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The Insider’s Guide to Passing First Year Clinics at

King’s College London

Insider’s Guide to passing First Year Clinics at King’s College London

Contents

Personal Accounts Nicholas Culshaw- pg 4

Elizabeth Dehinbo- pg 9

Towhid Imam- pg 12

Yasmin Leena Bashir- pg 16

Nicholas Culshaw

Description of written exams (topics and question types)

You will sit three written exams over two days at the end of phase three. Paper 1 is a three hour

exam containing clinical cases that test core knowledge of basic adult medicine. You must

interpret clinical data such as X-rays, ECGs, FBCs and clinical biochemistry in the context of a

short clinical history in order to be able to answer true/ false MCQs.

The answers to some questions may be obvious from the history alone but some questions

require the accurate interpretation of individual pieces of data so it is worth getting to grips with

X-rays, ECGs, haematology and clinical biochemistry as early as possible. The PasTest book

“Data Interpretation for Medical Students” is worth going through a week or so before the exam

to give you an idea of what you should know. The level of data interpretation required to simply

pass the exam is hard to know, the only ECG interpretation required in our year was calculating

heart rate but there were more complex sets of data requiring, for example, the calculation of

corrected calcium levels and interpretation of electrophoresis gels.

Paper two is entirely true/ false MCQs and paper three is extended matching and best of five

MCQs. Both Paper 2 and 3 are sat on the same day and cover material from the pathology and

therapeutics course as well as topics listed in the back of the log book. Paper 3 contained a lot

of microbiology and drug side effects as well as questions relating to public health and smoking

cessation. All three papers require theoretical knowledge of clinical signs elicited by

examination so don‟t forget these between the final ICE and the written papers!

Traditionally Papers 2 and 3 are sat first and Paper 1 is sat the next day. Do not fall into the trap

of leaving all your data interpretation until the night before Paper 1 as we had clinical

biochemistry relating questions in paper two.

Description of OSCE exams

Second year OSCEs at King‟s are referred to as Incremental Clinical Examinations (ICEs).

Each ICE station lasts for six minutes with a two minute break between stations. During the two

minutes you can read the instructions for the next station.

Possible stations can be subdivided according to what you are required to do:

Clinical examination stations.

o You will be asked to examine a particular part of the body or organ system. This

will be on a volunteer who may or may not have any clinical signs.

Clinical history taking stations

o You will be asked to take a brief history from an actor in front of an examiner.

At the end of the six minutes you will need to be able to offer a differential

diagnosis.

Procedure and Skill stations

o You will be asked to perform a clinical skill such as phlebotomy or blood

pressure measurement on either a model or an actor in front of an examiner.

Explaining stations

o You will be asked to explain either a disease or a medical procedure such as

bronchoscopy to an actor in front of an examiner.

Each station is assigned to a specific rotation and you will only be expected to perform stations

assigned to rotations you have already completed. It is usually pretty obvious which rotation a

station corresponds to but some are more ambiguous. For example, be aware that the Basic Life

Support (BLS) and peripheral vascular system examination stations are both assigned to the

cardiorespiratory rotation. The number and combination of stations, the timing of ICEs and the

criteria for re-sits should you fail a station can vary from year to year.

OSCE Stations you had last year

Rotation one (cardiorespiratory) stations:

Blood Pressure measurement

o My patient was a young man who was having a repeat blood pressure

measurement following a previously high reading.

Lung Cancer History

o Straight out of PasTest OSCEs for Medical Students Volume 1

Rotation two (abdomen) stations:

Abdomen examination

Polycystic Kidney Disease History


Peripheral vascular system examination

Rotation three (NOP) stations:

Visual Fields Examination

Delusional disorder history

o Not in any of the PasTest OSCE books!

Explaining diabetes


Basic Life Support

How are marks allocated for the exam?

Your overall mark for the year is calculated from several components. Your in-course

assessment makes up the majority of marks (55%) and written exams the minority of marks

(45%).

