 2005. Students currently studying in their second year of pre-clinical education have been advised of the proposed changes prior to making their clinical school applications in late 2004.

6. Lengthening the course will provide greater opportunities for students to develop professional behaviour and lifelong learning skills. The need to tackle the increased knowledge base now requires the definition of a core curriculum with the encouragement of reflective learning and protected time for student-selected material. The current course disadvantages Cambridge graduates in that they are less proficient in clinical skills and competencies than their counterparts from other medical schools. Cambridge graduates recently scored second lowest in a survey of UK junior doctors, when asked whether their experience at medical school had prepared them for their first posts. The revised course will enable the School of Clinical Medicine to design specific skills- and workplace-based educational programmes, to address the need not only for sound clinical knowledge but also for clinical, communication, therapeutic, and time management skills, and for appropriate attitudes and values for work in the changing NHS environment.

7. Increasing the length of the clinical course would have other significant benefits. A longer course would alleviate current pressures of delivering the course and help to reduce the high stress levels reported from students and their Colleges. The course extension will bring the graduation dates of medical students into line with other clinical schools and allow the Eastern Postgraduate Deanery to plan more efficiently the placement of pre-registration house officers within the new compulsory two-year foundation programmes for house officers and senior house officers within the NHS.

8. Under current funding arrangements, there would be no additional funding for the School of Clinical Medicine or the University from the HEFCE or other sources, other than from increased Composition Fee income for the two additional terms of residence. The proposed change to the length of the clinical course will have an effect on the University Composition Fees paid by students in their final year. Home and EU students will be required to pay for the full year, a fee of £1,150 (2004-05 figures; currently, they pay £560 for their final Michaelmas Term); overseas student fees will rise by about £16,000 (for the additional two terms of residence). In addition to these costs, students will complete their course and start work six months later than at present; however, students will be provided with an NHS bursary for this full final year if they so qualify.

9. Students on the Cambridge Graduate Course in Medicine and M.B./Ph.D. programmes will not be significantly affected by the proposed changes to the standard clinical course. The planning of the new curriculum has taken into account the need for integration during the final clinical years, hence all students will now qualify at the end of the academical year.

10. The revised curriculum has also allowed the Faculty Board to review the preclinical requirements, following a request from the Medical Education Committee. Students obtain their professional qualifications (Second M.B.) and satisfy other requirements of the General Medical Council by taking Parts IA and IB of the Medical and Veterinary Science Tripos. Students obtain their B.A. Degree by subsequently taking another honours examination. In order to allow our students equal opportunities to those at medical schools elsewhere, the Faculty Board have agreed to remove Schedule B, which outlines and limits the current definition of preclinical study.

11. The Faculty Board recommend:

I. That, for students commencing the clinical part of the course from 1 September 2005, new curriculum regulations be approved for the M.B./B.Chir. Examinations and Degree, as set out in the Annex to this Report.

13 July 2004KEITH PETERS (Chairman)D. H. JONESP. SIKLOS
  M. BOBROW M. LILLICRAP J. SILVERMAN
  J. A. BRADLEY J. P. LUZIO J. G. P. SISSONS
  A. J. CRISP D. MACDONALD D. WOOD
  J. DANESH J. D. PICKARD P. L. WEISSBERG
  A. K. DIXON B. PONDER A. WYLLIE
  I. A. HUGHES

The Council and the General Board make no objection to the recommendations in paragraph 11 of this Report but note that discussions are continuing on the impact on Colleges of the increase in clinical student numbers by approximately 90 students a year as a result of the extension of the Final M.B. course to three full years.

2 August 2004Alison Richard, Vice-Chancellor

ANNEX

Bachelor of Medicine and Bachelor of Surgery

1. These regulations, which shall be known as the New Curriculum Regulations for the degrees of Bachelor of Medicine and Bachelor of Surgery, shall apply to those students who begin their clinical course on or after 1 September 2005.

2. On completing the requisite number of terms1, a student who has passed in Parts I and II of the Final M.B. Examination as prescribed in these regulations shall be qualified to supplicate for the degrees of Bachelor of Medicine and Bachelor of Surgery. The short titles of these degrees shall be M.B., B.Chir.

