Life Cycle: integrated,interactive and relevantlearning for medicalstudentsNigel Simpsonon behalf of the Life Cycle Course Management Team,* University of Leeds*Sue Thomas, Mark Bradley, Georgia Testa, Pat McConnell, Michael Rivlin

‘The hungry sheep lookup and are not fed’(John Milton, Lycidas)

Milton wrote these wordsdecrying the idle and ineffectualpreachers of his time, but theyshould be a continuing spur toall teachers now. How do weenthuse and inform the keen,enquiring and (increasingly)postmodern student mindeffectively? The societal andglobal landscape presents a cur-riculum far beyond conventionalboundaries. This was recognisedclearly in Tomorrow’s Doctors,1

which called for a fundamentalchange in medical education. Yet

attempting to meet these com-peting demands has often led tolopsided and (for both studentsand their teachers) trying andirrelevant content. Knowledge inisolation is both unappealingand unhelpful, but effectiveintegration requires innovationand imagination. This paperdescribes one approach to thesechallenges: directing studentstowards the required tools, andtraining them in their use.

THE LIFE CYCLE MODULE

Life Cycle is a 10-week moduleundertaken at the beginning ofthe third year, as part of the new

medical curriculum at the Univer-sity of Leeds. A multi-professionalgroup of scientists, nurses, clini-cians, midwives, counsellors andethicists devised the module, andrevise it continuously followingconsultation with examiners and,most importantly, the medicalstudents themselves. As themodule’s name implies, it sets outto explore key life events (seeTable 1) in the context of con-temporary practice. The overallaims of the module are to enablestudents to:

• Understand the basic mecha-nisms governing reproduction,growth, development, adoles-cence, ageing and death

Students learnhow to careappropriately

Teachingmethods

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• recognise the applications ofthese principles in differingclinical settings

• be conversant with the legal,ethical, social and culturalissues within each clinicalsituation

THE ‘FAMILY TREE’ MODEL

The focus of the module is afamily tree (see Figure 1) whichweaves together a range of situ-ations, ages, infirmities and rela-tionships that serve as thebackdrop to each clinical scen-ario. In other words, it representsthe story behind every clinicalencounter met in practice, andlends credibility to the decisionsmade in each consultation. Eachcharacter in the family tree isprovided with biographical detailexplaining his or her position andsociocultural situation. Clinicalscenarios are drawn from thisfamily tree to illustrate thedilemmas posed in each of the keylife events. The intention is helpstudents to develop flexible, hol-istic approaches to practice.

Through a structured programmethey learn to break down a clinicalscenario into four principallearning areas:

• The basic science underpin-ning the case

• Clinical and pathologicalissues arising from thehistory, examinations andinvestigations

• Attendant social and culturalaspects

• The contemporary legal andethical framework

They then assess the situationas a whole in order to make thebest possible decisions. In thisway students learn how to careappropriately for a varying groupof patients: a couple trying tocope with infertility; the parentsof a premature baby; a teenagerwith anorexia; a family whosemother has dementia; and animmigrant with terminal cancer.The family tree allows for a num-ber of cases to be developed foreach life event, so the basicscenarios can be rotated from yearto year (see how the programmeoperates at http://www.histol-ogy.leeds.ac.uk/icu4/ (accessed08 November 2006)).

TEACHING AND LEARNINGOPPORTUNITIES

The scenarios are discussed andreviewed in small groups, eachgroup having 20 students and twotutors: one a clinician and the

other a philosopher with a par-ticular interest in ethics. For eachscenario, the group initially meetsto discuss the information pre-sented, and to define the relevantpoints within each of the fourlearning areas that need to beunderstood in greater detail. Fol-lowing this, the group splits intofour predefined subgroups, eachof which takes responsibility forexamining one of the four areas.The subgroup works as a team tocollate the information requiredand present it to the whole groupthe following week, usually in theform of a PowerPoint presenta-tion. These presentations may besupplemented by role-play, gamesand other approaches chosen byeach subgroup. Between theweekly group meetings, tutorsmake themselves available totheir groups to discuss areas ofuncertainty or to provide direc-tion. Each group has a securenetworked environment withinthe virtual Bodington Commonwebsite (http://vle.leeds.ac.uk),where discussion rooms for eachgroup may be found.

