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.
Intro
Third year can be tough. With so much going on, 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 guys 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. For the 2020/21 academic year, the amount of placement we had was increased to allow for missing placement in the case of COVID-19 outbreaks. This meant that we had placement every day, with lectures recorded to watch back any time on Tuesdays and Thursdays (approx. 6-8 lectures per week).
For placement, the year group is split into three: SJH, TUH and Affiliates. Your group changes 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). Everyone spends time in the Royal Victoria Eye and Ear Hospitals as part of their Affiliates rotation.
On placement you will be attached to a ‘team’. A team is made up of a consultant and NCHDs of various grades. This includes interns (just finished final year), SHOs, 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, clinics, MDT meetings, theatre, and journal club. If you appear enthusiastic and get your face out there, they’ll probably be more willing to teach you!
Since the pandemic started, all students must wear scrubs on placement. Depending on the hospital, they will either give you scrubs to wear or make you wear the TCD scrubs. Always have your stethoscope with you – but don’t wear it around your neck. Have your hospital ID card on display – you’ll get these when you start in each hospital. Other things that are good to have with you are an Oxford Handbook of Clinical Medicine (good for being productive when you’re waiting around for someone to return your bleep), a tendon hammer, pen torch, pen and paper and your logbook.
Get as many things signed off in your logbook as possible. 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. 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. It took us a long time to figure out the difference between a long and short case so we’ll try to explain. 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, eg auscultating a murmur, palpating hepatomegaly, describing a drain/tube/incision. These can often be signed off at the end of a ward round if you have seen some clinical signs. Some useful things to learn to recognise are hernias, stomas, scars, tubes, drains and ulcers.
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. If you ask them to let you watch them do it first, and then watch you do it, you won’t be doing anything that day. Having said that, if you truly don’t feel comfortable doing whatever they ask, say you would prefer to observe. This is the year to get really comfortable examining patients so that you appear confident come exam season.
Placements
Here’s some helpful advice about specific placements.
OLH
Buses 9, 16, 49 and 54a all stop on Dame Street and will bring you to Harold’s Cross. This is a really worthwhile placement which most students got a lot out of. The teaching is great. You’ll get lots of tutorials and there is time dedicated to presenting and getting feedback on your histories. Everyone does a 10 minute PowerPoint presentation on the last day.
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. Try to attend some MDT sessions while you’re here.
Peamount
The only way of getting to Peamount (other than driving) is the 68 bus. This takes about 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. To get there for 9 o’clock you need to get the 7.50 bus which goes past SJH at roughly 8.10. Most days though don’t require you to be in that early. Later in the day buses are hourly so try and leave close to the timetable. It’s a respiratory rehabilitation hospital so know the resp exam well and the basics of asthma and COPD before going. Last but not least, look out for the Peamount pig!
Naas
While students may not initially be very excited about going to Naas, in the end most people were really glad they were there. 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.
Surgery
You can go to theatre whenever your team are operating, provided it’s ok with them. 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.
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 in theatre 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 (Eye and Ear) the scrubs are in the changing rooms (not a machine). 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, money with you in your pocket (basically: small things!). You can’t bring bags or stethoscopes or anything else in so if f 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 are operating in (it’s on the noticeboard). Then you should hopefully find someone from your team that you recognise and ask them if it’s ok for you to be there for the next operation. Teams are generally quite happy to have you there. 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.
Modules & Exams
Laboratory & Investigative Medicine
This 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 at summer worth 50%. At Christmas, the paper is entirely MCQ. It will consist of single best fit questions, which include Clinical Vignettes, and extended matching questions. The summer 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 at summer. The final 15% of your overall mark is made up by a 3000 word essay that is usually due around the start of April. You choose your essay from a list of titles and it will either be Path of 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!
At Christmas you’ll have 50 T/F questions, 0.5 negative marking. At 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 people 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 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.
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. In 2021 the weighting of each of the components changed a lot so keep an eye on your emails/Blackboard for what the assessment will be like for this year. For 2021 the components were:
Medicine/Surgery MCQ paper – 40%
Medicine/Surgery OSCE – 15%
Logbook review – 30%
ENT/Ophth exam – 15%
Don’t be too deterred by the vagueness of the exam title and complete lack of past papers… The medicine/surgery MCQ paper is actually not bad. You have it at the end of the year along with your other summer exams. 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. In 2021 it was changed to a virtual format. While an OSCE can seem daunting, the examiners are very nice and really want you to pass. For the virtual OSCE there were 7 stations, each lasting about 7 minutes:
-2 history taking stations: You will be given a question stem e.g. 47-year-old male presenting with shortness of breath. You then have to say what questions you would ask, and why. 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.
-2 data interpretation stations: You will be shown clinical data e.g. blood results, an ECG, a chest x-ray, ABG results and ask to interpret them. Know the common things that show up on these e.g. what atrial fibrillation looks like on an ECG, causes of A fib, preferred management etc. Also know the structure for presenting an ECG (patient details, rate, rhythm, axis, etc) and a chest x-ray (ABCDE).
-2 clinical signs: For the virtual format there was a photograph of a clinical sign e.g. leg swelling, stoma, ulcer, varicose veins, chest drains. Know a basic approach for describing things (e.g. site, size, shape etc). The way to prepare for this station is to make as much of placement as possible, always go to see a clinical sign if a doctor recommends it and ask to present it to them afterwards if you can.
-1 ethics/professionalism station: this usually examines your communication skills. You will be given a scenario and there will be an actor* (*older year of medical student) that you then interact with. It could be something along the lines of breaking bad news to a patient or approaching a disagreement with a colleague. For breaking bad news, you will have a tutorial 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.
Ophthalmology & ENT
Everyone will spend 2 weeks on Ophthalmology and 2 weeks on ENT in the Royal Victoria Eye & Ear Hospital.
In 2021 Ophth and ENT were assessed solely by one written paper each in June. 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 good self-assessment revision lecture that you will either be given or you can find on the drive.
There was no practical element to the Ophth/ENT exam in 2021 due to the pandemic but in previous years there has been. The ophth practical exam took place during the rotation and involved performing a standard eye exam.
Advanced Clinical & Professional Practice
For 2021 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 practice. As long as you follow all the steps you are supposed to, you will pass, even if it doesn’t go perfectly for you! PPAM lectures takes place across 2-3 weeks in the second semester. 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 2021 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) + an individual essay on that topic. For Global Health, in 2021 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 this year. For the Ethical Reflection component, there will be a page in your logbook for you to fill out a reflection on a scenario you encountered during your placement. At some point during the year a member 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. There is usually a short reflection assessment to be submitted for this component.
Evidence-Based Medicine
You have lectures about evidence-based medicine (EBM) throughout the year and before Christmas you’ll write an EBM paper as a group. This is a very small module that is also assessed by your elective report after your 3rd year elective in summer.
Summary
In summary guys, it can be a tough year so pace yourselves. Try to stay on top of everything, but also make sure you make the time to come to all Biosoc events and enjoy yourselves!