Amira and Halima’s Year 3 Advice

Year 3 Advice 

Assalamualaykum!!!!! 

Congratulations on making it through one of, if not THE, worst year of medical school allahumabarik! The grass defo looks greener from here 😊 

Ahead of you is one of the best years so sit tight, grab some tea (or water if you’re like me (Halima not Amira as Amira actually has taste)), and have a read… 

DISCLAIMER: Please don’t read this in one sitting, come back to it whenever you need a specific part. 

بِسْمِ اللهِ الرَّحْمٰنِ الرَّحِيْمِ 

Spiritual 

We’re all growing up. As sad as it may be, it’s something we’re all going to have to face. If you haven’t already, you’ll soon start to have thoughts about why you’re really doing all of this. What you’re striving for, what this life is about, what your purpose is and what you need to do to fulfil it. Don’t be like the layman who buries these thoughts in endless Netflix series, food, socials etc. Take them and use them as an opportunity to really find out your purpose in this life. We all can say we live as slaves of Allah AZJ, to serve Him, but does our life currently reflect that? If not, then use this as a chance to change it around and give the meaning to your life that your heart aches for. If you don’t know where to start, try the life guide Allah AZJ has already given us- the Quran.  

What even is year 3? 

No one really explains what Year 3 is all about, so you usually spend half the year figuring out what is going on before realising what you need to do, then doing it. We’ll try our best to explain it all here: 

Year 3 is placement year. You would have already got your rotation allocations (i.e. RX/RY/RZ), and for those starting with MICA you may have already got your GP allocations. You have 3 8-week placements, one per term, with 2 weeks at the end of each term called ‘Consolidation weeks’. Ngl not much ‘consolidating’ occurs, but it usually involves interactive lectures on presentations, Amir Sam’s CCC’s (absolute legend), PVB sessions (go to these!!!) and CSI sessions + assessment.  

You will also have EFAs in your consolidation weeks- these are 50 MCQ’s (Multiple Choice Questions). You can’t really revise for these as you used to in previous years- they don’t give out the conditions they are going to assess on in each EFA. But you’ll notice inshaa Allah as time goes on and you cover more conditions you will get more right. Plus they release feedback on what exactly you got wrong, and the questions after the EFA for you to go through in your spare time. These are really useful, especially at the end of the year where you can collate them and sit it in one sitting to prepare yourself for the real exam! 

Your actual rotation allocation isn’t deep, but it’s worth keeping in mind what you will have in third term so you can adjust your revision schedule accordingly. We will talk about the individual placements and add a little bit on the end discussing what to do if you have it in third term. 

MICA 

Stands for ‘Medicine in the Community Apprenticeship’ aka GP with a fancy name. GP is better organised than hospital medicine usually, but the actual benefit with depend what time of the year you have the placement (i.e. if in winter your resp knowledge will be on point), where you have it (disease demographics) and how well-resourced your GP is (whether they have PA’s, nurses, HCAs etc). In the first two weeks, you’ll shadow a GP as they carry out their consultations, whether that be online/face-to-face. From the third week, they encourage you to independently do consultations- this will be you inviting the patient into the room, taking a history from them and possibly examining them. Then you’ll call the GP back in where you’ll present your findings. The GP will correct any mistakes there or after, and then prescribe the appropriate action plan.  

It is a very useful placement to have to refine your history taking and examinations. You will be partnered up as a pair or three, and you can decide with your partner how to split the opportunities- perhaps one does history and the other examination, or you each take a whole patient for yourselves. I would also encourage following up with patients- this can be you calling them up again in 2/3 weeks to see how their condition unfolded or looking them up on the system.  

Your GP should also do weekly tutorials with you- there they’ll cover a system e.g. cardiovascular, go through common presentations and conditions, how to take a history and the examination/skill. You can ask them if they would be willing to sign you off there for your examination, but usually they want to see you do it on a real patient.  

To make the most of this placement, aim to take one history & do one exam per day. Usually GP has a long lunch break and a lot of spare time, so use this to cover conditions, or just relax. It’s also a good opportunity to get skills signed off (sign offs are covered in more detail below).  

If this is your last rotation, it can be good or bad depending on how strict your GP is (i.e if they let you have half days or Friday off). Either way, having GP last is pretty good as the main thing you do is history taking and examination which is GREAT practice for OSCEs right before you sit exams so a W.  