By working in this way, severalkey aspects of learning are pro-moted: self-direction, suitablysupported by appropriate coreteaching, facilitation andresources; team-working andaccountability; pastoral over-sight; assessment and feedback;reflection and revision wherenecessary; and information dis-semination. These scenarios aretherefore the backbone of the LifeCycle module, and supportingeach of them are a range ofteaching and learning opportun-ities to help students applyappropriate knowledge. A well-defined programme of themedsessions, small-group workstationsessions, practical work and lec-tures provide variety in learningand approach for each key lifeevent (as an example, see Table 2,which shows the Childbirth work-stations). There is an emphasis onseeing the clinician as workingmost effectively within a health

Figure 1. Life Cycle family tree.

Table 1. Key life events

• Reproduction

• Pregnancy

• Childbirth

• Infancy

• Adolescence

• Ageing

• Death and dying

Several keyaspects of

learning arepromoted

230 � Blackwell Publishing Ltd 2006. THE CLINICAL TEACHER 2006; 3: 229–232

care team; and students aretaught by allied professionalssuch as occupational therapists,dieticians, speech and languagetherapists, midwives and special-ist nurses. On occasion, such as inpalliative care, a team will presenttheir roles and approach as anintegrated unit. Particular care is

taken to ensure that the teachingsessions are pertinent to thetheme addressed at the time andto the clinical scenario. A practi-cal approach is used where poss-ible, enabling students toexamine and handle equipmentand devices used by various pro-fessionals (such as obstetric for-

ceps, glucose monitors andwalking aids) well ahead of theiruse in the clinical setting.

Halfway through the module,there is an opportunity to providemutual feedback. Each studenthas a private meeting with his/her small-group tutors; individualapproaches and performance arediscussed informally, and anyrelevant pastoral issues are re-viewed. Each student also com-pletes an anonymous feedbackform rating specific areas of thecourse, and free text boxes on theform allow for further feedback.This mid-session break enablesissues to be dealt with well aheadof the summative assessment atthe end of the module.

PORTFOLIO OF CLINICALSCENARIOS

A major part of the summativeassessment is the portfolio of theeight clinical scenarios each stu-dent compiles. It comprises threeparts:

• A precis of each of the eightcase studies

• Four critical evaluations – onefrom each of the learningareas of basic science, clin-ical/pathological, social/cul-tural and legal/ethical

• A reflective commentary onthe overall learning process

Contemporaneous assessmentsof each of the eight in-course oralpresentations by the tutors alsocontribute to the final portfoliomark.

The precis of each case studyis intended to provide ‘a concisesummary of the essential points,statements, or facts’. To avoidlengthy explanations and toensure that relevant aspects areincluded, these are presented foreach learning area, each on asingle side of A4 (the recommen-ded format is downloadable fromthe Life Cycle website). Summa-rising clinical situations by

Table 2. Childbirth workstations

• Normal labour and delivery

• Abnormal labour and instrumental delivery

• Analgesia and anaesthesia in labour

• Neonatal adaptation and resuscitation

• Breastfeeding

Each workstation lasts 20 minutes and has a variety of hands-on props,devices and instruments. The small groups rotate around the workstations.

They havediscovered newways of findinganswers

� Blackwell Publishing Ltd 2006. THE CLINICAL TEACHER 2006; 3: 229–232 231

extracting pertinent details is aday-to-day skill that is invaluablein medical practice, and relayingaccurate and concise informationto colleagues and co-workershelps to ensure better outcomesfor patients. The point is madethat this is accomplished mostcourteously through prose ratherthan via a collection of bulletpoints, and the marking guide-lines reflect this. Students oftenfind this the most difficult aspectof portfolio compilation.

