Tips Tricks for Year 3 Sally Barker Yvonne

Tips & Tricks for Year 3 Sally Barker Yvonne Tsitsiou Mahmoud El-Khatib Laz Ranasinghe Michael Jiang Amer Al-Balah

Welcome to Med. ED! Your team: Dedicated Year 3 Coordinators: Michael Jiang mj 1216@ic. ac. uk Amer Al-Balah amer. al-balah 16@imperial. ac. uk Chairs of Med. ED: Sally Barker Sally. barker 15@imperial. ac. uk Yvonne Tsitsiou yvonne. tsitsiou 15@imperial. ac. uk

First things first DISCLAIMER: Med. ED does not represent the ICSM Faculty or Student Union. The lecture series and advice within this talk has been designed and produced by students. We have made every effort to ensure that the information contained is accurate and in line with Learning Objectives featured on SOFIA, however this guide should not be used to replace formal ICSM teaching and educational materials.

Talk Overview • “I heard that 3 rd year counts? ” • Support offered by Med. ED • Timeline • Ethics • OSCEs • Written Exams

‘I heard that 3 rd year counts? ’ FPAS = nationalised scoring system that determines where you are placed for F 1/2 • Final Year – rank your deaneries by preference • Allocations depends on your overall FPAS score FPAS = 100 points 50 Medical School Points • 34 points = everyone • 1 point = every decile (i. e. 1 st decile = 9 extra points, 9 th decile = 1 extra point) • 4 points = BSc (1 st = 4, 2: 1 = 3, 2: 2 = 1 etc. ) • 5 points = Ph. D • Up to 2 points = publications with PMID or presentations at conferences 50 SJT Points • Exam sat in final year • Based on situational judgment • Hard to prepare for Medical School Decile = Year 3 Ethics (10%) + Year 3 Written (15%) + Year 3 OSCE (15%) + Year 5 (60%)

What Med. ED can do for YOU: OSCE Tutoring Lecture Series Mock OSCE

Med. ED Year 3 OSCE Mentoring Scheme • Dates: December – May • Sign-up forms released shortly after this talk • Groups of people matched to 1 or 2 tutors from older years • Weekly or fortnightly meetings • OSCE resource pack given to tutors • Excellent way of learning and practicing examinations and clinical skills in an exam-focused style!

Med. ED Year 3 Lecture Series • Dates: January – March • Weekly lectures on Tuesday/Thursday evenings in Charing Cross • Covers all the main topics on SOFIA via interactive, case-based lectures • Also covers lots of practice SBAs • Lectures form an excellent platform for structuring revision • Mock written exam near the end of the series • FEEDBACK is needed before we can release the slides

Med. ED Year 3 Mock OSCE • Dates: May • Centralised system where everyone is allocated at least 1 mock • Sign-up form released closer to the time • Full 12 -station practice OSCE • Assessed by older years and 1 to 1 feedback given at the end

Timeline: Term 1 Month Key Events/Comments September Enjoy the start of firms Get to grips with basic examinations October & November Meet with OSCE tutors a few times December DPD – 3 weeks of lectures (ATTEND AMIR SAM LECS!) Ethics case released

Timeline: Term 2 Month January February & March April Key Events/Comments Ethics exam (usually first day back) Med. ED Lecture Series Meet OSCE tutors more frequently (focus on histories) Continue reading through Oxford Clinical Cases & other resources Med. ED Lecture Series Mock OSCEs begin Btw you don’t have an Easter holiday (lol)

Timeline: Term 3 Month May June, July, August & September Key Events/Comments Revision intensifies Continue to do regular OSCE practice interspersed with written revision End of May/Start of June: OSCE and Written Exams 3 rd YEAR SUMMER!!

THE ETHICS EXAM A few details

The Ethics Exam 1) What are you talking about? • • 2) I hate writing essays. . . FOCP exam, January • 1 paper, 2 hr 45 mins • • MEQs on prereleased case • • 20 A 4 pages notes • 30 Law SBAs MEQs are very similar to SAQs Ethics-by-numbers Sticking to time is the most important thing.

