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.

Intro

Congrats on making it through second year!! It is famously one of the hardest years so well done! We promise you that third year is much more enjoyable. You get to try out loads of specialities and learn relevant clinical knowledge that you will actually use (although imo you could-and should- use sea urchin sex as a great icebreaker). However, you’re really thrown into the deep end and expected to quickly adapt. It can be tough and there’s a lot going on constantly, between exams, lectures and placement. With so much happening, lots of students end up muddling through the year and exams. The key is to be organised and spread out the workload throughout the year. To help you fabulous people out, we’ve compiled this guide. We hope it will help shed some light on what everyone should know before embarking on the epic venture that is third med!

Third year consists of both placement and lectures. It *does not* count towards your degree and is a pass/fail year, so you won’t get a percentage grade at the end of the year (unless you maybe scream, cry, throw-up…).

For placement, the year group is split into three: SJH, TUH and Affiliates. Your group changes placement each semester so that by the end of the year everyone will have rotated through each of these three groups. During your SJH and TUH semesters you will rotate through different specialties (both medical and surgical) every 2-4 weeks. During your Affiliates semester, you will rotate through 2-3 affiliate hospitals (e.g. National Rehabilitation Hospital, Naas, Hospice, Peamount etc). Everyone spends time in the Royal Victoria Eye and Ear Hospitals as part of their Affiliates rotation. This is where you will experience your Ophthalmology and ENT rotations, which are both two weeks long.

On placement you will be attached to a ‘team’. A team is made up of a consultant and NCHDs (Non-consultant Hospital Doctors) of various grades. These include interns (just finished final year), SHOs (Senior House Officers), a registrar, and a SpR (Specialist Registrar). It’s a good idea to introduce yourself to consultants early on in the rotation. Ask about the outline of their typical week. The things you’ll be expected to attend include ward rounds, out-patient clinics, MDT (Multi-disciplinary team) meetings, theatre, and journal club. If you appear enthusiastic and get your face out there, they’ll probably be more willing to teach you!

All students must wear scrubs on placement. You wear the TCD scrubs which you must buy (but you can buy second hand scrubs from us). If you’re heading to theatre for surgery, you need to change into special theatre scrubs and clogs which will be provided. 

Always have your stethoscope with you – but don’t be caught wearing it around your neck. Majooor cringe. Pocket or bust until you graduate, them’s the rules. Have your hospital ID card on display – you’ll get these when you start in each hospital. They’re also essential to get through most doors independently. Other things that are good to have with you are pen and paper, and your logbook. It also might be handy to have a few cheeky PDFs on your phone such as the Oxford Clinical Handbooks, which can come in handy when you’re standing aimlessly, looking for doctors to adopt you. 

THE LOGBOOK

“Hey I just met you/ And this is crazy/ But here’s my logbook/ So sign it maybe?” ~ every third year ever to any kind-looking doctor.

Ahhh, the infamous logbook. All students develop a love-hate relationship with their logbook. It’s worth a whopping 40% of your MedSurg grade, which is relatively easy to get. However, it does mean lugging it around with you all the time, desperately searching for signatures. 

*HOT TIP* – take regular photos of the pages of your logbook so that if you lose it you don’t have to go back and get all your signatures again.

Get as many things signed off in your logbook as possible, as soon as you do them. I made the mistake of not carrying my logbook around with me in the first semester, meaning I missed out on a lot of priceless signatures. In the smaller affiliate hospitals it can be more difficult to get things signed off, but don’t worry- you will have plenty of time when you’re in SJH and TUH. It can be really daunting going to doctors and asking for things signed off. However, they’re well used to it and they probably remember their own logbooks so they’re more than happy to sign you off. Sometimes their hand might even slip, making them accidentally sign you off for three ABGs instead of one…

Any time you perform a clinical skill, see an ECG, hear a reg talking about an acute scenario – these are all opportunities to bulk up your book. If you’ve done basic clinical skills (tutorials on phlebotomy, IV cannula, NG tube etc.) and someone on the team asks if you can do something, say yes! Ask them to supervise you the first time to get their feedback. They will step in if you run into difficulty. Having said that, if you don’t feel comfortable doing whatever they ask, say you would prefer to observe. 

