Welcome to the Wards: Your Guide to Year 3

Congratulations on making it through your first two years at Imperial! Finally, after two years you’re let loose on the wards. While exciting, this can also be overwhelming, so I’ve put together some tips to help you make the most of your first clinical year.

Firms

General Practice:


This is a great place for you to take as many histories as possible. GP tends to vary a lot depending on where you are, but you can still be productive by getting most of your DOPs done, practicing examinations and getting used to typing in patients notes. If you ever feel like you aren’t getting as much teaching as you should, reach out to your GP tutor.

Medicine: 
While on medicine, it’s easy to get all your DOPs done. Head to AMU or A&E as well for extra history taking practice. Early on in your placement see if there is any bedside teaching available. This is where you are given a patient to clerk (take a history and do the appropriate examinations) in front of a tutor and get feedback. Even if there isn’t this teaching on your firm just ask a doctor who seems keen to teach if you can do some. Medicine ward rounds can be long so make sure you eat and drink plenty, it happens to the best of us, but no one wants to be the medical student who passes out during the ward round.

Surgery:
For any budding surgeons out there, this is a great opportunity to scrub in and gain some practical skills. On the flip side if surgery isn’t for you, find out which days your consultant is in theatre, so they know you’re alive. Otherwise you can just spend more time on the wards brushing up other skills. On your timetable you might have set clinics in different specialties which are great to practice examinations like vascular and breast. Your two weeks on anaesthetics are also good to practice cannulation. Anaesthetists are usually happy to teach, so have in mind some set topics you struggle on and when there is some spare time, ask them if they can teach you about it.

How can I make the most of clerking patients?

You will have probably heard in your intro week to ‘clerk a patient a day’. In reality this usually ends up being you going to the ward ready to clerk a patient, doctors telling you most of the patients are too confused to talk and then the one patient you do find is asleep. Don’t just give up here but try other wards, you literally have a hospital full of patients to learn from. Even if patients are cognitively impaired, there may be family around that you can take a collateral history from which is an important skill to have. Here are some pointers on how to make the most of clerking a patient.

  • Beforehand, ask doctors which patients would be suitable to clerk and ask if you can present to them afterwards. Then you can discuss with them what the appropriate management would be. It is best to try and do this in the afternoon when the ward is less busy. Or if you’re keen, clerk them just before the ward round and present to your consultant.
  • Try taking notes on examination findings as you may be expected to do this in your OSCE.
  • Note down any questions you have about the condition and look it up later.
  • Check the patients notes afterwards to see if what you got from the history and examination matches up, check the discharge summary later as well to see what happened to the patient. If you missed any signs mentioned in the notes, go back to the patient and do that part of the examination again.

Clerking a patient can take a long time at first but with practice you’ll become quicker and know what the most important questions are. Realistically you probably won’t clerk a patient a day but just getting two or three done each week properly is enough.

Formatives

During each attachment you’ll also have a formative. While these don’t count towards anything, they are good opportunities to learn skills you will need throughout your career. You can put in minimal effort into these and do just fine or if you want to go the extra mile you can present your work at conferences and win prizes.

Case Presentation
This is the easiest formative, you just choose you have clerked and present them to your consultant, after which they’ll ask you a few questions. You don’t need to choose something rare, it can be a basic case on one of the Year 3 conditions that you need to know inside out like pneumonia or heart failure. This will help consolidate your learning on these areas as well.

Quality Improvement Project (QIP)
For this project you just identify a problem on the wards and find a simple solution. Then if you have time you can see whether this improvement had an effect. Don’t overthink this project and choose something simple and easy to measure, it doesn’t need to be ground-breaking research to be effective and do well.

Community Action Project (CAP)
This is another poster project like the QIP. You need to identify a need amongst the patient population at your practice and then come up with an improvement that you can execute while you are there. In the past projects have involved creating exercise programmes for the elderly and making videos to help patients who don’t speak English as their first language.

Resources

Use this first term to figure out what resources work for you. I’m sure you’ve heard this before but just remember that everyone has their own way of studying. If some popular resources aren’t working for you, don’t worry, there are plenty of other resources out there.

  • Osmosis- Use Imperial library search to look up osmosis and use your free Imperial account. This is good for short snapshots for each condition.
  • Geeky medics- this is a great starting point to learn your examinations. As you keep practicing and pick up tips from your peers and doctors, jot them down and by the time the OSCE comes round you’ll be really slick. However, bear in mind that sometimes the way you see doctors do examinations isn’t necessarily the OSCE way- kind of like when you learn how to drive a car, you take short cuts once you actually pass. Base your learning off the resources provided in Blackboard and from teaching fellows.
  • Oxford Cases in Medicine and Surgery- Bread and butter of Year 3, it goes through 30 presentations with patient examples and teaches you how to classify conditions.
  • Oxford Clinical Handbook (cheese and onion)
  • AMBOSS and BMJ Best Practice- Great for reference when learning conditions
  • Simple OSCE
  • Macleod’s Clinical Examination
  • OSCE Stop
  • ECG Made Easy
  • MDCalc- useful to have on the wards to understand some of the scoring systems used
  • Brand new Synapse Podcast on history taking, fill out feedback for more episodes! https://anchor.fm/synapse-medics

Question Books:

  • Passmed- these questions are aimed at final years but have good explanations and notes
  • RevMED 300 SBAs in Medicine and Surgery (Laz’s questions)- pitched at more of Year 3 level
  • Meeran’s 500 SBAs
  • Get Ahead Series
  • Oxford Assess and Progress: Clinical Medicine- questions are a similar style to the written
  • Brainscape- These are great for commutes or have time to kill on firms https://www.brainscape.com/l/dashboard/medicine-year-3-2842020/decks (These are the E-lecture quizzes in flashcard form, they are quite buzzword heavy and some are outdated)
  • https://www.brainscape.com/l/dashboard/year-3-mm-flashcards-15797757/decks

    (BRAND NEW Year 3 MM flashcards- over 200 flashcards covering content on the main presentations in Oxford Cases, an anki version will also be available on our Year 3 page)

Final Remarks

Hopefully you now have a better idea on how to tackle Year 3. Unlike years 1 and 2 where everyone’s experiences are similar, year 3 is completely different.

It’s likely you’ll hear from others about how they had brilliant teaching or saw some super rare cases. While you may have had another unproductive day feeling like a spare part on the wards. But don’t let this dishearten you or stop you going in. Firms are really what you make of it and if you go in with a clear objective on what you want to learn, your time won’t be wasted. A lot of third year is about stepping outside your comfort zone, so really push yourself even if you feel you’re getting things wrong, it’s better than not trying and not learning at all. 

Support each other and work together throughout the year, whether that’s through OSCE practice or just encouraging each other on the wards. And don’t forget MM and any older years are here for you, reach out if you’re struggling, there will always be someone to help.

All the best with firms and Year 3!

Khadeejah Mujahid
MM Year 3 Coordinator 2020-21

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