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How to study during the clinical years?

Hi everyone :hi:

I'd really like some advice on how best to study during my clinical years - I'm currently on my second block and I'm a bit stuck.

During pre-clinical medicine, I would find the lecture slides online, look up the topic in a textbook and make notes. Obviously we were being spoonfed back then so it was much easier to know what to do - I worked hard and I'd normally spend an hour or two each evening making notes and I got decent marks in the end of year exams.

Clinical medicine is a whole other kettle of fish however. I think I've adjusted fairly well to the ward environment - I turn up on time, talk to the SHOs etc to find pts, jobs etc...but in terms of studying I'm not very sure about what I'm supposed to be doing and how I'm supposed to be doing it!

The med school has given us a book of learning objectives we're supposed to know by the end of the course. Here's an example:

Jaundice: The student should be able to distinguish prehepatic, hepatic and posthepatic jaundice on clinical and biochemical grounds.

So I went away and looked up jaundice in a few textbooks and made notes like in pre-clinical medicine. I used a combination of K&C, OHCM and Lecture Notes on General Surgery and I made three pages of (typed) notes and have now ticked off this learning objective. I have my exams next March so I imagine I'd start revising these notes in January.

This is a method of studying and revision which I've been using for several years now, but I just want confirmation that this is the right way of doing things! I've heard some people don't make notes at all and merely do questions on Pastest etc...how is this possible? I think I would be way too neurotic to do that...I need to use textbooks etc as I'm just too used to it...but I'm worried that I might not be studying very effectively.

Please help, all advice is much appreciated :smile:

Reply 1

Revenged

Tips:

1) find out the structure of the exams early, you need to balance theory and practical.

2) practical exam / osce - this needs a lot of practice. memorising examinations, spotting findings and presentation of findings is difficult. practice exam with friends on patients

- you should buy a book with clinical exams and make sure you learn all the likely exams and specialised examinations
- find out what was in previous exam and make sure you prepare for it (most important part!)
- finals: need to be sharp up on examining common conditions

3) theory / mcq

- harder to prepare for it short term but certainly mcq practice needs to be done. find out the structure of your questions.

All my mcq they were all two part ones

'A man presented with a/b/c which out of the following is the most appropriate management'

Many of the online banks were one part and not very similar to the exam. That said doing lots of practice questions is what many people do but make sure you have the right mix so you don't miss topics. Also use it as a template to find gaps in your knowledge. It is a quicker way to cover lots of topics.

Lastly there is no right way so don't be afraid to do it your way. I certainly did not spend anything like the time you did, do you really work 1-2 hours a day revising normally?! Lastly make the best use of your time. Ifyou think your time is better in the library than the hospital or you want to do a clinic not in your timetable, do it. Find your own way to do it.

Reply 2

Phagocyte

Thank you for replying :smile:

Original post by Revenged

Lastly there is no right way so don't be afraid to do it your way. I certainly did not spend anything like the time you did, do you really work 1-2 hours a day revising normally?! Lastly make the best use of your time. Ifyou think your time is better in the library than the hospital or you want to do a clinic not in your timetable, do it. Find your own way to do it.

This is what I'm confused about. During pre-clinical medicine yes, I did normally work 1-2 hours a day: more in the run up to exams.

So during your clinical years did you go to hospital, come back home and then do nothing for the rest of the day? That almost seems too easy/nice/painless :tongue:

Knowing about AST/ALT/ALP etc and the causes of each type of jaundice isn't exactly innate knowledge :s-smilie:

How would you have met that learning objective on jaundice if you hadn't have looked it up in a textbook, made notes etc?

I'm not trying to criticise your learning method btw, I want to better understand it so I can make more effective use of my time. Thank you :smile:

Reply 3

Becca-Sarah

Original post by Phagocyte

So during your clinical years did you go to hospital, come back home and then do nothing for the rest of the day? That almost seems too easy/nice/painless :tongue:

Knowing about AST/ALT/ALP etc and the causes of each type of jaundice isn't exactly innate knowledge :s-smilie:

Three pages of typed notes sounds really excessive for one objective. Your aim is not to recreate the bulk of K&C by graduation... We would have had a lecture on liver pathophysiology at some point in pre-clins, so I would have some baseline knowledge about liver enzymes and jaundice, and used my clinical time to match up my book knowledge with what real life looks like. Probably wouldn't have come home and made lots of notes, but looked it up in the OHCM whilst on the ward or talked about it with the juniors. If I did make notes on it, it would be some kind of little flow chart or bullet points, else if you have several pages per objective then it'll take an age to even read over them, never mind revise them before exams.

Reply 4

deathcraze

i found the main difference between preclinical and clinical was that there was less basic physiology and more management in clinicals. then again that jaundice learning objective was covered entirely in my preclinical so it probably varies between unis. in any case, do plenty of question banks so you can get a feel of the scope and detail expected for the exams.

3 pages is really, really excessive for that objective, i can only think of about one-third of a page worth of points on that topic that might come out in an exam. i think revision for 1-2 hrs a day is fine, just avoid burning out. if the wards are not being useful for actual learning (they often are), leave and go sit in a random clinic or go home and read 'at a glance' or k&c.

i was one of those people who made zero notes throughout med school, preferring to just read k&c during the rotations, and go through several 'at a glance' type books before the exam, although i understand it doesn't suit most people's learning styles.

also, look through several books at the library to see which you learn from best. for some reason i just could not learn anything from the ohcm (everyone elses favourite book) because to me it felt like endless lists with no explanation, and i found the 'life advice' sections annoying lol. good for seeing patients on wards, but not great for revision if you want to understand concepts.