There’s a lot of standing around, not knowing what to do, when you’re on placement. If there’s clearly nothing happening, don’t hang around because your time is precious too. Sometimes when some teams are busy, they will try and fob you off to take a few histories. Now you’re given a choice, as you could leave and they probably wouldn’t notice but it is worth your while to push through and visit at least one patient. Just think of it as going to have a quick chat with them – if you can get a full history and exam from them? Great. If it’s not going so well, just try and glean the presenting complaint and have a quick listen to their chest. It’s all worth it in the end. The patients also tend to love the chat because they’re usually v bored. 

This is the year to get really comfortable examining patients so that you appear confident come exam season. Get as many histories and exams done as you can because you will have the time. 

 A big mistake people make is not presenting histories. It can be unnerving presenting but it’s really worth it in the end because it’s great practice for exams. Interns are particularly great to present to because they know what information is high yield and can give really good, exam-focused feedback. 

Another thing to look out for on placement is any massive clinical signs which can come in handy for your long/short cases. It took us a long time to figure out the difference between a long and short case. A long case is a full history and exam, ideally observed by a consultant/reg. In reality, they may not have time to observe you but presenting to them afterwards is ok too. A short case is a short physical exam or inspection, e.g. auscultating a murmur, palpating hepatomegaly, describing a drain/tube/incision. Some useful things to learn to recognise and describe are hernias, stomas, scars, tubes, drains and ulcers.

Placements

Here is some advice about specific placements. In terms of selecting your preferences, I’d advise you look into how long it’ll take you to get there because you don’t want to be spending over an hour commuting to placement twice a day, five times a week, if there’s an affiliate hospital nearby! But be warned, the SoM don’t really pay much attention to the choices you put down so might still be shipped off to far away lands anyway (and by far away I mean Dun Laoghaire).

OLH

This is a really worthwhile placement which most students get a lot out of. Buses 9, 16, 49 and 54a all stop on Dame Street and will bring you to Harold’s Cross. 

The teaching is great, but the placement can be quite heavy due to the nature of palliative medicine. However, what many people don’t know is that there is much more to OLH than palliative care. You can find geriatrics as well as a rheumatology/MSK unit, both of which are great specialities to get histories and exams from. You’ll get lots of tutorials (which you can get signed off) and there is time dedicated to presenting and getting feedback on your histories. You might also end up going on community visits or doing a few days in the palliative services in TUH or SJH which are both very valuable experiences.

NRH

The journey from town takes about an hour. Get the 46A bus to Baker’s Corner and it’s a 10 minute walk from there. It’s on the outskirts of Dun Laoghaire so avoid the DART as the walk from the station is quite long. There is a dedicated tutor who does a lot of teaching and you may be asked to do a few short presentations. 

You will take a lot of histories from the patients, many of whom have brain injuries, spinal cord injuries and limb loss. You’ll get to learn the different types of neurological exam including upper limb, lower limb and cranial nerves exam which is great practice for exams!

You’ll also get the opportunity to talk to the different members of the MDT about their work and attend physiotherapist, occupational therapy and speech and language therapy sessions with the patients (which you can get signed in your logbook!).

Peamount

The only way of getting to Peamount (other than driving) is the 68 bus. This takes a bit over an hour from town (it starts at Hawkins Street near College Green) or 45 minutes from South Circular Road just next to the Rialto gate of SJH. 

You tend to finish early most days and get lots of breaks. 

It’s a respiratory rehabilitation hospital so know the resp exam and the basics of asthma and COPD well before going. There’s also a neurology wing so brush up on the aul neuro exam. You’ll get loads of good findings and cases (logbook!!!!). The nurses are super nice and, if you ask, they might let you help with the phlebotomy rounds in the morning which is great for practising taking bloods.

 There’s a farm right beside the hospital so look out for the Peamount pig! Rumour has it that if you spot the Peamount pig you will pass third year so keep an eye out!

Naas

While students may not be excited about going to Naas, initially, in the end most people were really glad they were there. You will be assigned to medicine or surgery. The teaching is fantastic. You have the opportunity to take free accommodation in a house right across the road from the hospital which is very handy (we’re talking a 3 minute morning commute). It’s also great because you get to live with the other students in your year in Naas, so you’ll really get to bond. You can even go out! Naas is famous for its booming nightlife. We’d recommend the Naas Court Hotel for a bop and some great live music!

