Subject Code/Name: Principles of Clinical Practise 2 (MD2) Workload: Will outline in further detail.
Assessment:35% end of year OSCEs (5 stations)
20% SAQ Written Exam
15% MCQ Written Exam
20% x3 Long Case Assessments
10% x6 Mini-CEXs
Lectopia Enabled: Depends on which clinical school you go to, but generally, assume that you don't.
Past exams available: Recalls from UMMSS are available from previous years.
Textbook Recommendation: Talley and O'Connors is a must have for learning clinical medicine. Learn all your examinations from here. Not everything in the book is required for OSCEs and sometimes they dwell into more physician level exams.
Examination Medicine by Talley and O'Connor is also useful for long cases - it's again aimed at BPT level but gives some good pointers on what you need to focus on in your history and examinations.
ECG Made Easy and other ECG textbooks are great for getting a basic handle on ECGs, but I never used them more than once.
UpToDate and BMJ are probably the best resources you have for learning about Core Conditions. UpToDate is quite dense and full of word-vomit. BMJ, in my opinion, has an easier and neater format to scroll through. However, you should be aware that UpToDate is an American source, while BMJ is British, so use Therapeutic Guidelines when learning about management in Australia.
BMJ onExamination (free subscription) and PassMedicine (requires fee) were question banks I used to fill out holes in my knowledge. Use the final-year medical student resources because you need to be exposed to a wide variety of conditions anyway.
Lecturer(s): Varies by clinical school.
Year & Semester of completion:2017
Rating: 5/5
Your Mark/Grade: H2A
Comments: MD2 is far better than MD1, It's much more interactive, practical, and relevant, but it's also far more challenging because not only do you realise the overwhelming amount of information you don't know, you also have to use your clinical reasoning, rather than just regurgitate facts. Learning is no longer restricted to lectures, but you will need to go out of your way to find things to look up out of curiosity, to speak to patients, and actually discussing cases with other students or doctors.
The year is split into four rotations. Foundation lasts for 4 weeks and is basically an introduction to learning in a clinical environment. Depending on your clinical school, you may be front-loaded with lectures during this time (my school had done 40% by the time we were finished). The next three rotations are Medicine, Surgery and Emergency/Ambulatory. You'll spend 8 weeks in each, and 1 week in each rotation is dedicated to reviewing and debriefing how the rotation went.
Medicine is the most content heavy rotation. People will be allocated to different wards, but generally you'll get a dip into Cardiology, Respiratory, Renal, Endocrinology, Rheumatology, Gastrointestinal, and Neurology. Surgery term is a bit lighter, while Emergency/Ambulatory is the most chill.
So how do you actually learn in your clinical year, aside from the lectures you're given (a significant number of which are case-based discussions)? The faculty gives you a whole pile of Core Conditions, Presentations and Drugs you need to know by the end of the year, and you're expected to learn about these conditions (on your own, or by seeing patients). It's pretty freaking daunting. I think there needs to be a balance from learning on the wards and also studying out of textbooks.
Going on Ward Rounds is a hit or miss. I went to as many ward rounds as I could in Medicine rotation and my attendance slowly slid off and I think the last ward round I went to was a surgical one in my second term. It really depends on the team - if you strike a good team, you'll be able to get involved and the doctors will actually bring up some critical points for you to know, and sometimes they'll suggest for you to see certain patients if you want to see some signs or take a history. Otherwise, you might feel like you're doing nothing and you're in the way. Don't feel discouraged, it's a natural part of being a medical student. Don't bother going to surgical ward rounds because they go through their whole list in 30 mins at 7am, unless you want to go to theatre. I found them pretty low yield because they usually spend 1-2 mins with each patient. I found theatre to be incredibly boring - hours and hours of standing on your feet not really knowing what's going on, but there's always a chance that you can scrub up and be involved. If you can, get there 45 mins before schedule so you can meet the anaesthetics team and watch them intubate the patient.
The same can be said with clinics. Some were incredibly good, others were notoriously boring. Try and sit in with a consultant if you can because generally they will always teach you a lot. One of the fellows encouraged some of us to see patients by ourselves and present back, so while you might freak out a little and not really know what to do (because you know nothing), it's good experience anyway.
During your ED rotations you'll be rostered onto a few ED shifts and again they are hit or miss. Try and find a registrar or consultant to buddy up with and ask if you can follow them around, see their next patient and present back to them before seeing the patient together later. Generally most doctors will be happy with this arrangement and it's valuable seeing what further information you missed. You'll also have the opportunity to do lots of procedures - suturing, plastering, and lots of cannulations/venepunctures. You'll also get 4x weekly GP visits during the rotation. Luckily I got to see a wide variety of conditions as well as see my own patients and do procedures, but it really depends on what practise you get yet again - some people just sat in with a doctor the whole day and observed.
