Welcome to Imperial College School of Medicine’s clinical school! In addition to Undergraduate and Graduate Entry students already here, I’d like to extend a warm welcome to new Direct Entry students joining this year – we hope you’ll settle in smoothly and soon feel right at home at ICSM!
This is a vastly different experience to pre-clinical medicine, as Year 3 is an exciting new world of experiences and opportunities that will soon remind you why you really applied to study medicine in the first place. In addition to the information given to you by the FEO, this website intends to give you useful information, learning resources and contact details to help you to make the most of Year 3 and achieve everything you want to this year.
Please never hesitate to get in touch with me at firstname.lastname@example.org if you ever have any questions or feedback. I hope this will be an enjoyable year for you all!
ICSMSU Academic Officer Clinical Years
Overview and Exams
What exactly does Year 3 involve?
The Course Map available on the Faculty of Medicine Intranet summarises Year 3 nicely with details of term dates and holidays. The year consists of three 10-week clinical attachments known as ‘firms’. You are randomly allocated to different hospitals under different specialist teams for each of these attachments, but the idea is that you should be able to gain the same basic clinical skills by the end of the year (for more information, see the Objectives tab). You will all have two medical firms and one surgical firm, and will rotate around various hospitals in North West and Central London.
On each rotation, you and your firm partners will be attached to a team in the hospital. In addition to any timetabled teaching you have on site, the idea is that you follow this team in their activities and you learn – whether this is on ward rounds, in clinics or in the operating theatre for example. Everyone’s experiences will be varied, and so whilst this is very much a lottery, your experience of Year 3 is still very much dependent on you (for more information, see the Firms Survival Guide tab).
Whilst you do enjoy freedom to take control of your learning in Year 3, there are a couple of compulsory activities each week that override everything else. The first is Clinical Methods Teaching (CMT) with your GP tutors. These are very useful small group learning opportunities for which there are set objectives on the intranet page. The second is Clinical Skills teaching on site at your hospital with the clinical skills tutors. These are invaluable opportunities to practice your clinical skills in a lab to gain the confidence to perform them on patients. Aside from this, although it is not always official at every hospital, our advice is to think of ‘on-calls’ as a compulsory activity. Try to go on-call at least once on each attachment, as these are unparalleled experiences for patient clerking and seeing some exciting cases.
There are also weekly lectures and quizzes, most of which will be online so you can do them in your own time. These are useful learning resources and the advice given to you by your teachers in Live Lectures is invaluable – listen closely!
How should I prepare for the exams at the end of the year?
There are three exams, currently all at the end of the year in summer term. For full details of dates and lengths of each exam, visit the ‘Exams and Assessment’ intranet page.
The first exam is the OSCE (Objective Structured Clinical Examination) where there are 12 stations to test your practical competence in history taking, clinical examinations, clinical skills, explaining procedures and (to a minor extent) formulating differential diagnoses, further investigations and a management plan. The best way to prepare is to attend your clinical attachments (see the Firms Survival Guide tab) and seek out the learning opportunities you know you need (for more information, see Objectives tab). Finding a role model on firms to pick up on patient interaction techniques is always useful to develop your own style, and then of course practice makes perfect! There are many student-led opportunities for OCSE tutoring and Mock OSCEs in the year, and seeing real patients with real signs on firms is key.
The second exam is the Written Paper, which consists of EMQs (Extended Matching Questions) on general medicine and surgery. There are various learning resources that most students use to do well in this exam, but the most important one is VLE Blackboard (for more information, see Resources tab). Whatever resources you choose to use, try to be organized and make notes on any questions you get wrong. In addition to Blackboard, many students use PasTest and other books, and attendance at the MedEd society tutorials in spring term is highly recommended by many students.