In-course assessment consists of three „end of rotation marks‟ plus your ICE marks.

Your „end of rotation mark‟ is, in turn, made up from a firm head mark (70%) as well as grand

round marks (30%). End of rotation marks are worth 30% of the total for the year and ICE

marks are worth 25% of the final grade.

The end of year written papers are weighted so that Paper 3 carries twice the number of marks

as Papers 1 and 2 do. As a result Paper 1 and Paper 2 are each worth 11.25% of the final year

mark and paper 3 is worth 22.5%.

How did you revise for the written and practical exams?

Working out what you need to know for the written exams can be problematic; I used the list of

topics in the back of the log book for core work and then the pathology and therapeutics course

handbook as a guide.

The medical school does not release past papers for Phase Three but it does provide examples

of each question type in the student handbook. Make sure you go through these early on to get

an idea of the standard that is expected of you but also go through them the night before the

exam because they do use some of the published questions in the actual exam.

Despite a lack of official past papers there are numerous sources of similar questions that you

can go to for exam practice. Any book containing EMQs or MCQs for medical school finals is

worth going through and the earlier you start doing questions the better. Over the year you will

have absorbed a lot of information without even trying so you need to work out what you do

and do not know. Practice questions are the best way to do this as they highlight your strengths

(areas that you do not need to spend much revision time on) and, more importantly, your

weaknesses (areas that you need to spend more time on).

On both ward and in the exam certain things are common. As a result you should know certain

topics really well- asthma, COPD, liver cirrhosis and diabetes are just a few of the conditions

that are very common in clinical practice. In an exam that is designed to ensure that you are on

your way to becoming a competent practicing clinician you can guarantee that common topics

are going to come up several times. Other topics that are fair game are less common but life

threatening conditions that you would need to be able to rule out in an acute setting. The chance

of any one obscure, non-life threatening condition coming up is minimal, if you get one in the

exam guess the answer and move on.

There are several excellent OSCE text books available for the practical exams but revising for

ICEs cannot be done on your own, you must practice with other students. Do this in pairs or

threes maximum as any more people isn‟t really conducive to studying! It can be good to

practice with different people as everyone has different strengths and weaknesses but if you find

someone that you work well with then stick with them. If you know anyone in the years above

you try and convince them to spend an hour or so going through stations so you can find out if

you are up to standard or not.

Unfortunately the medical school do not publish a definitive list of stations that can come up in

the ICEs. There is a short list of example stations published by the medical school and if you

combine this with all the clinical skills and examinations mentioned in the log book plus all the

history stations in the PasTest OSCEs for medical students books you should have a good idea

of what can come up. Note that unmanned data interpretation stations such as X-ray, ECG and

haematology are fair game as they are log book sign ups.

Beware of focusing on the mark schemes found in the PasTest OSCE books for history taking

stations. It is rare for anyone to get full marks in history taking stations which suggests that

King‟s use their own mark schemes for the same scenarios. Be confident taking a concise

history for any condition mentioned in the Log Book as not all history taking stations come

from the PasTest OSCE book.

Many firms, particularly those attached to DGHs will organise mock ICEs for you, these are

generally valuable. If you can‟t find anyone to organise one for you then at least make sure you

have performed a few examinations in front of your firm head as this will most likely simulate a

similar stress level as the ICE!

Which parts of the exam did you find the hardest?

Having transferred into Kings I probably found the first ICE exams hardest- I had not

experienced the second year OSCE and consequently was not really sure what to expect. Once

you have experienced your first ICE then you will have a much clearer picture of what happens

as well as what is expected of you. Paper 3 was undoubtedly the hardest written paper that we

had to sit simply because of the breadth of the pathology and therapeutics course combined with

the detailed knowledge required to answer MCQs with confidence.

Advice you would give to the following year

“See as many patients as possible” is clichéd but valuable advice. The more histories you take

now, the more comfortable you will be when doing them in the ICEs as well as on the wards.

