Passing 3rd Year at University College London Medical School

By James Geddes As exciting a year as your first clinical one is, it can be quite daunting to be facing a new style of examination, having barely gotten used to those used during pre-clinicals. Dont despair though, as with a few pointers in the right direction this challenging task can become very doable. I hope that this article helps to answer some of the questions you might have, and if nothing else settle your nerves and give you a more positive outlook on what is a highly enjoyable and memorable year. 1st year clinics exams are at the end of July and the format is split half and half between the OSCE, and a question paper consisting of 300 SBA (single best answer) questions. Each exam is scaled to a percentage mark and combined, to give an overall mark for year 3 out of 200, the average last year being somewhere around 150, but with not a great deal of variation either side. The written paper contains an even spread of the material that has been covered through the year, including pathological week teaching as well as work that has been covered in taught course and in clinical teaching. Taught course lectures are a very useful tool for the written paper and learning them in detail should not be overlooked, as many of the SBA answers can be taken directly from lecture slides. The stations used for the UCL OSCE in 2010 were as follows: Speech exam: For station most people just followed the exam in the AceMedicine handbook, which was very comprehensive. Beware the patient/actor will have real signs and dont be thrown by the fact that their speech will be very strange and inappropriate from the start of the consultation, as the five minutes available to complete the exam will go very quickly, even at the most straightforward stations. Drug prescribing: For this station we were given a short case and told which drugs we needed to prescribe. It is worth making sure you read the case as it will give you clues i.e. allergies and preexisting conditions, about what you can and cant prescribe. We were given a BNF but if this happens remember not to get too bogged down in reading every detail of it as in five minutes you will not be given anything too complicated. For my OSCE I had to prescribe oxygen and fluids so make sure you grab a drug chart and ask someone how to do this. Giving information to a patient: There was a station where a patient had come to see his GP with some statistical information about a meta-analysis that he had printed off after finding online. You may be asked to explain statistical terms and the significance of the data he shows you. He then went on to explain that his brother had recently passed away after a heart attack, and that he would like his cholesterol levels checked. I would imagine there would be marks here for showing empathy at the sensitive situation, as well as explaining what he would need to do for the cholesterol test.

Putting in a cannula: This station would have been relatively straightforward, but to mix things up a bit the scenario was that you were the new FY2 in A&E and the patient had had a lot to drink. The patient was extremely chatty and flirtatious with members of the opposite sex, and it is worth noting that with only five minutes it is not worth getting too bogged down in answering all of their drunken questions too thoroughly, and definitely not worth flirting back. Cardiovascular exam: This station was one at which what was expected actually happened, although it is worth emphasising again that the patients do have signs, and you will be asked to present your diagnosis at the end. My main piece of advice would be five minutes goes extremely fast when you are under exam pressure, and therefore it is probably not necessarily to try and list every single peripheral sign of infective endocarditis or cardiovascular disease at the risk of missing out the later stages of the exam. Visual exam: The visual station encompassed most of third year ophthalmology. When you initially enter, you are asked to assess the patients vision using the Snellen chart. The patient I saw didnt have signs, but you will be asked what to do in various situations-e.g. what would you write if they could only read to E on the third line, or what would you do if they couldnt read anything at 3m? Colorectal history: A patient presents here initially talking about various changes in bowel habbit. It is important to be specific here as it helps with the differential later which includes inflammatory bowel disease and malignancy, so dont forget to ask about rashes, fever, night sweats, weight loss. There will also be marks for things like foreign travel and change in diet, so ask about them even if you are sure in your mind that it is IBD or cancer. Make sure you do a social history too, as you will have to refer the patient to the colorectal surgeons in the next station. Writing a referral letter: This was the most straightforward station, provided you have obtained all the information in the one before! Make sure you are really systematic in the history station, and everything should be fine if you get a referral one. In our OSCE we also had to refer it as urgent, because of the risk of malignancy. Tired all the time history: The two history taking stations were very similar, and it is worth remembering that there are marks for properly introducing yourself, social history, and addressing the needs, concerns and expectations of the patient, which are easy marks and up for grabs. Urinalysis: We were told to perform urinalysis using a urine dipstick. To revise this station I had made sure that I knew the various times at which things would show up, and it is worth finding a pot of urine dips on the ward and asking, or better still performing it on a patient. If you get such an OSCE station, chances are there will be either blood or protein present, and it is probably better to give the three most common causes of this, rather than the ten rarest. They could ask about other symptoms of a cause, e.g. UTI as well, and how you might treat one. At the end of this station we had to tick a list of other tests we would offer, given the results of the urinalysis. Explaining a procedure to a patient: For our OSCE we had to explain an inguinal hernia repair to a patient, who would then ask questions about it, and our answers. The actors can be very probing in these stations so it is worth knowing more than just general surgical complications. They will want to know practical things such as whether they will be able to leave hospital the same day, and how the recovery process will go. It would be good to prepare for this by watching one of the doctors obtain