Each of the four critical eval-uations represent one of the fourlearning areas, and each mustcome from a different scenario.This allows a more in-depthappraisal of the issues considered,but each evaluation is limited totwo sides of A4. Again, relevanceto the case is very important, soexplanations developing or defi-ning evidence of why particulartreatment options or ethicalprinciples are preferred over oth-ers are rewarded. Diagrams, flow-charts, references and links maybe used, if they illuminate thetext.

Finally, a single-sided A4sheet of reflective commentary issubmitted. This is intended todetail individual progressthroughout the module in thisform of self-directed learning. Onoccasion, students may feel thishas been limited (but areencouraged to try to explainwhy!). Usually, they have discov-ered new ways of finding answersor deriving relevant questions.

They typically record fresh in-sights about small-group working;and not uncommonly have learntnew presentation or IT skills. Themain purpose of the reflectivecommentary is to discern whatmethods or styles appear to haveworked best for the students.

APPRAISAL OF THE LIFECYCLE MODULE

So how has Life Cycle itself beenappraised? Across its 10-weekspan it fulfils over half of all thekey UK General Medical Council(GMC) recommendations and cur-ricular outcomes outlined inTomorrow’s Doctors. The 2005 GMCvisiting team had an opportunityto examine its approach andcontent as part of the new curri-culum in Leeds. In its summaryreport, the GMC congratulated theSchool on the ‘integrated natureof teaching in the Year 3 LifeCycle [module]’ and ‘commended[its] multi-disciplinary aspectsand integrative approach toteaching’.2

Tutors on the course enjoy theclose interaction with students,the variety of approaches, and themultifaceted nature of the subjectmatter. However, as courseorganisers we are aware of certainlimitations: for example, studentsdo not meet any real patients(although the Patient Evaluationmodule that runs alongside bal-ances this); we depend on anextended commitment from tutorsoutside their contracted time for

the effective care of their smallgroup (although this time isinvariably given willingly); andportfolio marking is always anintensive schedule at the end ofthe module. Concerns regardinginternal variation in marking havebeen resolved mainly through theexplanation and use of a clearmarking grid, and the doublemarking of work from high- andlow-scoring students.

What of the students? Thereare occasional comments aboutthe intensive nature of the courseand the desire for less work but itis rare for time extensions to berequested. In general, feedback ispositive; the last five years haveseen course approval ratings con-sistently exceeding 95%, withtypically favourable responses(see Table 3).

CONCLUSION

In summary, Life Cycle providesa coherent approach to medicalpractice characterised by a syn-optic approach to clinical situa-tions, promoting multi-professional awareness andinvolvement. It enables inde-pendent learning, and thedevelopment of generic skillswithin a teaching fabric thatdemonstrates clear vertical andhorizontal integration and, mostimportantly, is delivered witheffective pastoral oversight. Wehope that even Milton wouldhave approved.

REFERENCES

1. General Medical Council. Tomorrow’s

Doctors. London: General Medical

Council, 2003. PDF version may be

downloaded from http://www.gmc-

uk.org/education/undergraduate/

tomorrows_doctors.asp. Accessed

08 November 2006.

2. General Medical Council. Report of

the visiting team to the University

of Leeds Medical School (2005).

The report may be viewed or a PDF

accessed at http://www.gmc-uk.

org/education/qabme/visits.asp.

Accessed 08 November 2006.

Table 3. Students’ comments

‘…very interesting and stimulating…’

‘…feels very relevant to future medical practice and challenges mythoughts…’

‘…well integrated, well run and very interesting…’

‘…case study sessions … great way of learning, really well structured…’

‘…I feel that the presentations are very useful for building confidence…’

‘…case study sessions very good, well organised … good to have ethical andclinical facilitators … and time in lessons to discuss other current issuesthat may be relevant…’

Tutors enjoy theclose

interaction withstudents

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