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The University of St Andrews School of Medicine (formerly the Bute Medical School) is the school of medicine at the University of St Andrews in St Andrews, Fife, Scotland and the oldest medical school in Scotland. The medical school offers several programmes to students, the BSc (Hons) in Medicine program teaches medical students for the first three years of their training, with students completing this training, earning their MB ChB/MBBS at various partner medical schools in the UK in a pre arranged fashion. From September 2025 onwards, a 5 year MB ChB will be offered with a particular focus on community healthcare. The school also offers a 4 year graduate entry medical program in combination with the University of Dundee, awarding a joint MB ChB from the University of St Andrews and Dundee. The school is associated with 1 Nobel Prize and 2 Victoria Cross winners. Famous alumni include small pox vaccine pioneer Edward Jenner, revolutionary journalist Jean Paul Marat, and inventor of beta blockers and H2 receptor antagonists, Nobel Prize in Medicine winner Sir James Black.

Medicine was the third subject to be taught at the University of St Andrews, at St Salvator's College and later the United College of St Salvator and St Leonard. Bishop Kennedy founded St Salvator's College in 1450, confirmed by a papal bull in 1458. From the 17th to the 19th centuries, medical degrees from St Andrews were awarded by an early version of distance learning. The university awarded the degree of MD to individuals who were usually already established in medical practice, the first being conferred in 1696. This degree was awarded on the basis of a testimonial written by a supervisor, and a fee was paid to the university. The whole process was conducted through the post, and the candidate did not have to visit the university. Recipients of the MD at this time include the French Revolutionary, Jean Paul Marat (1743–1793), who obtained his MD in 1775 for an essay on gonorrhea, and Edward Jenner (1749–1823), who developed the first smallpox vaccine, and was awarded the MD in 1792. In 1721, the chancellor of the university, James Brydges, 1st Duke of Chandos, established the Chandos Chair of Medicine and Anatomy, to fund the appointment of a Professor of Medicine and Anatomy at the university, and Thomas Simson was appointed as the first Chandos Professor. The Chandos Chair still exists, although it has now become a chair of physiology. In the early 19th century, examinations were introduced. Students had to visit St Andrews to sit them, but there was no teaching at the university.

In 1897, as Rector of the University of St Andrews, the 3rd Marquess of Bute, in addition to his provident restorations of other university buildings, initiated the construction of the current Bute Medical Buildings, south of St Mary's College, completed in 1899. The buildings, much added to and modified, especially after a gift from Andrew Carnegie, built labs to the north (now the Carnegie Building). These provided for the establishment of a regular medical school, which both taught and examined medical students. The 3rd Marquess of Bute also provided for the establishment of a new chair of medicine—the Bute Chair of Medicine.

In order to continue to be able to offer access to a medical degree, St Andrews established a new link with the English Victoria University of Manchester in 1970, which was at that time seeking to enlarge its medical school. Students completed a three year BSc in medical science at St Andrews, and could optionally complete an extra intercalated year for the award of BSc Hons at St Andrews, before completing their clinical training at the University of Manchester, with the final MBChB awarded by Manchester. Between 2002 and 2006 there was also the ‘option’ (mostly allocated on a compulsory basis) of completing clinical training at Keele University Medical School in Stoke on Trent, and annually around twenty St Andrews graduates went to Keele University. This option no longer exists for students.

Major changes to the curriculum were made in 2000 with increased emphasis on psychology and cellular biology, with the introduction of a two year course in cellular and molecular medicine and a three year course in behavioural sciences. Further curriculum changes took place in 2004, with a reduction in the amount of teaching but the introduction of a research project into the final year, allowing for an honours degree to be attained after three years' study, and therefore since September 2005, the University of St Andrews has offered a Bachelor of Science with honours in Medicine (BSc Hons Medicine).

St Andrews uses the multiple mini interview format, an interview system first developed by McMaster University Medical School which exposes applicants to several interviews of shorter time, exposing the applicant to more interviewers and reducing the chance that one bad or good interview determines the applicants success at gaining admissions.

The BSc (Hons) programme is three years long; on graduating from St Andrews, students will progress to one of the university's partner medical schools in Scotland or England for a further three years. Partner medical schools include Aberdeen, Barts, Dundee, Edinburgh, Glasgow and Manchester. Applicants who are ‘overseas’ for fee purposes will progress to the Medical School at Manchester. The school also runs the Scottish Canadian Medical Programme jointly with Edinburgh and the University of Alberta Faculty of Medicine and Dentistry for Canadian students. At the end of the six year programme, students will have completed their training as a doctor and graduate with MBChB/MBBS.