The third exam is Foundations of Clinical Practice (FoCP), which comprises the taught courses: Medical Ethics, Law, Clinical Communication (CC) and Personal and Professional Development (PPD). You will be given a case scenario with suggested reading one month before the exam, the case scenario is drenched with ethical goodies! Ethics, law, CC and PPD are tested by short answer questions related to the case. Law is tested by a couple of single best answer multiple choice questions not necessarily related to the case. Most students use the online material from lectures and e-Lectures to prepare for this exam, but you can also use books (e.g. Medical Law and Ethics by Jonathan Herring is a popular one) or student notes (see the Resources tab for more information).
Firms Survival Guide
Do you know where you are? Your clinical years are at Imperial College – at the North West Thames Foundation School hospitals. In 2012, the competition ratio for FY1 doctors to come here was 336%. The next most applied to deanery had a competition ratio of 142%. You are incredibly lucky to be here for your clinical years, it is a very desirable place for clinical training! But the fact is that it is up to YOU to make the most of it.
Years 1 and 2 may have lulled you into an unfortunate habit of being spoon-fed everything you’ll need to do well, Year 3 is a new experience and a different playing field. You’re out of the lecture theatre and into the hospital, so it means the focus of attention is no longer on you – the centre of attention now is the patient. But you are still in hospital to learn, so it is time to open that fridge yourself, it is time to turn on the hobs and fire up the oven – because you’re feeding yourself now! This could be the best year of your medical school career, because you will never have this much freedom in a hospital again. It is up to you to be proactive and seek out learning opportunities for you and your firm partners so that you can all go home every day with a smile.
Year 3 Firms Survival: Your Utility Belt
To make the most of every day in hospital, here are the top ten things I’d recommend you keep with you at all times:
1) Stethoscope – you never know when you might have the opportunity to examine a patient with interesting signs.
2) Notepad and pen – this is as important as your stethoscope, because the things you note down during firms are an unparalleled source of information for you during revision. These could be handy tips from doctors, mnemonics, or just the things you’ve observed and learnt.
3) Wristwatch – but obviously not on your wrist! A watch is important in many clinical examinations, and other than that a day in hospital can be busy so time-keeping is crucial.
4) DOPS Book – the opportunities to learn skills and get them signed off will spring up on you when you least expect it, so it is a good idea to have your DOPS book with you.
5) Mobile Phone – a hospital can be a very big place indeed. Your phone is important for communicating with firm partners and also with your FY1 doctors if you’ve exchanged numbers. Exchanging phone numbers with members of your team can be the most useful thing you do, as they can call you if something exciting is going on or if they are ‘free’ to teach you.
6) Pen torch – this isn’t an essential by any means, but it can be very useful. Don’t underestimate the importance of a pen torch in many clinical examinations – not just for eyes but e.g. for looking inside a patient’s mouth or shining a light through a lump.
7) Oxford Handbook of Clinical Medicine – this is the book of choice for the vast majority of medical students (and doctors!). It is a fantastic source of knowledge and revision, so if you don’t have something like ‘Medscape’ on your smart phone, then this book is a good one to keep in your back pocket/in your bag to quickly look things up.
8) USB stick – you could be given some great talks or presentations during the year, so in the unlikely event that your Teaching Coordinator doesn’t distribute the slides, you can embrace that ICSM Family spirit and politely ask the speaker for the slides for you and your classmates.
9) Tendon hammer – not entirely necessary, but again this can be very useful for examinations. If you have one that folds up this is useful as you can keep it with you.
10) Loose change – so you can grab a can of fizz from a vending machine to recharge during the day!
You are a member of the team – as a third year medical student you really are at the bottom of the food chain, so befriend the juniors doctors! They will treat you like a member of the team and teach you if you are there and if you are enthusiastic. Get their numbers, not their bleeps, and let them call you.
You are there to learn yourself – ask questions when it is appropriate and convenient. It is all about knowing when to do what. When you are free and have time, clerk patients with your firm partners. You can practice focussed histories and entire clinical examinations. When you are with members of your team, don’t waste time, just look at/listen to/examine the clinical signs. Scribble down everything on your notepad, ask questions and get involved.