3. In these regulations unless the context shall require otherwise:

(a)the term Faculty Board shall mean the Faculty Board of Clinical Medicine;
 (b) the term Regius Professor shall mean the Regius Professor of Physic;
 (c) the term instruction shall mean instruction given in the University or elsewhere and may include practical instruction;
 (d) the term approved course shall mean a course approved for the purpose of these regulations by the Faculty Board of Clinical Medicine;
 (e) the term approved courses of clinical instruction shall mean courses or attachments in the subjects specified below which are held in the University or in such hospital, general medical practice, or other institution associated with the University as the Faculty Board may approve for the purpose of these regulations, and which have been approved by the Faculty Board as courses appropriate to a Part of the Final M.B. Examination:
   
for Part I: Pathology and Epidemiology
for Part II:  Medicine and Surgery with Clinical Pharmacology and Therapeutics, General Practice, Public Health Medicine, Paediatrics, and other medical and surgical specialities covered in the curriculum.
 (f) the term year of clinical study shall mean a period of twelve consecutive months (including not more than seven weeks' vacation) during which a student has attended full-time approved courses of clinical instruction as defined in Regulation 3(e).
 (g) the term evidence shall mean:
 (i) in the case of study in another university, evidence signed by a responsible officer of the university concerned;
 (ii) during the period of clinical study defined in Regulation 3(f), evidence signed by the Director of Medical Education or another officer authorized by the Director;
 (h) the term satisfactory attendance shall mean attendance which satisfies the Faculty Board;
 (i) the term satisfactory performance shall mean performance which satisfies the Director of Medical Education or another officer or officers authorized by the Director;
 (j) the term M.B./Ph.D. Programme student shall mean a student who, having been approved by the Faculty Board for admission to a course combining research and clinical instruction in the University, has subsequently been admitted as a Graduate Student by the Board of Graduate Studies;
 (k) the term Cambridge Graduate Course student shall mean a student who holds an Honours Degree of this or a recognized university and has been approved by the Faculty Board for admission to a four-year course in medicine (Cambridge Graduate Course in Medicine).

4. There shall be a Second Examination and a Final Examination for the degrees of Bachelor of Medicine and Bachelor of Surgery, referred to in these regulations as the Second M.B. Examination and the Final M.B. Examination.

5. The Faculty Board, after consulting other bodies concerned, shall have power to issue from time to time supplementary regulations defining or limiting all or any of the Parts, subjects, papers, or sections of the Second M.B. Examination or the Final M.B. Examination. Due care shall be taken that sufficient notice is given of any alteration of such supplementary regulations.

6. Where a candidate for any of the examinations prescribed in these regulations is required by them to produce evidence of instruction or of any other matter, the candidate's entry shall not be considered to have been made earlier than the day on which the Registrary receives that evidence or the last part of it to be submitted.

7. No student shall be a candidate for any subject of the Second M.B. Examination unless he or she has previously satisfied the University's pre-medical requirements. The pre-medical requirements, which shall be determined by the Faculty Board, shall be specified in Schedule A to these regulations; the Faculty Board shall have power to amend that Schedule from time to time as they think fit.

8. The Faculty Board shall have power to grant exemption from all or part of the pre-medical requirements to a student who is deemed by the Board to have attained a satisfactory standard in an examination or examinations approved by the Board for this purpose in an appropriate subject or subjects.

9. The subjects of the Second M.B. Examination shall be as follows:   

Biology of Disease (BOD)
Functional Architecture of the Body (FAB)
Homeostasis (HOM)
Human Reproduction (HR)
Introduction to the Scientific Basis of Medicine (ISBM)
Mechanisms of Drug Action (MODA)
Medical Sociology (MSOC)
Molecules in Medical Science (MIMS)
Neurobiology with Human Behaviour (NHB)
Preparing for Patients (PFP)

provided that a candidate taking the Cambridge Graduate Course in Medicine shall not be examined in the subject PFP.

(a) The examinations in BOD, FAB, HOM, MIMS, MODA, and NHB shall each consist of a written paper of one hour, which shall contain compulsory short-answer questions (Section I), and a practical examination of two hours (Section II).

(b) The examination in HR shall consist of a written paper of one hour, which shall contain compulsory short-answer questions (Section I), and a practical examination of one hour (Section II).

(c) The examination in MSOC shall consist of a written paper of one hour.

(d) The examination in ISBM shall consist of a written paper of forty-five minutes.