The same goes for clinical examinations.

A significant proportion of your end of year grade (21%) is determined by firm head marks

alone. Unfortunately, despite the publication of criteria for firm head grading by the medical

school this component is extremely subjective and you will find that some firm heads are

unduly harsh or generous with their marks. There is little that you can do to change the overall

attitude of any firm head but if you are really determined to get the best mark you can then

speak to your firm head- if you want an end of rotation mark over 85% then tell them that. Ask

them what you need to do to get such a mark and do it. If you have stuck to their advice and

checked that you are on track at the mid-rotation review then they can have little choice at the

end but to give you the mark that you deserve.

See as much of the core curriculum as possible during your rotations but also spend your time

doing things that you find interesting and useful. Some people, for example, find outpatient

clinics boring and a waste of time, others get a lot out of them, same thing applies to surgeries.

If you don‟t get anything from them and your firm head doesn‟t insist that you go to them then

don‟t go, your time is much better spent doing something you find useful.

Finally do not be afraid to seek out help from doctors that are not necessarily attached to your

firm, particularly junior doctors as often they are keen to teach. F1‟s will remember the

knowledge level required for medical school and are likely to have time for sign-ups and

clinical skills teaching if you get to know them on the wards.

Elizabeth Dehinbo


The written exams consisted of three papers. Paper 1 was Data Interpretation and problem

solving and involved clinical scenarios. After the scenario was given there were sets of 5

true/false answer questions. For this paper additional sheets were given containing reference

ranges and images which were referred to in some questions, for example ECG recordings and

the image of the eye viewed through fundoscopy. Some of the sample questions came up in this

paper. This paper was 3 hours long and grossly covered all topics taught throughout the year. At

the end of the paper there were also a few single best answer questions.

Paper 2 was a true/false MCQ paper and was two hours long. This again covered most clinical

area encountered in the year although psychiatry was not covered in very much detail. Being

true/false the questions were not too difficult although I took care to always check the wording

so not to misread a statement which included a negative (e.g. the word not or prefix un)

Paper 3 was described as an extended matching and single best answer paper and mainly

consisted of material from the pathology and therapeutics course ran later in the year. There

were a few microbiology questions, regarding infectious organisms, and lots of pharmacology

questions including drug interactions and side effects. Some topics that were not formally

covered were also questioned, for example some dermatology questions were present but

phrased to fit into the area of lumps which was part of the curriculum. This paper was the

hardest and the grade from this was doubled when added to the overall grade.

All the papers were cumulative so unlike in previous years all papers did not have to be passed

in order to pass over all (the total of all 3 had to be over 50% of the available grades).


Throughout the year, at the end of each rotation, ICE examinations were given and if these were

passed the end of year OSCE would not need to be taken. The first ICE examination (after the

first rotation) consisted of 2 stations, with one being based in a clinical setting and the other

being history or explaining station. This then accumulated to 3 stations and then 5 stations for

the final ICE with there being one station of any type from the previous one or two rotations

each time. Failure at the resit attempt of any ICE station would then cause the candidate to be

required to take the end of year OSCE. This therefore means that failure of a resit after rotation

1 would render later ICE examinations worthless as regardless of passing, you would be

required to take the end of year OSCE.

The end of year OSCE consisted of 26 stations with 22 active stations and 4 rest stations. The

grade from this OSCE was capped at 50 for those taking part due to failure in ICE

examinations.