(edited 9 years ago)

Reply 5

Helenia

I made very few useful notes at clinical school. I would quite often come home from a day on the wards and do nothing. I learned the theory stuff like you're describing through a combination of osmosis/picking it up from wards, case-based seminars, occasional reading (but I didn't make notes) and "review and integration" weeks which my uni held at the end of each block, which was a week of lectures covering a lot of theory. Obviously I studied more near exam time, but I've never been one for making reams of notes. Most of my housemates seemed to do similar, though I do know a few others spent a lot more time in the library/making notes than we did. I was in the top quartile of my year, so not some slacker just scraping through!

You have to remember that clinical school is not just about learning all the facts about jaundice, it's about learning how to be a doctor, which is not something you can learn from a book.

Reply 6

BeanofJelly

I regretted making too many notes in the clinical years. Imo it is better to get as engaged as you can with the actual teams and patients around you, with a little reading here and there when necessary, and minimal note making (eg: essential core revision areas coming up to exams). It's a bit scarier than having notes to reassure and regiment you, but I think it is better learning, especially for OSCEs. You need to practice, not learn it out of a book. It could vary a lot by medical school, but in the clinical years I'm not convinced my notes (however comforting they were!) actually helped me much in exams. Not at all like in the preclinical years, where the exams are based on your notes and visa versa.

EDIT: I think it's also good to make the distinction between reference books (eg: Oxford handbook), learning/understanding books (I prefer illustrated, bottom-up physiological textbooks), and revision books (eg: crash course / lecture notes etc). If you can distinguish and make effective use of these (by appropriate amounts of reading), you can save a lot of time you would have spent making notes. Eg: start the year with learning books, progress toward "revision notes" style texts, use reference throughout where appropriate. All of this is fairly subjective, everyone has their own style.

(edited 9 years ago)

Reply 7

fishfacesimpson

You need to work out what works for you to allow things to stick in your head. Diagnosis in medicine is largely about pattern recognition (exams or real practice) and management involves tailoring simple things to certain situations. Truthfully some people can learn that from books and that'll be enough to pass their written exams. I found out very late in my clinical years (maybe not till F1) that I wouldn't really learn something unless I'd seen it and managed it for myself.

The clinical skills that allow you to recognise patterns can't be learnt from a book and the best way is definitley to practice on friends and patients in hospital. My advice would be to get as involved in the team's day to day activity as possible. Try and be the F1, or the F1's right hand man. You'll be slow and in everyone's way at the beginning but honestly people will persevere with you and like having you around and you'll be in a much better position to take things in. Ask to "take responsibility" of 2-3 patients - re-clerk them, chase their blood results etc, order investigations etc. Break things up with clinics and structured teaching but don't get bogged down with learning too many details from books. Get the basic principles first and everything else will come.

Reply 8

Da CorrupteD KiD

Sound advice from the guys above. I've got just one thing to add: One of the best ways to see real clinical signs and/or an examination technique being performed is by going with the senior doctors (Reg or consultant) when they review all the take patients of the day (this is usually in the evening, and there is normally a post-take ward round with the consultant). The patients tend to be still a little unwell and thus the signs are still there unlike during normal morning ward rounds which tend to be so fast it's finished before you can ask question. Also their examination tend to be more thorough as well during this evening review because often a diagnosis is yet to be made or at least need to be confirmed by the senior doc. (unlike the business rounds)

(edited 9 years ago)

Reply 9

Phagocyte

Thank you for the advice everyone - I'm trying to take it on board. I'm now spending about an hour or so each night just reading through an At a Glance... or Lecture Notes On... book and I'll subscribe to a question bank closer to the time of my exams. I just hope all this reading will sink in, it's very different to my usual way of doing things.

:smile:

Reply 10

seaholme

I would start Qbanks earlier than 'close to the exam', to be honest. They teach you a lot of the presentations in terms of how they come up in question stems, and important facts - plus you can do them in your downtime, when on the bus and so on. Stuff like passmedicine you can purchase pretty cheaply. Maybe I'm unique but I get a lot out of doing Qbanks! Obviously also making notes, but to be honest a lot of my notes out of textbooks I quickly realise aren't that clinically relevant (often) but sort-of long pathology rambles which are great for my understanding but don't actually help answer questions. Whereas the passmedicine notes are very clinical and really great for drumming guidelines into your head as well - which actually are relevant for exams. So I add all the additional clinical passmed notes into my own notes and the combination of the two works pretty well, I think.

Oxford Handbook + Qbanks (Passmedicine or OnExamination I've also used and that was very good as well, but more expensive - I only signed up when I ran out of questions) - plus a textbook you can refer to for really understanding the pathology and so on. Then IMO you're sorted. It's good to have detailed notes if you learn BY making notes... which I do, so my notes are pretty extensive. However I rarely used them after making them, I just did Qbank questions til my head exploded.

Personally I hated pre-clin lectures and did very little work until the leadup to the exams every year... almost all info from that time was wiped from my memory about 24hrs after the final exam, so I feel like I'm re-learning it all for clinics - and suddenly it's relevant to something and therefore interesting and memorable! So if you don't remember much from pre-clin, no worries, neither did/do I...