Fourth Year Guide

Please note this guide is based on the 2020/21 academic year. As assessment methods and exam weightings may change from year to year, keep an eye on your email/Blackboard/handbook for the most up to date information for your year.


Fourth year, whilst academically challenging, is an incredibly enjoyable year. It is a great opportunity to experience specialties that one may not encounter again throughout the course of your career and so every effort should be made to enjoy the four placements to their fullest and to get stuck in early as each will be over as quickly as they began. Being the first year that counts towards your final degree brings with it a considerable amount of pressure. Be mindful of that, both for yourself and others. It is a very manageable year if approached with a clear mind and the correct amount of support. Rely on your friends, practice with your family – especially in times of Covid where learning opportunities will be limited.


Resources: Dr. Anne-Marie O’Dwyer’s textbook, RSCI handbook

Doing well is very achievable. Your end of rotation exam is easier to do well in than your summer exam so capitalise on that. The end of rotation exam is clinical so just practice formulating your history, mental state exam, differential and management plan. The lecturers in psychiatry are all passionate about their (sub)specialties so enjoy their lectures and ask questions at the end. These will be the people examining at the end of the rotation so it’s good to make yourself known to them and show an interest. The summer exam is quite challenging initially but you will improve on practicing from past papers. The questions at the end of each chapter in the RSCI textbook are also helpful. Your grade in psychiatry no longer counts towards your degree result but psychiatry is re-examined as part of MedSurg in final year so it’s worth spending the time learning this material well. You may get a long case in final year based entirely off a psychiatry patient or it may be a component of the case.

How do the 7 weeks break down?

Weeks 1-3: Lectures (9-5 most days). You will also be asked to sign up for student selected activities and projects. You then work on this project as a group and present at the end of week 3. This presentation is very relaxed but is worth some marks towards your grade for the module. There are also tutorials during these weeks on general psychiatry topics such as depression, anxiety, psychotic disorders, personality disorders etc. It is worth preparing for these and fully engaging with them, otherwise they can feel quite drawn out.

Weeks 4-7: General psych placement. You will be assigned to a team, in pairs, in St Patricks, James’ or Tallaght. During this time you are encouraged to take as many histories and perform mental state exams. It is worth presenting your histories immediately after taking them as this is the case in the Clinical Formulation and Management exam at the end of the rotation. Normally, there is some exposure to specialist areas such as Forensic Psychiatry in the Central Mental Hospital but this may change according to the state of the pandemic. On the last Friday of the rotation the Final Test will take place.

How do the marks break down?

The EMQ exam in June counts for 50% of the marks. The other 50% of the marks are obtained whilst on rotation: 34% of the marks go for the end of rotation Clinical Formulation and Management Exam. 4% of marks go for a Written Case History that must be submitted to the lecturer at your placement site. 3% of marks go for the group presentations. 9% of marks go for a Case that you present. In previous years however the breakdown of the module was significantly different, especially for the marks gained whilst on rotation. For this reason I would suggest reading the Course Guidebook well and know what you should be doing on the first day of your rotation as it can become quite stressful doing all the tasks towards the end.

Assessment in previous years was by:

  • Consultant evaluation forms: Your consultants will give you a percentage mark and tick a box regarding attendance and give a brief feedback report.
  • Case based discussions: Basically a history and mental state exam presentation. You have to do at least 4, 2 can be sighted by a senior registrar and 2 have to be signed by your consultant. You do 3 from your general placement and one from your specialist placement.
  • Case conference: this is a PowerPoint presentation of a case. You present the history and mental state exam to the group of students in your hospital and a consultant who marks your presentation. Half of the students will have to do a case conference. The other half will have a TV interview.
  • TV interview: a recorded 15 minute interview with a patient. You are supposed to take a ‘full history’ but most people only got as far as the history of presenting complaint. The purpose is to look at your interviewing style and communication skills. The week after you take the interview a group of students and a consultant will watch the tape and give feedback on the interview.
  • Project: during the first week you will have to sign up for a project topic in groups of 7. Once you have signed up for the topic you contact your tutor who will give you direction on how to approach the topic. You will give a PowerPoint presentation with your group in front of the class and your tutor, who marks the project. You will be asked some questions about your presentation afterwards.
  • Student selected activities : everybody must attend two activities from ECT, domiciliary visit or evening on call

Obs Gynae

Resources: Impey (bible, but sometimes needs supplementing), Profs Deane and Murphy lecture slides and PassMed MCQs as a break from studying. Note that PassMed questions are significantly easier than what comes up in the exam so don’t spend too much time on these.