The OSCE Stations you had last year

There is an endless list of possible OSCE stations as there are many different histories that can

be given along with a variety of different explain topics. A list of the OSCE stations were as

follows:

1 Communication Skills: Explaining Endoscopy

3 Practical Skills: Handwashing and Gloving

4 Clinical Skills: Neurology - GAIT / Co-ordination

5 History Taking: TB

6 Ophthalmology History Taking: Acute Anterior Uveitis

7 Clinical Skills: Abdominal Examination

8 Clinical Skills: Cardiovascular System

10 Practical Skills: ECG

11 History taking: Psychiatry - Obsessive Compulsive Disorder

12 Clinical Skills: Chest

13 History Taking: IHD

14 Clinical Skills: Visual Acuity

15 Focused History Taking: Renal Colic - Calculi

17 Clinical Skills: Examination of the Neck

18 Ophthalmology History Taking: Giant Cell Arteritis / Temporal Arteritis

19 Clinical Skills: Post Myocardial Infarction Advice

20 Clinical Skills: Ophthalmology - Fundi

22 Focused History Taking: Explaining Diabetes

23 Clinical Skills: Neurology - Cranial Nerves

24 History Taking: COPD

26 Clinical Skills: Peripheral Pulses

25 History taking: Psychiatry - Bipolar Disorder

All of these stations were previous ICE stations with many of the histories being taken from the

Pass test OSCE books. In these books model answers are given with mark schemes. Model

answers for the explain stations can be found in the Master pass OSCE guide by Akunjee. This

also gives very good guidance for examination and practical skill stations.

Two types of stations to note however are hand washing and the psychiatry histories which

generally had a higher failure rate.


The clinical assessment grades are made up of the end of rotation marks, grand round marks and

ICE grades, with the ICE grade carrying most weight. The written paper grade was an

accumulation of the grades from all 3 papers, with the grade from paper 3 being doubled.


The best way to revise for the written exam is to use the clinical handbooks such as baby Kumar

and Clark (pocket essentials of clinical medicine) and the Oxford Handbook of Clinical

Medicine. I personally made notes from these books, but some of my colleagues found simply

reading them were enough to suffice. For the Pathology and Therapeutics course, the course

book given containing lecture notes was generally very good however some lectures did require

further reading , which I did from online resources, textbooks or my notes from previous years

(e.g for immunology).

Revision for the practical exams involved working with my colleagues and practicing the skills.

A good tip is to work with people who were based at different sites and on different firms as

their teaching may have been slightly different and by doing this you can pick up things you

may not have been taught. I also made use of the clinical skills centre by using their equipment

and also attending patient educator sessions.


Paper 3 was the hardest aspect of the written exam as the format of the questions was different

from the other papers and more thought was required when trying to determine the correct

answer (sometimes up to 12 possible answers were given). This said thorough revision of the

pathology and therapeutics course would have probably made this paper easier.

I would not say that the ICE exams were hard but some stations can be particularly hard so it is

important to prepare well for these e.g. psychiatry stations. Also it was hard to squeeze all that

you need into the time restraints imposed. It was difficult to do well in some examination

stations as giving an accurate diagnosis was not always possible as you have to be seen doing

certain things which can end with there not being enough time to come to the correct

conclusion.


In all be confident in all your skills and examinations as early in the rotation as possible as you

will then just be perfecting your skills rather than learning them when it comes to revision. Also

be sure to practice the ICE skills needed from previous rotations throughout the new rotation

otherwise you can find yourself forgetting things.

As for the written I would advise going to all the available lecture given throughout the year be

it urology or ophthalmology as short MCQ may be given in these lectures which is good

preparation for the exams.

Towhid Imam


Paper 1 will be clinical cases (12 Data Interpretation Problems and 10 Problem Solving

Problems). Each of the Data Interpretation Problems has 5 True/False MCQs; each of the

Problem Solving Problems has 3 sets of True/False MCQs.

This paper covers all subjects and is 3 hours long to give enough time to read the clinical

information and results. Be expected to be able to decipher X-rays, Ophthalmology slides,

ECGs and clinical chemistry (reference ranges provided in a booklet).

Paper 2 will be MCQs only (60 stems plus 5 True/False MCQs). This paper is 2 hours long.

