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Otago MBChB - Overview of the Years

academedical

Otago MBChB V
I was looking back over some earlier MBChB threads and came across some comments from recently-accepted med students wanting to know more about ELM2. A few people had said they’d been planning a post of everything-ELM2 but it never came about, so I thought I’d put one together myself. This is super lengthy, but I hope it'll at least be informative.

I’ve created a new thread for this in hopes that I might make one of these at the end of each of my MBChB years at Otago (I say that now...), but also that others can create their own reflections/overviews of their years. With a bit of luck this post is useful for future ELM2s and, with further contributions from others or from future-me, will be useful for those going into other parts in the Otago Medical course.

Overview - The Basics

Early Learning in Medicine 2 (ELM2) is divided into block modules and vertical modules. Block modules occur in clumps, anywhere from 4-7 weeks. In order, these are Psych Med (aka Behavioural Med), Musculoskeletal, Cardiovascular, Respiratory, and Gastrointestinal. Occurring throughout the year, usually when relevant to the block modules, are a number of vertical modules. These are Blood, Cancer, Evidence Based Practice, Palliative and End of Life Care, Ethics, Genetics, Hauora Māori, Infection and Immunity, Pathology, Pharmacology, Professional Development, Psych Med (vertical), and Public Health. They try to fit in lectures from these modules into the relevant block modules (e.g. lung cancer is taught in respiratory) but sometimes they’re stand-alone and feel a bit random (the Blood module is very much stand-alone). All lectures are held in Colquhoun (pronounced 'Col-hoon') lecture theatre in Dunedin public hospital.

Tutorials are a massive part of med school. For tutorials and labs, the class is split up; first into four streams (A, B, C, D) of about 70-75 people – these will be your lab groups. Then each stream is divided to give the different tutorial groups of ~11-12 people. The different subjects/modules have different tutorial groups, so you won’t be with the same 12 people for every single tutorial. The three you’ll spend the most time in are the ones you have every week: Early Professional Experience (EPE), Clinical Skills, and Integrated Cases.

EPE basically aims to make you a well-rounded person. It looks at things like culture, addiction, disability, and ageing. Within five weeks or so of starting med school, you’ll go on a home visit to see someone. Usually this person will have at least one medical condition and the aim is to learn about their experience and see a new perspective. The prospect of this was super terrifying to me, but it really isn't so bad. There are also two agency visits throughout the year where you visit a particular agency/organisation and learn about what they do and why they do it. Then there are the rest-home placements where you spend 20hrs at a rest home, shadowing the carers and learning about living in a rest home. For some people this is very confrontational, but it’s a fantastic learning experience. Typically you’ll spend four hours a day, one day a week (for five weeks) going to your placement, though there are also options to use your weekends or holidays to do it in one big hit. I chose to do it across three consecutive days over the holidays, which I personally found very effective as it immersed me in the experience and really let me focus on the placement. At the rest home you’ll do anything from helping people eat and making beds to showering and dressing people. If I have any advice for this placement, it would be to make the most of it - get involved and try to consider everyone's perspective. So many people don’t want to be bothered with placement and just think of it as something tedious and pointless, but there’s so much you can learn from it.

Clinical Skills is exactly what it sounds like – they teach you the skills you need to take a history and do a physical examination for a particular body system. The first seven weeks of the year will be generic things: hand-washing, general observations, and history-taking for general symptoms. Don’t forget that these first few weeks exist; next thing you know you’ll be asked to make general observations in the exam and you’ll panic (half my year lost points in mid-year OSCE for struggling with general obs). For MSK, CVS, Resp, and GI, you’ll learn about the major conditions and symptoms associated with each of the systems and the examination techniques used. If you’re looking to do well in OSCEs (see later) I’d definitely recommend knowing the condition list they give you by the end of each module (they’re all basic conditions you have to know before going into ALM anyway). If you can understand why certain conditions have certain symptoms, you're doing well in your understanding of physiology, pathology, and clinical skills.

Integrated Cases, or just ‘cases’, takes a very well-rounded approach to learning. It draws information from every module and emphasises patient perspective to work through a particular case. Typically (although it got a bit inconsistent by the end of the year) you get one case every two weeks, and you spend the two tutorials for that case drawing info from the relevant block and vertical modules. The aim is to develop a well-rounded approach to a case. There’s very strong emphasis on independent learning here – you’re expected to do your own work and research between cases, including in groups… Just do it! There are three cases you have to do online instead of in a tutorial - a lot of people hated this because they can be a bit time consuming, but it tends to be fairly well-examined. Put aside 2-3 hours or so to get this done and you'll manage fine.

