#med school tips

[help-im-a-medstudent]

Hi! I was wondering if I could ask you for advice about OSCE prep? I'm a final year medical student and one area I've noticed I've struggled with is time management during OSCE stations? Eg, I find that I take a history and by the time I have to do a management plan, the OSCE station time has finished. One area I also struggle with is how to structure a management plan of the level of a first day FY1. I'd be extremely grateful is you could give advice? Thank you in advance!

Hi anon! apologies I didn't see this in my inbox, I hope I'm not too late with this reply

My final year exams were MOSLERs so we had a little more time and they were split so we had a specific amount of time for the discussion afterwards and were told to move on, but we did have to manage a history and examination in the time so I hope these help

If your medical school publish the generic mark schemes for OSCEs look at them and look at what you have to cover and how many marks each part is. For example, there may be only one point to ask about medication and allergies, but more for digging into the history of presenting complaint, but it's important not to forget those small things as they can be easy marks to pick up with just one question.

Practice getting a balance of open and closed questions - if you're asking lots of closed questions you're taking lots of time up asking them, whereas something broader to cover more things lets you get more information with only one question. "Are you having any other symptoms" is better than "do you get x, y, z"

Practice with a timer, over and over. There's resources out there with cases so you don't get bored of the same things, but practice with someone, and only do the history part and try and get it down to less than the osce station time. Then you'll get a better sense of how long you're taking on the day and be able to move on through the questions.

In terms of a management plan I would think of it as bedside investigations, bloods, imaging and treatment and this will help you structure it - bedside are tests like urinalysis, peak flow, ECG - bloods - think about why you want them rather than just reeling off all you can think of - will the one you're asking for help with the treatment or diagnosis - imaging - again why are you getting it, justify why are you getting a chest XR for cardiac sounding chest pain? etc - treatment - this depends on what the case is, if it's an emergency case then using the ABCDE structure and treating what's wrong in each part is usually the best way to go, if it's more of a chronic disease then it's going to be disease specific, but don't forget more holistic things such as giving an asthma plan, or referring to a specialist nurse/physiotherapist

I don't think we had to describe management plan of a first day F1 in our exams, but if you want my advice generally for starting out as an F1 and how to make a management plan my advice would be:

If you're on a ward round the question you need to think is how does this person get home? It might not be that day, but what are we aiming for? they need to be off IV treatments onto oral, they need to be at a mobility and independence level that they can get home, and they need to have follow up organised if it is needed. So think: is this patient ready to step down to oral antibiotics? Do they need physio/occupational therapy?

Or alternatively - is the current treatment working? are their bloods getting better, do they feel better? if not, how can we change the management or do they need more investigations?

I know this all sounds really overwhelming and you won't be doing it on your own, and you won't cover everything when you first start but that's ok! You're there to learn and I would encourage you to make suggestions. It feels horrible if the consultant disagrees and even now 5 years in I don't like writing my management plan before the consultant has seen the patient because 'what if it's wrong' but often it's not 'wrong' just not quite what that particular consultant would do, and another consultant might do things completely differently (it's very frustrating)

Hope that's helpful with my hazy memory of exams at med school haha. If anyone else has advice then feel free to add! and good luck anon :)

[figs-and-olives]

does it take anyone else a really long time to get through Anki cards? Any advice on how to speed up review process and use my time more efficiently would be greatly appreciated :)

[organised-kitty]

As you step up from high school into college you might realise that taking notes becomes harder since there’s more material to cover, teachers go fast and they don’t really write everything on the board. I remember my notes would end up looking cluttered and I didn’t really understand my own notes at the end of the day. So here are 4 tips which can make note-taking easier and more effective:

1. Preview the material. By using your syllabus or the slides given by your professor make your notes prior to the class and that will help you be more active during your lecture and grasp concepts more easily. Plus it will give you time to make it pretty!