Paper 3 will be 17 Extended Matching themes (each theme has 8 or 9 options to be matched

against five statements); plus 10 best-one-of-five questions. This paper is 2 hours long. These

types of questions are grouped together because the pass mark is lower (it is more difficult to

guess randomly the correct answer, compared to the other papers).

The following is a list of the topics I suggest revising for the written exams:

General Medicine – main makeup of the exams; including Diabetes, hyper/hypothyroid,

Cushing‟s, Addison‟s, UTIs, Nephrotic/Nephritic Syndrome, Renal failure, COPD, Pneumonia,

TB, Lung cancer, Asthma, Pleural effusion, Fibrosis, MI, Heart failure, Arrhythmias,

Congenital & Neoplastic Haematological diseases, Anaemia, Sickle cell, IBD, Hepatitis, Rectal

bleeding, Coeliac, PBS, Cholangitis, Metabolic disorders, and Emergencies relevant to each

rotation.

General Surgery - including Peripheral Vascular disease, Pancreatitis, Gallstones, Cancers,

DVT but not much on surgery.

Neurology – including migraine, meningitis, syncope, epilepsy, neurodegenerative & common

disorders.

Psychiatry – including suicide, overdose, psychosis, depression/bipolar/mania, pharmacology

and mental capacity.

ENT – including pharyngitis and congenital disorders.

Ophthalmology – including red eye and diabetic & age related disease.

Dermatology – there was one EMQ on various superficial skin lesions, i.e. lipomas, squamous

cell carcinomas etc.

Rheumatology – SLE, Giant Cell Arteritis

Pathology & Therapeutics - including drug side effects, endocarditis and valve disease, specific

actions of bacteria and viruses, antibiotics, cancer.

Basic Medical Sciences – some common sense questions.

Most of the questions can be worked out if you have revised. These exams generally have a

good pass rate.


They are called ICEs and you have them at the end of every rotation. They are cumulative so at

the end of the second rotation there is a station from the previous term and at the end of the

third rotation there is a station from the first and second rotations. They are 6 minutes each and

have a description on the door and inside the station of the task. There is a patient and an

examiner and usually you have very little space to operate in. Remember that they are testing

your competency for a skill and so most often (unless the signs are obvious) not reporting signs

to the examiner does not warrant a fail so concentrate on going through the motions. Many

students often get thrown off by signs or run out of time so practice finding them. For certain

stations where it is required, equipment will be provided, although a stethoscope isn‟t usually.

Beware that sometimes you will be given more equipment than you need (e.g. a fully equipped

neuro trolley) where using all the equipment is not necessary. There are no surprise stations and

the ones that come up are the ones that you would expect that are in the revision books.

If you fail a station then a week later you will resit that station or one from the same category

and rotation. If you fail the resit then you will have to sit the End of Year OSCE which is has

more stations. Your OSCE mark for the year will also be capped at 50. At times you may feel

the exams are unfair, especially when very little feedback is given when you fail. This I‟m

afraid is a fact of life.


30% of the overall mark for the year comes from In Course Assessment (each rotation

contributes 10% towards the final overall mark).

25% comes from the Clinical Examination (marks are allocated for each ICE station

assessment).

45% comes from the Written Examinations – within which paper 3 (the EMQ/SBA paper) is

worth 22.5% and the others 11.25% respectively.

The marks of written exams are aggregated so you could fail one paper but pass overall if the

marks from the other two are good enough. There is no negative marking.


For the written exams and for general study the two books that are used are nicknamed Baby K

& C and Cheese and Onion. These are The Pocket Essentials of Clinical Medicine by Ballinger

and Patchett, and the Oxford Handbook of Clinical Medicine by Longmore, Wilkinson,

Turmezi and Cheung. These books are adequate in breadth and more than sufficient in depth.