You know your learning objectives for the year – seek out opportunities and enjoy the freedom of setting your own targets. For more on this, see the ‘Objectives’ tab.
You’re all in it together – it is surprising that this has to even be said to Year 3 students every year, but please work with your firm partners and help each other. You will not benefit in any way whatsoever if you try to look better than your firm partners to the team. Don’t deprive each other of learning opportunities and don’t you dare try to screw anyone over.
You are there to be taught – try to attend all scheduled teaching, but the freedom is yours to choose opportunities at the discretion of your firm leader. Take advantage of all the teaching that various doctors and professionals will offer you!
You are learning for life – make notes on everything you have come across, specific cases will leave lasting memories and will facilitate further reading.
Your OSCE patients will have signs – it is useless to just practice on your friends. Real patients have a different manner, and they will have the signs you need to learn to pick up.
Site Specific Student Tips
Whether it is Dr Orchard’s evening teaching at St. Mary’s hospital or Mr Bhutiani’s sessions at Central Middlesex, there are always perks of being at various sites and lots of ways to really make the most of your time on your attachments. Handy hints and tips by students for students are on the facebook group, but this will be brought to the ICSMSU website very soon, so watch this space!
The best learning resource in Year 3 is the hospital. There is always more going on than meets the eye, and at each of your attachments await experiences you’ll never forget. “Keen is the new cool” was a phrase famously coined by Professor Meeran, and actually this will never be truer than in Year 3. Be proactive about your learning. Find role models, find good and bad examples of patient interaction and use this to tailor your own style. Develop a strong framework not just for your OSCEs, but for Years 5 and 6 and your future as a doctor, and be the best you can for your patients.
The Year 3 Reps
Got views about Year 3? Your year reps are your first port of call. They were elected by the year group to represent students in matters relating to all aspects of education. Together with Rahul, your SU Academic Officer, they voice the needs and opinions of students to Student Staff Liaison Groups and Education Sub Committees to see that real positive changes are made for now and the future.
They are always contactable at the email address above, and furthermore they are always approachable and would be glad to have a chat with you about anything you’d like to talk about. Don’t let your voice go unheard, if there is ever anything you need or want to ask about, talk to your year reps!
For full agendas and minutes of SSLG meetings, please visit the “Staff-student liaison group” link on the Year 3 intranet page.
The hospital is truly the best learning resource you have in Year 3. Seeing cases and professionals in action is the best way to achieve most of your learning objectives, but in addition to this there are many resources you can use to complement your time on your clinical attachments…
The ICSMSU Notebank has been updated with student made notes for Year 3! Go to the ‘Education’ tab at the top of this page and click on ‘Notebank’ to access the notes. You know what the password is…
It should be noted that all the resources in the Notebank are student-made and so may contain errors and discrepancies from textbooks and lecture materials! The Faculty certainly does not endorse the notes and so you are advised to follow Imperial College course materials and published texts if in doubt!
Log in to Blackboard via the School of Medicine teaching intranet – education.med.imperial.ac.uk. Do not underestimate the importance of using Blackboard in Year 3. The e-Lectures are a fantastic overview of the basics you are expected to know for Year 3 and questions in the written paper and OCSEs may build on the content covered here. Later on in the year when the Practice EMQs go online, these are an invaluable source for practice and learning – if nothing else, make sure you have made the most of the resources available on Blackboard this year.
The Intranet Clinical Skills Page
Again, this is a wonderful online resource for general medicine and surgery provided by the School of Medicine. There are lots of materials for learning and revision, such as run-throughs of examinations, surgical short cases and guides on how to interpret investigation results. There are also great opportunities to practice skills like interpreting radiographs and ECGs. Try to cover the content given to you here over the course of the year, it will stand you in good stead for both the written and practical exams in the summer.