Almost all of the modules (block and vertical) will have their own tutorials throughout the year. For the most part these are two hours (although the odd one will be one hour). Pathology is the major one here – it’s probably the most heavily examined vertical module. By the second half of the year, you’ll start having path every week and the amount of content builds up really rapidly. Basically: just keep on top of path from the start. The labs throughout the year largely come from the block modules (in the dissection room and histology classroom), but there are also a number of vertical module labs: infection and immunology and blood being the main ones. The five blood labs at the start of the year mostly reflect BIOC 192, but I’ve found that they’re almost never examined so don’t panic too much about learning everything from these. Infection and Immunity, on the other hand, is a bit hit-and-miss. There’s a huge amount of content for I&I with very little assessment –this year the lab I&I content wasn’t examined at all.

ELM2 doesn’t really hit the ground running. The first two weeks are ‘foundation weeks’ that lay down your basic knowledge for med. If you go digging far enough through this forum, you’ll see people saying not to bother with this content because it’s hardly ever examined. I don’t fully agree with this, as some of the content from foundation weeks was examined in our SAQs this year. Regardless of if it’s examined, the knowledge from those two weeks underpins everything else you learn, so I’d be really worried if anyone didn’t understand the major concepts of these weeks by the end of ELM2.

Exams

For the first time this year, the med school made in-course assessments summative. In previous years the final exams were worth 100% of our grade, but this year they made up 80% of our grade with 20% being earned throughout the year. The grading is a bit odd; instead of giving us percentages, we get numbers 1-5. These represent a clear fail (1), bare fail (2), bare pass (3), clear pass (4), and potential distinction (5).

To pass the end of the year, you have to pass both the written and OSCE halves of the course. The easiest way to think of it is as getting two overall grades for the end of the year: written and OSCE. The OSCE grade is just an accumulation of in-course OSCE and its associated assignment (20%) and the end-of-year OSCE (80%).The written grade is an accumulation of pretty much everything else: the Cases SAQs, both OSPEs, the EPE reflective essay, the genetics assignment, and the three end-of-year SAQs.

In-course Assessment:
  • Cases SAQs: there are two of these throughout the year. Basically: they suck. They give you 35 minutes, which is never enough time and has people scribbling as fast as they can. Apparently the idea is to make us ‘think on our feet’ but I honestly just feel like my writing speed is being tested. In general, the Cases SAQs are really easy to pass but very difficult to get 5s on because the marking criteria is brutal. Each test will be allowed to draw information from 4 cases (or 8 weeks worth of content) that will be pre-specified. The test gives you a scenario and tries to get you to think through it thoroughly. They’re worth 3% and 5% of the overall written grade, so it’s not a big deal.
  • OSPE: stands for Objective Structured Practical Exam and basically involves 50 stations, each with an image, model, or prosection and two questions. You have one minute per station, and everyone rotates around to the next station at the same time. The main content of the mid-year OSPE is anatomy (40 stations) from MSK and CVS, but there is also some pathology and histology (5 stations each). I found the mid-year OSPE much more difficult than the end-of-year OSPE (not for lack of study; I did a lot more study for mid-year than end-of-year) so there’s something to be said for the rumours suggesting that mid-year OSPE tries to scare people into getting their shit together. Ultimately mid-year OSPE is only worth 4% of the written grade, but MSK is so anatomy-heavy that it’s definitely worth putting a decent amount of time into engraving that anatomy into your brain. If nothing else, it’ll take some of the pressure off at the end of the year.
  • OSCE: stands for Objective Structured Clinical Exam. At ELM level, there are two stations: history-taking and examination stations. In each station you’ll sit down with an examiner and an actor patient and have 7 minutes to complete the task at hand. Examination stations require you display a particular skill and usually assess your knowledge with a few questions at the end. They’ll typically assess your ability to perform a particular examination technique, then ask you to do one other thing; this could be making general observations (sigh), reporting your findings, answering specific questions, or explaining what is assessed with a particular examination technique. 7 minutes is heaps of time in an examination station and you’ll almost definitely finish early (I finished my final OSCE examination station 4 minutes early, although that is apparently a less common situation). Focus on making sure you do everything you feel you need to do, go slow to avoid panic, and treat the actor as a real human being! The actors give you a mark for how comfortable you made them feel. For history-taking stations, you start as soon as you sign in to Bracken (which films your OSCE) – 7 minutes isn’t a lot of time for a history, so make the most of it! It’s easy to get flustered in these stations because you’re having to think rapidly on your feet while remembering what you’ve been told, but if you can avoid panicking and make sure you treat your actor as a person, you’ll be okay. After the OSCE you’ll have a week to write up an assignment based on the video that was recorded, which is marked by your tutor (fair warning: watching your own video is hell). The whole mid-year OSCE makes up 20% of your OSCE grade – 5% from each station and 10% from the assignment.
  • ELM2 Reflective Essay: this can be a reflection on your clinical placement or a particular learning experience throughout the year. You’ll get taught how to write a reflection during EPE, but as long as you’re honest and use lots of ‘I’ statements you should be okay. I personally found the reflections to be a very valuable learning experience and I’d recommend writing it as soon as you’re done with clinical placement (if this is what you’re going to reflect on). They’re great for trying to understand other people’s viewpoints and are useful for understanding where you can do better. It’s worth 5% of the written grade.
  • Genetics Assignment: you can pick a genetic disorder you’d like to do research on, or otherwise you get assigned on. It’s a pretty limited research essay and makes up 3% of the written grade. Try to avoid leaving this to the last minute as a number of other (non-graded) assignments are due around the same time as this one, so you don't want to be left panicking. You also have to work with two or three other people from your group to make a powerpoint to teach the rest of your tutorial group about the condition – this doesn’t contribute to your grade but it is a terms requirement.