However, they miss out some other key topics of revision such as ENT, Ophthalmology,

Psychiatry and Pathology, all of which can be assessed in the exams. You are supplied with an

ENT booklet but seeking a textbook may be wise for those seeking top marks. Ophthalmology

requires a textbook and I managed with ABC of the eyes. Psychiatry requires a textbook, and I

recommend either Psychiatry at a Glance or Psychiatry PRN. The second covers more depth, is

written by KCL psychiatrists and is more practical with examples and OSCE practice stations.

For pathology, the booklet is more than sufficient.

For the practical exams, practising as a pair or in a small group with reference texts or notes is

the best form of revision. Make use of the clinical skills centre when it is free rather than busy.

For history practice the Pastest series are essential, but is not exhaustive and so learning general

histories from other textbooks is advisable. For other stations there are several books to choose

from. The blue Clinical Skills for OSCEs book and The Easy Guide to OSCEs for Final Year

Medical students are both good.


For the written papers, I found the EMQ/SBA paper the hardest particularly because they were

asking difficult questions, some of which I had done no revision for and were not aware we

were taught on.

For the ICEs, without a doubt most students will say the Psychiatry stations are the hardest

simply because they fail a lot of students. Histories can be problematic because of the

actor/actress. They can sometimes be very unresponsive so you have to work quickly and

choose your questions. They may also spring questions on you like „do I have cancer‟ and so

dealing with concerns can be difficult sometimes. Another potential difficulty is empathy. This

can be hard to show in such an artificial environment so one must take this into account. For the

ICEs overall I found keeping to time difficult as I worked too slowly. By practice you get an

idea of what 6 minutes feels like.


I believe that if you are a model medical student then you will learn most of what you need to

and score well in the exams. Revision will be easier as you will have been working consistently

during the year. The model student also clerks patients for fun and spends a lot of time on the

ward. It is a very good way to learn everything.

Whatever student you are, the best way to work in year 3 is to work consistently and to do a

little bit every week. This way you gain a better understanding as you proceed through a

rotation.

In Year 3, the two main skills that need to be honed are history taking and examination. It can

be daunting to think you will need to interact with patients! However most of them want to

interact with you! So no need to be afraid, just dive in.

In terms of optional reading, I would recommend Clinical Examination by Epstein et al. It not

only goes over examination in depth but has pictures of signs and ways to find them and starts

at the beginning by going over stuff from 1st/2

nd year briefly. I believe it to be better than

Macleod‟s. Another good book is the Oxford Handbook of Clinical Examination which is

shorter and has bullet points. For history taking and diagnosis, Tutorials in Differential

Diagnosis and the Oxford Handbook of Clinical Diagnosis are particularly useful as references

when doing Grand round presentations.

For ICEs there are some rules I would advise following. Always use alcohol gel where it is

provided. Psychiatry will always come up and is the most commonly failed station. In these any

of these stations, not asking about suicide is an instant fail. Always remember the patient is the

primary focus of your attention, not the examiner or their marksheet. Always look carefully at

your surroundings (usually done when standing at the foot of the bed) and note anything you

see (e.g. medication, walking stick). Always examine your equipment as this can sometimes

remind you of something you have missed. Always report findings and tell the examiner what

you are doing as you go along. If you mess up, forget it and move on.

Do not worry about the written exams; provided you start revising during your final rotation

early you should not have a problem.

The other forms of assessment are Grand Round presentations and the end of rotation mark. The

presentations sound a lot more daunting than they are. A higher mark is often achieved not from

the amount of medical knowledge but simply how well it is presented. This comes form have a

short and simple presentation that is easy to understand and delivered confidently. It is always a

good idea to prepare for potential questions (and if you are feeling green fingered, maybe even

plant some). Further more, a high scoring presentation needs an interesting case. As for the end

of rotation marks, I think it is best to either aim for a very high mark or just carry on as normal.

A high mark stems from a lot of effort and displaying of knowledge and competency to those

that matter. One of the SpRs called Narin once gave me sound advice, „Time your enthusiasm‟.