Because there are so few students in the hospital at any one time, you can wander around, take histories and do exams on any patient that is happy to oblige! You really have to take the initiative though because no one is there to tell you what to do, especially on the medicine side. Surgery is much more organised and there are a lot of tutorials. I learned a loooottttt here on surgery.

 You’ll be surprised at the amount of times you find yourself referring back to your time in Naas throughout the year. It’s an experience and a half and you’ll love it. 

Blackrock

The Blackrock placement is extra relaxed but very educational. Almost all of the time is spent in ICU with the anaesthetist. Last year it was Dr Omar- he liked to teach and had students interpret lots of X-rays and ABGs which is just as well because there were never more than 4 or 5 patients. RCSI students occupy the remaining, more active parts of the hospital (including the indoor pond (which you CAN’T swim in)) and will have tutorials scheduled for them which you can attend if you use your relentless and overwhelming charm like me to talk your way into their whatsapp groupchat. On the first day just introduce yourself to the staff at the main reception and they’ll sort you. They’ll come looking for a tenner to use as ransom in case you try to run away with their swipe card (they can tell by the look of you). The cafe is fantastic if you’re happy mispronouncing fancy people foods- I just put on my best South Dublin accent, mumbled a bit and hoped for the best. It’s very nice and relatively cheap for staff and, being the dedicated medical student that I am, was what I remember best from the rotation. If you can only take one thing away just remember that you really can’t swim in the pond. I’m not joking. It’s not deep enough. I was told it was very unprofessional and afterwards no one will be sound enough to lend you a towel.

Hermitage

At the Hermitage, you get to see lots and as they don’t have many students, most of the doctors are delighted to see you and love to teach! You are not assigned to a team so each day you get to see something different ranging from the cath lab and radiology to the wards and theatre! I would recommend theatre the most as the theatre nurse makes sure that you’re with a consultant who will teach you and many of them let you scrub in and assist a lot! The anaesthetists are also very nice and may let you help them out too! 

Isle of Man

 In third year, you can apply to do a placement in Noble’s Hospital in the Isle of Man for four weeks. Groups of about 4 students travel to the island between November and April. It is absolutely worth applying to.

The Isle of Man is a small island of about 80,000 people in the Irish Sea. There is one large hospital on the Island, near Douglas, and one health centre towards the north of the Island. The island has gorgeous scenery and amazing places to go for a swim in the sea.

The hospital itself is really well equipped for students with a simulation room and model, VR headsets, and regular teaching sessions that you can attend and even request. We were all assigned one doctor outside of our team as our ‘tutor’, who would teach you any exams or skills you felt you needed to practice- this was great for getting the logbook filled.

As there are so few students, you will likely be the only medical student on your team and the only student they have had for a while. This meant the teams were really excited to teach us and get us involved in procedures and surgeries that we wouldn’t get to see in the busy Dublin hospitals.

Getting to the Island is quite easy as Aer Lingus run flights most day out of Dublin. You can then get a taxi or a bus to the hospital accommodation. We were given free bus passes by the student coordinator which made it much easier to get around the island. There are also bikes provided for free. It would be useful to have a car with you to get to more difficult places if there is a ferry at the time you’re going!

The house where they accommodate students was recently built and each room has an en-suite and large desk. There are usually students from the UK staying in the house who are also on placement so it’s a good opportunity to make friends with other med students!

Even if the weather is bad, like it was last January (it even snowed…), the island is a beautiful place to explore and it’s a nice break from the city scenes of Tallaght and James’… and you’ll hopefully learn loads without even trying like we did!

TUH & SJH

Tallaght and James’s are where most of the action happens. They’re very accessible via the red line and various buses. They’re very busy hospitals where you’ll get loads of experience, both surgical and medical. 

Medicine

You get a medical rotation in each hospital which lasts 3-4 weeks. 

Rounds usually start later than surgical rounds (9am onwards) and tend to be longer.

From your medical rotation you can go to clinics and MDTs which are all things you can get signed off. Clinics are great to attend especially if you’re with a doctor who loves teaching.

You can also try to get a few clinical skills done like bloods or 4ATs/MMSEs. Tell the interns what you want to get done because they will really look out for you and help you get things done. Ask for their number or give them yours and they can text you if anything pops up!