(e) The examinations in PFP shall each consist of the submission of records of such course-work done by candidates as shall be specified from time to time by the Faculty Board of Clinical Medicine after consultation with the Faculty Board of Biology.

10. The Second M.B. Examination shall be held as follows:

(a) The examinations in BOD, FAB, HOM, HR, MIMS, MODA, and NHB shall be held twice a year, as follows:

(i) in the Easter Term, on the dates prescribed for Part IA and Part IB of the Medical and Veterinary Sciences Tripos2;
(ii) in September, beginning on the Monday next but one before the first day of the Michaelmas Term.

(b) The examination in ISBM and MSOC shall be held twice a year on the last day of Full Lent Term and on the Monday next but one before the first day of the Michaelmas Term.

(c) Records of course-work for PFP shall be submitted, in accordance with detailed arrangements approved by the Faculty Board after consultation with the Faculty Board of Biology.

11. A candidate for the Second M.B. Examination shall be required to have diligently attended approved courses of instruction appropriate to the subject or subjects to be offered in the examination. The Second M.B. Examination may be taken by an unmatriculated student who has satisfied this requirement and who is certified on behalf of a College to the Registrary to be a bona fide candidate for admission to the College. The Director of Medical and Veterinary Education shall have the authority to waive this requirement in exceptional circumstances.

12. There shall be a Joint Exemptions Committee for the Second M.B. Examination and the Second Veterinary M.B. Examination, which shall consist of:

(a) the Regius Professor (or a deputy appointed by the Regius Professor) as Chairman;
(b) the Director of Medical Education;
(c) one person appointed by the Faculty Board of Clinical Medicine;
(d) the Director of Medical and Veterinary Education in the Faculty of Biology;
(e) two representatives of the Department of Anatomy;
(f) two representatives of the Department of Physiology;
(g) one representative of each of the Departments of Biochemistry, Public Health and Primary Care, Experimental Psychology, Genetics, Pathology, Pharmacology, and Veterinary Medicine.

Representatives of Departments in classes (e)-(g) shall be nominated by the Head of the Department and appointed in the Michaelmas Term each year by the Faculty Board of Clinical Medicine, with the concurrence of the Faculty Board of Veterinary Medicine in the case of veterinary representatives in classes (e) and (f). The Secretary of the Faculty Board (or a deputy) shall act as Secretary of the Committee.

13. The Joint Exemptions Committee shall have power to grant exemption from any subject or subjects of the Second M.B. Examination to a student who has satisfied the conditions of Regulation 11 and who is deemed by the Committee to have attained a satisfactory standard, as prescribed by the Faculty Board, in the appropriate subject or subjects of the Natural Sciences Tripos, or in corresponding subjects taken in an examination for a degree with honours of a university other than Cambridge; provided that for the purpose of granting exemption to a candidate for admission as a clinical student from a university other than Cambridge the Committee may in exceptional circumstances deem a degree other than an honours degree an appropriate qualification. The subjects of the Natural Sciences Tripos which the Faculty Board have agreed to recognize for this purpose, together with the corresponding exemptions, shall be listed in Schedule B to these regulations; the Faculty Board shall have power to amend that Schedule from time to time as they think fit.

14. A candidate who is unsuccessful in the examination in any subject of the Second M.B. Examination shall be eligible for re-examination, provided that except by special permission of the Faculty Board granted in exceptional circumstances

(i) a student who fails to satisfy the Examiners in any subject other than ISBM, MSOC, or PFP shall not be a candidate for re-examination in that subject later than five months after his or her first attempt in that subject;
(ii) a student who fails to satisfy the Examiners in ISBM or MSOC shall not be a candidate for re-examination in that subject later than thirteen months after his or her first attempt in that subject;
(iii) a student whose submission for any course of PFP fails to satisfy the Examiners shall be required to submit a revised report for that course not later than 31 August next following;
(iv) no student shall be a candidate in any subject on more than two occasions in total.

15. The Final M.B. Examination shall consist of two Parts, Parts I and II; Part II shall be divided into five components. Both Parts shall be held in June and December in accordance with the timetable that shall be published by the Board of Examinations, after consultation with the Faculty Board, before the division of the Easter Term each year for the calendar year next following.

16. The Parts of the Final M.B. Examination shall consist of the following components:

Part I: two written papers, one of two hours and one of two hours and twenty minutes, and a practical examination. The Examiners at their discretion may examine any candidate viva voce.
Part II: three written papers, two of three hours and one of two hours, and two clinical examinations.