I chose to just ride the year out and focus more on learning and I didn‟t do too badly. One

reason why I did was because the marks vary from rotation to rotation and only a handful of

firm heads stick to the marking criteria. I think it is better to just enjoy the year because it is

long (so plan a holiday) and continue to live an active student life because soon enough you

won‟t be one anymore!

Yasmin Leena Bashir


The written exams were quite a handful- they weren‟t easy and if I hadn‟t been reading

throughout the year then there would have been tears of woe. There are essentially three papers

at the end of Year Three; Paper 1, 2 and 3. Paper 1 is three hours, with the other two being two

hours each.

Paper 1 is the Data interpretation paper and is much like the web based scenarios. You may be

given a Chest X-ray, ECG‟s and few pictures i.e. of the retina. Each question has 4-5 true/false

stem questions, covering all areas of Year Three. All normal values are given so you don‟t have

to memorise them although knowing normal values of Hb and ABG‟s are useful, as you won‟t

be looking back and forth. Overall I felt it was the nicest paper and I quite enjoyed it.

Paper 2 consists of entirely true and false questions, which are reflective of the material covered

in Year Three.

Paper 3 included single best answer and extended matching question. Containing questions

from all three areas of Year Three and some microbiology question from the pathology course!

I‟m afraid you‟ll have to learn all the material covered in Year Three including pathology

lectures, even though you may not have received any teaching on the subject.


There are three ICE examinations sat after each rotation; the stations assess skills examinations,

procedures and history taking.

The first ICE exam contains two stations assessing the first rotation; the second ICE includes

two stations assessing the second rotation and one station assessing first rotation. The Third ICE

exam includes; 2 station for rotation 3 and one station each for rotations one and two. In total

you will have 9 stations.

Unlike the OSCE‟s you have to pass each station to pass overall and if you fail to pass a station

then you will have to resit that station. If you fail the resit then you will be sitting the BIG 24

station OSCE at the end of the year. However you will be briefed for these exams with more

detail nearer the time.

The OSCE Stations you were asked last year and model answers

Station 1- Examination station,’ examine the patient eye using a fundoscopy’

Answer:

Introduce yourself, explain the procedure and take a brief history (30 seconds)

Start with general observations, and then the red reflex.

Now start your examination, approach the patient at a 30 degree angle from the side to

which eye you are assessing. So from the right side for right eye and vice versa,

remember to use your right eye for their right eye and vice versa.

Once you have seen the optic disc describe it and then look at all four quadrants with in

the eye, looking for exudates, cotton wool spots, and haemorrhages, following the

blood vessels look for aneurysms.

Gel in and gel out as with any skills, procedure or examination station.

Station 2 – History taking „This patient has taken an overdose, please take a history‟

Answer: This was a psychiatry station and she had suicidal ideation.

Remember to screen for depression!!

Ask about past psychiatric history personal and family.

Most importantly assess her risk of suicide! Or you will fail. In any psych station

remember to assess suicidal intention.

„ Have you ever considered to harm yourself/others?‟, and then once you‟ve set the

scene, „have you ever thought of ending your life‟ or „have you felt so low that you

wish you weren‟t here?‟

Master a style which suits you.

Station 3- Examination station „Please examine the cardiovascular system’

Answer: Remember Inspection, Palpation, Percussion and Auscultation.

Starting with general inspection, looking around the bedside and at the patient.

Start with the hand, moving on to the neck and face and then coming down to the chest.

You will be given a guide to how to examine in your induction week and this can also

be found in many text books.

Station 4- History taking, COPD history

Answer: introduce yourself, state the purpose and go through SOCRATES

With a respiratory history remember to ask about occupation and exposure to asbestos

Ask about asthma and whooping cough and also don‟t forget pets.

Station 5- History taking station, psychiatric history „Patient who has been acting strange’

Answer: This patient had delusional ideation.

Go through Schneider‟s first rank symptoms of schizophrenia.

Remember to ask about past psychiatric history, and importantly ask about suicide.