End-of-year Assessment:
  • SAQs: there are three SAQs (A, B, and C) at the end of the year, all of which are case-based and can assess any of the content from the whole course. You’re guaranteed to get a couple of cases from every block module, 3-4 pharmacology questions, and at least 3 pathology questions. Other than that, the rest of the content is a bit hit-and-miss. There’s no pattern to what will be in each of the SAQs, but lecturers will occasionally drop hints (thanks Matty B) or accidentally blatantly tell us which SAQ their question will be in. The public health and EBP questions are based on a paper that you’re given in advance (like PUBH 192) so you’ll know which SAQ that will be in. Other than that, just focus on the core block module knowledge and don’t ignore the case-based tutorials/lectures Matt Bevin gives!
  • OSPE: this is the same as the in-course OSPE but covers all of the anatomy, pathology, and histology from every block module. There was more MSK (~20 questions) in our OSPE than any other module, but it’s a bit unpredictable how many questions will come from each module. It’s not a particularly large portion of the overall written grade (I can’t remember exactly how much, but it’s something small like 12%) but you have to get at least 45% to avoid coming back for specials in January. If you stay on top of the anatomy throughout the year you’ll be fine. Honestly, I studied all of my anatomy during the year and did absolutely no OSPE study at the end of the year (thanks, burnout) and OSPE was still a breeze. Use all of your dissection room lab time to look at prosections and ask lots of questions of the lab demonstrators – the people who struggled most with OSPE were the people who left labs early because they couldn’t be bothered.
  • OSCE: this is four stations (two history, two exam) across two days, covering each of the four main block modules. Your history stations aren't recorded, so you don't have to sign in to Bracken. Otherwise, this is the same as the in-course OSCE. You can pretty much guarantee you'll get a station from MSK, CVS, Resp, and GI, which makes predicting stations easier for day 2. Ultimately the best thing you can do for OSCEs is practice your technique throughout the year and get feedback from your tutor. Ask any and all questions if you're confused about a particular skill. Don't leave practice to the last minute - examiners can tell if you're not that comfortable with a particular skill. And contrary to what has been said on this site previously, do not tell your examiner everything you're doing as you do it (e.g. "I'm palpating for fluid in the joint") because it's pretty dehumanising for the actor and you'll get marked down.

A number of other assignments are terms requirements but don’t contribute to your overall grade, including a drug formulary for pharmacology (start this as soon as you start learning about any drugs, you won’t regret it!), ResearchSmart (basically just quizzes on moodle about research), and the presentation during Hauora Māori week.