In order to satisfy the Examiners a student shall produce evidence of a satisfactory performance in the pelvic examination of gynaecological patients.

Candidature for the Final M.B. Examination shall be subject to the restrictions and conditions specified in Regulations 17-21 below.

17. Before taking either Part of the Final M.B. Examination a student shall

(a) have completed the Second M.B. Examination by having passed in, or been granted exemption from, all the subjects thereof, and
(b) have obtained a degree deemed appropriate by the Faculty Board.

18. A student who proposes to be a candidate for either Part of the Final M.B. Examination shall produce evidence of having satisfactorily attended the approved courses of clinical instruction appropriate to that Part. Except by permission of the Faculty Board in exceptional circumstances, and subject to any conditions determined by them, a course of clinical instruction shall not count towards the requirements of the Final M.B. Examination:

(a) if it began more than one month before the student's completion of the Second M.B. Examination, or more than eight years after the student first took any subject in that Examination or an examination leading to exemption from any subject;
or (b) if it began before the student obtained the degree required under Regulation 17(b) above.

19. (a) Subject to the provisions of sub-paragraph (d)(ii) and Regulation 21 below, Parts I and II of the Final M.B. Examination shall be taken separately.

(b) A student shall not be a candidate for the first time for Part I until at least fourteen months have elapsed since the beginning of the student's course of clinical study.

(c) A student who is a candidate for the first time for Part II shall offer all components.
(d) A student shall not be a candidate for the first time for Part II unless
(i) he or she has completed two years and eight months of clinical study in the University or provides evidence of having satisfactorily completed the first eighteen months of the Cambridge Graduate Course in Medicine,
and unless
(ii) the student either has previously passed in Part I or in exceptional circumstances has been granted permission by the Faculty Board to be a candidate for Parts I and II on the same occasion.

(e) Except by special permission of the Faculty Board in exceptional circumstances, no student shall be a candidate for the first time for Part I later than three years after beginning his or her course of clinical study and no student shall be a candidate for the first time for Part II later than five years after beginning his or her or course of clinical study.

20. The following provisions shall apply to M.B./Ph.D. Programme students:

(a) such a student shall not be a candidate for the first time for Part II unless he or she has completed two years of clinical study in the University together with such other part-time clinical study as may be prescribed by the Faculty Board;
(b) except by special permission of the Faculty Board in exceptional circumstances, such a student shall not be a candidate for the first time for Part II later than eight years after beginning his or her course of clinical study.

21. If at the first attempt a student fails to satisfy the Examiners in Part I or Part II or in a component of Part II he or she shall be eligible for re-examination in the relevant Part or component, taking them separately or together, provided that

(a) a candidate for re-examination in Part II
(i) shall already have passed in Part I unless in exceptional circumstances he or she is granted permission by the Faculty Board to be a candidate on the same occasion for Parts I and II or for Part I and a component of Part II;
(ii) shall offer all components of Part II unless he or she has already satisfied the Examiners in one component;
(b) a candidate shall not be re-examined in either Part or in any component of Part II later than two years after his or her first candidature for that Part or that component, except by special permission of the Faculty Board in exceptional circumstances;
(c) if a candidate fails to satisfy the Examiners in either Part or in any component of Part II on two occasions subsequent to his or her first candidature for that Part or that component, he or she shall not be re-examined in that Part or that component again except by special permission of the Faculty Board in exceptional circumstances.

22. For grave cause a student may be required by the Faculty Board to defer taking a Part of the Final Examination until he or she has received the permission of the Faculty Board to do so.

23. The arrangements for the appointment of Examiners shall be as follows:

(a) The Faculty Board shall nominate for each subject of the Second M.B. Examination a Senior Examiner and such number of other Examiners and Assessors as are required to conduct the examination; provided that for sittings of subjects of the Second M.B. Examination held under Regulation l0(a)(i) the Examiners shall be the Examiners appointed for those subjects in the Medical and Veterinary Sciences Tripos.

