This is an article I wrote about a year ago for first-year clinical students. I was to moderate an online session on practical tips to passing their first Medicine and Surgery tests, and I wasn’t sure I could make the time, hence wrote an article to share with them instead. As fate would have it, I was available on the set date and moderated the session using the article as a guide. I just came across it today hidden somewhere on my laptop and have decided to share.
I did not alter any information in the original draft as you will notice from the tone of writing.
I believe that the tips will have some usefulness for every medical student in clinical school, but the maximum good will be derived by those who are just starting clinical school.
My name is Ikechukwu Chukwudi and I am deeply humbled by this opportunity given me by Dr. Leye to speak on practical tips for your first test in clinical school.
Most of the things you will need for this test have been mentioned by previous speakers on this platform. They have done an excellent job, I must confess. My task today is to summarize all the information you have received and help you apply them practically towards your upcoming test.
First and foremost, walk up to an immediate senior colleague and ask them about the test and things to focus on while preparing for the test. For your level, they have the most recent experience from the departments.
The bulk of what I will be saying (howbeit personalized) will be what they will tell you and more. I may have some difficulty recollecting everything I will want to tell you, hence my earlier advice.
MEDICINE (OSCE and MCQ)
OSCE means Objective Structured Clinical Examination, it is supposed to replace the more subjective and less encompassing long case examination. It is like steeplechase with the difference being that, here, you get to interact with patients and examiners. There will be about 20 stations which include physical examinations (about 3 stations), clerking (2 stations), follow up questions to these stations, investigation results to interpret (e.g. Chest X-Ray, Full blood count, Urinalysis, etc.) and micrographs that will require you to make diagnosis from a picture (maybe Acne, Steven Johnson, etc.) then give answers to the follow-up questions.
MCQ means multiple-choice questions. In Medicine 1 test, it is usually in the form of a leading stem question with options from which you will choose the true and false ones, and marks will be subtracted for wrong answers.
Before my Medicine 1 test, I spoke to an immediate senior colleague Dr. Sina, who was my mentor from preclinical school. He told me everything I needed to prepare for the test and thoroughly emphasized the importance of PRACTISING PHYSICAL EXAMINATIONS, CLERKING AND PAST QUESTIONS. These turned out to be high yield, and I want to share them with you.
Get a physical examination partner (a group of a maximum of 2 people), preferably someone from another medicine group, with whom you will practise the physical examinations as you have been taught by your consultants and small Falase textbook. You will examine each other to perfection. Practice the high yield physical examinations; general physical examination, chest examination, upper and lower limb examinations, Precordium examination and focused examinations of organ systems depending on what pattern of questions have been asked in recent tests. Try to practise them every other day starting from 3 weeks to the test, then every day from a week to the test, so that they become automatic (joining a group practice will not enable this).
*NB:* You can never learn an examination by merely observing others. You actually have to do it, this holds true for procedures as well.
While practising examination of the systems, it is important to also practise clerking the common presenting complaints in each of the different units in Medicine. This can be done in a larger group of 3 to 4 people, for adequate criticism and correction.
Both physical examination and clerking practices should be timed.
For the MCQ part, cover all the necessary topics in the lecture schedule. Then, find past questions and practise them, in a tutorial group and alone (PQs are especially important if you are unable to cover the lecture schedule). They really do make a huge difference. There are always circulating questions. They exist even if you don’t come across them, so, actively look for them.
P.S: Your continuous assessment will largely determine if you will pass or fail medicine in the final year (THIS STATEMENT IS NOT TO BE TAKEN LIGHTLY). It can even determine to an extent if you will win the Medicine departmental prize on graduation, if you have such aspirations.
Essays were my strong points in medical school examinations, so, I capitalized on them and got all the marks I could. You may have heard that all Surgery essays are scored between 18 and 24 out of 40 with 2 or 3 outliers getting scores like 15 and 26. I am sure some of us will want to be a positive outlier.
Preparing to write good Essays
Allow me to share how I managed to be a positive outlier in my Surgery essay scores. First, I tried to understand everything being taught us in lectures and tutorials. Arranging the concepts in my head in a way that I can easily explain to another person. Having some idea about every topic and a lot more on important topics (I apply this to every subject that requires me to write an essay). Some reading is important to achieve this. During the posting, I went around with the essay past questions for the different units and ensured I could answer every common question in the different units before the test (occasionally, I wrote out a few essays in practice to test my writing speed).
Practical tips for writing good Essays
During the test, I wrote the essays with underlined subheadings (try to write all your essays in medical school this way, only the Department of Obstetrics and Gynecology wants a prose form). I went with a wristwatch and timed myself, giving each essay an equal amount of time with a little time to go over the work and rule the subheadings and important points in the essays that might be missed due to my bad writing or in a hurry by the examiner. I tried to write something substantial on every question, no matter how little I knew about it. (It is usually a bad sign to be blank on a question, the few times it happened, I wrote out possible subheadings, underlined them and beat around the bush (‘spread’) with wisdom).
Essays test your broad understanding, so having a clear broad understanding of concepts in a field is germane to writing a good essay.
SURGERY LONG CASE
During our time, we did the picture test and not the long case in the Surgery test. For this section, I will be drawing on my Pediatrics long case experience. Longcase is very easy to pass, far easier than OSCE and picture test. Have an idea of every important case in the unit you are having the test. Dress sharply in a neat ward coat. Have a positive mindset that you will be tested on things you actually are supposed to know (this, in itself, is the truth).
Clerk and examine the patient thoroughly and present the patient to yourself. Write out your differentials and reason for them, if indicated list out relevant investigations and possible findings.
(Pro tip: Make sure that the presenting complaints you give can be strongly tied with your final diagnosis e.g if the presenting complaint is cough, your final diagnosis must have cough as the main presenting complaint in 99% of cases, if it is not tying together you need to panel beat it to tie).
Find out your lapses and correct them before the examiner comes. Be confident. Think carefully about the question before you reply, if you do not know the answer, calmly reply that you don’t remember ( this line should not be used more than twice).
In my opinion, it is more difficult to fail an exam in clinical school than pass it. Look at it this way, most of your mates will pass the test with minimum effort, why shouldn’t you? Know how to titrate your efforts to produce your desired results.
Finally, I can’t overemphasize the importance of a tutorial group in medical school. This is where you know what your mates know and prepare better for tests and exams.
I wish you the very best!
That’s the end!
If you have any contribution to make to this, kindly state them in the comment section.
Once again, remember that your immediate senior colleagues (or group mates who are ahead in a posting) in clinical school are the peer authority in practical tips for examination/test preparations as they have the most recent experience. Be quick to consult them.