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nervous for 3rd year/starting clinicals

hello :smile:

I'm about to start my 3rd year at medical school which I have always been anxious about since the start of first year and not due to popular reason of being scared of interacting with patients. I'm quite a sociable/polite/people-person which has always worked to my advantage in osces. I am nervous about the knowledge side of things. So far throughout my 2 years I'v got roughly the average %mark in the written exams (sometimes slightly better, sometimes slightly worse) which I'm content with overall as with everything else OSCEs etc I seem to do better than the average %.

My confidence has been completely shattered after getting a very low mark (- actually it was the pass mark!) for my final semester exam before the summer holidays began. I was just relieved to have made it through to 3rd year and spent my summer travelling/visiting family etc.

Now reality is kicking in again, with about a fortnight to go I'm preparing myself by buying smart clothes, stethescope and gathering all my uni things together. Im still worried about the work though as this exam that i scraped (on nutrition , metabolism and excretion) it wasnt like I hadnt worked hard on, I'm pretty sure I spent hours each day studying - which is what worries me! My new module when i start on september is different however (phew!)

Any advice? /any way to better prepare myself?
(edited 9 years ago)

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Original post by tpxvs
hello :smile:

I'm about to start my 3rd year at medical school which I have always been anxious about since the start of first year and not due to popular reason of being scared of interacting with patients. I'm quite a sociable/polite/people-person which has always worked to my advantage in osces. I am nervous about the knowledge side of things. So far throughout my 2 years I'v got roughly the average %mark in the written exams (sometimes slightly better, sometimes slightly worse) which I'm content with overall as with everything else OSCEs etc I seem to do better than the average %.

My confidence has been completely shattered after getting a very low mark (- actually it was the pass mark!) for my final semester exam before the summer holidays began. I was just relieved to have made it through to 3rd year and spent my summer travelling/visiting family etc.

Now reality is kicking in again, with about a fortnight to go I'm preparing myself by buying smart clothes, stethescope and gathering all my uni things together. Im still worried about the work though as this exam that i scraped (on nutrition , metabolism and excretion) it wasnt like I hadnt worked hard on, I'm pretty sure I spent hours each day studying - which is what worries me! My new module when i start on september is different however (phew!)

Any advice?



I'm about to start 3rd year too. I think it's quite normal. I seem to do alright in exams though I never understand why and I am still really nervous and feel like I won't know anything. I think everyone is feeling pretty much the same and anyone who isn't is probably lying haha.

Just think of all the people who made it through in the years above you. And how many of them would have had the same grades and knowledge as you.

Safety in numbers!

Good luck :h:
The clinical side of the course is an entirely different kettle of fish. If you feel as though the academics side wasn't your strong point, it's very possible that you will flourish in a clinical environment. It's much more practical, pragmatic and down to earth. The fact that you're content with OSCEs and you describe yourself as a people-person suggests that clinicals may suit you better.

I think the non-clinical half is all about building up a foundation of knowledge. A lot of what you learn during this time is (I don't want to say useless) often rarely relevant in the real world. And in a years time you will have selected and retained all of the essential, core medicine that you need to practice safely. This is the main thing. The clinical side is all about how to apply that knowledge and developing hands-on clinical skills, including your interactions with patients and other staff.

In medicine, a pass is a pass at the end of the day. You've been deemed competent to enter into the next stage. And you'll find that when you're grilled on the wards, you won't be grilled about which peptides are absorbed by which cotransporter. You'll be grilled on things like 'top 5 most common..' for example. It's more about being able to present very simple medical facts in a more organised and coherent way.