The OSCE Station YouTube Channel
A group of talented Imperial College Medical Students have made a YouTube channel giving you a basic framework for clinical skills that you should also be able to perform by the end of Year 3. Please send any feedback about these videos to email@example.com. Some of the links are given below:
OSCE Examination Channel: http://www.youtube.com/theoscestation
Abdominal Examination: http://www.youtube.com/watch?v=F49-ESmbCuY
Respiratory Examination: http://www.youtube.com/watch?v=ySfysvFXE7Q
Cardiovascular Examination: http://www.youtube.com/watch?v=nq-pc0Ty2n4
Digital Rectal Exam: http://www.youtube.com/watch?v=MSBSiC9Ldp8
If you fancy some reading to complement what you see on firms, there are a number of books that students often recommend during Year 3. The ‘Oxford Handbook of Clinical Medicine’ (Longmore) is a very popular book as it is a brilliantly concise yet comprehensive overview of all general medicine and surgery topics. ‘Pocket Essentials of Clinical Medicine’ (Ballinger) is another book which is similar, it is a good overview of general medicine and surgery. ‘Surgical Talk’ (Goldberg) is a popular book for topics on surgery.
If you enjoy reading, then “little and often” is the key. Half an hour a day throughout the year is far better than wasting your study leave spending hours in a textbook.
To help learn more about clinical examinations, many students choose ‘Macleod’s Clinical Examination’ (Douglas). As for practice questions, many students use the PasTest ‘EMQs for Medical Students’ books and practice papers, as well as ‘EMQs in Clinical Medicine’ (Syed) and ‘500 Single Best Answers in Medicine’ (Dubb).
The overall purpose of Year 3 is to give you a basic scaffold of clinical skills that you can not only build upon in the future at medical school, but use as a strong backbone for the rest of your lives. In addition to this, your experiences and reading during Year 3 are intended to give you a good basic overview of general medicine and surgery.
There are three documents given to you by the School of Medicine, which I strongly recommend you read cover to cover so that you know what your learning objectives are…
1) Year 3 Course Guide
You’ll find elements of your syllabus for the OCSEs here. These include History Taking (basic structure, communication skills, focussed histories), Clinical Examinations (the major systems and common complaints), Explaining Procedures, and the skills of formulating a diagnosis, further investigations and managementplan. The best place to learn these skills and see them in action is on your clinical attachments, especially on-call.
You’ll also find a nice syllabus for the written paper here too. There are a lot of diseases and conditions to know about, but you do NOT have to know the ins and outs of every single one! You should, however, be able to know five things about each condition: definition, risk factors, presentation, investigations and treatment. You’ll find comprehensive lists of conditions on page 10 and pages 27-32 of the course guide. Again, the best place to learn about these conditions is to try to see them on your clinical attachments.
2) Guide to Practical Clinical Skills
This document can be found as a Word Doc or PDF on the Year 3 intranet. Under ‘Information for Students’, click on ‘Guide to Practical Clinical Skills’, and this will take you to the ICSM Clinical Skills page. Scroll down to ‘Useful Links’ and find the document here. This guide contains step-by-step instructions on how to perform various clinical procedures, and so essentially you’ve got your ‘mark-scheme’ should these stations come up in your OCSE exam! Make sure you attend all the clinical skills sessions timetabled at your clinical site so you can practice and ask any questions you may have.
3) Clinical Logbook and DOPS Assessment
The DOPS book contains walk-through instructions on how to perform various clinical procedures. These are an invaluable ‘mark-scheme’ for your OSCE exams. Things like taking and reading an ECG, giving asthma advice, venipuncture, cannulation and explaining an MSU could all be stations in your OSCE exams, and so it is worth having someone assess you critically during your firm attachments so that you know you can pass the stations in your exam.
Finally, I cannot stress to you enough the importance of Clinical Methods Teaching (CMT) with your GP tutors. If you visit the Year 3 intranet page you’ll find there is a timetable for what you should cover in your sessions, this is the last crucial check list for your OSCEs – make sure you’ve covered them all with your GP!