In GP you also have to do a Community Action Project; don’t worry it is pretty chill. You basically have a look at the assets in and around the area, propose a change and try get demographic input on the change, then enact it and see whether it improves. The main thing is to try and evidence you engaging with the community as in calling up local support groups etc. The examples they show you will be really cool ones, but sometimes depending on time, resources, your GP etc, it’s hard to do something cool so just focus on something simple. It is worth bearing in mind that if you win the CAP prize, it counts in achievements for future applications (but everything is happiness algorithm so idrk). 

Sign offs to do in GP: 

Medicine 

By far the best and most chill placement (imo).  

Again, the experience really depends on your hospital, ward and consultation, but you can use it to your advantage. 

For those of you who have consultants that are on it, they may show you a timetable or tell you key things that occur in the week e.g. consultant meeting every Tuesday, ward round starts 8am, outpatient location and appointments. If they don’t already tell you this, ask them, because you want them to see you at least for some time every day to show you exist, and also you’re more likely to benefit. Also, please for the love of god try and secure a date and time for your sign off!!! 

The hospitals usually run tutorials as well- can be lunchtime tutorials, or tutorials set on a particular day of the week. These run through a particular examination/presentation, and sometimes they ask you what you would like to cover. If you have this at the beginning of the year, you can perhaps get them to go through a hefty condition e.g. myocardial infarction, so you get early insight on common and important conditions, and it’ll be easier to revisit once you start revising.  

Aside from the ward rounds, occasional meetings and tutorials, medicine is very free. It’s ideal to have in second/third term as you’ll have a lot of spare time to revise. If you have it in first term though, it is your chance to socialise and enjoy Year 3😊.  

Especially for this placement, the benefit comes from the opportunities you go and seek. Be smart about it though- i.e. find out on your ward when the phlebotomist comes, then seek that chance to practice bloods. Also work out when your consultant is present on the ward so you know to go at that time. If you find that you’re just sitting around on the ward, just go and do something else.  

Amir Sam also loves to say that opportunities come past 6pm. Sadly it is true- sometimes I left at 5:30, and then I came back the next day to be told that 30 mins after I left there was a major haemorrhage protocol alerted, or some crazyy presentation turned up to A&E. If you’re keen, maybe once every week/2 weeks you can pop in after 6pm to see if there’s anything interesting, but it’s not necessary.  

In Medicine you have to do a Patient Case Presentation. It is very easy, you just have to make a presentation of a patient that you saw, how they presented, initial tests that were done and results, and what treatment was initiated/diagnosis 

Signs offs to do in Medicine 

Surgery 

I (Halima), personally had surgery in third term, and so was basically not really interacting with the placement. I would say try to find out as early as possible when handover takes place, when ward rounds occur and when your consultant(s) have their surgical lists. That way you know where and when you need to be.  

 I think it’s a good opportunity to see whether surgery is for you, and if you have the time do go and sit in some surgeries- many surgeons love to get students involved, whether it be holding equipment or suturing. Just be aware to always ask permission from staff and consent from patients before doing anything.  

Anaesthetics is generally a positive experience for most people. It’s two weeks of our 8-week surgery placement, and you really get to see the complexity of keeping the patient alive throughout the surgery. If you’re at ChelWes, you’ll need to find a consultant anaesthetist to latch on to during this time, so you can get your sign off! 

(Amira) I had surgery in second term and it is very chill, imo it is the easiest one to bunk from. I would say be smart about what you do with your time here, try to go to a ward round a week, an MDT meeting a week, and see some surgeries (don’t bother going to surgeries if you’ve already seen them before unless you love it I guess?). You can ask the F1s in the morning what is going and make your decision then.  

I was at CXH so had rotations between plastics, breast and acute GI. They all have different things going on, like wound clinic (I got to suture someone’s leg), minor biopsy, major surgeries etc. If there is a skill you’d like to practice just ask someone to teach you it and then ask for opportunities to do it on someone.  

In Surgery you have to do a QIP (Quality Improvement Project) which is studying a problem within the ward, enacting a change and evaluating whether it was effective. Some consultants are so helpful with this and you can potentially go on to present at conferences but some consultants are useless (mine) but you will get it done. Start early and keep It simple and cheerful. 

Signs off to do in Surgery 

Placement Conclusion 

In conclusion, your placements are really what you make of it. Usually people really engage with placements in first term, then become more revision focused within second and third term. I would say do listen to the advice of Amir Sam- I learnt so much from placement, and it was genuinely such a joy for me to go and speak to people.  

