ACE Medicine_Guide to Passing Leicester Finals

8/13/2019 ACE Medicine_Guide to Passing Leicester Finals

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H O W TO PASS M EDIC A L FINA LS AT UNIV ERSIT Y OFLEICESTER

!"#$%&'($ *+%&', -'./ - Edi t or: T e iz ee m Dhanji . Au t hor s : David Bry s on , Jaina Par m ar , Nil e s hDin e s h k u m ar Bhara k hada , Mani s ha Ki s hor c handra Morjaria , Laura Taylor .

David J Bry s onAu t hor R e s pon s e s :

1. Exa m information re garding the qu e s tion type and how th e marks ar e alloc at e d for e ac h pap e r(i.e . what pe r ce ntage of the marks ar e alloc at e d to m e dic ine / s urg e ry / e th ic s / e pide miology / pharma c ology e tc .)

!"#$% '()* %+' ,-./0 %1) +*$%%)2 "-")* $/23% /' much a mental strain as it is a test of endurance.The written component of finals is really very basic - much more so than one would expect. It is advisableto be very familiar with old favourites such as heart failure, diabetes, myocardial infarction, hernias, and%45)*64#'/$/0 54% - /'42, 42,)*/%-2,$27 '8 9'/% 6'99'2 %'"$6/ $/ -## %1-% $/ *):4$*),; '23% )()* / top to ponder if what you have written will be considered too simple of an-2/+)* -2, +1)%1)* %1) )?-9$2)*/ +$## 5) #''=$27 8'* /'9)%1$27 - #$%%#) 9'*) )?'%$6@ %1). +'23%; A' +$%1your initial instincts and do not question yourself. If you do, you will not only be wasting time but may

persuade yourself to substitute a correct answer for an incorrect one!B *)-##. 6-23% /%*)// $% )2'471 54% %1) "-")* $/ $2%)2,), %' %)/% 5-/$6 =2'+#),7) '8 6'99'2

conditions and ailments. In this regard, sometimes knowing too much can actually make your life a trifledifficult (of course, this is always preferable to not knowing anything!). The space available for answers is

limited, as is the amount of time you have for each answer, and it is easy to fall into the habit of attemptingto furiously scribble all of your knowledge regarding say, the mechanism of action of warfarin, into a small

box that has only been allocated 2 marks! Questions on pharmacology are certainly a feature (warfarin in particular, along with questions on its interactions) but again, only common drugs will come up and will doso in the context of associated medical conditions e.g. warfarin & DVT or cellulitis & flucoxacillin.You will also find a liberal scattering of questions on Paediatrics and Obstetrics & Gynaecology, topicswhich should not be overlooked during revision. Though you will be examined on these areas as part ofend of block assessments, they feature heavily on the written exam and it would benefit you to study hardwhen undertaking the respective blocks so that you will merely need to refresh your knowledge before thefinal exam. But, as is the case with other topics, a basic understanding is all that will be expected.


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So, where possible, keep your answers clear, concise and fairly simple. If you are a veritable)26.6#'"),$- '8 =2'+#),7) '2 '2) %'"$6 5. -## 9)-2/ %-=) %1) %$9) %' -2/+)* %1) :4)/%$'2 84##.0 54% ,'23%do it at the expense of other questions. If two marks have been allocated you will only ever get two marksand no more!

2. Whe n you s hould s tart r e vis ing to a c hie ve :a) Pass ! b) Me rit ! c ) Dis ti nc tion !

I am a firm believer that success at medical school and in medicine and surgery in general, is built

upon consistency. For those students who work steadily throughout the junior and senior rotations, finalswill not be a problem. With a sound foundation upon which to build, for those students who have appliedthemselves evenly for the five years, the months preceding finals represent an opportunity to fill in anygaps and to reinforce and refine history and clinical examination skills. Fortunately, for those whosestudying has been a bit haphazard, the junior and senior rotations provide some invaluable opportunities tocatch up. With the senior rotation packed with specialist blocks, the Elderly Care block represents aninvaluable opportunity that nobody should pass up. For many it will be the last chance to hone generalmedical knowledge and clinical skills. Take the opportunity on this block to polish up on topics like Stroke,CBD0 E4#%$"#) !6#)*'/$/0 F-*=$2/'23/ ,$/)-/) G-## '8 +1$61 /%-2, - 7'', 61-26) '8 8)-%4*$27 $2 %1) +*$%%)2and the clinical) and be sure to rectify any shortcomings in neurological knowledge or understanding. TheElderly Care block is one of the best resources available for finals preparation so even if it falls at the

beginning of the senior rotation, be sure to use it wisely.B 6-23% /-. %1-% B -9 - 147) "*'"'2)2% '8 /%4,. ing in earnest months and months in advance. I

have found that starting my studying well ahead of the game serves only to give me sufficient time to forgetthe material! For this reason, I would advise working steadily and consistently throughout the juniorrotation with a view to begin increasing the work-rate in October/November of your final year. Start with%'"$6/H-*)-/ %1-% .'4 ")*6)$() %' 5) +)-=)* %1-2 '%1)*/ '* /$9"#. ,'23% #$=) -2, 5)7$2 5. I4/% /))=$27answers to questions that have long eluded you. Make a habit of refusing to accept things as fact. If you,'23% 84##. 42,)*/%-2, /'9)%1$27 2'+ $/ %1) %$9) %' /))= -2/+)*/ -2, )?"#-2-%$'2/;


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Regardless of your goal; pass, merit or distinction, a consistent and sensible approach will ensure that yourexam success continues.

3. How do you plan your re vis ion ove r s uc h a long p e riod of time ?

So, after four and a bit years of intense work all that remains is finals. It is a daunting prospect. In themonths leading up to my finals I continually flitted between feeling confident and terrified.Everybody, at some point in the run up to finals will go through similar emotions. It is entirely natural andwill actually spur you on to do just a little bit more work as you begin to approach saturation point.