Retained Knowledge Tests are a bit off-to-the-side in that they don’t really reflect the content you learn in ELM2. There are two RKTs each year, in April and September. They’re 150 questions each, sat online in your own time within a specified two week period, and sat by every student in years 2-5. They’re meant to reflect the level of content you need to know by 5th year; for 5th years they supposedly indicate whether someone is on track to pass their final exams (but you’d have to confirm that with someone who’s done 5th year, I actually don’t know how true it is). Ultimately what this means is that you won’t really know much of what’s being tested as there will be questions from every aspect of the course through to 5th year. For second-through-fourth years, the RKTs aim to show how well you’re progressing in your learning – you’re not expected to score high or have a high degree of certainty early on, but you are meant to improve over time. Make sure you take this seriously; if you take less than ~30 minutes so (i.e. you just put random answers down for every question instead of making a proper attempt) or you get a mark lower than the chance mark, you’ll be contacted by the med school regarding improper professional conduct. Later years have told me that it’s valuable to see the progression from second year, so it’s worth making an honest attempt even though you’ll know very few answers.

What to Buy

This is always a big question. The school lists a bunch of books it wants you to buy as well as a few miscellaneous items that should help your study. I’ll give my two cents about what was helpful and what wasn’t, but again what works for me might not work for you.

Textbooks – before I start here I just want to point out that you will gain access to all of the required textbooks online (via ClinicalKey). I personally find the site super clunky and I much prefer to have actual books while I study, so I went with the actual books. However, if you don’t mind online versions you can always save yourself a whole lot of money.
  • Gray’s Anatomy for Students: I found this useful for MSK anatomy but little else as it lacked some relevant detail (particularly for GI). The physical version is much easier to use than the online version, if I could do it again I would have just bought Netter’s Anatomy Flashcards and left it at that. 6/10
  • Pharmacology textbooks: I got one of the Goodman and Gilman’s ones but honestly it was completely useless. The book’s content was completely different to the course content, so it did little for me. Definitely one I wouldn’t buy again. 1/10
  • Talley & O’Conner’s Clinical Examination: this is an interesting one to reference but really doesn’t add much to your learning. The course-book they provide for clinical skills is more than sufficient, so while there’s nothing wrong with this textbook it really just isn’t necessary. 4/10
  • Being A Doctor: Understanding Medical Practice: this is a book written by some of the people from the med school. I suppose it’s meant to supplement EPE, but on the whole it was a bit of a dull read and I didn’t manage to get half way. It doesn’t add anything to the course, but I guess it’s meant to give you some perspective. In place of it I’d recommend Being Mortal by Atul Gawande, which is much more valuable and is referred to a number of times throughout the course. 2/10
  • Clinical Biochemistry and Metabolic Medicine: this textbook is used for Chemical Pathology. There are only three of these tutorials during ELM2, but they’re super full-on and require a solid amount of prep to have any understanding of what’s happening. I personally loved the tutorials and therefore used the book to prep for every one of them. It’s very relevant to the course, but because there aren’t many tutorials and a lot of people don’t like doing so much prep work, most people consider it to be a bit useless. Plus, you get the relevant readings online. Just a tip here: they list it is ‘optional reading’ as prep work but it’s heaps more relevant to the tutorials than the ‘required reading’ – so do the optional reading instead! I loved the book, but I’d probably be in the minority. 8/10
  • Guyton and Hall Medical Physiology: this can be used to supplement Matt Bevin’s teaching, but honestly Matty B explains exactly what you need to know so having a textbook isn’t that helpful. Plus, the language used doesn’t make the content super easy to understand, so it wouldn’t be on my top-priority list. If you really want a textbook, I heard Matty B wrote/contributed to one so you could search previous threads to see if that’s worth buying. 4/10
  • Robbins Basic Pathology (“Baby Robbins”): like every other textbook, this isn’t 100% necessary for doing well but I found it to be a huge help in preparing for pathology tutorials. It explains things well and has the right amount of detail for ELM. It’s definitely worth either buying this book or using the online version (although I found the online version a little harder to work with as the formatting isn’t quite right). You’ll use it heaps as there are 14 pathology tutorials throughout the year. 9/10
  • Focused History Taking for OSCEs: this comes recommended by quail from this thread. I definitely referred to it a lot (as I was most stressed about OSCEs) but I can see that it’ll be more worthwhile in ALM than ELM. That said, it was definitely useful in helping me figure out what to ask and why. Plus, I think it’ll be very handy to be familiar with the book already when it comes to working through diagnoses in ALM. I certainly don’t regret buying it. 8/10