consent, perhaps even from an anxious patient, obviously provided that they are happy for you to be there! Foot exam: The foot exam was our only orthopaedic station, and it would be wise to learn all of them before the OSCE. If in doubt, look-feel-move, in a logical manner, will get you some of the marks. The actors will have injuries so make sure you dont start touching the limb that they have supposedly broken. In our OSCE we were asked questions such as Will I need an X-ray? and Is it broken? Setting up an ECG: For this station we had to attach the pads to the patient in the correct positions, and then attach the correct leads. It is worth doing this on each other and patients as the clinical skills dummies do not really feel the same as human chests. We were then asked questions such as what we would write on the paper, what speed it should be set at, and what settings should be on. Airway management/BLS: The two stations were combined here, to begin with a patient choking in A&E, whose airway you manage, but who goes into cardiac arrest. You then had to perform BLS. The examiners asked various questions about airway equipment and why you use certain things when you do, how you measure them and when you wouldnt want to use them.

My personal experience of the OSCE was that it was extremely fast and hectic, and I think there is a lot to be said for going through a mental checklist of marks, rather than spending ages on one particular area, however impressive it might seem! Make sure you read the instructions outside, and that you introduce yourself as what the sheet of paper says you are, rather than as a 3rd year medical student for every station. Without wanting to throw in too many corny cliches, it is important to relax a little as well, as huge amounts of stress are likely to make you forget things. On the way back home after the exam, everyone was laughing about the mistakes they made, which they wouldnt have normally expected to have made, and they had attributed to the pressure of the exam. The staff help with this though, both the actors/patients and examination team being extremely encouraging and supportive. In terms of juggling clinics and revision, I would almost argue that the two are synonymous. A lot of the marks in the OSCE come from bits and pieces that you are more likely to have seen if you have been spending more time on the wards. This is easy to say, but becomes questionable when you look at the amount of book work that is meant to be learned for the exams as well. It is probably a good way to view it as having one to not only complement the other, but to break the other up. The two really do complement each other too, as there is a great amount of overlap between the questions the doctors will ask you on the wards, and the lectures you will be given in pathology week. If you can supplement the two with a bit of outside reading, then you cant go far wrong. Clinics is a bit of a transition from preclinical too, and Id say that starting well is important, as it allows you to judge how things work quickly, and if the doctors and nurses see that you are keen, they will be more likely to give you cool jobs to do. It is also quite a long slog compared to previous years; at the start of the year someone advised me that it was a marathon and not a sprint, and it would be hard to argue. For this reason also, it is important to break up the year, and maybe plan something to look forward to after the exams. Working flat out all year will only be sustainable for a small number of people, and generally the people who got into a balanced pattern of medicine and

other stuff enjoyed it more, and seeing as this is arguably the first year of the rest of your career, that is probably quite important. On the question of when to start revising, it seems difficult to answer. Really you have to be working throughout the year for clinics, and this will help a lot, as there is a great deal to remember at the end and what you have learnt well at the time will stick. For those after a black and white answer I would suggest giving more revision time than for preclinical exams. April would probably be the ideal time for the keener, and I wouldnt leave it too far into May. But different people will have different methods, and Id hugely advise taking plenty of breaks. It is probably more important to talk about how you actually plan to revise than when to start, and as a general message there is no substitute for testing yourself. Practicing exam stations, with one person as the patient, one the examiner, and one the examinee, is a very useful way of preparing mentally for the OSCE, and being confident in your own professionalism once you are in there is vital, as this will project. The written exam is all SBA based, so using resources from books or the internet which contain SBAs is paramount, as they will probably not only be of the same format, but around a similar standard. Any resources from UCL itself will be extremely useful, as it is very likely that previous questions and OSCE stations may be very similar to the ones that are used in the exam. I personally found it very useful to revise with groups of people from my year for the OSCE, and have OSCE nights where one person will have learned a particular exam very thoroughly, who will then teach the group, and then give everyone some time to practice the exam on one another. Using ACE the OSCE as a resource for this was very helpful, as it not only told us how to do the exams, but likely questions that might be thrown in by the examiners. Even when these questions didnt come up on the day itself, being prepared for them made a big difference to the confidence with which I approached the various stations. I would highly recommend this resource to anyone sitting OSCE exams for the first time, and certainly plan to carry on using it. And even if you panic once you are in there, by the time you have practiced it a thousand times introducing yourself and obtaining consent (WIPER QQ) will be so automatic that you will have time to calm yourself as you say it. Having said this it is also worth noting that examiners can tell if you are actually doing the examination properly or just going through the motions, so dont be afraid to say if you see, hear or feel something. As a final note the first clinical year is a really fun one, and the first in which you get to enjoy a lot of new experiences. It is worth stepping back, on the bleak February morning when the honeymoon period of clinics is waning, and reminding yourself what an exciting and privileged career medicine is, and if you enjoy the year, you are certain not only to get the most out of it, but to excel in those that follow.