The good thing about finals is you know it is coming, you know roughly when the exams will fall so you

have a good chance to prepare. When it comes to studying over an extended period I think that threesimple rules should be adhered to: 1) Start slowly and build up gradually: you really will have sufficient%$9) /' ,'23% 7)% /%*)//), $8 .'4 6-23% /%4,. 1$" 8*-6 tures because you are being forced to read up ondevelopmental milestones for the Paediatrics block. Remember, you are st ill studying, it may not be whatyou planned to do as part of your revision schedule but you will benefit from it nonetheless. You will havetime to cover, even if it is just superficially, most of the major topics. In fact, you may be surprised justhow much you already know and how quickly you will get through some areas affording you more time tospend on perceived weaknesses. 2) Be flexible: as illustrated as part of point one, you must ensure your/%4,. /61),4#) $/ 8#)?$5#); !'0 $8 .'4 ,$,23% 7)% - 61-26) %' *)-, 4" '2 KLM G2)6= '8 %1) 8)94*N 5)6-4/) '8F-),/ *)($/$'20 +1)2 $% 6'9)/ %' *)-,$27 4" '2 F)*%1)/3 ,$/)-/) '* !#$""), 4"" er femoral epiphysis (part ofthe Paeds block) take a few minutes to go back, revisit your Orthopaedics notes, and review the anatomy ofthe hip, hip pathology, including NOF. Similarly, when studying the Hypothalamic-Pituitary-Adrenal axisand while gett $27 %' 7*$"/ +$%1 %1) 9$24%$-) '8 D,,$/'23/ '* O4/1$273/ ,$/)-/)0 5) /4*) %' '")2 .'4*

pharmacology notes and polish up on the side-effects of steroids. Ultimately, you should try where possible to make connections between topics. This will not only help your studying but will foster afluidity of thought that will prevent you from getting hung up on one fact or one answer and will encourageyou to assess problems from multiple angles. 3) Use all the resources at your disposal: if those kind soulsin the medical school take the time to create web-based learning tools then be sure to use them.Completion of these tasks will afford some variety, they will advance your understanding on various topics,

but more importantly, will give you some valuable insight into what the medical school is looking for in%)*9/ '8 =2'+#),7) -2, %1) 6'2/%*46%$'2 '8 -2/+)*/; P)9)95)*0 %1). +'4#,23% 7$() .'4 /'9)%1$27 )?%*-to do just for the sake of doing it. It will be intended to help you and you should make the most of everyform of assistance. Lastly, use each other. When you have reached breaking point and can no longer facesitting at a desk pouring over stacks and stacks of notes, meet up with some friends and practice yourhistory and clinical examination skills. Make up several histories each and then one of you can pretend to

be the patient while the other is the student. Set a timer and just hammer out one history and exam after

another. Here you will be able to get certain phrases/instructions down to an art and when uncertainty orquestions arise, you will be able to mull them over in a group.

Finally, try to relax. It is important to take some time out, even if it is for just a few minutes, to gofor a walk and get some fresh air. Take regular breaks; watch an episode of friends? Go for a run or to thegym? You need some time to recharge your batteries and doing so will ensure that the period spentstudying afterwards will have more benefit.


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4. A re the r e any books that you would pe rhap s advis e to avoid and why?

When it comes to finals preparation you want a book that tells you what you need to know and little more.You are not preparing to write the definitive text on medicine and surgery and so the books you read/1'4#,23% 5) "*)"-*$27 .'4 8'* %1 at. Any book that necessitates a bag bigger than a ladies evening purse istoo big! Something that is small and concise and easily referenced is what you need on a day-to-day basis.For this reason stay away from the behemoths such as Kumar and Clark or >-($,/'23/ 5)6-4/) .'4 +$##'2#. 7)% 5'77), ,'+2 $2 422)6)//-*. ,)%-$# -2, .'4 *)-##. ,'23% 1-() %$9) 8'* %1$/; E'*)'()*0 .'4 *)-##.,'23% 2)), %' =2'+ -## %1) $28#-99-%'*. 9),$-%'*/ $9"#$6-%), $2 -/%19- '* %1) 24-26)/ '8 %1)haematological malignancies, which is of course the sort of laborious text that these books specialise in.However, if you are a great fan of these venerable texts and find that they have worked well for you in the

past, then by all means continue!

5. Y our thoughts / fee lings afte r e a c h e xam

By the time the written exam rolled around I had pretty much reached saturation point. I had intended tospend the afternoon post- )?-9 '2) *)-,$27 4" '2 %1'/) %'"$6/ %1-% ,$,23% 8)-%4*) '2 %1) 8$*/% ,-.; B2 *)-#$%.I spent the afternoon in front of the TV rotting my mind; I felt physically and mentally drained after thefirst exam and still had one more written and two days of clinical examinations to come!

The actual exam period really is a time to look after yourself. You will almost certainly have put in manymonths of intense revision and in all reality anything you do now, unless you are incredibly lucky, is notgoing to make a great deal of difference. While many students feel compelled to scrutinize everycomponent of the exam and relive every question, I prefer to forget about all that has happened and focus

on what is to come. Once it is over you can do nothing to influence the outcome and time spent frettingover things that you have written serves only to consume valuable energy. Consequently, I would urge allstudents to take a well-earned break after the first written, and indeed on any interludes between clinicals,to relax and recharge their batteries in preparation for the arduous days that follow. Resist the temptation todive right back into the studying. You will have covered just about everything in preparation for the firstwritten so why go back and do the same for the second sitting? Instead, go and see a movie, go to the gymor iron clothes ready for the clinical!We have all left exam halls certain that one has failed miserably only to be amazed on the day that theresults are posted. Overwhelmingly most of you will pass without a problem and even those convinced thatextended finals beckons will be pleasantly surprised. You merely have to take each component at a timeand forget what has come before. Regardless of how much work you have done, nobody will be able to$28#4)26) %1) 6-/)/ .'4 7)% $2 %1) 6#$2$6-#/ /' ,'23% 8*)% -5'4% $%; M'*7)% -5'4% -## %1) *49'4*/ /wirling overexotic presenting complaints, about the family with Charcot-Marie-Tooth or the Marfans patient who has

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The best advice I received and which I can pass on now is this: be yourself; do as you have done for the "-/% 8'4* -2, - 5$% .)-*/@ 5) =$2, -2, *)/")6%84# %' %1) "-%$)2%0 %1-2= %1)9 -8%)*+-*,/ -2, 5) R6''#2)// -2,calmne // ")*/'2$8$),3 G+$%1'4% 5)$27 6'6=.SN;