Don't sweat it! You'll be fine!
Also nutrition and metabolism is a lot of very complicated stuff you'll never need to know. In my opinion! I learnt so many pointless enzyme pathways for that... I say pointless, I know they're not, but the fact is you'll be perfectly fine just having to look them up for the virtually-never that they're needed. Of all the things to do less well on, that's probably up there :wink:

As the above person said, the knowledge you need for clinics is almost entirely different to pre-clin. I'm surprised you've already done OSCEs in pre-clin but I guess that's where medical schools differ. I personally felt like clinical medicine involved learning an entirely new subject called 'medicine' which bore very little relation to all the stuff I'd slaved over in the years leading up to it! It's a lot more logical (and dare I say, interesting...) so I'm sure you'll be fine. I think most people find clinical medicine much easier.
Reply 4
I think feeling nervous is completely natural. The transition from non-clinical to clinical can be quite daunting. You kind of feel like you are suddenly plonked in a hospital and expect to know how to examine/talk to patients.

I remember my first day, I was on psychiatry (not the best placement to start with)... I was standing there ready with my stethoscope and really super keen/excited ... my first patient was a schizophrenic patient who thought i was the devil and kept seeing dolphins flying past the window. It freaked me out. Obviously, that is not a normal day in hospital and i am sure your first day will be fine ... the point i am making is dont get too stressed or nervous about things.

For me, third year was all about getting used to speaking to patients and taking a good history. Dont worry about knowing all about the drugs, investigations, being able to take blood etc. Just ease yourself in. I found it quite helpful, taking a little pocket notebook around with me and jotting down things i didn't recognise. Later at home i would look things up... ps dont write down the entire drug chart- i started doing that.... error.

Also dont worry about exam results, at the end of the day, a good doctor isn't about whether you were in the top 10% or got 80% in your pathology paper. You may be able to list all the different streptococcus bacterium but it doesn't mean you have good communication skills.
Original post by annread
I think feeling nervous is completely natural. The transition from non-clinical to clinical can be quite daunting. You kind of feel like you are suddenly plonked in a hospital and expect to know how to examine/talk to patients.

I remember my first day, I was on psychiatry (not the best placement to start with)... I was standing there ready with my stethoscope and really super keen/excited ... my first patient was a schizophrenic patient who thought i was the devil and kept seeing dolphins flying past the window. It freaked me out. Obviously, that is not a normal day in hospital and i am sure your first day will be fine ... the point i am making is dont get too stressed or nervous about things.

For me, third year was all about getting used to speaking to patients and taking a good history. Dont worry about knowing all about the drugs, investigations, being able to take blood etc. Just ease yourself in. I found it quite helpful, taking a little pocket notebook around with me and jotting down things i didn't recognise. Later at home i would look things up... ps dont write down the entire drug chart- i started doing that.... error.

Also dont worry about exam results, at the end of the day, a good doctor isn't about whether you were in the top 10% or got 80% in your pathology paper. You may be able to list all the different streptococcus bacterium but it doesn't mean you have good communication skills.


I'm starting in psych :sad:
Everyone will probably be nervous about starting 3rd year. I was when I started it and I'd like to think I'm very comfortable talking to people etc. Chances are, there will be loads of others in the same boat if you asked them about it.

3rd year is fun (not as fun as 4th year/speciality year IMO), but still fun. As has been mentioned above, with 3rd year, your aim should be to take a very good history by the end of each rotation, and certainly by the end of the year. You will hear variations of the the phrase "60/70/80% of the diagnosis is from the history" or "listen to the patient, they are telling you the diagnosis", and both of these points are actually very true! Spend time on the wards clerking patients - if nothing is going on, pop down (with a clinical partner) to A&E to clerk some new patients and present them to one of the junior doctors or even one of the final year med students on the ward. Pick good tips up from the doctors/nurses/other medical students you see and incorporate them into the way you carry yourself: the way they communicate with patients, the way they present a history to a senior, the way they prioritise tasks, the way they speak to patients' families etc. This all forms part of the "informal curriculum", i.e. what you're not explicitly taught by anyone but are expected to know at the end of medical school.

Having said that, balance the hospital work with the book work - I found that quite difficult to do initially as I was in awe of the all the options open to you as a clinical medical student, so would spend almost all my time there doing random jobs (which obviously has its perks), but spent very little time actually reading around the subject for the written exams. Yea, erm, don't do that. Once you get that balance between ward work and book work, I actually found clinical years more exciting (and easier to revise for) than pre-clin years. Learning things in context aids a lot with recall for the exams.