In the first year of the course, the modules provide a scientific foundation for clinical practice. Students also commence communication and clinical skills training, alongside patient interaction, which continues throughout all three years.

The Honours programme, which runs through both second and third year, focuses in detail upon the normal function and dysfunction of specific physiological systems. Students attend a range of community based clinical placements.

ScotGEM is an intensive four year graduate entry medicine programme run by the universities of St Andrews and Dundee in collaboration with four health boards: NHS Fife, Tayside, Highland and Dumfries and Galloway. The course is led for first and second year by the University of St Andrews and in third and fourth year by the University of Dundee. The course focuses on rural medicine and healthcare improvement with students living and studying in rural areas from second year onwards. The course undertook its first cohort of students in 2018 with the intention of graduating students in September 2022 and awarding a joint degree from the University of St Andrews and the University of Dundee.

In 2002 the Scottish Parliament passed the University of St Andrews (Postgraduate Medical Degrees) Act 2002 which re instated the university's right to award the postgraduate research degree of Medicinae Doctor (MD) to students who have completed two years of full time or up to 5 years of part time research, which had been removed by the Universities (Scotland) Act 1966. The first MD since 1967 was awarded in 2004.

The University of St Andrews’ new Medical and Biological Sciences Building brings together the medical school (relocated from the Bute Building), biologists, physicists and chemists, while also linking to the School of Physics and Astronomy via a first floor bridge—making it one of the first medical schools in the UK to fully integrate research facilities across the sciences. The School, which has been built at a cost of £45m, contains research laboratory space, as well as teaching facilities and a lecture theatre.

Over recent years, many medical societies have been developed, alongside the historical Bute Medical Society, to help incorporate the clinical aspects into the course—one which was traditionally science based only. These societies include Surgical, Clinical and Preventative medical societies.

The Bute Medical Society was founded in 1915, by its first president Margaret Shirlaw, with the support of Miss Mildred Clark, Calum McCrimmon, Clive Mackie Whyte, Cecily Thistlewaite, Mary Ellison and W. G. Robertson. The initial aim of the society was to hold clinically oriented lectures that the students could attend voluntarily. This tradition still continues today with the society's bimonthly 'cheese and wine' evening. As an independent, non profit organisation it is still run entirely by medical students, supported by some sponsorship. Fundraising events held throughout the year also enable the society to contribute to charities.

In 2009, a small group of students set up the university's first surgical interest society. Since then, a multitude of lectures, skills workshops and anatomy revision tutorials have been run by the society and it continues to grow in size. The Robert Walmsley Lecture was created in 2011 as a yearly event held in the old Bute Buildings to commemorate this previous setting of the teaching of medicine in St Andrews; the inaugural lecture was delivered by David Sinclair.

St Andrews undergraduate medical students are members of the United College of St Salvator and St Leonard, and as such wear the scarlet gown with burgundy velvet collar for official academic occasions. They graduate as a BSc or BSc (Hons) and so wear a black gown with a fuchsia hood trimmed with white fur. On graduation from Manchester they are entitled to wear a black gown with scarlet hood trimmed with white fur, and black cap. When postgraduate students graduate with the MD degree, they wear a black gown with a crimson hood with a white lining, alternatively they may wear a crimson gown.

In 2010 the Bute Medical School of the University of St Andrews, where Black had studied his initial degree in medicine, unveiled that an honorary 'Sir James Black Chair of Medicine' would be created. This post remained unfilled for the remainder of the academic year 2009–2010. In September 2010 the first Chair of Medicine at the ancient University was given to Professor Stephen H Gillespie MD, DSc, FRCP (Edin), FRC Path, leaving his post as Professor of Medical Microbiology at UCL.

In 2012 the Bute Medical School of the University of St Andrews, appointed Prof. David Harrison to the John Reid Chair of Pathology, leaving his previous post as the Head of Division of Pathology in the University of Edinburgh. He remains an Honorary Consultant Pathologist in Lothian University Hospitals Division and Director of the Breakthrough Research Unit, Edinburgh.

The current holder of this chair appointed in 2013 is Prof. Will Stones