6. De s c r ibe your OSC Ee xp e rie nce how the e xamine rs t r e at e d you and what c as e s you we r e give n

When the timetable of clinicals was posted I was dismayed to discover that my first session was to beconducted in Kettering. While this would necessitate rising earlier than I would normally do so, it was

pleasantly reassuring to be conveyed to the hospital in a mini-bus seated adjacent to colleagues consignedto the same fate. Firstly, I had been up with the birds fretting over what cases I would get (exactly what I%'#, 9./)#8 2'% %' ,'N /' $% ,$,23% *)-##. 9-%%)* %1-% %1) 54/ #)8% %1) 9),$6-# /61''# -% T;UV0 -2, /)6'2,#.0

travelling en-mass in a bus chartered for us was infinitely less stressful than driving oneself to a foreignlocale, searching for parking and finding the appropriate ward. At least if we hit traffic we would all bedelayed! Imagine the stress if you were sitting alone, stationary on the A14 watching the clock relentlesslymove closer to your scheduled start-time.As with the written exam, the clinical component was far easier than I expected it to be. My first case, a

pregnant lady with moderately elevated blood pressure was relatively uneventful and though I initiallystumbled with my second, an elderly gentleman with pneumoconiosis, both cases proved remarkablyreassuring. In both instances the patients were incredibly kind W they too can see that you are a nervouswreck W and helped walk me through the history and exam, with the examiners being equally kind andgentle. You quickly realise that these people want to help you, they want to see you succeed and see you

pass.Unfortunately for me I had an entire day off between the first and second set of clinical cases. Much of theafternoon was spent on the phone inquiring how colleagues had fared, the sort of cases they had

encountered and the nature of the questioning.

My final day of the clinical exam took place at the General and here I had an elderly gentleman with more pathology that one would reasonably expect to encounter in an individual breathing and mobilizing under1$/ '+2 /%)-9; B +-/ -/=), %' 8$2, '4% 9'*) -5'4% %1) 7)2%#)9-23/ 4*$2-*. /.9"%'9/ 54% %*. -/ B 9$71% 1)refused to focus on his prostatic problem and spoke only of enduring a bad case of bacterial endocarditisthat had necessitated valvular replacement surgery. It was horrendous. When I enquired about his

pharmacology he promptly produced a list several pages long, including a prescription for catheters. WhenI asked him if he self-catheterised he said no. When I asked him if somebody else put in his catheter heagain said no. We I asked him if he had a catheter in-situ the response was the same. When I came toexamine him and was assessing for pedal oedema I was dismayed to discover a catheter bag, glowing withconcentrated urine, strapped to his leg. I was convinced that I had failed and that the examiners were trying

desperately to conceal their laughter behind my back. Of course they were not. The questioning focusedon bacterial endocarditis, the causative organisms, investigative procedures and pharmacological therapies.They had sat and witnessed what I went through, saw what happened and had taken it into consideration.To top it off my last patient was another specialised case, an elderly lady with depression. Having beenknocked off stride slightly by the preceding gentleman I managed to bumble through somehow. It was along afternoon and a rough way to bring an end to five years work but my exam was over.

Now, I will be brutally honest here; the hours leading up to the posting of results are the mostuncomfortable you will endure during your time at medical school. I would rather stick a rusty nail in myown eye than go through those few hours again. It is a time when you are utterly powerless, when youcannot help but relive every second of every one of the exams. All that sticks in your mind is the fact that1/3 of the class will have failed the clinical section and will be required to return. However, all that pent-up


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fear melts instantly when the results are posted and you have never before been so happy to have beenoverlooked (the candidate numbers of those required to return are posted).B 6-23% *)-#$/%$6-##. /-. %1-% %1) 6#$2$6-# $/ 2'% -/ 5-, -/ you think it will be. Overall it is not a pleasantexperience. You can, however, take solace from the fact that nobody wants to make it any more unpleasantthan it already is. I was told on a number of occasions that when you walk in the door you have passed the)?-9; C1'/) %1-% ,'23% "-//0 8-$# %1)9/)#()/; C1$/ *)-##. $/ %*4); !'0 5) .'4*/)#8@ 5) "'#$%) -2, =$2, %' %1)

"-%$)2% -2, %1-2= %1)9 -2, %1) )?-9$2)*/ +1)2 .'4 1-() 8$2$/1),;


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Time is what you have, so use it well! Your revision starts from the beginning of the senior rotation asmany of the blocks involve general specialties in which you can revise many topics e.g. acute care, Elderlycare, and Cancer Care. Use the time in these blocks to go through most of general medicine and surgery.Start off with topics you find difficult or know little about because you will probably see patients withthose conditions in these blocks, or try and find relevant patients to practice history taking and examination.If there are any difficulties you then have the opportunity to ask doctors you are working with for help.E-2. ")'"#) 4/) %$9)%-5#)/@ B 8'42, %1-% %1$/ ,')/23% *)-##. +'*= 8'* 9) -2, $2/%)-, B /)% 9./)#8 %-*7)%/that I would read about a certain condition(s) one night or do certain topics over a weekend.If you do enough work throughout the blocks and follow the objectives from the Phase 2 Course Document

book you will find that you have covered most of the material by the Christmas holidays. Use spare timeduring blocks to go through objectives that you have not covered.During Christmas time, I read Master Medicine and Surgical Talk. After Christmas, I went through the theOxford Handbook of Clinical Medicine and reread my own notes.Study hard during Paediatrics and obstetrics and Gynaecology as if you revise the material well you willhave less to revise for finals.After the Christmas holidays you should have a general overview of most things. Use this time well forsome serious revision ensuring you know all the details. Do question books because this actually tests yourstrengths and weaknesses of certain topics.

4. What books / mat e rial s hould you us e for e ac h e xam and why did you find the s e u s e ful?

! PHASE 1 COURSE DOCUMENT!! Use this as a guide. Make sure you cover all the objectives because these are the topics

they will ask questions on!

J)*)3/ - #$/% '8 %1) 5''=/ B 4/), -2, +1.\

! Master Medicine! Covers all the medical specialties. Excellent book for reviewing material on topics not

covered for a while. Has everything you need from the essential pathophysiology tomanagement of conditions. Also has questions after each chapter.

! Surgical Talk! I was apprehensive about using this book initially as it is in prose and I prefer bullet

points/short sentences. However due to the excellent reviews I bought it and was not letdown. It includes all specialties including Orthopaedics and ENT. However, itoccasionally does go into detail regarding procedures, but does give you a warning, soyou can skip these parts!

! Surgical Finals: Passing the Clinical by Pastest.! Excellent revision book for the clinical exam. Gives advice on which questions to ask in

history taking and a step-by-step guide on all the examinations for surgical cases.Provides core information on many common conditions and also has questions at the endof each chapter. Another must buy which is very helpful for the clinicals.


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! These are fantastic! Short-answer questions, similar to our exam format and are a greatway of testing how well you are revising. Also includes emergencies, Obstetrics &Gynaecology, Paediatrics and Psychiatry. A MUST buy for a Leicester Medic!