For us OBGYN was an incredibly well organised module. Much of the teaching is delivered by Professors Deane and Murphy. These lectures are the mainstay of what you should know and then other topics are delivered by different teaching staff. There is a lovely focus on the soft skills of medicine in this module – such as patient empathy, listening and emotional intelligence. The Profs are very inspiring and you will enjoy every one of their lectures. There is a mix of pre-recorded lectures and live lectures.

Tutorials are delivered in the three different hospitals: The Coombe, SJH and TUH. These are delivered on topics such as the gynaecological and obstetric physical exam. You are assessed on these at the end of rotation exam so it is worth going into these tutorials prepared and not starting from scratch. Remember what you were taught during it and write this down as you may not get the opportunity to practice again until your exam, which will be 6 weeks from when the tutorial is delivered. Other activities include OPD clinic, operating theatre sessions and most importantly the labour ward shift. It is a tremendous privilege to be present for this process and you should try to get the most out of it. The midwives will be keen to teach and involve you if you are kind and courteous from the start.

The OSCE is based off a clinical case and you must take a history and exam in 15 mins. This is usually a basic case so you should practice each topic with your friends alternating as patient and student. This is really important as it means you can go into the OSCE then with all your questions learned off and the exam will run more smoothly. There are tutorials given by Prof Crowley and Curtain which also prepare you well for the OSCE but the one recommendation I would have for OBGYN would be to practice with friends. In other years there were more than one station in the OSCE but they dealt with similar topics e.g. Obs history, gynae history, consenting patient for procedure etc.

How do the marks break down?

*this may change year to year*
Paper 1 MCQs – 40%
Paper 2 MCQs on clinical cases – 40%
OSCE – 20%
40% end of term long case.

Delivery Suite

Delivery Suite is three 12 hour shifts. Either 2 days and one night or vice versa. You should arrive early enough to change into scrubs (for guys it’s in theatre, go through the double doors and it’s the second or third door on the right, through a small room with a couple of chairs). For girls it’s inside the delivery suite. Wear comfortable trainers, there’s a huge amount of standing.

You’re expected to stay with one mother all the way through her DS visit. If you aren’t asked to, offer to do the Obs, and take the history of the woman. You have spaces to use this as a case in your logbook. If you’re stuck with no patients during the day, ask in theatre about sections. If you’re stuck with no patients at night bring a textbook or follow anyone going up for section/manual removal of placenta. Midwives and Clinical Managers vary wildly in their tolerance for medical students so just cross your fingers.


Neonatology is part of Paediatrics. There’s a separate bundle of sheets with spaces for signatures for this, these are not required so don’t bother filling them in. The baby checks you’re scheduled for are useful for being able to do a neonatal exam. Go to as many as you feel you need to. Dr Sheridan’s tutorial on Thursday is long but she doesn’t ask many questions. Everything else is explained clearly by Dr Doolan. The OSCE runs in the last week of the rotation. The questions we got were the same as last year. You get three from the following:

1. Congenital Heart Disease signs

2. Taking a feeding history

3. Normal skin findings

4. Testes examination

5. Measuring the head circumference

6. Tone and 4 reflexes

7. Liver palpation and causes of hepatomegaly

It is a combination of talking about these things and doing them. It’s all done on real babies and mothers. This OSCE is easy to pass but difficult to do well in.

GP and Public Health


Resources: lecture slides. It is a good idea to split the lectures up amongst friends and each make notes for each one.