It may take a while to get used to being so independent and deciding how you chose to spend your time (the timetable is a lot less rigid than in pre clin), but once you get into the swing of things and into a nice little routine, you'll be fine. Most people prefer clinical years anyway so chances are you'll be in that majority. :smile:
Original post by Neostigmine
I'm starting in psych :sad:


Psych is great! Don't be sad, it's a great start. Lots of opportunities to practice taking very very interesting histories and work on your communication skills while not being tackled to do bloods/cannulas/ECGs etc every ten minutes. And in my experience psych consultants are very patient and will help guide you through if you need it. It'll set you up well for your other placements! :smile:
Original post by colabottles
Psych is great! Don't be sad, it's a great start. Lots of opportunities to practice taking very very interesting histories and work on your communication skills while not being tackled to do bloods/cannulas/ECGs etc every ten minutes. And in my experience psych consultants are very patient and will help guide you through if you need it. It'll set you up well for your other placements! :smile:


Thank you!! There seems to be a distinct split between "It'll be fine" comments and total horror stories :erm:.

I'm sure it will be good. I like the idea of start in community which in theory I am more familiar with, then moving to medicine and then ending with surgery ^_^
Original post by Neostigmine
Thank you!! There seems to be a distinct split between "It'll be fine" comments and total horror stories :erm:.

I'm sure it will be good. I like the idea of start in community which in theory I am more familiar with, then moving to medicine and then ending with surgery ^_^


I think if you approach it with a positive attitude, an open mind and lots of curiosity then you'll gain a lot out of it! I'm coming to the end of my psych attachment now and I've loved it, lots of fascinating cases :smile: ooh great sounds like you've got a good run of lots of different things ahead of you to look forward to! :smile:
Original post by Neostigmine
I'm starting in psych :sad:


Sorry, i didn't mean to scare you. I actually really enjoyed psych. It is one of those placements, i found, if you showed an interest they were keen to involve you. Psychiatrists are super friendly too so it is quite a nice placement actually to start with.

Plus after your psych placement you are pretty good at chatting to patients ... will ease you onto the wards!
Original post by Neostigmine
Thank you!! There seems to be a distinct split between "It'll be fine" comments and total horror stories :erm:.

I'm sure it will be good. I like the idea of start in community which in theory I am more familiar with, then moving to medicine and then ending with surgery ^_^


By far the best thing about psych is that it takes away the fear of asking 'the big questions'. As a medical professional, it should be your duty to ask the questions that everyone else was too afraid to ask (especially topics such as suicidal thoughts and planning suicide).

It will help you feel much more comfortable talking to people about very intimate problems. You'll also feel a lot more at ease comforting people in tears, allowing for silence etc. (PROTIP: Offering someone a tissue is gold-dust when it comes to breaking that awkward moment when someone starts crying. It also provides an easy in to hold someones hand or place your hand on their shoulder).

I think the most humbling moment I've had since being at medical school was a frank, honest and open conversation that I had with elderly gent, three times my age, about how he attempted to hang himself from his light fixing after living alone for a decade.

Psych is definitely not for me career wise, but you'll learn a damn lot as a person and a future clinician.
I'm also starting third year, and this thread was super useful! Thanks everyone who's given great advice :biggrin:

Also OP, I was in a worse position than you regarding grades, I had to do a retake a week ago, and found out yesterday that I passed, so just count your blessings and remember than clinical years is a new slate :smile: that's the way I'm looking at it anyways.
Reply 13
Original post by Neostigmine
I'm about to start 3rd year too. I think it's quite normal. I seem to do alright in exams though I never understand why and I am still really nervous and feel like I won't know anything. I think everyone is feeling pretty much the same and anyone who isn't is probably lying haha.

Just think of all the people who made it through in the years above you. And how many of them would have had the same grades and knowledge as you.

Safety in numbers!