! Oxford Handbook of Clinical Specialties! Get to know this book well; there is a phenomenal amount of essential information in this

book, which is useful core knowledge for exams. Pay particular attention to theemergency section towards the end of the book and revise them well for finals! There aregreat pages on drugs also. I think before finals I had read nearly all the pages in this book.This was by using it during rotations and referring to it whilst doing general revision. I

personally would find it difficult to sit down and aim to read one whole chapter at once!It works well when using it is an aid with other revision material.

! Pocket Prescriber! I got this book from the MDU and it is brilliant. It contains all the essential drugs (most

of which are on our student formulary) that you need to know. It tells you the drugsaction, use, contra-indications, side-effects and interactions in bullet-form format. Anexcellent quick reference for looking up a drug.

! Obstetrics & Gynaecelogy by Impey! Easy to use and understand. Not a lot of prose with all the essential information you need.

It has excellent summary pages at the end of each chapter, which are great when revising.Also at the end of the book there are revision pages on management of most of thecommon conditions.

! Illustrated Textbook of Paediatrics by Tom Lissauer and Graham Clayden! During my Paediatrics 5#'6= B 9-,) 2'%)/ 8*'9 %1$/ 5''=; B8 B ,$,23% B +'4#, 1-() 8'42,

it difficult to reread this book again! A good book but has more information than youneed.


! Core clinical cases in Medicine & Surgery.! I thought the questions and answers were very vague and found the above question

books to be more useful.! Medicine at a glance

! I found this book difficult to follow, as I do not think there is a set structure. I thinkthe pictures/tables are good but adequate information cannot be found on most topics.It can be useful for those who prefer each topic to be covered over a spread of 2

pages and to consolidate what you know/don't know about a topic.

6. Your thoughts / fee lings afte r e ac h e xam

Paper 1I thought this was a tough paper, which seemed to be the general consensus. The paper was about commonsense rather than core medical knowledge and reflecting back it was not as bad as it had seemed at the time.The topics they had were fair and predictable and for most parts you could think of answers for eachquestion.However at the time you expect the second one to be just as tough and that night you panic as you do not


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know what else to revise. The truth is you can't r )-##. *)($/) 9461 9'*) -/ .'43() *)($/), *)-##. 1-*, %'this point and generally should have revised most things before the first paper. Hence I found myselfworking through some of the question books again that night (by Pastest).

Paper 2After this paper I felt happy as it had been what I had expected/wished the 1st paper would have been like.The 2nd paper asked simple questions on core topics.


Overview of the clinical exam:! 4 cases in total! 2 days (2 on each day)! 2 examiners (for us there was a shortage so for 2 of our cases we just had 1 examiner)! 10-minute history, 5-minute examination. 15 minutes to go through your findings. Use this

valuable time to create a problem list and propose a management plan.! ]-/% UV 9$24%)/ *)%4*2 %' %1) )?-9$2)*/ 8'* - R,$/64//$'23; C1$/ $2('#()/ -2.%1$27 8*'9

presenting your findings and management plan to being asked anything on that topic.! In total, each case lasts 45 minutes.

E. )?")*$)26)^ I actually did not think it was too bad. Reflecting back it may have even been enjoyable!

Cas e 1D 7)2%#)9-2 $2 1$/ _Z/ "*)/)2%$27 +$%1 R8))% "*'5#)9/`; In this case you had to figure out quickly that he was describing symptoms of peripheral neuropathyallowing you to do a full diabetic history and discover any other complications. This is crucial in someonewith diabetes and examiners want to know you are competent in doing this.Examination involved a sensory examination of his feet. As I was running out of time with the examinationI did most of it and told the examiners how I would finish off the examination. Make sure you tell themwhat else you would do before leaving the room. I then got asked loads of simple questions regardingdiabetes, insulin, and diabetic emergencies.I then had to return to the patient and explain to him how to manage his diabetes e.g. diet control, exercise,regular BM checks etc.

Cas e 2An elderly chronic asthmatic who had had recurrent chest infections in the past but no present problems.The history for this patient was straightforward and I did a respiratory examination.I was asked lots of questions on asthma therefore recommend you know:

! The BTS guidelines on management so you can regurgitate it in exams!! Different types of inhalers and how you would advise patients to use them.! The side-effects of steroids

This case went well and the examiner was soon struggling to think of more questions to ask me!


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Cas e 3An 11 year old boy presenting with a rash.This was my most difficult case but it turned out to be very simple and the child had eczema, asthma andatopy. I do feel I made a slight mess of it though.The boy was there with his mother and so I gained most of the history from the mother.Examination involved respiratory, skin (eczema) and ENT (as I was advised to look into the ears and throat

by one of examiners)I found the questioning more difficult as I was asked about eczema and other dermatological reactions. Iwas also asked about asthma again, however this time they were concentrating on the pathology.The examiners were very helpful but at the end of this case I thought I was going to be in extended finals asthe examiners were having to give me many hints. I tried not to let this affect me for my final case and wentin with confidence.

Cas e 4A gentleman in his 50s had cholecystitis followed by a cholecystectomy and had then developed a

pancreatic psuedocyst.The history was straightforward as the patient told me everything.I did an abdominal examination commenting on the scars present.I was asked about the complications of cholecystitis & acute pancreatitis and was asked to define a

pancreatic pseudocyst.I was asked to return to the patient and explain to him what had happened (seemed pointless as the patientalready knew!)This was by far my best case. The MDU surgery course is how I knew all the answers to the questions Iwas asked!

Overall experience:B 1-, R2$6)3 )?-9$2)*/ +1$61 +-/ +1-% 9-,) $% -2 )2I'.-5#) )?")*$)2 ce. The patients are very kind andvery helpful as they genuinely want you to do well.My advice is to be calm. After all these years and all the revision you have done you can easily take ahistory, perform an examination and answer questions that you will find are actually quite reasonable.If you do get a bad case, you have to try and put it to the back of your mind and perform your best in thefollowing cases. You may not have done as bad as you think you did and therefore do not ruin your chanceswith the other cases. Same applies if you come across a horrible examiner. Act professional and as long asyou have performed well in the case you will be fine.

8. "#$ &''()(*#&+ &',(-./ (#0*12&)(*# $*34' +(5. )* 6(,. )7. $.&1 8.+*9 - in c luding how to pa ce th e ms e lve s / u s ing re vis ion groups / how to juggle going in to atta c hm e nt s and r e vis ing s imultane ou s lye tc .

My advice would be to use your time well during your clinical rotations. Practice history taking &examinations within the time limit and try and get doctors to watch you and provide feedback.Try to cover objectives that you have not done so far.If you like to make notes then start them early.Revising with a small group of friends is invaluable as it allows you to ask each other questions and

practice role-plays in the format of the clinical examination. Stick to the time limit and then ask questionsaround the topic and regarding the management plan. I found this to be extremely useful and it is a greatmethod for teaching each other.