To get the most out of rotations, you are going to need to take initiative and ask for opportunities. Sometimes there is an extent of luck involved, but you are not going to get to do much unless you ask for it. Ask nurses if you can practise a cannulation. Ask if you can suture the next patient. Ask if you can scrub up and help out in theatre. Don't expect everything in a giant platter - it's up to you to make as many learning opportunities for yourself. That being said, you do not need to go all out because you will burn yourself out if you end up staying in hospital until from 7am-10pm each night. You'll hear stories of some gunners being that crazy but you really don't need to be in hospital for that long! A lot of medical students also get freaked out hearing about what other people do on their rotations but try not let that get to you - run your own race, as long as you're satisfied with what you've learnt, then you should be ok!
Long cases and Case Presentations are great learning tools, and you should ideally practise at least one a week. Basically, you need to take an appropriate history and examination of the patient, then present the patient back and synthesise everything together to form several management issues and perhaps some differential diagnoses as well. This is usually followed by a barrage of questions by your examiner, and often each case raises great learning points. You'll have three assessed long cases, one in each rotation. You're allowed unlimited time with the patient and access to their notes in Rotation 1, only 24 hours in Rotation 2, and then only 60 mins with no access to notes in Rotation 3, Your first few will be terrible - use them as an opportunity to experiment with your format. By Rotation 3, you should really be practising what you'll do in terms of timing and organisation of your manilla folder before your final assessment. Practise is critical. After each patient, try look up their condition so that you'll become familiar with it - the biggest challenge is when you don't really know what's going on. In the final long case, patients are recruited by the hospital so they may have extremely complicated histories - which is why it's critical that you read widely and see many patients before then.
MiniCEXs are basically an OSCE station done in hospital. Find a patient beforehand, consent them, then undertake a supervised 6 minute examination or history of the patient. You'll get some useful feedback after!
During the year there will also be 3 optional Progress Tests that you can sit. They're essentially a NAPLAN for medical students. The university pools questions from USLME papers (aka final-year medical student level) and you're able to see where you stand in the cohort. I recommend sitting them to see if your study technique is working or not. I got a huge wakeup call when I realised I was in the 30th percentile for my first one (because I had no idea how to study), then began to actually write notes and there was a pretty dramatic difference. So while they're difficult, it's definitely useful to gauge how effective your study is.
Now, onto OSCEs. You don't really need to practise for these until maybe halfway through Rotation 2. They're worth a big chunk of your grade so don't forget about them! In MD2, the main aim is to not only have a working diagnoses by the end of your history/examination, but to also rule out other diagnoses you cannot miss. It's different from ticking off a checklist of things to ask, as was the case in MD1. Again, practise a wide range of conditions and presentations regularly. It's a good idea to form an OSCE study group and meet up on the weekend and go through some stations. There are also some combined stations where you will need to first take a history from the patient, and then perform the appropriate examination. You should be actively synthesising during each OSCE station you're in - you need to not only practise automating your questions and examination technique, but also interpreting what you are actually seeing and going out of your way to look for red flags. You'll generally be asked a few questions about what further investigations you'd like to perform (and perhaps need to interpret them as well). Just remember the golden rule of not just rattling off a whole bunch of investigations for the sake of it, but to say why you'd like to perform each one and to say what you're actually looking for.
The written exams are a huge pain in the butt and can pretty much test anything. Even things that are not on your Core Conditions. Some questions are repeated from recalls but the vast majority are usually new. These test your clinical reasoning as well as your steps in management. Always read the question carefully because there are usually multiple answers that would generally be ok, but you're usually asked "what is the NEXT step you'd do" or "what's the BEST investigation to do". So read the question damn carefully!
Wrapping up, MD2 was probably the most challenging year of university so far, but I've learnt so much. It was amazing seeing how much me and my peers had progressed in just a year's time, even though we still don't know much at all! You realise that there's so much to learn in medicine in the clinical years and it's such a great thing to actually see things you're taught be applied in the real world. That being said, it is also a very overwhelming year. It's vital that you have a good support network of other medical students to lean on, and to remember to have a life. Gunners usually come out in the clinical years, but don't get too psyched by them. Worry about your marks less - as long as you know what is going to make you a safe and competent doctor, you'll be on the right track. It's infinitely better than the preclinical years!