Surgery

Surgery rounds tend to start earlier than 9 (usually 7:30/8ish). 

You can go into theatre whenever your team has an operating list, provided it is ok with them. If you’re not in theatre, there’s also clinic or small procedures like scopes etc that might be on.

For theatre, if there are more than 2-3 students assigned to a team, it’s a good idea to divide up the theatre time because often 2 is the maximum number of students allowed in at a time. Theatre lists generally start around 9. Make sure you get a good breakfast into you because you can end up standing for ages and if you don’t eat you might end up fainting. If you feel faint, make sure you let the surgeon know and step away from the operating table!!

You’ll need your hospital IDs to get into theatre and you may also have to sign a guest log at theatre reception. To go into theatre you need to wear a surgical cap. These are usually found in boxes in the changing rooms. You also need to wear theatre scrubs (you can’t wear the TCD scrubs). You can get these from the machines outside the theatre changing rooms (in SJH) but you usually need to have your hospital ID card specially activated to use these. You can ask at theatre reception and they will activate it for you. In some hospitals (RVEEH, TUH) the scrubs are in the changing rooms instead. When you’re finished with your scrubs, you either use your card to return them to a machine, or put them in a laundry bin in the changing room (depending on the hospital).

You shouldn’t leave valuables in the theatre changing rooms. When you’re going into theatre you can bring your phone, a small notebook, (basically: small things!). You can’t bring bags or stethoscopes or anything else in so, if you have anything valuable with you that day, it’s best to leave it in your locker, if you have one.

Find whatever theatre your team is operating in (it should be on the noticeboard) or else ask them at morning rounds. Teams are generally quite happy to have you in theatre. If you’re not scrubbing in, just stand back a little bit and DON’T TOUCH ANYTHING GREEN!

The surgeon may ask you if you’d like to scrub in. If you’ve never done this before, ask a theatre nurse to teach you. It’s really important that everyone who is scrubbed in has done it properly, so if you don’t know what you’re up to, no one will mind if you ask for help. If you want an idea of what’s involved, just watch a few videos on YouTube. Hold your hands up and when you’re not helping operate, keep them rested on anything sterile (green). No nail varnish when you’re on theatre rotations especially. The theatre nurse will spot it.

Modules & Exams

Laboratory & Investigative Medicine

This module is examined at Michaelmas and Hilary and, along with Pharmacology, comprises the majority of formal lectures. It is a combined Pathology and Microbiology module with a bit of Chemical Pathology and Immunology thrown in for good measure. The material is pretty interesting and it finally feels like you’re learning ‘medicine’. However, it’s a mammoth course and it’s a difficult task to comprehensively cover every aspect of pathology and microbiology in a single year. Our best advice is to work consistently throughout the year and be sure to attend all revision tutorial/lecture opportunities.

You will have a LabMed paper at Christmas worth 35% of your overall mark and another one around April worth 50%. At Christmas, the paper is formed entirely of MCQs. It will consist of single best fit questions, which include Clinical Vignettes, and extended matching questions. The Hilary paper consists of short answer questions where you will have to answer 10 out of a choice of 14, two essays (one on path, one on micro, no choice), and two MCQ clinico-pathological cases (CPCs). There is no negative marking in either of the papers. Some people will have a LabMed viva (pass/fail or honours). The material covered in the first term is carried over and examined again in summer. The final 15% of your overall mark is made up by a 3000 word essay that is usually mid April. You choose your essay, around the end of February, from a list of titles and it will either be Path or Micro.

The lecture notes are great for study, some people didn’t use anything else. A lot of the MCQs are made up from small details on the slides. If you prefer to use books, we liked Kumar & Clark and Robbins (some used big Robbins, others used baby Robbins). If you need to consult a book for microbiology ‘Clinical Microbiology Made Ridiculously Simple’ is excellent. Of note, many of the EMQs require a bit of clinical knowledge – it’s a good idea to know the signs and symptoms of common diseases, even if they are not specifically mentioned in the lectures.

Pharmacology and Therapeutics

Like Lab Med this is examined at Michaelmas and Hilary with material carrying over. You’ll be happy to hear that most people find third med pharmacology easier than second med. It builds on your second year foundation and makes it a bit more clinical. This means less new esoteric drug names to memorise! The module itself is very well organised and the lectures are very to the point.