Also remember to ask about family history. This is important in psychiatry as there is a

trend.

Station 6- Skills station „Surgical scrub and gowning’

Answer: You will learn how to do this in theatre, one of the scrub nurses will teach you.

Remember to prepare everything first before you scrub and remember to put your mask

on

There are essentially three washes, look this up in a text book.

You will be asked what solutions can you use and for how long would you scrub?

You do not use brush anywhere else other than hands, there is a risk of bringing out

deeper bacteria from the pores, when used on the arms.

Gown up, using sterile method, do not touch the outside part of the gown.

When putting on gloves, do not pull the sleeves out from inside the gloves. Keep sleeves

inside.

Keep hands above the waist.

Station 7- History taking, Endocrine history

Answer: this is a classical history of Hypothyroidism.

Text book example.

Station 8- Skills station, „Record this patient’s BP’

Answer: Very simple

Use the correct cuff; you will be given a choice of three.

Speak to the patient, not the examiner, i.e. give your findings to the patient.

Remember to mention that you would like to assess for postural hypotension and that

you would like to assess the BP on three different occasions.

Station 9- History taking, Neurological History

Answer: This was a classical migraine history if you knew what to ask.

Remember your triggers for migraine, cheese, wine, chocolate etc... You have to ask

specifically, the patent won‟t tell you.

Go though SOCRATES.

Ask specifically about neurological signs, to rule out space occupying lesion.


The pass mark for all MBBS examinations is 50%. These marks are of course standardised to

the year by the time results come out with merits awarded to those who fall into the top 15% of

the year.

You will receive three marks, an ICA mark (awarded by firm heads at the end of your rotations)

a Clinical assessment mark (ICE) and the written marks. ICA marks account for 30% of the

year, written papers account for 60% and clinical assessment accounts for the remainder.


Revision for the written papers for me were mainly in the form of reading and making notes

from Oxford handbook of clinical medicine „Cheese and Onion‟, pocket essentials of Kumar

and Clarke and the pathology lecture notes.

„Cheese and Onion‟ in my opinion was by far more superior to Kumar and Clarke as it was

more relevant, however I found that in order to understand „Cheese and Onion‟ as it is clinical,

you need to know the basic science which is where K and C came in. When studying and

revising, I found referring to all three together made it very easy to understand the topics.

Revising for the practical exams, in my opinion is best done with friends and with family. If

you have brothers and sisters ask them to be patients for you, although they are actors the

patients you will face in your ICE exams will be like your family members or your non medic

friends, normal lay people. Make circuits among yourselves and practice until you are sick of it

as you should know the stations like your ABC! I found Macleod‟s, Clinical examination to be

very useful in my revision.


I can‟t say for everyone but this year many of us were surprised to see questions on

microbiology in the Data Interpretation Paper. The questions never seemed to stop, there were

around 5 questions, one after the other. When I stepped out of the exam it was all I could

remember! Considering the fact that I didn‟t have a clue what the answers were, hand on heart ,

those questions in Paper 2 were by miles the hardest for me.


Let me dispel the myths which may possibly have reached your ears by now and if not, will

probably do so soon:

„It‟s impossible to fail year 3‟

„You can pass the written papers by revising in the last two weeks before exams‟

These are all myths!! Nothing is impossible in medical school and you can‟t pass by revising

two weeks before the written exams. If you find that you have been reading and making notes

throughout the year, then of course two weeks REVISION may be plenty for some, however it

is certainly not enough to those who have not been reading throughout the year. You must

understand the meaning of revision here; I don‟t mean learning but rather re visiting.

Make sure that you make the most of your attachments, take advantage of the doctors and

patients and take every opportunity you get; you may not get the same opportunity again.

All of this may sound a bit scary and you may be put off however regardless of what I have said,

I found Year Three to be amazing, although it was tough trying to get all my sign ups and

finding my way into the network, I enjoyed every bit of it and I‟m sure you will too.

1 sty ear kings

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