(b) The Regius Professor shall be an Examiner and Chairman of Examiners for all Parts of the Final M.B. Examination, provided that, on the nomination of the Regius Professor, any Professor who is medically qualified, or any Doctor of Medicine who is a member of the Regent House, may be appointed to deputize for the Regius Professor for the purpose of this regulation. In addition, the Faculty Board shall nominate for Part I and for each component of Part II of the Final M.B. Examination, a Senior Examiner and such number of other Examiners as the Faculty Board may deem sufficient. Such Examiners shall be appointed to serve for the calendar year next following their appointment.

24. The Faculty Board shall appoint for each calendar year such number of persons as they may deem sufficient to act as Collectors and Assistant Collectors of Cases, provided that the persons so appointed shall be not less than three in number and shall include one Physician, and one Surgeon. The Collectors and Assistant Collectors of Cases shall invite such patients and shall make such arrangements as may be required for the clinical examinations in Part II of the Final M.B. Examination.

25. The Examiners and Assessors in each subject or component of each examination shall observe the following requirements:

(a) the Examiners shall be jointly responsible for all the questions set in the written paper and the practical examination (if any) of that subject or component;
(b) no candidate shall be judged to have failed in any subject or component unless his or her work has been assessed by at least two Examiners or Assessors;
(c) two Examiners or Assessors in each subject or component shall both be present at, and shall participate in, the oral examination or the clinical examination of each candidate in that subject or component, and both shall be responsible for the marks allotted.

26. Separate class-lists shall be published for each subject of the Second M.B. Examination and for each Part of the Final M.B. Examination. The names of successful candidates in the several lists shall be arranged in alphabetical order. The list for Part II of the Final M.B. Examination shall indicate the components of the examination in which the candidate has passed. On the occasion of a candidate's first attempt at either Part of the Final M.B. Examination, but not on any subsequent occasion, special merit may be recognized by the award of a mark of merit or distinction in Part I or in Part II.

27. Each Senior Examiner shall communicate to the Registrary the marks of all the candidates for the Part, or component of a Part, or subject, of the examination with which he or she is concerned. The Registrary shall communicate to Tutors or other designated College officers, for transmission to their pupils, the marks of their pupils and such other information as may be considered advisable.3

SCHEDULE A

Pre-medical Requirements

See New Regulations, p. 434.

SCHEDULE B

Exemption from subjects of the Second M.B. Examination

A student shall be entitled to exemption from a subject of the Second M.B. Examination if he or she is deemed by the Joint Exemptions Committee to have attained a satisfactory standard, as prescribed by the Faculty Board of Clinical Medicine, in one of the corresponding subjects of the Natural Sciences Tripos, as shown in the following table:
Subjects in Second M.B. ExaminationSubjects in Tripos Examinations
Biology of Disease Natural Sciences Tripos, Part IB, Pathology;
 or Natural Sciences Tripos, Part II (General), Pathology.
Mechanisms of Drug Action Natural Sciences Tripos, Part IB, Pharmacology;
 or Natural Sciences Tripos, Part II (General), Pharmacology.
Molecules in Medical Science Natural Sciences Tripos, Part IB, Biochemistry and Molecular Biology;
 orNatural Sciences Tripos, Part II (General), Biochemistry and Molecular Biology.

Appendix 1

The Faculty Board of Clinical Medicine have approved the following supplementary regulations for the subjects of the Second and Final M.B. Examinations (New Curriculum).

SUPPLEMENTARY REGULATIONS

Second M.B. Examination

Biology of Disease (BOD)

The examination in BOD will be treated from the standpoint of abnormal biology. It will include the variations that may occur in the structure and functions of living cells, tissues, and organs, together with the biology of parasites, bacteria, and viruses. Section I will consist of compulsory short-answer questions on the lecture material. Section II will consist of a two-hour practical examination which will include laboratory work and questions on practical aspects and problem solving.

Functional Architecture of the Body (FAB)

Section I will consist of compulsory short-answer questions on tissue anatomy, aspects of organogenesis, the topographical, functional, and applied anatomy of the human body. Section II will consist of a practical examination and will cover similar aspects.

Homeostasis (HOM)

Section I will consist of computer-marked and short-answer questions on nerve and neuromuscular transmission, muscle, autonomic nervous system, cardiovascular system, respiration, kidney, salt and water balance, digestion, absorption, and temperature regulation. Section II will consist of questions on the practical work in experimental physiology and histology.

Human Reproduction (HR)

Section I will consist of compulsory short-answer questions and Section II will consist of practical questions.