At Christmas you’ll have 50 T/F questions, 0.5 negative marking. In summer you’ll have 50 more T/F questions, 10 SAQs and 2 out of 4 essays. Last year the Christmas exam was worth 20% and the summer exam was worth 80%. There are also pass/fail and honours vivas for those who are borderline.

The viva is nothing to be afraid of. You’ll be given a patient’s drug chart to work through, describing each drug, drug interactions and errors on the kardex (these vary from a missing prescriber signature to incorrect doses of common drugs to drug contraindications etc.). You’re also asked for your impression of the patient’s condition(s). This exam is actually a lot less intimidating than it might sound; there are Kardex tutorials throughout the year in which they cover cases that are very similar/identical to those that come up in the exam. If it’s a pass/fail or honours viva you may also be asked additional questions related to your written exam.

The lecture notes for pharmacology are generally quite good and you can definitely do well with them alone. Take heed if you hear the words ‘That would make a nice MCQ, wouldn’t it?’! A BNF (British National Formulary) is also really useful. A new one is published every 6 months so if you ask the hospital pharmacy very nicely, they might let you take an old one. Just don’t all go at once! We found it useful to draw out the flowcharts for treatment plans, e.g. heart failure, anxiety, community/hospital-acquired pneumonia; and know the doses for the ‘big’ drugs, e.g. low-dose aspirin, heparin, antidotes, antibiotics. 

Principles of Medical/Surgical Practice

This module pertains to placement, including clinical tutorials during attachments and radiology tutorials etc. There are 4 components to the assessment for this module. For 2023 the components were:

Medicine/Surgery MCQ paper – 30%
Medicine/Surgery OSCE – 15%
Logbook review – 40%
ENT/Ophth exam – 15%

Don’t be too deterred by the vagueness of the exam title and complete lack of past papers(!). The Med/Surg MCQ paper is actually not bad. You have it at the end of the year. It’s primarily based on tutorials held during placement and the radiology tutorials given during the year. Unfortunately, not everyone has the same clinical tutorials/placements. It is a good idea to ask your friends what material was stressed by their tutors in the peripheral centres. Nonetheless this exam is not hard and it’s actually nice knowing you can’t really prepare (read: cram) for it. There’s a fair bit of crossover with Lab Med.

The MedSurg OSCE takes place at the very end of the year in June. For us, it took place either the Wednesday or the Thursday of our final exam week. The ENT/Ophth exam was Monday and the MedSurg MCQs were Friday. This obviously may change year to year. While an OSCE can seem daunting, the examiners are very nice and really want you to pass. In 2023, we had 8 stations which included: 

• 1 history taking station: You will be given a question stem e.g. 47-year-old male presenting with shortness of breath. You then have to go through the scenario, taking a history from the patient, who will more than likely be an actor. Once you know the format of a history and stick to it, you will be fine. To prepare for these stations it is worth thinking of common, broad presentations e.g. abdominal pain, cough, weight loss. Afterwards, if there’s time, you might be asked on your differentials and how you would manage the patient. 
• 2 exam stations (one medicine, one surgery): They can be anything from neuro, resp, cardio, abdo or MSK. Like with the history, the cases here are usually common cases that you will have seen before. The important thing is to be as fluid and as confident with your exam as possible, so you look like a natural. Know some signs/ special tests because the examiners LOVE to see them e.g. Murphy’s sign, McBurney’s point etc.
• 2 data interpretation stations: You will be shown clinical data e.g. full blood screen, liver function tests, an ECG, a chest x-ray, ABG results and ask to interpret them. Know the common things that show up on these e.g. A Fib, pneumothorax, cholestatic vs hepatic LFTs, anaemia etc. Also know the structure for presenting an ECG (patient details, rate, rhythm, axis, etc) and a chest x-ray (ABCDE).
• 1 Clinical Images Station: We were given an iPad with 10 different clinical images. The examiners expected a spot diagnosis as opposed to a full description of the image. Even though there are ten images, you might even finish this station early because you literally just have to name what’s on the screen and move on to the next image  e.g. leg swelling, stoma, pneumothorax, varicose veins, chest drains. Know a basic approach for describing things (e.g. site, size, shape etc) just in case you are asked to describe something.  The way to prepare for this station is to take advantage of placement as much as possible – always go to see a clinical sign if a doctor recommends it and ask to present it to them afterwards.
• 1 communication station: This examines your communication skills. You will be given a scenario and there will be an actor* (*medical student from year above/ complete stranger) that you interact with. It could be consenting someone for a procedure, breaking bad news to a patient or approaching a disagreement with a colleague. For breaking bad news, you will have several tutorials on this during the year so know the SPIKE model. Remember that tone and eye contact are really important, speak calmly and clearly throughout and you will be fine. BIG HINT: If your chair is positioned opposite the patient, physically move it so you are sitting beside them.
• 1 rest station