Other things:
  • Stethoscope: oh boy this gets a lot of discussion. To put it simply, my answer is: yes, buy a steth. It’s technically not a requirement because they’ll have spares for skills tutorials and OSCEs, but it’s easier not to have to share during tutorials and having your own means you can practice more easily in your own time (i.e. in places other than the skills rooms). I might be a little biased because I’m still salty about the time someone literally pulled my steth out of my hands to use for themselves because they didn’t have one, but still. Getting mine was an important ‘I made it into med school!’ moment, so I got mine during summer. You’ll want it before cardio which is a few weeks before the end of first semester. I highly recommend the Littman Classic III (which is equivalent to the one on the OUMSA shop) as there are more colour options and you can get it engraved for free (thief preventative). The cardiology steths are complete over-kill. Some ALM students have said some registrars are a bit judge-y about students having cardiology steths.
  • Sphygmomanometer (blood pressure cuff): this is in no way necessary to buy, but I did and I don’t regret it at all. Having a sphyg let me practice taking BP outside of the tutorial rooms and it got heaps of use at groups OSCE practices. It’s only $35 or so, so if you can spare the money I’d definitely recommend getting it.
  • Netter’s Flashcards: the anatomy flashcards are a god-send for OSPE and you can always identify med students in the library at the end of the year because they’ll have the flashcards with them. Get them and don’t regret it (lots of people try to borrow other peoples’ throughout the year). The physiology flashcards, on the other hand, are a complete waste of time. I bought them because I thought they’d be helpful, but I opened them once and never used them. Physiology needs to be understood, not memorised, so it’s not worth buying flashcards.
  • 5-Year Subscription to OUMSA and NZMSA and NZMA: get it. There is so so so much debate about whether or not people should get this because it’s $200, but lemme tell you, you’ll save way more than $200 after 5 years. You get heaps of benefits and discounts, plus it contributes to the budget OUMSA has to run events during the year.
  • OUMSA Cases Book Level 1: this is a book written by past med students according to previous years’ content in med. I personally used it a lot, but I have to put out a word of warning: it is not always correct and nor is it always representative of what’s in the course (in some topics more than others). A lot of the time I spent with this book was crossing out things that were wrong and adding a whole lot of extra information from lectures/teaching. My book has barely a blank space in sight because I wrote all over it - its base level of info really just isn't sufficient. My advice here is: use the book throughout the year (not as a last minute resource!) as a guide for which topics to study, but make sure you are constantly referring back to your own notes to make sure what you’re reading is correct and to add more detail in. I found that it was a good way to cover the whole course, including the key conditions we need to know.

Pre-ELM2 Requirements

The med school requires that you provide proof of your vaccinations, undergo a comprehensive first aid course, and get a pile of (expensive) blood tests to look at your immune status. A number of people try to get out of these but you may as well just do it. I don’t think vaccinations are required if you have a solid reason for not getting them; I think you then have to sign something saying you understand the risks (or something). If you have had the vaccinations, just get a record of it from your family GP and send it in to them. They don’t teach you first aid in ELM. The course helps with your first two weeks of Integrated Cases, but I also thinks it’s just common sense for med students to have knowledge of basic first aid. There's a cheap full-day course run at the uni in late January; going to that one will save you a lot of money but get you the same qualification. The blood tests are super important – they look at your immunity against things like Hepatitis, Measles, Mumps, Rubella, etc. They’ll also tell you if you’re HIV positive or have been exposed to TB so that you can take appropriate precautionary measurements. If you lack sufficient immunity (i.e. your vaccinations have ‘worn off’) to particular conditions, there will be clinics during the year to get booster vaccinations.
It's worth noting that you're required to keep weekdays free from 8am-6pm, which means you can't really work during the week (unless it's late evenings). The timetable is different each week so you can't schedule work into the 'gaps' of your first week's timetable (i.e. mondays might be free until 1pm but later in the year this block might be filled with lectures or labs, so you couldn't schedule work for then).