Good luck :h:


thanks, i do sometimes think of it like that it sometimes helps but not always.. like with this last exam that i scraped, it makes me feel like - absolutely everyone must be better than me to be getting through to the next stage, as obviously they have passed too so theyve got atleast my mark or better. Don't get me wrong i have no issue with others being good med students/becoming good doctors, i suppose it just makes me feel like im a poor one in comparison and i guess in exams how well you do depends on how well everyone else does :frown:
Reply 14
Original post by shiggydiggy
The clinical side of the course is an entirely different kettle of fish. If you feel as though the academics side wasn't your strong point, it's very possible that you will flourish in a clinical environment. It's much more practical, pragmatic and down to earth. The fact that you're content with OSCEs and you describe yourself as a people-person suggests that clinicals may suit you better.

I think the non-clinical half is all about building up a foundation of knowledge. A lot of what you learn during this time is (I don't want to say useless) often rarely relevant in the real world. And in a years time you will have selected and retained all of the essential, core medicine that you need to practice safely. This is the main thing. The clinical side is all about how to apply that knowledge and developing hands-on clinical skills, including your interactions with patients and other staff.

In medicine, a pass is a pass at the end of the day. You've been deemed competent to enter into the next stage. And you'll find that when you're grilled on the wards, you won't be grilled about which peptides are absorbed by which cotransporter. You'll be grilled on things like 'top 5 most common..' for example. It's more about being able to present very simple medical facts in a more organised and coherent way.

Don't sweat it! You'll be fine!


Thanks for the response.

You say preclinical is about building up your foundation of knowledge - how much of this are you expected to recall? i dont think i remember much! i feel like (even with the exams i did do well on) that my memory is very short term, as in I cram over christmas/easter before the exam periods and seem to do alright but within weeks forget the vast majoirty of what i have learnt. do you recommend reading up on some relevant physiology or anything before my first placement?

Thanks it made me feel better that you said all those co-transporters etc are a bit "useless" - I found all that particularly difficult to remember. Could i ask you to give me a few examples of what kind of "top 5 most common" things they ask you about? just to get an idea. Is it like risk factors/medications/diseases..? I have no idea.
Original post by Neostigmine
Thank you!! There seems to be a distinct split between "It'll be fine" comments and total horror stories :erm:.

I'm sure it will be good. I like the idea of start in community which in theory I am more familiar with, then moving to medicine and then ending with surgery ^_^


Hey look the medication is much better these days!

( I went to an acute psychiatric ward as a student nurse in my third year - one of the patients had me up against the wall with her hand round my throat. ANother patient looked like the Big Chief from one flew over the cuckoos nest - as I said the medication is much better now)
Reply 16
Original post by seaholme
Also nutrition and metabolism is a lot of very complicated stuff you'll never need to know. In my opinion! I learnt so many pointless enzyme pathways for that... I say pointless, I know they're not, but the fact is you'll be perfectly fine just having to look them up for the virtually-never that they're needed. Of all the things to do less well on, that's probably up there :wink:

As the above person said, the knowledge you need for clinics is almost entirely different to pre-clin. I'm surprised you've already done OSCEs in pre-clin but I guess that's where medical schools differ. I personally felt like clinical medicine involved learning an entirely new subject called 'medicine' which bore very little relation to all the stuff I'd slaved over in the years leading up to it! It's a lot more logical (and dare I say, interesting...) so I'm sure you'll be fine. I think most people find clinical medicine much easier.


Im so glad you said nutrition & metabolism was complicated, word around my school was that its easy just very boring. whereas i not only found it boring but actually found it difficult! probably more so than neuro too. (neuro i found to be verrrrryyyyyy vast)

What kind of knowledge do you need to know in clinical?

I found it interesting that you said most people find clinical easier - this is what I have heard from people at uni too, but another commenter further down said people find preclin easier and id be in the majority. i guess ill have to wait and see what i prefer! Can i ask you what makes you say its easier though? is it the actual workload or more free time or more interesting..?
Reply 17
Original post by annread
I think feeling nervous is completely natural. The transition from non-clinical to clinical can be quite daunting. You kind of feel like you are suddenly plonked in a hospital and expect to know how to examine/talk to patients.