2. Digital or written? It’s best to do what accommodates you better, as long as you are able to understand the order of ideas, it helps you in your learning process and and very importantly in a way that you don’t lose or forget your notes. I decided to go for a mix of both. I make handwritten notes in my preview, go to class, fill up the details and my final notes are digital so everything is in order and in one single place.

3. What technique to use? Feynman, Cornell, diagrams? What’s right? It really depends on the topic. My tip is to go back to older notes which were really useful to you and that can give you an idea of what techniques you can use per subject.

4. Will I really have the time? There are plenty of ways to go around this. Split the content with friends, watch a video, use blogs or webpages instead of reading the textbook (after all you first need to grasp the main ideas in a preview), give yourself a time limit and prioritise your subjects.

But the most important thing is preventing a mental block. If you feel stressed out give yourself a break, 20 minute break is better than 2 hours sabotaging yourself because you can’t focus or start to get overwhelmed. So take care of yourself so you can make the most out of your study time.

Those are all the tips. Wish you good luck in your studies! <3

[dxmedstudent]

Hey! Do you have any tips for a current third year medical student with exams a month away? I'm really struggling with how to revise

Hello! Good luck in your exams :) I’ll try to break down some of the things that have helped me in the past when it came to revision.Planning your revisionThe first step is uaually to make a study timetable. When you know how much time you have, you can work out how much time you have per subject. I usually start off by allocating an equal amount of revision time for each subject, but then fiddle around with it based on how hard I found subjects. So a subject I find easy might get less days, whilst the ones I find hard might get more.When you are planning out your timetables, don’t do it in blocks. An entire week of a subject you love seems perfectly reasonable, but what about subjects you hate? I like to break mine up into chunks; I sandwich the unpleasant bits between days of subjects I like, so I don’t have to suffer for long periods of time. Also, you don’t have to be rigid. Having a bad depression day and can’t handle your least favourite subject on monday? Swap that day with friendlier subject. as long as you stay strict with yourself and do it when you feel a bit better, then it doesn’t matter if you are flexible with when you cover it. The important thing is this: plan out your revision, and don’t get caught up revising the stuff you like and know well, because you’re avoiding the bits you don’t like. We all tend to instinctively avoid the bits we hate, but timetable them in, and don’t let yourself leave them til the end. What to revise from

Only you know what kind of materials your university uses. But I personally liked to be minimalistic. What matters most is:

your learning objectives (which should explain every topic you need to learn)

your lectures (because they should cover almost all you need to know).

I preferred to work primarily from these, supplemented with short books (like the ‘lecture notes’ or ‘short course’ or ‘crash course’ type books) because you don’t usually have time to go poring through 500 page tomes which go into heaps of unneccessary detail. By all means, you can dip into papers or big textbooks etc as you go along, to supplement your studies or revision. But I’ve always found it important to stay focused on the topics you need. Medicine and science are vast, and if you’re easily distracted it can overwhelm you or cause you to waste time veering off course reading stuff that is interesting but pretty irrelevant. If you have time, you can absolutely go into more detail; sometimes that’s what separates a good mark from a great one. But if you’re panicking, running out of time and struggling to get by and pass, then you need to be ruthlessly focused on your objectives.A month is a reasonable amount of time; with prioritising the most important material and good planning, it should be possible to get what you want done. Good luck :)

[help-im-a-medstudent]

Hi, thank you for answering my questions over the years, I really appreciate it! I'd be really grateful if you could answer another question I have haha - how did you go about approaching your finals 1 month before your exams? E.g what was a typical day studying for you after placement? What was a weekend like studying for your exams? What study resources would you recommend? Thank you again!

Hi anon!

I'm glad i have hopefully been helpful to you and it's exciting that the end is in sight for you now!

