that may not be relevant to their first years in clinical practice, however this has more to do with curriculum design and course structure than teaching method. both lecture-based learning and problem-based learning may involve teaching from academics who are not medically qualified themselves. one meta-analysis has suggested that pbl education produces graduates with no better factual or clinical knowledge than students from a lecture-based course, despite in some cases the graduates' belief that they are, questioning whether pbl learning is merely a popular trend. course structure undergraduate medical curricula can be divided on the basis of how they integrate or separate the theoretical learning in areas such as anatomy, physiology, ethics, psychology and biochemistry from the clinical areas such as medicine, surgery, obstetrics, paediatrics. traditionally, medical courses entirely split the theoretical learning, teaching this on its own for 2–3 years in a pre-clinical course before students went on to study clinical subjects on their own for a further 3 years in a clinical course. in some cases, these were taught at geographically distinct sites or even separate universities, with an entirely separate staff for each course, sometimes with the award of a ba or bsc at the end of the pre-clinical course. st andrews, cambridge and oxford universities are three of the most traditional pre-clinical medical schools- for example, the cambridge first year of the medical sciences tripos is split into anatomy, biochemistry and physiology. whilst there is a nominal "preparing for patients" aspect to the course when the students speak to real patients, this comprises a total of three afternoons over the entire year. there has been a move for universities have tended to integrate teaching into "systems-based teaching" rather than "subject-based teaching". e.g. rather than studying separate distinct modules in anatomy, physiology, ethics, psychology and biochemistry, students study distinct modules in different body systems, e.g. "heart and lungs" or "nervous system" - during which they will study the anatomy, physiology, biochemistry, psychology, etc. relevant to that system. the same also has happened with clinical subjects, so for example rather than studying "medicine" and "surgery" separately, students may have a "heart" module in which they study clinical cardiology and cardiothoracic surgery together. in some medical schools there is integration of clinical and pre-clinical subjects together - e.g. a "heart" module would include anatomy of the heart, physiology of the heart, clinical examination, clinical cardiology and cardiothoracic surgery being studied in one module. since tomorrow's doctors, there has been a move in the uk towards integrating clinical and non-clinical subjects together to a greater extent. this has varied considerably between universities, always with an emphasis towards non-clinical subjects towards the start of the course and clinical subjects towards the end. a variety of models are in operation. any model may use pbl or lbl learning methods: for example manchester has a pbl-based curriculum but a strong pre-clinical/clinical divide, whilst brighton and sussex medical school has a more integrated curriculum, delivered via a lecture-based programme. many factors influence the choice of model, including the educational philosophy of the institution and the distance of the attached teaching hospitals to the university base (it is much easier for universities with teaching hospitals nearby to offer an integrated curriculum). models include: 2/3+2+1 (london, st andrews, edinburgh, oxford and cambridge) 2/3 year pre-clinical course in which predominantly non-clinical subjects are studied, with occasional day or half-day "early experience" events where students will visit a hospital, a general practice or visit a family in their home. reference to clinical application of knowledge may be made, but little interaction with patients at this stage. exam at end of this in pre-clinical subjects only. 2 years clinical subjects studied 1 year "preparing for practice" where students will consolidate knowledge, go on elective attachments, sit finals exams with emphasis of finals on clinical subjects 1+3+1 1 year basic introduction to general principles of pre-clinical subjects 3 years combination of pre-clinical and clinical teaching with a ratio of 1:2 nonclinical:clinical subjects, often taught in systems-based "blocks" - 'e.g. 4 weeks studying anatomy and physiology of heart followed by 8 weeks studying clinical cardiology' 1 year consolidating knowledge, elective attachments, sit finals exams - often integrated exams incorporating clinical and non-clinical testing 1+2+2 (e.g. cardiff) 1 years studying basic principles of pre-clinical subjects 2 years studying pre-clinical and clinical subjects with equal weight given to both, again in system based blocks 'e.g. 6 weeks studying anatomy and physiology of heart followed by 6 weeks studying clinical cardiology' 2 years predominantly clinical teaching and consolidation of knowledge, during which time electives and finals exams will occur support for a less integrated course includes that it achieves a basic scientific foundation from which to build clinical knowledge upon in later years. however it is criticised for producing graduates with inferior communication skills and making transition into the clinical environment more difficult in year 3 or 4. support for a more integrated course includes that by allowing patient interaction early, the course produces students who are more at ease with communicating with patients and better developed interpersonal skills. criticisms include, questioning whether students in the first year have a place in the healthcare environment, when actual clinical knowledge may be virtually nil. tomorrow's doctors also led to the introduction of significant student choice in the syllabus in the form of student selected components. immediate post-graduation period after graduation medical students enter paid employment, as a foundation house officer (fho), during which they will complete the first year of foundation training. foundation training focusses on the seven principles of the mmc training ethos: trainee centred, competency assessed, service based, quality assured, flexible, coached, and structured & streamlined. graduates are still a year away from obtaining full registration with the general medical council. during this year trainees are legally only able to work in certain supervised jobs, as a foundation house officer 1 (fho1), and cannot legally practise independently, and it is the responsibility of the medical school they attended to supervise this year until they are fully registered with the general medical council. students in their final year will begin the process