Introduction to clinical

years: year 3 overview

How do you feel about the upcoming VIA?

Perspective on assessments

40% MED2031 40% MED3051

10% Y1 20%Y2 30%Y3 30% Y4 10% Y5

For the VIA, the difference between receiving the

median 70% mark and the top 90% mark makes :

20% to your VIA score

4% to your year 2 score

0.8% to your MBBS scoreLearning is important. Study well, do the best you can. Don’t stress!

Content delivery

Year 2

• Lectures• Tutorials• Written assignments

• Exams• OSCEs• Patients

Year 3• Lectures• Tutorials

• Written assignments• Exams• OSCEs

•Patients

Travelling to year 3

Sites and rotations

Where?

Metropolitan• Central Clinical School

o Alfred Hospitalo Epworth Hospitalo Sandringham Hospital

o Cabrini Hospitalo Frankston Hospital

• Eastern Health Clinical Schoolo Box Hill Hospitalo Maroondah Hospital

o Angliss Hospital

• Southern Clinical Schoolo Casey Hospital

o Cranbourne Hospitalo Dandenong Hospitalo Monash Medical Centre

o MMC Moorabbin

Rural• Bendigo Regional Clinical School

o Bendigo Health• East Gippsland Regional Clinical

Schoolo Central Gippsland Health Service

(“Sale”)• Gippsland Regional Clinical School

o Latrobe Regional Hospitalo West Gippsland Healthcare Group

(“Warragul”)• Mildura Regional Clinical School

o Mildura Base Hospital

Clinical school liaisons

• New positions (previously clinical site liaisons) – will be elected with other MUMUS positions

• Liaison between you and the clinical school if you have any issues (mini academic rep)

• Run smaller social events (mini social rep)

Logistics

• Accommodation: at home, at a residential hall (Clayton, Berwick), student accommodation apartments, sharehouse

• Travel: public transport, parking• Tips can be found in the MUMUS Year 3B

Guide

Rotations

• Medical or surgical• General or specialty• 2-7 weeks depending on site• ‘Home’ team of doctors for: – Ward rounds– Outpatient clinics– Theatre/endoscopy– Answering questions if they’re free

A typical week (surg rotation)Monday Tuesday Wednesday Thursday Friday

7:30 Ward round Ward round Ward round Ward round Ward round

9 Theatre Outpatient’s clinic, radiology meeting, consultant ward round

Anatomy, radiology, pathology, pharmacology etc. lectures (all clinical schools)

Theatre

10 Case presentations

11 PBL

12

1

2 Medical bedside 5th year mentorship tute

EBCP, occupational medicine, PBL etc. lectures (all clinical schools)

Theatre Theatre

3 Theatre/ endoscopy

4 Site-specific lecture

Surgical bedside

5 Site-specific lecture

A typical week (med rotation)Monday Tuesday Wednesday Thursday Friday

8 Ward round 7:30 startGrand round

Ward round Interdisciplinary meeting

Interdisciplinary meeting

Morning Anatomy, radiology, pathology, pharmacology etc. lectures (all clinical schools)

Case presentations & PBL

Afternoon Medical bedside & site-specific lectures

Outpatients clinic EBCP, occupational medicine, PBL etc. lectures (all clinical schools)

Surgical bedside

PBL

Patient cases and paper cases

Patient cases

• Similar to PBL in second year except the ‘case’ is a real patient seen and presented by a group member

• Based on conditions• Run in small groups• Depending on your tutor your group may

research an aspect of the task each and present or the tutor may give a PowerPoint presentation.

List of patient cases 2013• Chest Pain• Acute Glomerulonephritis (GN)• Breathlessness • Cough and weight loss• Deep Venous Thrombosis/Pulmonary

Embolus• Abdominal Pain• Diarrhoea• GI Bleeding• Obstructive Jaundice• Anaemia • Breast Cancer• Splenomegaly and lymphadenopathy

• Pneumonia • Thyroid Disease• Osteoporosis• Type 2 diabetes• Delirium• Stroke• Peripheral Neuropathy• Seizure• Movement Disorder/Parkinson’s

Disease• Peripheral Vascular Disease• Urinary Obstruction• Skin rash/ulcer

Paper cases

• Run in larger groups• Based on a set of symptoms• Depending on your site, these will either be

run as a lecture by a doctor or a group of students, who will be given the topic about a week in advance to prepare. An expert facilitator will discuss aspects of the topic and provide feedback to the presenting group.

List of paper cases 2013• Mr Lance Patrick - swollen legs• Ms Ghelani Singh - breathless on

exertion• Mrs Jessie Johnson - calf pain• Ms Sophie Panopoulos - tired and out

of sorts• Mr Peter Hood - cough and loss of

breath• Mr Michael Todd - jaundiced• Mr Stephen Tsagakis - severe stomach

pain• Mr Maxwell Jacobs - fever and night

sweats• Mr Tony Spencer - severe headache

and flu symptoms

• Ms Jenny Randall - muscle aches, fever and cough

• Mr Josh Felix - extreme lethargy• Mr Simon Smith – cannot get out

of bed• Ms Siu Jung - rash• Mr Peter Paunch - knee pain and

swelling• Mr Jules Brady - health check• Ms Anne Smith - history of

headache• Mr Branco Vladic – motor vehicle accident

Bedside tutorials

• The style of bedside tutorials varies between tutors• Format 1: No preparation required, tutor picks a

patient and everyone gets a chance to examine the patient

• Format 2: Tutor asks group to find a couple of patients, someone who has not interacted with the patient examines them

• Format 3: Tutor sends group leader a shortlist of patients and every patient is seen by someone in the group before the tutorial and we present back

Great opportunity to:

• See patients not related to rotation• Get feedback on a range of clinical skills• Ask questions about content• Learn from watching peers• Practice MCRs in almost exam conditions• Have MCRs assessed (don’t worry, not during

actual tutorial)

5 final tips for third year

Spot the difference

See a patient every day

• Find a patient (ward rounds, day procedure unit patients or a friend from another unit)

• History: 8 minutes• Examination: 8 minutes• Look at drug chart, notes: 4 minutes• Read more about the condition (Kumar & Clark’s or

BMJ BestPractice): 10 minutes• If they’re really sick you might spend more time on their investigation

results and less on the examination

• You should complete this in 30 minutes

30 minutes of extra ‘work’ a day

• Potentially on the wards in year 3: 36 weeks in the year

• Allowing for orientation/consolidation/study weeks: 32 weeks

• Allowing for Wednesdays and weekends: 128 days

• 128 patients• That’s more conditions than on the curriculum!

What’s wrong here?

Three year job interview? Perhaps, but if at the end of it all, you’re too burnt out to

care for your patients, what’s the point?

The last time something will be summarised on the final slide for you :p

1. Not everyone in the hospital knows what you’re after so don’t be afraid to ask nicely

2. The content is very manageable if you do a little bit steadily throughout the year

3. You are colleagues, not competitors4. Look after yourself first, seek help when you

need it5. [This line has been intentionally left blank. What

are your hopes/goals for the year?]

Good luck!

Any questions?

Feel free to contact me on vwon9@student.monash.edu