To make the absolute MOST of your placement, before you start, write down what you would most like to get out of placement, what you would like to see/practice, and what sign offs you need to get done. I also recommend journalling your experiences with patients; it’s nice to look back on, useful for the QBCL sessions on Wednesdays and helps keep experiences in your mind.  

Just put yourself out there, for each of these placement blocks you are there for two months, you want to try and integrate yourself with the team. Everyone is helpful or can at least direct you to someone that is. One of the doctors recognised me when I wasn’t even on placement and asked me to join her to do a pneumothorax aspiration. Also, if there is something specific you want to see, ask or go find it. Whilst you’re on a specific ward technically you can go with a doctor anywhere. Genuinely, this is the time to try the things out that you want to do and really get a feel for things.  

Also, please for the love of god, be smart about your time. Whilst at the start you’ll probs be expected to be on the ward for more time, don’t go to the ward round if it is all the same people and not helpful for you!! Don’t go to a surgery if you have seen a billion times and don’t get to do anything. Use your time wisely. Can be helpful to ask what is happening tomorrow and plan your day around that. 

Just as a last thing, don’t be put off by a particular placement, hospital or ward because of things you have heard from older years. Everyone is different, and you may like one field of medicine that someone hates, and vice versa. Staff change, and so what may have been a bad experience for someone else may end up being a pleasant experience for you! May Allah AZJ grant you all good placements and kind helpful doctors Ameen! 

Syllabus 

The thing to note about Year 3 is the lack of syllabus- you’re basically just give FAT conditions and presentations lists on Sofia and told to learn them. 

As a general pointer, you should aim to cover all the conditions in the conditions list, as they have the potential to come up.  

The presentations list is very broad, and you can be assessed on any condition within a presenting complaint. E.g. Headache is a presentation, and they can test you on migraine (in the conditions list), and also temporal arteritis (not in the conditions list). This may seem scary, but the number of conditions outside the conditions list they test on is very small, and you will cover the important conditions within presentations when you do Passmed/Quesmed naturally.  If you went about JUST learning the conditions in the conditions list, you could very well achieve ~80%.  

What to cover for a condition 

Main aspects to learn for a condition is 

  • What it is  
  • Key signs & symptoms  
  • (don’t just learn a list, rather learn how to differentiate it from similar conditions e.g. migraine is unilateral generally whilst tension headache is bilateral) 
  • 1st -3rd line investigations  
  • Management 
  • You need to know drug names, but not quantities  

You can split your conditions list into system (e.g. resp, cardio), then list your conditions by commonality (e.g. myocardial infarction, heart failure being top, then less commonly right heart valve disease). 

‘CoMmOn ThInGs ArE CoMmOn’ – you’ll hear this a lot, but essentially means focus your efforts on conditions that you’ll most likely see. Go into depth on the big conditions like diabetes, heart failure, COPD. With less common conditions like trigeminal neuralgia, still learn them but perhaps learn the differentiating symptom, key investigation and management. You’ll see in our notes that the big conditions naturally have more detail to them. 

There’s a section in the conditions list called ‘Adverse drug effects in …. patients’ . No one really says (or perhaps no one even knows) what this is. I think it’s asking you to know the important side effects of common drugs. This list is a general idea of the conditions who’s drugs and side effects are important to know: 

  • Acute coronary syndromes 
  • Heart Failure 
  • Hypertension 
  • Diabetes mellitus 
  • TB 
  • Epilepsy  
  • Migraine  
  • Hyperthyroidism 
  • Cushing’s 
  • Addison’s 
  • Anti-coagulants 
  • Anti-platelets  
  • IBD 
  • SLE 
  • Arthritis- i.e. steroid s/e, immunosuppressants, biologicals 

This list is not extensive, but you’ll be in a good place knowing the drugs and main/important side effects of these. In terms of finding the side effects, the Passmed textbook does a good job with listing the main ones to know. The BNF is quite detailed but also a very good place to look.  

How to learn conditions 

I wouldn’t bother making a fresh set of notes- it takes ages trying to find info on conditions, and it’s sometimes not clear to what extent of detail you should be going. 

Instead, take a set of notes from the older years (I took Ayaan’s who took from Qasim- both of theirs are linked below), and annotate it with any detail you wish to add/remove. Some treatments/managements may have changed- when going through the conditions for the first time, run through the NICE guidelines to check this.  