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A couple of my friends made PowerPoint presentations on most of the specialties, which I thought was a8-2%-/%$6 *)($/$'2 %''#; a1-%3/ )()2 5)%%)* $/ $8 .'4 9-=) %1) "*)/)2%-%$'2/ .'4*/)#8; B ,$, '2) '2Cardiology and if you do this you will remember everything on that topic! However these are timeconsuming and so I would advise you to start on these early if you want to do them.

In the last few months before the exam all you will be doing is revising, but ensure you take breaks and tryand take some time out to do things you enjoy!

Nil e s h Bhara k hadaAu t hor R e s pon s e s :


At Leicester, finals is split into the clinical and the written. The latter consists of two 2 ! hour papers. The papers have a mix of clinical cases and there is no division, with respect to medicine and surgery orotherwise, between the two. Each question typically begins with a short clinical scenario and is followed bya range of short answer questions (SAQs). The SAQs test some preclinical knowledge but have an)9"1-/$/ '2 %)/%$27 b9-2-7)9)2%Y $;); $2()/%$7-%$'2/ -2, %*)-%9)2% '8 6'99 on clinical conditions.Management of emergencies (something that would be difficult to test in the clinical exam) is also commonin the written.


Before the exam, a two week revision period consisting of an assortment of revision lectures is given. Youshould attend this as it gives you an insight into what will be tested in the written exam as many of thelecturers will have set the questions. In order to pass the written paper, you will need to have a reasonable7*-/" '8 )()*.%1$27 G*)9)95)*0 $%3/ 5*)-,%1 %1-% $/ 9'*) $9"'*%-2% %1-2 ,)"%1N; >)"%1 5)6'9)/ 9'*)important if you are aiming for a merit or distinction.

It is a clich but one I realised is well deserved c do not leave it to the last minute! There is simply toomuch information to cram into the last month before your exam. Ideally, if you have worked steadilyduring your clinical years, you will have little to do come to finals and revision will be just that. If, however,.'4 1-()23% -2, .'4 -*) - ")*/'2 +1' #$=)/ %' 7' %1*'471 )()*.%1$27 -7-$20 %1)2 B +'4#, -,($/) /%-*%$27 -%least six months before finals.

When planning your revision, aim to revise concepts! It is not enough to simply commit everything tomemory as the exam will test your ability to apply knowledge. Therefore, I reiterate, learn the concepts;spend longer on learning the principles of management as opposed to nitty gritty bits about the order ofadministering certain drugs, their doses, etc!


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When revising a topic, look at it as a whole. Spend time working out the underlying principles of that topic(the skeleton) and then fill in the detail (the meat). What tends to happen is that as finals gets closer,students will identify gaps in their knowledge c a good thing if these gaps were filled with the principles.However, more often than not students spend countless hours learning long lists and details c which is oflittle help if you 1-()23% #)-*2), %1) -5$#$%. %' -""#. %1) =2'+#),7); C1$/0 $2 %4*20 6-2 '2#. 6'9) $8

principles are understood.

As far as detail is concerned, I would recommend doing lists of four c learning four causes, fourdifferentials, four investigations, etc as questions are unlikely to ask for more than this number.D,,$%$'2-##.0 $2 %1) 6#$2$6-# )?-9 %1) )?-9$2)* 9-. -/= b7$() 9) /'9) 6-4/)/ '8 1)-*% 8-$#4*)Y %' +1$61replying with three common causes is usually enough to satisfy the examiner that you know your s tuff.

However, learning four properly means that you can say at least three of them quickly. Learning only three9)-2/ *$/=$27 8'*7)%%$27 '2); D,,$%$'2-##. /'9) )?-9$2)*/ 9-. -/= %1) ,*)-,), b-2.%1$27 )#/)dY :4)/%$'2after you have stated your three. It is nice to be able to silence them by giving at least one more.


First identify gaps in your knowledge. Start with these topics as you will need the longest time tound e r st and these. If you leave this to the last minute c you will have no choice but to simply try andcommit them to memory c a much more difficult task without the prerequisite understanding.

K)?% 9-=) - *)($/$'2 %$9) %-5#); C1$/ ,)")2,/ '2 %1) $2,$($,4-# -/ )()*.'2)3/ # earning needs are different but in general it should cover everything at least once.


In terms of books, it is important to choose a few which agree with your learning style and then to stick tothese. This will save valuable time when you come to your final reading in the weeks before the exams.It is important to remember that, although finals seems daunting and many feel that they need to knowabsolutely everything about everything, it is only an undergraduate exam designed to assess basic clinicalcompetence. This is not to say you can afford to miss entire chunks as doing so is a sure route to failure.However, many of the bigger traditional textbooks like Kumar and Clark, although very good for learningnew things from scratch, are probably a bit too much for the purposes of revision. Instead, invest in a goodmedical and a good surgical textbook aimed at undergraduates. These have usually been pitched at the rightlevel for finals and learning these books w e ll will result in greater success.Books I found particularly useful were:

! Medicine c ! E-/%)* E),$6$2) 5. L3 K)$##0 >'*2-20 >)22$27; C1$/ $/ -2 )?6)##)2% %)?%5''= +1$61

espouses understanding of the core material and is detailed enough to enable you toachieve the highest grade.

! Oxford Handbook of Clinical Medicine 7 th edition. A must for everyone c goodsummaries of all the clinical conditions and a must-read section on emergencies and theirmanagement.


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! Clinical Skills (Oxford Core Text) by Cox & Roper. A very good book for ensuring goodhistory taking and examination in the clinical exam. It is also very detailed and offersexplanations about why certain things should be done.

! Surgery c ! Surgical Talk by Goldberg & Stansby. Excellent surgical textbook. Deceptively small but

very thorough covering almost everything you need to know for the exam.

As finals approaches in the last month or so, I would recommend investing in some SAQ books andworking through these as not only will they will help you to practice your ability to recall subject matter butyou can also use the questions as a means of focusing your revision on core knowledge.