Passing 3rd Year at University College London Medical School

By Anon 1st year clinics exams at UCL usually take place at the very end of July. Following your last clinical rotation, you are usually given a week study leave followed by exam week, with exams at the end of the week. There is an OSCE exam lasting approximately one and a half hours, with 13-16 stations, each five minutes long. The exam works like a circuit, which students rotate around, with a warning one minute before time elapses for each station, in much the same way as the ICCM OSCE. The written exam is usually 3 hours long and made up entirely of single best answer questions, mostly based on clinical scenarios. The January/February formative is good practice for this style of question as are online question banks. Your performance in the formative is not a good judge of your end of year mark. If you do well, take encouragement from it, but if not, its too early in the year to draw any conclusions so don't worry. It is always up to the individual as to when to start revising and it depends on how you feel about how long it will take you to get through the important topics. As a rough guide though, starting when the last module begins (roughly 3 months before the exam) will leave more than enough time. Try not to leave it any later than a month before. One of the most difficult things to do is plan your revision over such a long period. Try to combine OSCE and Written Paper revision as you go rather than focus on one or the other. Make a list of all the main specialties you need to cover, and work your way through them, one a week. Bear in mind that if you cover something 8 weeks before the exam, you will need to refresh your knowledge later so factor this in. I personally found it easier to focus on one specialty at a time and revise everything in the same order as I was taught it. Leave out whatever you are covering in clinics till the end as it will be fresh in your mind anyway. With OSCEs, again make a list and cover a few a week, stepping up your revision as it gets closer to the exam. The OSCE can be an incredibly successful experience depending on how you approach it. The less you have to think in the exam the better, a lot of it is routine and the more of the routine you are used to, the more of your brain you can use for the aspects of problem solving in the exam. The pressure of being on the spot can help you sometimes and hinder you at others. It can be disconcerting when you forget things that you knew a few days earlier and the time constraints can be very off-putting. You just have to remember that a few mistakes are not going to ruin your whole exam and do your best to put them out of your mind. Practice thoroughly under timed conditions before the exam so you are ready for this in the exam. The examiners range from really helpful to really rude. Some will tease answers out of you if they feel you know, others will expect you to do all the work. However, no examiner can give you a mark for something you do not say and no examiner will ignore a right answer. Do not be afraid of saying something even if you think it might be obvious; a lot of obvious things will be worth marks. There are a range of skills tested including histories. It worth revising all the examinations as a few could come up, including the orthopaedic examinations. Pay attention to what is in the Surgical Mock OSCE as any of those practical skills could easily come

up. It is also worth practicing the mock Ethics and Law scenarios you are given towards the end of the year and the Prescribing Skills scenarios as these are very examinable. Other useful things for revision are OSCE revision sessions, which provide brilliant opportunities to learn from older students and practice in front of them, picking up any tips they may have for you. Mix up group revision with solo revision. Group revision is especially useful for OSCEs, but if you do not always have that opportunity, practice on your pillow or your teddy, if you have any lying around. It can be hard to juggle clinics with revision, especially if you have long, tiring days on the wards. If you're feeling particularly drained on some days, do something a bit lighter like practice questions or OSCE practice. Make sure you keep up with clinics towards the end of the year, as you will probably need to cover it anyway, but towards exams, do not overkill on your reading for clinics. Focus on the key points of the topic that will be more useful for exams. Watching revision videos can always be helpful, as seeing somebody else perform a good exam can help you mould your manner on theirs. However, do not forget that the most important part of OSCE revision is practice. Other very useful things are looking at Mock OSCE sheets, practicing questions and being an examiner for your friends as it will alert you to a different perspective on OSCE performance. Remember you ICCM and Surgical OSCEs as they will have provided you with a good experience of what the end of year OSCE will be like. Be organised and ambitious when you revise and take every opportunity to practice. Most importantly, be as confident as you can and relax, the majority of people do well and if you have done a fair amount of work, it will reflect in your mark, even if it does not seem so at the time. Good Luck!