When it comes to memorising, it’s sadly a lot of recall. Doing past paper banks will help, but sometimes they don’t cover everything, and so it’s worth having a think of the best way for you to recall info then doing it. E.g. if Anki’s your thing then make decks based off your notes.  

There isn’t a specific timeline to follow. Generally, people start revising around Jan time, and do perfectly well. I would suggest using term one to prep your notes, then in term 2 and 3 you can just focus on learning the content.  

What resources to use 

Conditions info 

  • BMJ Best Practice– it’s good at summarising the info, but there’s a lot of detail. Also does not really list first line investigations & management.  
  • NICE guidelines– the NICE clinical knowledge summaries are very good, but generally also a bit wish-washy when it comes to outlining first line investigations and management  
  • BNF– very good for learning drug side effects, contraindications. Not needed in detail in year 3, but for some drugs it’s good to know. 
  • Passmed textbook– very good with highlighting the main things you need to know! They have a short-hand version and extended version- when you’re first making/editing your notes, use the extended version to check any detail. Then when you’re doing questions and want to review a condition, the short-hand textbook is good.  
  • Quesmed textbook– it’s very good, but very detailed. A good resource if you’re having trouble understanding a condition as it gives info on pathophysiology.  
  • Amira’s notes in Anki form if that’s your thing (attachment on the email) 

Questions 

  • Passmed/Quesmed 
  • Your go-to resource for practice questions 
  • Passmed is good at homing in on key facts (e.g. lipase is a more accurate measure of pancreatitis than amylase). It’s harder though as it’s aimed for final years- so don’t worry about a low score when you’re starting out. 
  • Quesmed question style more closely matches that to the Year 3 exam, as people say. Sometimes the question answers are wrong, and there are mistakes in the questions, so just be wary of this (it’s very rare).  
  • CONSISTENCY IS KEY- I would recommend starting questions from September, maybe 30 a day, then add 5/10 more every 2/3 weeks. You won’t know anything at the start, but it gets you used to answering questions and will hammer in key concepts.  
  • Faculty EFA’s 
  • Go to the EFAs, and then when you get your feedback highlight which conditions you need to work on. 
  • I would revisit the EFA’s closer to exams as they’re previous exam questions and directly from the source so the best idea of how well you’ll do.  
  • Generally I found they got more difficult as time went on, but that’s to be expected. I also found the actual written more difficult than the EFAs, but it was more what they were testing (they basically chucked in some strange conditions no one has heard of, but it was max 10 marks), as opposed to the question style.  

Ethics 

Don’t worry too much about ethics. Most of the question banks have a small ethics question section. All the content you need is covered in PVB sessions in the introduction and consolidation weeks. It is worth going to the last couple of sessions where they do questions and talk you through the answers. 

Some Key Ethics to ABSOLUTELY KNOW: 

http://selective-devourer-38f.notion.site  

Ethics & Law Self-Test Notion:  

https://amber-caption-3c3.notion.site/Ethics-Law-0d274ec1d59649c1829b6fc3ec7ebbab?pvs=4

Sign offs 

Do all your doable sign offs in term one (obvi clears and end of placement sign offs have to be done at each specific placement but all the DOPs do it in your first placement or your medical one if it’s not last). It will just help you out so much to not be running around in the last term trying to get something signed off. Make the most of the patients, go to speak to them, go to examine them, practice skills. It is the only time you really get to do this. 

Some sign offs are easier done in certain places than others, like cannula, infusion and IV drug on anaesthetics or inhaler in GP. Just make sure you are aware of what you need signed off and have a rough plan of when you could potentially do it. Don’t panic, you will get it done. 

It is worth mentioning that different sites have different amounts of forms and types of forms to submit like supplementary ones etc. All the info is on Medlearn you will be fine. 

PLEASE DOUBLE CHECK WHAT FORM YOU ARE USING (faculty will make you do it again if it the wrong form such as supplementary instead of end of placement) 

Sign offs template table notion: https://amber-caption-3c3.notion.site/Forms-5a4e0b40490648ee90786dd9b3fecbe1?pvs=4  

Exams: 

Written – It is like an EFA but 3x. By this point, at the end of the year, you get so used to MCQs. I felt and lot of others, that the written exam is more about actual resilience because your brain becomes so tired doing 150 questions in 3hrs. It is not too bad and the questions are fair, exactly like the EFAs and past exams you’ll do. It’s way better than VSAQs and SAQs – since you have choices you have a 20% chance on getting  it right for the questions you don’t know at all.  