During our exam, questions we *) 9-*=), -/ bOY 8'* 6'*) '* bXY 8'* )?%)2,),; B8 %$9) ")*9$%/0 $% $/ 5)%%)* %'-2/+)* %1) bXY :4)/%$'2/ -/ .'4 7' -#'27; J'+)()*0 %1$/ /1'4#, 2'% 5) -% %1) )?")2/) '8 8-$#$27 %' -2/+)*core sections in other questions c remember passing is most important and anything else is a bonus! If afterthe 1 st paper you feel you had enough time then answer all of the questions. If, however, you struggled thenmake a judgment about this and answer all the Core sections first. If after this, you still have time, then dothe extended questions.Anything can come up in the clinicals and it is best therefore not to bank on certain cases at certainhospitals (they move patients around)! Instead spend time on the wards in pairs timing each other, takinghistories and examining. Take turns to role play the examiner, criticise each other and bombard each other

with questions. This is essential practice to hone your histories and examinations and will better prepareyou to finish your clinical assessment in the allotted 15 minutes.Commonly, finals clinical cases are based on chronic disease and it is expected that the candidate can take afocused history concentrating on the salient aspects. Therefore practice these on the ward and aim to getyour histories done in about 8 minutes as this will give you a couple of minutes to wash your hands, answerany questions, reposition the patient and expose them ready for the physical examination, which you should

be able to complete in the last 5 minutes.


As I have previously alluded, knowing about a few past cases does little to help as anything can come up in

your exam and it is therefore far better to spend time on the wards practicing the skills you need to be ableto confidently tackle any case that comes up. However, it is perhaps useful to gain a flavor for the examroutine and I have tried below to give a few tips on what may help during the various sections of theclinical exam and how to tackle tricky situations.

! Case 1: A patient presenting with low mood. (depression)

This was a fairly straightforward case on a patient suffering with low mood. After the history, I was asked by the examiners to use the examination time to focus on something I felt relevant to the case. I chose arelevant aspect of the mental state examination and explored it further. Overall the patient (an actor) was


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very facilitating and I seemed to glean a lot of information in a short amount of time. However, this is notalways a good thing as there were two points where I felt I had exhausted my questioning. A good tip inthese sticky situations is to feedback to the patient important parts of the history. In this way they canreiterate or elaborate on something you may have missed. It also demonstrates to both the patient and theexaminers that you are listening and helps build rapport.

After the history and examination, you get 15 minutes thinking time. It is important to use this wisely. Iused it first to cla *$8. %1) 1$/%'*. -2, 54##)% "'$2% %1) '*,)* $2 +1$61 B3, #$=) %' "*)/)2% $%; B %1)2 2'%), ,'+2all the clinical findings which went with a diagnosis of depression c core symptoms, biological symptoms,etc. I also noted down a few differentials and a comprehensive management plan. I then tried to anticipatesome of the questions I would be asked about and wrote down notes to myself about antidepressanttherapy, side effects, etc.

When you get called back in, unless the examiners clearly want to direct, I would advise starting off byinforming the examiners that there were certain things that you failed to do in the history/ examination andreassure them that as a house officer you would go back to the patient and clarify these details. This showsyou to be conscientious and safe. After this, the examiners asked me about my differential diagnoses andsupporting aspects of the history. The viva finished with questions regarding side effects of antidepressants.

It is important that in the viva you sound confident. Even if you do not know that answer, say so6'28$,)2%#. -2, ,'23% 9-=) %1$27/ 4" -/ ,'$27 /' +$## /$9"#. 5) ,$77$27 - 1'#) 8'* .'4*/)#8S B2/%)-,0 $8 %1).ask you a question you do not know, say that you are unsure and that as a house officer you would look itup in the BNF, for example, or ask for senior advice; try not to overuse the latter!

Cases two and three (below) followed a similar format and I have little advice to add to that given above.However, I would just reiterate that do not lose easy marks by neglecting to use alcohol gel or wash yourhands (if the patient has diarrhoea), both before and after examining the patient.

! Case 2: A patient with an abdominal mass (an incisional hernia) on the background of non-1',7=$23/ #.9"1'9- -2, %14/ ) xtensive abdominal surgery.

! Case 3: A patient with rheumatoid hands

! Case 4: A patient with multiple abdominal operations (ulcerative colitis, stoma, etc)

Traditionally the job of examiners is to try and find out what you do know c and on the whole you can trustthat the examiners know this as well. However, if you are unlucky, you may have examiners that are ratherobstructive and clearly have no idea about the patient who they have asked you to assess. Unfortunately, Ihad such a pair for my fourth case! If you find yourself in this situation, I would advise doing your basicswell and being thorough as they cannot fail you for it. If you are interrupted, keep calm, stop what you aredoing and answer their questions. Only once they are satisfied resume with your history-taking or physicalexamination. The questions from this examining duo were also very different from my other experiences. It


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seemed clear that as soon as they realised I was able to answer their question, they lost interest and soughtto find something I may have trouble with. Any other examiners, and I would suggest that they were simplytrying to stretch me, but it was clear that this was not the case. When all else failed, one of the examinersresorted to playing on words c when I suggested that the patient required a flexible sigmoidoscopy toascertain whether he had any of the macroscopic features of ulcerative colitis, he asked whether I intendedto place a microscope up there! Suffice to say, this case was a bit of a nightmare but I d $,23% 1-() %' *)%4*2for extended finals so I presume I passed the case. I imagine that this was an isolated incident and that this/'*% '8 %1$27 *-*)#. '664*/ $2 8$2-#/ /' B +'4#,23% +'**. -5'4% $%; C1) 9-I'*$%. '8 )?-9$2)*/ -*) 8-$* -2, +$##facilitate your passing the case. However, I have included the above to illustrate that sometimes this doeshappen and hopefully, the fact that you are aware of it, will better prepare you to deal with it should you befaced with such an ordeal.

8. Any additional ad,(-./ (#0*12&)(*# $*34' +(5. )* 6(,. )7. $.&1 8.+*9 - in c luding how to pa ce th e ms e lve s / u s ing re vis ion groups / how to juggle going in to atta c hm e nt s and r e vis ing s imultane ou s lye tc .

Finally, I would like to say keep calm and work hard. In your last attachment, take time out to visit otherwards to see signs to which you may not have been previously exposed. Be proactive and ask houseofficers or nursing staff whether they can tell you which patients have signs to illicit.Ask junior doctors to supervise y '4 '* %*. -2, -**-27) - %$9) %' ,' - R9'6= 8$2-#/3 6-/); B%3/ -## ()*. 7'',

practice and will stand you in good stead for the real thing.

