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Year Guide: Third Year


Adapted from the 2006 Guide by Joe Manjaly

Welcome to Year 3Year 3 will come as a long-awaited breath of fresh air for many people. If you’ve just intercalated, it may come as even more of a relief. It’s the first time where you really start to feel like you’re doing what you first applied to med school for in the first place. I for one, enjoyed the daily donning of a smart shirt and tie with a cool belt to match – the ladies in their 80s loved it.

Seriously though, 3rd year can be great if you make it work for you. You are given the freedom to hone your skills of history-taking and examination without the pressure of needing to know huge amounts of knowledge.

You may find that it’s also a year where you can afford to really get stuck into your wider interests without having to worry that you’re not having enough time for work, so don’t miss the opportunity.

Work-wise, I felt that I made quite a slow start, as I just didn’t have an idea of what I really ought to know, what was the best way to spend work time, and where were the best sources of gaining the required knowledge. Hopefully these tips will be useful in getting you a little ahead of the game.

They are just opinions though, not the gold standard – but my biggest piece of advice is this: talk to as many people as possible – don’t be too proud – if you try and go it alone, you won’t do as well. That’s a huge difference between pre-clinical and clinical medicine. A quick tip gained about the OSCE from someone in the year above can definitely be worth more than 4 hours sat with a textbook. Share your observations with your mates, and they’lll share with you too. Gradually, you’ll get a feel of what’s worthwhile spending your time on, and what’s not. Textbooks don’t tell you that.

Medicine & Surgery

Medicine and SurgeryEveryone works on different timetables and you’ll have weeks which are busier with extra-curricular stuff than others, but I found working to this rough schedule helpful for AERN & TUBES.

Week 1: acclimatise

Week 2: get your SSC done – it shouldn’t really need more than a week or two. You never really find out how well you actually did – just bear that in mind when you’re spending ages tweaking those last few words.

Weeks 3-4: Get really good at history and examination – absolutely vital for your end of unit clinical exam and the rest of the course! Use Appendix 1 of the Medicine & Surgery handbook to check you haven’t missed anything.

Weeks 4-5: Pick the main topics and get clued up on the facts: aetiology, presentation, investigations, treatment etc..

Weeks 6-7: Get into groups of 3 with an OSCE book – one person be the examiner, one the doctor and one patient and just blast through loads of different cases, doing histories and examinations for every one. Obviously it’s not a complete replacement for seeing real patients, but there’ll always be times in the lead up to your exam where it just seems to take forever to find suitable patients to clerk and you’ll get more done in a shorter space of time this way.

The OSLER: anything could come up really, but just be systematic: be sensitive, don’t hurt the patient, take a thorough history and do a slick examination – even if haven’t got the foggiest what the diagnosis is, you should still pass. Appear confident. Don’t get nervous!! – easier said than done but there’s no need to be, and this will possibly be the only thing that actually stops you from passing!

Psychiatry & Ethics

This is a little different – you can’t really get your SSC finished early as it’s a presentation. You should get your Ethics essay done pretty swiftly though – don’t let it get in the way as the end of the attachment is quite busy work-wise. Identify your long case early – if you’re lucky, someone may have already summarised the history already for a presentation or previous project – definitely worth asking!

The focus here is not so much on memorising how to take a complete psychiatric history so don’t get too bogged down with it. They may however, in your viva, ask you how many times you performed an Mental State Examination on your patient, so either do it several times or be ready for the question!

More so than TUBES & AERN, you do have to be quite clued up on knowledge for the end of unit exam – Psych is actually the unit that people failed most in my year. There are lots of tutorials and handouts which you might use. However, at some point during the course, they should post a revision guide on Blackboard, written by a previous student – this was awesome – I pretty much did most of my revision from this as it covers all the learning objectives.

In addition to that topic reading, get clued up on your long case inside out – for every term you use, know the definition – for every drug your patient is on, know the side effects, and make sure you’ve thought about the differential diagnosis for your case and your reasons – they ask most people this and want to make sure you haven’t just copied out of the notes.

There should be a definitive list of possible vignette topics – find out what they are and prepare a thorough answer for each one. If they haven’t changed, 5 of them were definitely: ECT, Learning Disabilities, CPA, Alcohol Dependence, Suicide Risk Assessment.

MDEMO

Make sure you know how to examine every joint – you could get anything in the exam. Again, get clued up on factual knowledge – it’s a viva-style exam so you need to know a little more – try and cover the common orthopaedic topics (complications of joint replacement surgery etc..) and know a bit about all the main rheumatology conditions too – make sure you know one in particular really well, as they may well ask you to pick a topic to talk about. The tutorials are not bad, but very long and require a lot of printing! – some people used the Oxford Handbooks instead.

Know how to describe an X-ray confidently. Make sure you’ve practised using an ophthalmoscope on the fake eyes – they’re different to real ones and require a different focus setting, so don’t get caught out in the exam. The Eye hospital in Bristol definitely has some to practise on if your academy doesn’t. You will also be shown 2 photos of eye conditions – I won’t publish on here what we got, but let’s just say those 2 photos haven’t changed in about 3 years….Enjoy your A&E week and pray that something interesting comes up whilst you’re there. If you’re really keen, use it as an opportunity to practice bloods, cannulas etc.. but exam-wise it doesn’t come up very much so don’t fret.

The Medicine & Surgery OSCE

The following stations made up the 2006 exam:

  • History taking: Tension headache/ Epilepsy
  • Neck Examination
  • Blood Pressure – get hold of the mark scheme to make sure you get full marks! eg, keep the arm at the level of the heart etc..
  • Chest X-ray: Pneumothorax & Pleural Effusion
  • Spirometry: name type of lung disease + 2 causes
  • Video of a person describing the symptoms of Inflammatory Bowel Disease – need to make diagnosis and list 2 investigations
  • ECG: Anterolateral MI
  • History: Claudication
  • Urine Dipstick – interpret and list further investigations
  • Communcation Skills – informing and explaining a diagnosis of diabetes

End of year written exams

RevisionThe first thing to say about these is that they’re not negatively marked. The second is that the questions are incredibly random, testing really small-print stuff and not really focussing on the main facts. You could either slog for weeks writing out notes from Kumar & Clark, or you could read a revision book in the 10 days prior to the exam and do some practice questions. Just bear in mind that you might, and probably will, end up with the same mark either way! For the purposes of this exam, try and go over a broad amount of stuff, even if it is not in much detail – in the exam, the answer is on the page, so recognising it and remembering that you read it will count for much more than being able to recite 7 different causes of a disease.

For MDEMO, there are lots of past questions floating around – find out who’s got them and get hold of them as they tend to repeat questions from previous years! For Psych, there are EMQs in addition to MCQs so just be a little bit wary as it’s not so easy to guess!

Also bear in mind that minor topics like Diabetes, Ophthalmology, ENT and those IST lectures (which of course you will always attend without fail) are all things that you obviously need to know about as a doctor, but come up in extremely small amounts in the exams if at all, so don’t fret too much about them – the nature of the exam means you could revise them to death and end up with the same mark as if you had guessed anyway!

In general, I found that (sadly) doing practice questions was much more valuable than any textbooks I’d read when it came to the exam. Make sure you check the links section of this website for some links to MCQ websites.

Module Tips & Notes

You might find the following sets of revision notes useful to print off and highlight. Don’t say Galenicals don’t look after you!

TUBES – Medicine and Surgery A

AERN – Medicine and Surgery B

Psychiatry and Ethics

MDEMO

OSCEs

Other Information