What Worked and What Didn’t

This is more of a ‘me personally’ section – I want to share the strategies I used to gain distinction, but bear in mind that what works for me might not work for others. The fact is that the content in second year isn’t hard, it’s just a lot (and I really do mean a lot). As someone who’s very susceptible to burnout, I couldn’t afford to do nothing but study (and not take decent breaks) in the last month or two before finals. Instead I started studying from the start of the year and kept up a steady pace. I found that if I prepped for tutorials and labs, then reviewed every tutorial/lab for that week during the weekend, the information I learned was easily accessible by the end of the year. Pulling the lecture content into context of labs and tutorials also makes a difference to understanding the key concepts of the course (particularly physiology).

So, 4900 words and 8 pages later we’ve made it to the end. I imagine I’ll think of more and add to this later, but please feel free to ask questions if you’re heading into ELM2, or add your own overview of your year if you’re in MBChB! With a bit of luck I’ll manage to do one of these every year, but no promises… I’d be super keen to hear from other year levels, or anyone who disagrees or agrees with anything I’ve said :D
 
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Great summary, I'm curious to know what they have told you about the Drug Formulary. When I was in ELM2 a few years ago now, we were told it should be finished by end-of-5th year but Wellington & Christchurch meds school don't actually have this requirement (no idea about dunedin)
 

academedical

Otago MBChB V
Great summary, I'm curious to know what they have told you about the Drug Formulary. When I was in ELM2 a few years ago now, we were told it should be finished by end-of-5th year but Wellington & Christchurch meds school don't actually have this requirement (no idea about dunedin)
Thank you! My understanding of the formulary is that ELM2s have to submit a formulary comprised of 10 drugs (from the Core Drug List), then at the end of ELM3 we must add to it and submit a second formulary consisting of 20 drugs (i.e. previous years' drugs plus 10). I was aware that we were expected to continually add to it through ALM, but I'm not aware of it being assessed in ALM - so that's news to me! That being said it could be something they tell us closer to the time.
 
Thank you! My understanding of the formulary is that ELM2s have to submit a formulary comprised of 10 drugs (from the Core Drug List), then at the end of ELM3 we must add to it and submit a second formulary consisting of 20 drugs (i.e. previous years' drugs plus 10). I was aware that we were expected to continually add to it through ALM, but I'm not aware of it being assessed in ALM - so that's news to me! That being said it could be something they tell us closer to the time.

That sounds more reasonable than 'make a drug formulary for all the drugs on the core drug list by end of 5th year' - we never actually did this, but it was definitely worthwhile to know the bolded drugs for 5th year OSCEs education stations
 

quail

Registrar
Great overview, very handy summary for the incoming ELM2 cohort. I just thought I might add a few things:

