THIRD YEAR

*The modules are consistent with MB21 year 3 but some details may be out of date*

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INTRODUCTION

Whether you’re coming from the intensity of an intercalated degree or a year spent in the E29 lecture theatre, for most of you year 3 will come as a long-awaited breath of fresh air. Finally you start to feel like a real trainee doctor. With a little bit of effort year 3 can be fantastic, you get out of it what you put in. You have the freedom to explore your interests, hone your skills of history-taking and examination whilst not having the pressure of needing to know a huge amount.

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It can be somewhat tricky starting the year, trying to adapt to a new way of learning outside the lecture theatre. This is a good time to work out what learning techniques work best for you: e.g. some students take a little note-pad onto the wards, when others would make notes at home etc and what revision/note making is best for you e.g. notes/diagrams/flash cards/group work etc. Try to discover which sources of information that best help you learn (e.g. from websites, to textbooks, to images, flashcards etc.). Hopefully these tips will be useful in getting you a little ahead of the game going into the later clinical years.

 

The best piece of advice: talk to as many people as possible – don’t be too proud –unlike preclinical, if you try and go it alone the journey is much harder. Everyone has a different way of learning; try to find yours by asking around. Talking to the years above is also a great way for gaining advice: 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’ll share with you too. You may feel slightly bogged down at the start of the year but gradually you will get a feel of what’s worthwhile spending your time on, and what’s not. Textbooks don’t tell you that.

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Junior Medicine & Surgery (JMS)

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ADVICE, TIPS AND THOUGHTS:

• JMS is first time you get to start clerking patients!!

• Between Academies you may find different schedules and timetables but try not to compare: your learning/teaching may differ but the basis of teaching will be the same.

• Organising your time:

  • You may feel a little lost in the first week or so but don’t worry things will start clicking into place. Use this time to go to ward rounds, clinics, follow consultants or your F1/F2s that you should be allocated. Speak to your Clinical Teaching Fellows. Get to know the hospital. Ask the nurses if you can help them. Ask to help go and take blood etc. This is your time to learn!

  • Depending on what Academy you are based in you may sometimes have to organise teaching: the old self-directed approach. Don’t be afraid to speak to your Academy admin team if you have any difficulties contacting your tutors/consultants etc.

  • You may have weeks that are busier than others. JMS gives you the freedom to learn in your own time.

• Ask for advice, help, tips etc. Your Academy admin staff will be willing for you to pop in and ask any questions: whether you are finding something tricky and want a bit more support or teaching, or if you think things need changing etc. similarly your Clinical Teaching Fellows and Tutors will be there to help you.

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JMS ASSESSMENTS:

 

iSSC and presentation

• Try to get this done as early as possible so you can spend the rest of your time learning on the wards – as this is the best learning environment and you will learn SO much more then reading a textbook.

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Long Cases

• You will have 2x Long Cases towards the mid-to-end of JMS. Each one lasts 1 hour and involves taking a history and full examination before presenting to your examiner.

• When revising/practicing look at the Year 3 curriculum for the diseases you need to know, but be prepared that anything could come up so be systematic.

• Ensure to be sensitive, kind and friendly to the patient, take a thorough history and slick examination – even if haven’t got the foggiest what the diagnosis is, you can still pass.

• Most importantly: PRACTICE, PRACTICE, PRACTICE! This will help you to become confident and prevent the nerves from taking over. Get friends to watch you and present back to them, before talking over how it went; discuss what you saw, discuss different techniques.

• Ask F1/F2s for practice long cases, and use your wonderful Clinical Teaching Fellows! (Just a tip: you may get teachers telling you there is only one way (their way) when examining…find the way that works best for you!)

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Portfolio

• START EARLY: buy a folder and get clerking!

• The best tip from all 3rd years is to start clerking early. Even if the first ones are a mess, incomplete or just unreadable, put these into your folder. Towards the end of JMS you can then decide which ones to keep in.

• You should show progression from your first to last clerkings – DON’T write up your first clerking to make it look complete and pretty…it is okay for it to be slightly messy and incomplete. It will show the examiners how far you have to come when comparing it to the last few clerkings.

• Talk to people: to students, to your CTFs or F1/F2s etc for advice on how best to clerk or write up clerkings. Look at patient notes and see how others write them.

• Use your clerkings to practice presenting: use your tutor group, friends, teachers etc. or ask any doctor on the wards. It only takes 5 minutes or so and can be crucial to help with your long cases and also later in life as a qualified doctor!

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Musculoskeletal Diseases, Emergency Medicine & Opthalmology (MDEMO)

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INFO AND ADVICE

• MDEMO = Musculoskeletal Diseases, Emergency Medicine and Ophthalmology

• This unit composes of a lot of self-teaching and organising: in your teaching groups, you may have to arrange teaching for yourselves: try to contact the consultant/teacher early on in MDEMO and arrange the sessions – it can be hard to find time in their busy schedules!

• Here you spend most of your time in clinics and tutorials, sometimes the wards (although less time on the wards than JMS) and also you will attend A&E

• Any free time you have, use this as an opportunity to practice bloods, cannulas etc. or feel free to go and sit in clinics – just ask the nursing staff – be prepared you may be turned away at times.