The Ethics Exam 3) How do I prepare. . . now? • Do the Ethics and Law E-modules on Blackboard • And again After the case is released? • Go to a prep lecture • Groupwork: make questions and answers

THE OSCE The structure and how to smash it

OSCEs: structure • Exam consists of 12 stations in a circuit • 10 minutes per station • Stations are NOT released beforehand • Tick box marking scheme x 4 • Histories x 4 • Examinations X 4 • Clinical Skills

OSCEs: Examinations Cardio Basic structure +/- ECG, notes, questions Resp Basic structure +/- CXR, notes, questions Abdo Basic structure. PAIN. +/AXR, LFTs, notes, questions Upper or lower limb, cranial nerves. +/perimetry, notes, questions Neuro

Basic structure? • The sequence of steps in a classic examination of that system. • Should be taught to you in beside teaching and/or OSCE tutors. • Also useful: Don't forget those easy marks! • Introduction and consent • Washing your hands • Explaining each step to the patient • HR, BP, JVP

OSCEs: Examinations Cardio Basic structure +/- ECG, notes, questions Resp Basic structure +/- CXR, notes, questions Basic structure. +/AXR, LFTs, notes, questions Abdo Neuro PAIN. Upper or lower limb, cranial nerves. +/perimetry, notes, questions

Pain? • At the beginning: “Before I start, do you have any pain anywhere? ” • Yes – “Has anyone offered you pain relief yet? ” • No- offer pain relief • During: show me again where the pain is • Ask patient’s consent to examine that area • Yes – examine carefully • No – move on • After: remember to include the pain location in your presenting findings, even if the patient refused proper examination.

OSCEs: Examinations +/- ECG, notes, questions Basic structure +/- CXR, notes, questions Abdo Basic structure. PAIN. +/AXR, LFTs, notes, questions Neuro Upper or lower limb, cranial nerves. Cardio Resp 7 minutes Presenting Basic structure 3 minutes +/perimetry, notes, questions

Presenting? • “I have performed a cardiac examination on Mr X, a 55 year-old male who presented to A+E one hour ago with breathlessness. • There was no obvious stigmata of chronic cardiac disease. • • HR was 100 bpm, pulse weak and irregular, RR 26, BP was 160/100 and capillary refill was <2 seconds. Jugular venous pressure was 3 cm above the sternal angle and the character of the carotid pulse was strong and regular. Upon inspection of the chest, there was no chest wall abnormalities, the apex beat was not palpable in the 5 th ICS in the MCL and there were no heaves or thrills. On auscultation, hearts sounds one and two were present with no added sounds. There was no evidence of pulmonary or peripheral oedema. • In summary Mr X has an irregular tachycardia, tachypnoea and a raised blood pressure. • To complete my examination I would take a full history, perform a full peripheral vascular exam, check for an abdominal aortic aneurysm, check oxygen saturation and temperature, do a urine dip and fundoscopy and perform a 12 lead electrocardiogram. ”

OSCEs: Examinations +/- ECG, notes, questions Resp Basic structure +/- CXR, notes, questions Abdo Basic structure. PAIN. +/AXR, LFTs, notes, questions Neuro Upper or lower limb, cranial nerves. Presenting Cardio Basic structure +/perimetry, notes, questions

The extra stuff

OSCEs: Examinations +/- ECG, notes, questions Basic structure +/- CXR, notes, questions Abdo Basic structure. PAIN. +/AXR, LFTs, notes, questions Neuro Upper or lower limb, cranial nerves or AMTS. Cardio Resp 7 minutes Presenting Basic structure 3 minutes +/perimetry, notes, questions

OSCEs: Histories 7 minutes Cardio History Explain diagnosis to patient Resp History Report findings to examiner GI History Next clinical steps Neuro History Prescribe General History Explain management to patient Advice History (new) • Like a checkup Advice on medication 3 minutes

