Fourth Year Guide

Please note this guide is based on the 2022/23 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 is a jam-packed year which needs to be approached mindfully! It tends to be viewed as the ‘first real year’ as the marks you get count towards your final degree – but it doesn’t have to be all work and no play. The year is overall a varied, engaging and different learning experience as the specialities are very different from what you may have seen in third year. It is an opportunity to see new areas of medicine and certainly involves a more structured teaching program than earlier years. 

Fourth year is a manageable year with more intense periods leading into more relaxed placements  in that a module which counts towards your degree will be followed by a pass/fail module. The specialties which count towards your degree are Obstetrics and Gynaecology and Paediatrics and those that are pass/fail are GP and Psych. This means that despite the lack of breaks between modules (which is undeniably very tiring) there is a little bit of let up between the bigger exams to blow off some steam. Make sure a good social event is planned for each end of rotation and celebrate the end of each exam period! 

At the end of the year fourth years sit each topic again in written format, excluding Obs Gyn which is 100% at the end of the rotation. This can be challenging when referring back to your first placement unless you started with Obs Gyn so make sure you are aware of that. However, you will realise as you go along that the information you need and the learning style required really depends on what type of exam you are studying for so don’t be too concerned about forgetting things for the end of year. Stay focussed on your current rotation and try not to concern yourself with the past or future modules! Every module is quite challenging in a different way so it wouldn’t be advisable to be cross-studying rotations you’re not currently on. As mentioned above, the year is achievable but it does require a calm approach.


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

Doing well in this module is achievable. The end of rotation exam tends to score higher and be found easier by students than the summer exam so it can be a good way to pick up lots of marks. The clinical end of rotation OSCE involves a video which students watch and the history is then reported during an OSCE style session with one of the professors. The cases are usually quite common ones rather than anything too niche for the first exam so focus on the big players. Dr. Anne-Marie O’Dwyer coordinates the module and wrote the textbook so her textbook and her lectures are good hints to what she wants you to know! The end of year written is a little more comprehensive and rarer cases can appear in this one.

For the clinical make sure to practise formulating your history, mental state exam, differential and management plan. A good structure and knowledge of psych-specific history is a good place to start. The summer exam is quite challenging initially but you will improve on practising 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!!

OBGYN is an incredibly well organised module. Much of our teaching was online via blackboard which allowed a break from commuting to and from hospitals. There is a lovely focus on the soft skills of medicine in this module – such as patient empathy, listening and emotional intelligence. 

This module is very heavy on tutorials (which are great for teaching but can be tedious!) and you are expected to have watched the relevant material on blackboard beforehand. These can be gruelling if you haven’t prepared but can be super worthwhile if you have watched the pre-recorded lectures for that day and a good way to solidify learning. 

In person tutorials are delivered in the three different hospitals: The Coombe, SJH and TUH. You will have the opportunity to practise on the models that will be used in your OSCE during these sessions and it is important to make the most of these as the teaching is great and you might not see the models again unless you arrange to go in yourself to the tutorial rooms to practise. Other activities include OPD clinic, operating theatre sessions and two labour ward shifts; one daytime and one night shift. The placement is compulsory but not many hours per day and some days you will only have online learning which allows plenty of time to catch up on work.
Our OSCE involved a history and an exam and a counselling session. These are usually basic cases so you should practise 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. 

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 two 12 hour shifts. Wear comfortable trainers, bring proper meals and snacks and your notes.

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 the theatre about sections. Midwives and Clinical Managers vary in how much they like the student to be involved so you may or may not be lucky.. Same with the babies – some people see three in the first few hours while some people see one over the course of the full shift! The labour ward shift is also a handy way to pick up some sneaky signatures for the end of your logbook in the supervised task section. They are quite strict about having all of these completed so the DS shift can be good for a last minute logbook dash. 

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 as there are LOADS. They can seem quite random but make sure you focus on epidemiology for the end of rotation exam as this is a guaranteed question! The end of rotation can be quite harsh, but the end of year exam seems to have slightly more clinical each year (anecdotally!) so can be a little easier to rely on your general medical wisdom. 

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. However, in our year this seems to have come out of your next round of college fees (..incase you expected a wad of cash in hand). The day that everyone gets their rotations is an awfully stressful day of shouting across the sweaty Russell Centre classroom, three way location swaps and huge emotional bribery. Just be prepared for that. The system is flawed.. You will be okay. 

As hinted at above, 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 but you should know your results of the first one before you sit the end of year so will have some idea of what you need to achieve.

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 (almost) 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!


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.

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