Do remember that despite the best preparation, there will inevitably be things that you are unsure ofwhether it be i 2 .'4* 6#$2$6-#/ '* +*$%%)2/ 54% %1$/ ,')/23% 9)-2 %' /-. %1-% .'4 +$## 2'% /466)),; B% $/ %1)thinking process that is important c provided you can show the examiners that you are safe on your ownand have the ability to form sensible differential diagnoses from clinically assessing the patient & can forma management plan, you will pass. If I was taking finals again, I would perhaps take a step back and enjoy$% 9'*)0 8'* -## '8 $%/ 1$71/ -2, #'+/0 %1)*) $/23% -2.%1$27 :4$%) #$=) %1) %1*$## '8 5)$27 -5#)to answerquestions confidently in a viva. Keep at it as finals will be over before you know it c good luck

!"#$%&" ( !)*+"*$"

Au t hor R e s pon s e s :

1. Exa m information re garding the qu e s tion type and how th e marks ar e alloc at e d for e ac h pap e r(i.e . what pe r ce ntage of the marks ar e alloc at e d to me dic ine / s urg e ry / e th ic s / e pide miology / pharma c ology e tc .)

Questions that were aimed towards a merit/distinction were clearly labelled with an (E) standing forExcellent.The components examined for the clinical were: History taking, Examination, Investigations, ProblemSolving and Management. Students were graded with points allocated to each grade and a C+ or abovewere required to pass. A grade below C+ received demerit points.C- " -1D " - 2


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E " - 3A total of -9 demerit points would put a student into the extended clinical exam. In this exam a further four

patients are seen and the same guidelines are used for marking.Failing the written paper and/or the extended clinical would put a student into re-sit finals which took placein June.


The amount of time spent on revision does not always reflect on the end outcome. Every person has

different revision strategies, strengths and weaknesses. Revision for finals should not be a last minute rush.There is a lot of stuff to take in, understand and apply. Students normally start revision 5-6 months inadvance. I would advise reading through one book completely for medicine and another for surgery beforelearning information by heart. This will allow for better understanding and planning of revision.


Planning and actually sticking to your plan is probably the toughest challenge when it comes to preparationfor any exam. For my finals I did not make very strict plans with regards to set times because I felt that bydoing this I would stress myself out even more, in case I was unable to stick to the time frames.

It is important to cover everything at least once and it is better to start off with the topics that scare you the

most. It is important to have breaks, eat and sleep well during revision. Although it is easy to forget, bookwork will not suffice for medical finals so make sure you have ward days scheduled and you see at leastone patient per speciality before your finals. Also having a day off in a week where you spend time doingsomething you enjoy will help relieve some stress, and will get you more motivated to work the next day,allowing you to achieve better results.


It is important to find one book that suits you the most that you can read from cover to cover.

The books I would recommend are:-1) Master Medicine - Paul A. O'Neill, Tim Dornan, David W. Denning2) Pocket Essentials of Clinical Medicine c Anne Ballinger, Stephen Patchett3) Surgical Talk4) Rapid Medicine5) Rapid Psychiatry6) Medical Finals: Passing the Clinical 2nd Edition c Moore and Richardson7) Surgical Finals: Passing the Clinical 2nd Edition - Kuperberg and Lumley


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When you are revising for finals avoid big texts such as Davidsons, Harrisons and Clinical Medicine(Kumar and Clark). These books should be used during your clinical rotations and not during revision,

because it covers a lot in depth and you need a breath of knowledge for finals.


After the first part of the written and the clinical exam you will be better informed and mentally preparedfor the second part. From my first written paper I realised that I was pushed for time and that my timemanagement needed to be improved for the second paper. I also noted down the topics that came up in the8$*/% "-")* -2, *)($/), %1) %1$27/ %1-% ,$,23% 6'9) 4" 8'* %1) /)6'2,;The clinical exams are not as predictable as the written. Most people got one case that was targeted towardsa specialty (Obs/Gynae, Paeds, Psych) and three that were either medicine or surgery. Although it is not-,($/-5#)0 B 5)#$)() $%3/ - 7'', $,)- %' 8$2, '4% +1-% '%1)* ")'"#) 1-() 5))2 7)%%$27 -% %1) /$%) where youare going to have your exam. This will allow you focus your last minute revision as it is impossible tocover everything the night before.After my first clinical exam I felt more relaxed and confident about the next day.

7. De s c r ibe your OSC Ee xpe r ie nce how the e xamine r s t r e at e d you and what c as e s you we r e give n

Cas e 1 Psych c Depression(simulated)

This was a ex police-woman who had taken earlyretirement because of depression. There was anincident at work which had a great impact on her.I had to do the mental state examination after 10minutes and from this it was obvious that she hadgood insight.I had ten minutes to gather my thoughts. During thistime I noted down the things I had missed, andcame up with my investigations and management

planI then had to present the history and MSE to theexaminers. The questions they asked me were aboutdifferentials, investigations and management.I then had to go back to the patient and explain themanagement plan.

The examiners wereextremely friendly andsupportive. They gave metime to explain myself andthe questions they askedseemed fair.The time management withthese examiners was reallygood and they tried to relaxme when I first got into theroom!

Cas e 2 Man with aoperation in the past" non- 1',7=$23/lymphoma "

paraincisionalhernia

This man had a very vague presenting complaint,which on further questioning pointed towards non-hodgkins lymphoma. I had to make sure that Icovered most aspects of the history.I carried out a GI system examination (patient had asplenectomy), was then required to examine thehernia in 1 min and talk through it!I was questioned on the medication the patient wason and staging of non- 1',7=$23/ #.9"1'9-; B +-/also asked a bit about prostate cancer (the examinerwas a urologist).I had to go back to the patient and discuss screening

I had only one examinerfor this case. He wasfriendly and askedquestions which againseemed fair. He washowever looking for a verysleek & fast examinationroutine.


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of prostate carcinoma.Cas e 3 Ulcerative colitis Although this seems like a simple case, it was very

challenging, because the patient had had 12operations in the past. The examiners wanted me togo into a lot of detail with each operation, which+-/23% "'//$5#) because of the limited timeavailable. I made sure however that I covered most

parts of the history.The examination was mostly GI. The examinerasked me to talk through what I was looking for. Ifound this very daunting and time consuming. I wasalso told to demonstrate how I would use theophthalmoscope!

My questioning by the examiner was very intenseand at a rapid rate. It was mostly based onemergency management.I was then asked to go back to the patient and speakto them about their treatment.

I found these examinersvery difficult to deal withas they would interruptwith every single thing Isaid. They were very badwith managing time.

Cas e 4 RheumatoidArthritis

This was a typical case of RA affecting small joints.I examined the hands and was questioned ondifferentials, investigations and management.I had to speak to the patient about differenttreatment modalities.

This was the ideal case fora medical final! Theexaminer was really nice aswell. However, I felt that Idid not perform as well as Ishould have because I wasextremely affected by theexaminers from Case 3.

My biggest advice would be to do a case and forget about it as soon as you have done it!