Is there anything you can do to better prepare for this situation? Cause im a little worried about being thrown in the deep end, if theres anyway i can lessen that itd probably be a good idea. would you recommend going over physical examinations etc?


Original post by annread
I remember my first day, I was on psychiatry (not the best placement to start with)... I was standing there ready with my stethoscope and really super keen/excited ... my first patient was a schizophrenic patient who thought i was the devil and kept seeing dolphins flying past the window. It freaked me out. Obviously, that is not a normal day in hospital and i am sure your first day will be fine ... the point i am making is dont get too stressed or nervous about things.

Thats so interesting! For me its going to be A&E to start though :s-smilie: not sure if its better or worse! any tips?

Original post by annread
For me, third year was all about getting used to speaking to patients and taking a good history. Dont worry about knowing all about the drugs, investigations, being able to take blood etc. Just ease yourself in. I found it quite helpful, taking a little pocket notebook around with me and jotting down things i didn't recognise. Later at home i would look things up... ps dont write down the entire drug chart- i started doing that.... error.

Also dont worry about exam results, at the end of the day, a good doctor isn't about whether you were in the top 10% or got 80% in your pathology paper. You may be able to list all the different streptococcus bacterium but it doesn't mean you have good communication skills.


Thanks! very helpful.
Reply 18
Original post by Medicine Man
Everyone will probably be nervous about starting 3rd year. I was when I started it and I'd like to think I'm very comfortable talking to people etc. Chances are, there will be loads of others in the same boat if you asked them about it.

3rd year is fun (not as fun as 4th year/speciality year IMO), but still fun. As has been mentioned above, with 3rd year, your aim should be to take a very good history by the end of each rotation, and certainly by the end of the year. You will hear variations of the the phrase "60/70/80% of the diagnosis is from the history" or "listen to the patient, they are telling you the diagnosis", and both of these points are actually very true! Spend time on the wards clerking patients - if nothing is going on, pop down (with a clinical partner) to A&E to clerk some new patients and present them to one of the junior doctors or even one of the final year med students on the ward. Pick good tips up from the doctors/nurses/other medical students you see and incorporate them into the way you carry yourself: the way they communicate with patients, the way they present a history to a senior, the way they prioritise tasks, the way they speak to patients' families etc. This all forms part of the "informal curriculum", i.e. what you're not explicitly taught by anyone but are expected to know at the end of medical school.

Having said that, balance the hospital work with the book work - I found that quite difficult to do initially as I was in awe of the all the options open to you as a clinical medical student, so would spend almost all my time there doing random jobs (which obviously has its perks), but spent very little time actually reading around the subject for the written exams. Yea, erm, don't do that. Once you get that balance between ward work and book work, I actually found clinical years more exciting (and easier to revise for) than pre-clin years. Learning things in context aids a lot with recall for the exams.

It may take a while to get used to being so independent and deciding how you chose to spend your time (the timetable is a lot less rigid than in pre clin), but once you get into the swing of things and into a nice little routine, you'll be fine. Most people prefer clinical years anyway so chances are you'll be in that majority. :smile:


Thank you for all this! How was clinical easier to revise - what kind of material did you use to revise off? As so far its been the notes iv made from lectures etc throughout that semester. We had semester exams so it was more focused than the exams we will have in clinical where absolutely anything can come up about any system of the body! how are you supposed to know/remember it?

Also, in what way did you prefer clinical years to non clinical?
Reply 19
Original post by tania<3
I'm also starting third year, and this thread was super useful! Thanks everyone who's given great advice :biggrin:

Also OP, I was in a worse position than you regarding grades, I had to do a retake a week ago, and found out yesterday that I passed, so just count your blessings and remember than clinical years is a new slate :smile: that's the way I'm looking at it anyways.


Congrats! Good luck to you too :smile:

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