• The online tutorials on Hippocrates are a great place to go for learning/revision notes etc. They are very well structured and a brilliant learning tool for this module!

 

ASSESSMENT:

• iSSC and presentation

  • Case study on a patient you have seen: ask your tutor for advice. Find something that interests you. There is good information on BB to guide you and also the mark scheme.

• Group Poster

  • Your tutor group will be expected to create a poster: you will be given a number of titles to choose from. At the end of MDEMO all students will return to Bristol to have an afternoon displaying and presenting their posters.

• Practical exam: OCSE

  • There are 5 stations involving: joint examination, history taking, ophthalmology, A&E and viva station.

    • Joints: know how to examine every joint – you could get anything in the exam. Use the Arthritis UK videos/website

    • History taking: largely around how you communicate: be kind and friendly to the patient and ask all the relevant and focused-questions as time is rather limited. Keep calm and think logically. Show off your personal skills!

    • Ophthalmology: make sure you’ve practiced using an ophthalmoscope on the plastic/Prof Levy eyes – they’re different to real life eyes and require a different focus setting, so don’t get caught out in the exam – you can find them in the BRI, Dolphin House if your Academy doesn’t have any.

    • A&E: you have equipment presented in front of you with scenarios on the paper. You have to select the piece you would use first. Keep calm: there are many scare stories at how awful this station is and many people don’t finish but that’s okay! Read the questions carefully and keep calm.

    • Viva: get clued up on factual knowledge you can be asked pretty much anything (they often start with easier questions and may push you if they think you can do it so don’t be down-heartened if they ask you hard questions. It’s a good sign!). Learn 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 online tutorials are a good resource – they can be long! Some people used online resources such as Patient.co.uk or textbooks such as the Oxford Handbooks.

  • Know how to describe an X-ray confidently – practice presenting to friends or doctors on the wards. They will be very happy for you to do so! Go and spend a few hours/day in the Radiology department.

• Ask the years above for tips and advice!

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GP Placements

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• You will spend a number of days at your GP throughout the year. Your GP will get in patients relevant to the unit you are currently on.

• You will find out where your GP is at the start of the year

• Enjoy your time at the GP: it is a chance to learn and ask questions, which you feel you sometimes can’t on a busy ward round in the hospital etc. It is a relaxed and fun learning environment. The GP’s are there solely for you to learn unlike on the wards where you are often just shadowing someone else at work. Use this opportunity to request extra watching on areas you find difficult or want more experience in. Sometimes a bit of a bore travelling to the GP but enjoy it!

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Pathology & Ethics

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All students start this unit with 3 weeks of lectures in Bristol – great as you get to be in Bristol and see everyone. It can at times be pretty intense sitting in the same room from 9-5pm…you may feel that you’re back in 1st and 2nd year! But these 3 weeks will form the basis of the unit: you will receive the lecture booklets at the start (use these for revising for the exam). The rest of the unit you will head to your Academy where you will have tutorials based on the lectures as well as attend clinics and go on wards etc. You can feel a little lost at times, with all the free time you have between teaching…but most students having done Path would say use this time to write up revision notes. Don’t leave it until a week before the exam as you have JMS/MDEMO to also think about and may not have the time to write up notes then.

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ASSESSMENTS:

• iSSC Presentation

  • Short 10-minute presentation on a topic of your choice – you will be sent titles to choose from but they advise creating your own…however, many used the titles given and all passed!

  • Create a ppt that is easy to present and easy to read. Don’t put loads of information on the slides – that you cant explain if asked questions, and also it’ll bore the audience!

• Written Exam – end of year

  • Use the lecture booklets. Make revision notes during your unit so you don’t have a made panic looking at the lecture booklets a week before the exam!

  • Remember try to cover a broad range of topics and not get too bogged down in the details…there is a lot to cover so be logical!

  • Practice questions are a must!!

 

ETHICS

You will be given a couple of tutorials around ethics in your Academy.

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ASSESSMENTS:

• Ethics Essay

  • 1000 word essay…as with all things, get started early when you can so you can get it out of the way! This essay counts towards your final year mark so use it to gain those extra marks! You will choose from 3 scenarios and then write an essay on it. Use references to help you and read all the marking schemes/guides etc. to see what you need to add in or how to write it. It can be a bit of a bore but it has to be done…

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Final Tips for End of Year Written Exam 

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• The 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 focusing 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!

• 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.

• You will have one paper for JMS & MDEMO, then another for Pathology. All MCQs (multiple choice questions), best of 5.

• You should receive a break down of how many questions there will be for each topic e.g. 15 questions on Cardiovascular etc. Use this information wisely to help you revise.

• Doing practice questions is VITAL! Get to grips with these as opposed to just reading textbooks. You can get textbooks out of the library with many questions or some students often sign up to online questions banks like Passmedicine and PasTest – although these sometimes are set at a higher level more for 5th years so beware. Some use flashcards like Anki – you can create your own and great way of learning on top of revising your notes.

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ESSC

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After exams you will have 2 weeks of freedom before coming back and carrying out your eSSC.  You will have to produce a report at the end of your eSSC (approx. 3000 words). It will be hard coming back after exams but think about your 1-month off in August to keep you going!!

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