I have to be totally honest I graduated in 2020 when the world was on fire and they graduated us early to get us out into the hospitals to work, so I didn't actually do the final written exams

However we had done a lot of MOSLERs through final year for each rotation and so I hope this advice is still useful

To practice history taking and examination I revised with my housemates, practice on each other and then answer questions about the condition we had diagnosed, I also practiced examinations on my non-medical parents, because they had no clue what i was about to ask them to do, so i had to explain everything clearly (this was especially helpful for neurological examinations). We would tend to do this at weekends

We also had big sheets of paper and would pick a condition or a presenting complaint and then each write everything we could remember from it, and then swap and add things that the other had missed, and then explain things to each other, which was really helpful

A typical day after placement was often spent writing summary cards about conditions/presenting complaints and treatments, although i would have at least one night off a week to relax

I think i must have used a question bank but i can't remember which one and i didn't use it that much because i was worried about becoming too good at just spotting patterns in the questions and not having an underlying knowledge (i think question banks for specialty exams/MSRA are better because they are designed for a clearer curriculum, but might not be the same style for your university's exams)

For online resources I used throughout med school see this post

If anyone can add on to this i would be very grateful! Good luck for your finals anon :)

[help-im-a-medstudent]

Hi! I'm a clinical medical student on placement. I've been recently struggling with getting flashback (blood) into cannulas and vacutainers and struggle to ascertain patient veins. Do you have any advice about how I can get blood into cannulas/vacutainers and palpate patient veins. I'd be very grateful.

Oh man I HATED cannulas as a med student, although I had the opposite problem, where I would get flashback but couldn't advance and fully site the cannula.

Also apologies for the delay on replying to this, it's been a busy end of placement to get things sorted haha

My tips would be:

take your time with EVERYTHING. Make sure you've got all your equipment set up and to hand, because just slightly turning to try and pick up the blood bottles or flush or something can cause a slight movement in the needle and cause it to come out of the vein. Similarly take your time selecting the best vein and also advance the needle slowly - it's difficult to judge how deep the vein is just by palpating, especially if its in the ACF, so it's easy to get flashback but advance too far. Stop at the first sign of flashback then advance a small amount (about 1cm unless you're inserting a widebore cannula) to ensure the entire needle tip and cannula tip are in the vein, but haven't gone through the other side. Also get yourself and the patient into an optimal position. I can guarantee this helps, because the cannulas I most commonly missed are ones where I'm slightly at an angle, trying to get around stuff around the bed, or have tried to do it without the patient's arm being fully straight. Get a second pair of hands to help position the patient if they aren't able to do it themselves. It's not a failure or sign you're bad at cannulas if you have to do this, and means you're more likely to get it first time so that's better for the patient

Rest added under the cut

2. Get the skin taut Especially with older people who's skin has list some of the collagen, or if the patient is dehydrated. Palpate where the vein is when you've got the skin taut and keep it there. Veins can wriggle especially when trying to get a needle in them, but they move when the skin is pulled so there's no point palpating unless you've got the vein in the position you're going to approach it from

3. Tap, use alcohol wipes and gravity The hand veins can pop up really nicely with a bit of encouragement. Get the tourniquet close to the hand, get the patient to open and close their fist and dangle their hand over the side of the bed for a bit to get the veins nice and juicy.

4. Think about anatomy You don't always need to go in the middle of the ACF - I like to feel in the lateral or medial parts because the veins can be more palpable. Also people often have a nice one running from the thumb joint along the back of the hand over the wrist (it's often nice and straight and doesn't have valves/confluences with other veins) image below for demonstration:

5. Don't automatically get a smaller gauge needle It's tempting to think oh I'll use a blue because the veins are small/difficult, but actually you're more likely to miss with a smaller one and it's more likely to clot when trying to take blood off, and less likely to be properly in the vein if it's deeper.

That's all off the top of my head but basically it's just doing them over and over again until it feels natural and easy. Also US guided is great but I'd recommend not just immediately learning and relying on US because it's slower, there's not always a machine around and it's fiddly (also it does feel really satisfying getting a tricky one in without the US). Get good at it without ultrasound then add that skill to your repertoire later :)

If anyone else has tips feel free to add on!