The first day of your GP rotation, you will get a talk from the Public Health and GP directors. They each give a brief overview of their sections of the course. After this, the secretary, Ailbhe Mealy ([email protected]), will hand around an envelope containing the contact details of GP attachments. You will select a GP from the envelope for both your Inner and Outer Rotations. After each round, you will have an opportunity to swap GPs if you choose. After selecting your GPs, Ailbhe will take note of who is assigned to each GP. There is only 1 student assigned to 1 GP.

Placement is made up of 2 weeks “inner” and 2 weeks “outer”. Some people try to swap into a GP which is close to their hometown so they can live at home for 2 weeks. Some try to swap to an “outer” rotation that’s close to Dublin so they may commute for the 2 weeks. Others try to swap into rural locations like Donegal and go as a group and live there for two weeks which is a relaxing experience during a busy year. You get €150 towards accommodation costs which makes choosing a rural location more attractive.

The end of rotation exam is harder than the summer exam. You’ll get a feel for how serious this rotation is when you start it. Don’t flunk your end of rotation exam it does require some attention.

How do the weeks break down?

Weeks 1-2: Lectures
Weeks 3-4: “inner” GP rotation (within Co. Dublin)
Weeks 5-6: “outer” GP rotation
Week 7: lectures with the end of rotation exam on Friday

How do the marks break down?

30% continuous assessment
40% end of rotation MEQ paper
30% end of year – 100 T/F MCQs with no negative marking

Inner Rotations

These placements range in location, however, they are all within Co. Dublin. Some people had to commute for an hour and a half to reach their placements. You do not receive reimbursement for transport for your inner rotation. Rotations can range from private clinics to GMS clinics. Some are large group practices, while others are small single-GP practices.

Outer Rotations

These are located around the country. Approximately half of the class is located in Co. Donegal, while the remaining half are scattered elsewhere.


Throughout your GP placements, you will be required to do small projects. These include a Genetic Disease project, MUPS, Professional Insight, and Practice Population comparison. There is a detailed description of each project in your logbook. These must be typed up and stapled into your logbook.

Practice Log: during your GP placements, you will be required to include the description of 25 patients you encountered. You log their presenting symptoms, the diagnose and disease code. There are boxes to tick if the patient receives a prescription, investigations, advice or a referral.

The logbook is handed in at the end of the rotation. It must be handed in to Ailbhe at Tallaght prior to the exam. No logbooks may be handed in at the exam.

It is worth outlining to your GP on the first day the tasks that you must complete. They will have an idea of what patients are coming in during the week and will be able to set time aside so that you can interview these patients for your logbook. Your GP rotation is a great way to get back into learning clinical skills. There are mornings when nurses will be taking bloods etc and they usually are very keen to allow students to do this.


Lectures range in topics, but are primarily about Public Health Policy, Epidemiology and Statistics. There are smaller group seminars scattered through the 4 weeks of lecture. You will be divided into two groups based on alphabetical order and attend your allocated seminars. If you are unable to attend your assigned seminar, you can swap seminar times with a colleague.


Resources: Unofficial Guide to Paediatrics, Sunflower Paeds, CHI Guidelines, PassMed

Paediatrics, like OBGYN, is worth 25% of the marks towards your final degree. Don’t let this take away from what can be a really enjoyable rotation. Paediatrics can seem daunting at first because it is essentially all of medicine and surgery, but for little people. One of the ways to break it down is by systems – study a system each day and the key diseases within that system. Each of the textbooks (Sunflower and Unofficial Guide to Paeds) does this quite well. Have a look at each of these textbooks before you begin the module and decide which is for you – and stick with it!

How do the marks break down?

30% – end of rotation exam
33% – end of year true/false exam
33% – end of year OSCE

How do the 7 weeks break down?

Weeks 1-2: Lectures online
Weeks 3-5: Placement between CHI Crumlin and Temple Street
Week 6: Lectures online
Week 7: Group presentations and end of rotation exam

It is recommended to really take advantage of your time on placement, especially in Crumlin. It is a much larger hospital with a much wider variety of cases to see and due to our limited time there you should really grab hold of any child (and parent) that will talk to you, particularly as Tallaght only has two wards