8. "#$ &''()(*#&+ &',(-./ (#0*12&)(*# $*34' +(5. )* 6(,. )7. $.&1 8.+*9 - in c luding how to pa ce th e ms e lve s / u s ing re vis ion groups / how to juggle going in to atta c hm e nt s and r e vis ing s imultane ou s lye tc .

I found revising with friends for my clinicals extremely useful. I would make sure that your examinationroutine is clear and sleek for all the systems. Also the questioning in the clinical exams was mostly onemergencies, so revising the last chapter in the oxford handbook would make the questioning bit of theclinical exam a lot easier. In your last clinical attachment, make sure that you only go to the sessions that

will be of use to you. Explain this to your clinical team who will usually be very understanding. Go to thewards in your spare time and also make sure you keep up with your bookwork.Make sure you enjoy your finals and not dread them! The key is to start early and be positive!


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Laura Taylor

Au t hor R e s pon s e s :


Leicester, like most places, divide finals into clinical and written exams.

Written

The written exam takes the form of two papers. Both are 2 1/2 hours long and are sat over two days. Theexam c '2%-$2/ 8$8%))2 :4)/%$'2/ +1$61 5)7$2 +$%1 - b/%)9Y -2, "*'7*)// %1*'471 :4)/%$'2/ *)#)(-2% %' %1)clinical scenario. The questions can theoretically cover any aspect of medicine covered in the objectivesguidelines. However, they are relatively predictable covering basic medical science/pathology, histories,examination findings and management. Taken as a whole, the emphasis in finals appears to be moretowards the clinical aspects and you could probably pass by knowing this well. However, approximately20% of marks referred in some way to basic clinical sciences so it would be wise to read over this too.

Clinical

O#$2$6-# )?-9/ -% ])$6)/%)* %-=) %1) 8'*9 '8 b#'27 6-/)/Y; C1)/) -*) *42 '()* %+' ,-./ -2, /%4,)2%/ /)) %+' patients each day. If your results are borderline you will be asked to come back for a third day where you

will see another four cases.

C1) #'27 6-/) 6'2/$/%/ '8 -2 )?-9$2)* 7$($27 .'4 - #)-, $2 %' - "-%$)2% G8'* )?-9"#)@ b%1$/ $/ - eV .)-* '#,lady who has been having problems with her hands ;YN; C1) /%4,)2% %1)2 1-/ 8$8%))2 9$24%)/ %' ,' - 1$/%'*.and relevant focused examination. Examiners differ in how they run this part. Some will tell you that.'43*) 6'9$27 %' %1) )2, '8 .'4* %)2 9$24%)/ '8 1$/%'*. +1$#/% '%1)*/ +$## )?")6% .'4 %' 9-2-7) the timeyourself.

Following this, students are given approximately fifteen minutes in which to consider their patients problem and come up with a relevant plan. They are then asked back into the examination room and givena viva for another ten minutes. The viva can be on anything related to the case. Some examiners want youto present the case and discuss your management plan. However, others will be more focused on the

pathophysiology of the disease or mechanism of action of drugs.

Unfortunately, it just depends on who the examiner is.


B ,'23% 5)#$)() %1-% $% 6-2 5) /-$, %1-% $8 .'4 /%4,. 8'* - 6)*%-$2 -9'42% of time you can predict whether youwill pass, get a merit or a distinction. As much as it is a clich, it is quality and not quantity that matters.


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That said; if you have drifted through medical school without making much of an effort it would beadvisable to consider starting to write notes and revise approximately six months before the exams. If youhave worked hard throughout the clinical years, three months should be more than enough. The maindifference between those getting passes, merits and distinctions was less the time spent studying and morethe focus of their study. Make sure you are aware of the objectives book which was handed out at the

beginning of the course and use it to guide your study.


B% $/ $9"'*%-2% %' ,$($,) .'4* %$9) 5)%+))2 6#$2$6-# "*-6%$6) -2, b5''= +'*=Y; C1) +)$71% %1-% .'4 7$()

each of these will probably change in the run up to finals as you finish memorising facts and begin puttingthem into practice with clinical case scenarios. As your revision progresses, find a group of friends whoyou work well with and arrange to practice with them for the clinical exams.

It is also important to have breaks. Go out in the evenings and go away for weekends so that the monotonyof revision is broken. Then, when you do sit down to learn, you will be much more receptive.


The main resource to use is the objectives book that you were given at the beginning of the course as itcovers every area that you are expected to know. Ideally, work through it during the clinical years andmake sure that you can say at least a little about every topic covered.

There are several textbooks which are ideal companions to working through the objectives:Medicine at a Glance (Davey)Surgery at a Glance (Grace and Boreley)Medicine and Surgery: An integrated textbook (Lim et al)


We sat the written papers in the week before the clinical exams. The first written paper was rather vagueand seemed to focus on the more obscure aspects of the course. For example, there was a whole question onGroup B Streptococcal infection in pregnancy. This was not what we expected as we had been told thatb6'99'2 %1$27/ '664* 6'99'2#.Y '2 249)*'4/ '66-/$'2/; There was also a lot of focus on pharmacologywhich was not entirely unexpected.

D8%)* %1) 8$*/% +*$%%)2 "-")*0 B 1-, %1) )()2$27 '88 -/ $% ,$,23% /))9 -/ $8 +) +)*) 7'$27 to be askedanything that we had revised anyway. However, the second paper was much more what I had expectedfinals to be like.

There were questions on medicine, surgery and paediatrics and it was actually possible to work out whatthe examiners were asking. As a result, I left this exam feeling a lot more positive than I had done

previously.


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The clinical exams were also held over two days. There were five centres in which you could sit the exam:The LRI, Glenfield, LGH, Kettering and the MSB. The MSB was introduced this year and seemed to haveworked well.

On arrival, students are given their numbers and a clipboard and taken to sit outside their first case. Anexaminer then greets you and gives you a small introduction to the patient. You are then expected to take ahistory, examine the patient and come up with a management plan for discussion.

I had cases of rheumatoid arthritis and depression at the MSB on the first day and diabetes and peripheralvascular disease at the LGH on the second.

In all cases the examiners were encouraging and friendly. The vivas took a predictable route for the most part and covered differential diagnoses, pathophysiology and the management plan.

RB2/$,)*/ A4$,)3 C)-9

EditorTeizeem DhanjiAuthors

David BrysonJaina Parmar Nilesh Dineshkumar BharakhadaManisha Kishorchandra MorjariaLaura Taylor

Documents

ACE Medicine_Guide to Passing Leicester Finals