OSCEs: Histories Basic structure PC Why are they here today? Open questions HPC SOCRATES Associated Sx: closed questions PMHx Related conditions Common medical conditions PSHx Previous operations Anaethesia? SHx ETOH FHx ICE! Allegies! Current medication Smoking Drugs Work – relevent? Related conditons Deaths Cancers Easy Marks! I usually do after HPC

"The new combo station" WHAT IS IT? • Previously specific 'explain' station part of clinical skills • Now this clinical communication is being integrated into other stations • E. G "Patient comes for annual BP check, advise the patient accordingly" WHAT TO DO? • TRAP – STILL A HISTORY STATION • Remain calm • Don’t get caught up in having aimless conversation • Still marks for: PMHx, PSHx, etc • Try to identify the RFs for the patient's KNOWN condition instead of figuring out WHAT the patient has!

OSCEs: Clin Skills Clinical skills: • Catheterisation • Explaining peak flow and inhalers • Suturing and wound care • Taking blood • Cannulation • Performing ECG DOPS: • Urine dipstick • Basic Obs • Fluid administration Special Exams • Thyroid, Breast, DRE

Imperial rumours: True or False? Forgetting to wash hands Automatic fails Swearing Vivas Must pass all stations You can't do well on both OSCE and Written You need to be Patch Adams to do well People who do well in pre-clinical tend to NOT do well in clinical year and vice-versa

OSCEs: what to do now and later Oct-Dec • Sign up to the Med. ED OSCE tutoring scheme • Start meetings • Nail the basic structures of examinations and histories • Attend all clin skills sessions and make the most of them Jan-Feb • Start timing yourself • Use firms to get more comfortable with patients • Perfect your presenting scripts • Start stockpiling clin skill kit • Attend Med. ED lectures for data interpretation gold March-May • Practice, practice • Treat mocks like the real thing • Practice under exam conditions

Written Paper – Advice Overview • What to make of DPD • SOFIA – useful or misleading? • Best resources to use! • Rough timeline for the year

DPD • 3 -week lecture series just before Christmas • Amir Sam Lectures are ESSENTIAL – many exam questions are based on his lectures • The other lectures are not essential but may be useful if you learn well from lectures

SOFIA • Massively overhyped • ‘Completing’ SOFIA is time-consuming, dull and not a particularly effective learning exercise • Useful list of conditions and presentations that you should know by the end of Year 3 • Use older years’ notes to save time • IMPORTANT: SBAs in Year 3 exams are CASE-BASED, so they require a wider understanding of topics rather than knowing discrete details

SOFIA Tachycardia Fever Furred tongue Lying still Coughing hurts Foetor with/without flushing Shallow breaths

SOFIA Type of question that SOFIA prepares you for that you wont be asked: ‘Which of the following is NOT a typical sign of appendicitis? ’ Type of question you are likely to get: ‘An 18 -year-old girl is rushed into A&E with severe right iliac fossa pain. She also has a temperature of 39. 2ºC and marked abdominal tenderness. What is the most likely diagnosis? ’

RESOURCES: Oxford Clinical Cases • BEST BOOK FOR YEAR 3 • • • Talks through presentations from head to toe – easy to follow Useful for history taking and data interpretation ADVICE: read up on the presentations that you are most likely to see on your firm (e. g. Urology – poor urinary output)

RESOURCES: Rapid Medicine • Written by Amir Sam • Same layout as SOFIA • If you are really intent on completing SOFIA, this book is useful • Otherwise, quite dry and only occasionally useful as a reference book • ‘Rapid Surgery’

RESOURCES: Question Books • • EXCELLENT way of learning and consolidating knowledge Much more interactive than simply reading a textbook Get. Ahead books have excellent explanations – HIGHLY recommended Some questions will be targeted at Final Year students, so try and identify which questions are relevant

RESOURCES: Brainscape • Download app and search ‘Year 3 Medicine’ (Author: Joe Vincent) • Contains all 1023 blackboard questions • Can rate difficulty of the question from 1 -5 • Not especially representative of the exam (some questions are outdated) • Useful when travelling to firms/got time to kill