Introduction to the Scientific Basis of Medicine (ISBM)

The examination will consist of compulsory short-answer or computer-marked questions on the ISBM course.

Mechanisms of Drug Action (MODA)

Section I, which will include or consist entirely of short-answer questions, will require knowledge of the actions of drugs on whole organisms and mammalian systems, and also of the mode of drug action at the cellular, subcellular, and molecular levels. Section II will consist of a practical examination, which will include questions on data handling and problem solving; laboratory work will not be involved. Questions that require an elementary knowledge of statistical procedures may be included in both sections of the examination.

Medical Sociology (MSOC)

The written paper will require knowledge of medical sociology.

Molecules in Medical Science (MIMS)

The examination will test knowledge and understanding of the material contained in the MIMS course. Section I will consist of short-answer questions on the lecture. Section II will consist of questions on practical aspects, including interpretation and handling of data.

Neurobiology with Human Behaviour (NHB)

The examination in NHB will require knowledge of the structure and functions of the central nervous system and the special sense organs, neuroanatomy, experimental psychology and some of its applications to medicine. Particular topics will include neuropharmacology; learning and memory; perception and information processing; intelligence and development; emotion and its physiological basis; and social psychology. Section I will include or consist entirely of compulsory short-answer questions. In Section II, candidates will be examined on practical aspects of neuroanatomy and in experimental neurophysiology; questions may be included which require an elementary knowledge of statistical procedures.

Preparing for Patients (PFP)

Each candidate shall submit to the Examiners such written work for each strand of Preparing for Patients as shall be required by the Faculty Board of Clinical Medicine.

Final M.B. Examination

Part I. PATHOLOGY

The examination in this part will be concerned with the application to human disease of the principles of pathology. It will cover morphology and clinical aspects of pathology, including haematology, microbiology, chemical pathology, epidemiology, and preventive medicine. There are two written papers; one paper will consist of multiple part objective questions and one will consist of essay questions.

Part II

The examination in this Part will be concerned with the principles and practice of medicine and surgery with clinical pharmacology and therapeutics, general practice, public health medicine, paediatrics, and other medical and surgical specialities covered in the curriculum. The examination will be designed to assess the candidate's knowledge and experience of medicine and surgery in their widest sense; her or his ability to apply that knowledge and experience to the management of patients; her or his ability to communicate effectively with patients and to respect their autonomy; and her or his experience of ethical problems in clinical medicine.

The examination will consist of five components testing all areas of the curriculum:

Component 1 will consist of no fewer than 100 multiple choice questions covering factual knowledge and its application in a clinical context.

Component 2 will consist of no fewer than 25 extended matching questions covering application of knowledge and clinical problem solving skills.

Component 3 will consist of not less than five short structured-answer questions covering written communication skills, ethics, and law in clinical medicine.

Components 4 and 5 will be clinical examinations in which students will be assessed on their clinical performance; Component 4 will consist of not less than 10 stations covering clinical history-taking, clinical reasoning, and interpersonal communication skills; Component 5 will consist of not less than 18 stations covering clinical examination and practical skills.

Appendix 2

Subject to the approval of the recommendations of paragraph 11 of this Report, the General Board, on the recommendation of the Faculty Board of Clinical Medicine have amended the Revised Regulations for the degrees of Bachelor of Medicine and Bachelor of Surgery (Statutes and Ordinances, p. 437) with effect from 1 September 2005, as follows:

Regulation 1

By amending the regulation so as to read:

1. These regulations, which shall be known as the Revised Regulations for the degrees of Bachelor of Medicine and Bachelor of Surgery, shall apply to
(a) those students who begin their clinical course any time between 1 September 2003 and 31 December 2004,

and

(b) those students who begin their clinical course any time between 1 September 2002 and 31 December 2004, having undertaken not more than two years of preclinical medical study in the University.4

1 See Statute B, III, 5, and 9; terms kept or allowed before beginning the years of clinical study shall count for this purpose.

2 In this sitting of the Second M.B. Examination the papers set are Sections I and II of the papers set in the corresponding subjects of Part IA and Part IB of the Medical and Veterinary Sciences Tripos. See Regulations 16 and 21 for that Tripos.

3 See also the regulations for the disclosure of examination marks, p. 217.

4 That is having taken Part IA and Part IB of the Medical and Veterinary Sciences Tripos as Affiliated Students.