of applying for jobs. the new system, called the uk foundation programme, (implemented by the nhs modernising medical careers) involves a simplified online application process, without interviews, based on a matching scheme. students rank their preferred foundation schools (which often comprise a catchment area of two or three cities). they are ranked based both on the answers given on their application form, and their marks gained in examinations during their undergraduate career, the resulting score determines which job the student will get when they graduate. after being selected to a foundation school, applicants are then selected into specific jobs by a selection procedure determined locally by each foundation school, which may include an interview, submission of a cv or use of the score gained in mtas. previously, another online system called multi-deanery application process (mdap) system was used for applications to the foundation programme in some areas of the uk. this was criticised in the media and in some medical publications, and was replaced by medical training application system in 2006. graduate entry programmes recently several four year graduate entry schemes have been introduced in some english and welsh medical schools which cover a similar range and depth of knowledge to the undergraduate scheme but at a more intensive pace. the accelerated pace is largely in the pre-clinical phase of the medical programme, with the gmc mandating a minimum number of clinical hours in the clinical phase of medical degrees. these courses have a limited number of spaces and include some funding after the first year, so competition is very high. some sources report in the region of 60 applicants for each place as these courses have become more widely known. until relatively recently, people over thirty were strongly discouraged from applying. entrance to these programmes usually involves sitting a competitive selection test. the most common entry examinations are the gamsat (graduate australian medical schools admissions test) or msat (medical schools admissions test). some schools may use existing entrance examinations that school leavers are also usually required to take e.g. ukcat or bmat (see above). the admissions criteria for these graduate entry programmes vary between universities - some universities require the applicant's first degree to be in a science-related discipline, whereas others will accept a degree in any subject as sufficient evidence of academic ability. the following universities offer four year graduate entry programmes: university of bristol university of cambridge (candidate may offer bmat) cardiff university university of dundee (as part of scottish graduate entry medicine) (require ukcat and gamsat) keele university (require gamsat) king's college london (require ukcat) university of leicester (last entry september 2014) (require ukcat) university of liverpool (require gamsat) newcastle university (require ukcat) university of nottingham (require gamsat) university of oxford (require bmat) barts and the london, queen mary's school of medicine and dentistry (require ukcat) university of southampton (require ukcat) st george's, university of london (require gamsat) bute medical school (st andrews) (as part of scottish graduate entry medicine) (require ukcat and gamsat) swansea university (require gamsat) university of warwick (require ukcat) imperial college london (require bmat) however, graduates are free to apply to some of the regular five/six year courses. indeed, universities offering both graduate entry and school leaver entry courses often encourage applications to one of the two course types, depending on the graduate's educational background. intercalated degrees some medical students spend one or two additional years at medical school (lengthening a five-year course to six or seven years) studying for an intercalated degree. this is an extra degree awarded in addition to their medical degrees, giving the student the opportunity to gain an extra qualification, and aids students' research and individual study skills. at the end of this intercalated year or two students are awarded a degree, which is variously styled as bsc, ba, msc, bmsc (hons), bmedsci(hons), ma, mph, mclined depending on the university, level of award, and subject studied. usually students complete an intercalated bachelor's degree the year after completing the second or third year of their medical course. master's degrees are offered at some schools for students who have completed the fourth year of their medical course. higher research related masters and academic doctorates are typically undertaken at the end of the fifth year of the course. there is typically strong competition to secure funding from external institutions such as pharmaceutical companies, as such research related intercalated degrees may be in an area the student has little long-term interest, a frequent criticism. the major benefit of an intercalated degree is the increased chance of selection to competitive training routes such as academic medicine or surgery. the way the programme is implemented varies across the country: sometimes the intercalated degree will be specifically for medical students (e.g. a supervisor-led research project culminating in a dissertation), whilst sometimes the intercalated student will complete taught courses offered to final year bsc or masters students, or a combination of these. at some medical schools the intercalated degree may be undertaken in a specific subjects (e.g. immunology, pathology, cardiovascular science, respiratory science, social medicine, management, history of medicine, humanities etc.), whilst at other medical schools there is a common curriculum for all intercalated students (often with some choice within it). at many medical schools, the year is optional, and a relatively small percentage of students elect to study for it. at the university of nottingham, all students undertake a research project and dissertation under the supervision of schools within the faculty of medicine and health sciences, leading to a bmedsci (hons) degree in the third year. whilst this additional degree is uniquely awarded within the five-year period of study, nottingham medical students undertake heavily extended third and fourth years of up to 48 weeks in order to accomplish both the bmedsci and early clinical training. in contrast to this, all students at university college london, imperial college london, bute medical school (st andrews), university of oxford, university of edinburgh and university of cambridge study for a bsc/ba in addition to their medical degrees. these five medical schools have a six-year curriculum, in which students complete a three-year pre-clinical course, which leads to a bsc or ba, followed by a three-year clinical course, which in