Someone told me that people who change their answer after putting one down are more likely to get it wrong. This was the case for me, so if you’re in doubt and you’re stuck between two options, go with your gut feeling.  

READ THE QUESTION. 

OSCEs – CPA on steroids. You will have four examinations (abdo, cardio, gastro, neuro (either Upper limb, lower limb or cranial nerves)), three histories (abdo, cardio, gastro, neruo), one PVB station and four skills (such as ophthalmoscopy, suturing, venepuncture or cannulation and a special exam like thyroid or breast).  

Examinations- are the same as CPA, except you have to do the whole thing, report your findings at the end and then give suggestions on what you would do like basic obs or ecg or bloods). The whole thing includes  

  • Introduction  
  • General inspection 
  • Closer inspection (of hands, arms, face, neck, chest (or legs if neuro) 
  • Full examination in order e.g. palpation, percussion, auscultation, special manoeuvres 
  • Completing exam 
  • Presenting findings 
  • Next steps- investigations you would order  

I would prepare (or use one from the year above) a script, which I just memorise and regurgitate, especially when presenting my findings. Sometimes they like to chuck in a ‘presentation’ like abdominal pain, so just be wary of that when you’re presenting the findings.  

Histories- You’re expected to take a full history, including-  

  • presenting complaint 
  • history of presenting  complaint 
  • past medical history 
  • Past surgical history 
  • drug history 
  • allergies 
  • family history 
  • social history  
  • ICE – ALL OF ICE IS ONE MARK, SO ASK ALL ASPECTS 

Timing is the most difficult aspect to this- they give you 7 minutes to take a history, and sometimes 1 minute to present, but the rest of the time (2-3 minutes) is spent asking you questions. These questions aren’t difficult- differentials, investigations and management plan. PRACTICE, PRACTICE, PRACTICE. I would practice really difficult histories, where the presenting complaint is vague and the past medial history is heavy- in the actual exam, none of my patients had a past medical history, but it got me used to making sure I asked everything. The book ‘OSCE Cases with Mark Schemes’ gives really good history scenarios to practice.  

Skills stations-  you consent the patient and do the skill and give the aftercare (its more about the communication than the skill tbh). You clinical skills sessions in your placements are your best place to practice these (MM also do clinical skills sessions so keep an eye on the groupchat/newsletter for these 😊). These require practice, again to refine your technique. They usually have the typical venepuncture, cannulation, suturing, and then chuck in a random one, which were previously: 

  • In 2023- vascular exam 
  • In 2024- ECG, cranial nerves and ophthalmology, breast 

PVB 

A station you cannot really prepare for, but worth going through the PVB lectures to get a good understanding of the remits of a doctor and the law in general.  

Examples of what it has previously been 

  • Patient comes to see a nurse for asthma checkup, and questions the credibility of nurses compared to doctors 
  • Patient comes for a routine urine dip before surgery, where they reveal to you they’ve had unprotected intercourse, and do not want you to tell the surgeon (risk of pregnancy). 

Useful explanation video from faculty- https://imperial.cloud.panopto.eu/Panopto/Pages/Auth/Login.aspx?instance=ic.ac.uk&Auth=SessionView&panoptoState=ba829103-a2e6-4034-9183-b1d801091f0c  

OSCE exam is fine, just long. Practice, practice, practice. Make the most of your friends (only ones you won’t waste time with) AND the patients on the ward are bored and will most probably say yes to practicing examinations. There’s nothing else to it, apart from practicing and timing yourself. 

Get yourself a fourth year tutor!!!!! 

————————————————————————————————————– 

If you have made it this far, I don’t blame you  if you haven’t or you skipped some bits on this  big fat document, don’t be scared or disheartened. Third year is the BEST year. It is so much fun, you experience cool things and for me (Amira) personally is the one that you actually see yourself growing into the doctor you are gonna be. Remember, you have a bunch of friendly fourth years ready to help you whenever you need, you have this document you can come back to at any time, and you’ve made it this far already there’s nothing stopping you from continuing on. 

May Allah AZJ grant you all immense success in this life and the next AMEEN. 

All the best, 

Amira & Halima 🙂