[help-im-a-medstudent]

Hi, I'm a medical student and curios to learn about the whole portfolio process for applying for specialty training in the UK. What type of experiences did you have that you put in your portfolio for your training to be an anaesthesiologist? More context, I volunteer to be a medical student society and there's a person on it, who keeps on hounding us to ask doctors to write us a letter for any event we've done for the society e.g. conference- I'd also be grateful to know your perspective on this

Hi anon! Apologies this is so late, i started it but then have had a rough month so never got round to posting it

The annoying thing about applying for specialties in the UK is that each one requires different things from you, so this is only based on my experience of applying to anaesthetics as someone who went to medical school in the UK.

To complicate things further applying to initial 'core' anaesthetics is a different process and you need different evidence for applying to higher specialty anaesthetics training

When I applied for anaesthetics you did not need to provide a 'portfolio'. The application form was essentially where did you go to medical school, do you have any other degrees, what's your GMC number and where have you worked. You then do the Multi-Specialty Recruitment Assessment - an exam with clinical questions and Situational Judgement (ethical) questions, and you get offered an interview based on your score.

Currently, the interview is then half clinical and half about you and what experience you've had, so if you don't talk about it, the interviewers have no clue what you've done.

This is the part where you talk about your 'portfolio' - what conferences you've been to, courses you've been on, if you've had any leadership roles, audits etc. but also what you've learnt from them.

The only thing I had done at medical school that was related to anaesthetics was that in 4th year we got to pick 3 more specialised placements and one of them I did in cardiothoracic anaesthetics. I hadn't done a lot of extra things at med school as I was too busy trying to just get through the exams to be honest, but I'd also been thinking more about emergency medicine, so the one conference I had been to was for EM not anaesthetics. I'd also done a presentation and poster at a (non-anaesthetics) med school conference based on my masters.

As a foundation doctor I had then done some online taster days and an anaesthetics skills course, and done an audit when I was on working on intensive care, I had some education experience that was not related to anaesthetics. I scored well for commitment to specialty and knowledge about specialty on the interview.

Collecting the evidence is important because other specialties do require it on applications. When I was at med school, a lot of societies would organise events and if you attend you get a certificate when filling out the feedback, I kept these in a folder for future reference. If you present/do a poster there is normally an acknowledgment email or something confirming you're attending, and if you've won a prize they'll give a certificate. If you're doing an audit then you should be doing some sort of report on it anyway which can be used as long as it's anonymous.

Because of that I've not had to ask anyone for events I've attended. If you're helping to run an event though that might be slightly different, but there should still be ways that you can get evidence for this.

I'd say it's worth asking, and doctors should be helpful and do things like signing off because we know what it's like and what's needed, but be patient if you're waiting for them to send things because they might wait until a non-clinical day and they have their own portfolios to keep up with too!

I hope this helps

[help-im-a-medstudent]

Hiiiii! I'm a 4th year medical student. Do you have any advice/resources you recommend about how I can explain a treatment to a patient?

Hi!

The main thing is to remember that patients won't remember a lot of verbal information, no matter how well you explain, and the more information given, the patient will remember proportionally lass and be more likely to misremember.

The best way (if you have time) is to give them written information and allow them to read and then come back later if they have questions.

There's loads of good things out there, for example the British Heart Foundation guides (both the hospitals i've worked in had these on the cardiology wards to give out), Cancer Research UK, Macmillan, Diabetes UK etc. Most conditions will have patient friendly information leaflets

For patient's whose first language isn't English, giving the information in the way they will best understand is really important. Health Information Translations has lots of different topics, and all their guides have English as well so you know exactly what information you're giving to the patient.

There's some specific treatment information guides on Geeky Medics too, it's a great site for everything during and after med school tbh.

In terms of generic advice I just use the stuff they taught us at med school because it does tend to help, like checking what they know already, breaking information down and checking they understand, making sure there's no distractions and giving them options and working out what is important to them to allow for shared decision making. I don't know if there's any resources for that, if anyone knows any feel free to add to the post!

Hope this helps :)