We can’t recommend the ‘little blue book’ aka Essential Examinations enough. It really is ‘essential’ (lol, pun intended) for learning exams and the important exam findings to look out for. 10/10 would recommend. 

Ophthalmology & ENT

Everyone will spend 3/4 weeks in  Ophthalmology/ ENT in the Royal Victoria Eye & Ear Hospital. Ophth and ENT are solely assessed by one written paper each at the end of the year. Both papers consisted of 5 short answer questions. The answers to all of these were things covered in tutorials during your time at RVEEH so make sure you pay attention to those and take good notes. For the ENT exam, Emma Cashman’s lectures are really everything you need to know. For Ophth, Prof. Cassidy has a series of podcast lectures and a good self-assessment revision lecture that you will either be given on Blackboard or you can find on the drive.

There was no practical element to the Ophth/ENT exam in 2023 but in the past there have been practical exams. However, they will try and make sure you can use an ophthalmoscope by the time you leave. 

Advanced Clinical & Professional Practice

For 2023, this module was made up of 5 components:

Clinical Skills Assessment – 20%
Psychology and Psychiatry Applied to Medicine (PPAM) essay – 20%
Global Health – 20%
Ethical Reflection – 30%
Inter-professional learning (IPL) – 10%

The clinical skills assessment took place at the end of our clinical skills week. The best advice is to attend your scheduled clinical skills tutorials and take any opportunities you have to practise. As long as you follow all the steps you are supposed to, you will pass, even if it doesn’t go perfectly for you! 

In 2023, PPAM lectures took place over a week, which took place at different times for different groups. We were given in person lectures and, also, asked to view some online lectures. This builds on some of the stuff you covered in HDBSE in first year and helps prepare you for your Psychiatry rotation in fourth year. In 2023, there was a choice of assignment: either to write an essay by yourself about how a health app encourages people to change their health, or do a group presentation about a topic (you could choose from a list) and then complete an individual essay on that topic. 

For Global Health, in 2023 there was an online module to be completed in your own time to pass this component but, in previous years, there have been some very interesting speakers and group project assessments so keep an eye out for that.

 In 2023, like the PPAM week, they scheduled different Ethics weeks for the different groups. We spent a week on campus where we had small group lectures and tutorials. For the Ethical Reflection component, there will be a page in your logbook for you to fill out a point during the year (before your ethics week) a reflection on a scenario you encountered during your placement. At the end of ethics week, someone from the ethics team will meet with you to discuss your reflection. 

IPL is a group discussion with other health sciences students e.g. nurses, physios, OT, SLT where you are given a scenario that you work through together, like a PBL scenario. You will have 2 IPL sessions. There is usually a short assignment to do before the session and a short reflection afterwards.

Evidence-Based Medicine

This is a very small module that is also assessed by your elective report after your 3rd year elective in summer and by a group project. The group project is a paper you write and you can choose from a list of headlines around October. You’ll have about a month to complete it and there is a group supervisor that will help you. 

Summary

In summary babes, it can be a long, tough year so pace yourselves. Third year is sold as the ‘Transition Year of Medicine’ (which doesn’t sound as sweet when someone in ANOTHER COURSE reminds you of this, as you’re deep in the throes of Lab Med..). Nonetheless, try to stay on top of things as they happen but, also, mind yourselves and look out for one another. And, OF COURSE, make the time to come to all Biosoc events and enjoy yourselves! It’s the last year that doesn’t count towards your actual degree so live young, wild, and free 😉