General tips
  • A lot of ELM is assessment driven. For this reason, it can be difficult to tease out what is 'high-yield' and what isn't - so I'd recommend referring to past exams early in the year to get a sense of what the written questions are like, and to have a go at answering the questions as you go. As previously mentioned many of the lectures (i.e. first four weeks of introductory lectures) and labs (all I&I) are almost never assessed. (Also it's worth noting that pathology only assesses tutorial content). You might hear some students saying the important ones are the 'A + 3Ps' (anatomy, physiology, pharmacology, and pathology) - but even this isn't quite correct. Infection and immunity lectures make a common appearance in exams for example, whereas the cancer module or EPE will have only one question and thus mean you should allocate less precious study time to these areas come preparing for finals
  • ELM2 is notorious for students relaxing given the high stress load of HSFY and not starting study until a few weeks out from exams - while it is indeed possible to cram ELM given the predictability of exams (ONLY if you know the content of the exams - i.e. have reviewed exam questions throughout the year), your life will be much easier if you put work into case and your case tests, and your major conditions in each block module as you go along
  • Enjoy your labs and dissections - this is an opportunity you will never get to experience again throughout medschool and a lot of the learning is self-driven; the demonstrators are there to help.
  • While mentioned above you should not describe exactly what you are doing during an exam OSCE - i.e. you would not say "I'm palpating for fluid in the joint" (this is tacky and not demonstrating the sign you are trying to elicit), if you are to present findings as you go (especially in ALM) you would definitely explain to the examiner what you are doing i.e. "on palpation the patella margins were palpable with negative bulge/swipe and patellar tap tests" - this is also how you should present your findings should you be asked to do this at the end of the OSCE. In ELM OSCEs marks are for confidence and for demonstration of a particular skill, and the actors appreciate if you explain to them what will happen before you do something. General observations include the patient looks well alert and comfortable, no fluid/oxygen/adjuncts or medications around the room - and generally 1 or 2 sentences should suffice
  • Contrary to what many people believe, distinction in history taking stations is given for completeness of your questions rather than how much empathy you showed - another reason to know your questions for all the presenting complaints
  • A top tip for preparing for the critical analysis for the SAQ EBP question (taking a published paper and answering questions on it) is to check the literature (using google or Medline OVID) prior to the exam and looking for journal club presentations or letters to the authors highlighting key aspects of the paper which you can include in your answers
  • Lectures are often based on other texts which you can refer to to help understand concepts - for example the majority of the year's physiology lectures are based on the following textbooks which you can loan from the library (please don't buy them)
    • An Introduction to Cardiovascular Physiology
    • West's Respiratory Physiology
    • Lecture Notes on Human Physiology (highly recommend this one, especially for gastrointestinal and renal physiology. Many of the diagrams are taken from this book)
Textbooks and other resources
While for ELM this topic has been discussed extensively in the MSO forums, my personal recommendation would be the following
  • At a minimum, buy an anatomy text, Netter's flashcards for MSK and a copy of Robbin's. As noted above, I'd personally recommend you buy Focused History Taking for OSCEs (and you could even consider buying a copy of Data Interpretation for Medical Students if blood is difficult to understand)
  • Do not buy TOC, as the clinical skills handbooks are more than sufficient and are what the exam answer schedules are based off. Definitely don't buy any EPE recommended texts or a pharmacology text - I'd recommend finding a book in the library called The Top 100 Drugs but there are many websites out there that do the trick as well
  • Many students think the Oxford Handbook of Clinical Medicine is useful for reference but I feel this text is not ELM-focused and thus that you hold off on buying until ALM
  • I personally don't recommend the metabolic medicine text as the tutorials are nothing short of fantastic and continue in endocrine in ELM3. The tutors are very approachable and the quizzes on moodle have excellent explanations that going into exams this will be more than sufficient.
  • The best resource you aren't told about is UpToDate which unfortunately the med school stopped paying a subscription to but if you can get access use it for almost anything. Get acquainted with this resource early as you will use it for ALM and the rest of your life
  • Buy a steth and a sphyg from Medisave (or other places) early in the first semester otherwise the examination sessions in skills will be awful - and buy a tuning fork and a tendon hammer for third year
  • Personally, I'd recommend First Aid USMLE Step 1 for both ELM2 and ELM3 as a reference tool rather than the book my colleagues wrote. It is succinct, comprehensive, and you can compare with your lecture and lab notes along the way
I'll add to this as I think of more, and will add some thoughts on ELM3 at a later stage.

ELM 3
  • Relative to ELM2, ELM3 begins with neuro which indeed hits the ground running. Neuroanatomy is perhaps one of the most difficult modules in ELM and is essential to understand in order to nail the written exam questions - so will require a lot of study straight out of the gates. The craniotomy lab is definitely a highlight - make sure you attend this! My class had a lot of differing opinions on the lab handbook - but my take on it is that the lab book is indispensable and the best source of information for OSPE and SAQ preparation. The recommended neuro text is useless - I'd recommend you loan a copy of Neuroanatomy through Clinical Cases (Blumenfield) which is nothing short of outstanding
  • Metabolism is like an extended BIOC192 module with a huge focus on diabetes and genetics. It is very dry, and thankfully the exam questions are the same every year. It was perhaps the only module in ELM I didn't enjoy.
  • RCA (regional clinical anatomy) starts the same time as metabolism and requires a lot of study for a small amount of yield in the SAQ - but unfortunately this module comes up in the end of year OSPE and isn't assessed in the mid year one (only neuro is - thus this can be a huge reason for people failing the end of year OSPE and not reaching the 45% threshold which is very anatomy heavy). RCA is a large module split up into four parts - head and neck, thorax, abdomen and pelvis - for which I'd suggest making flash cards for and keeping up to date through the year otherwise it can sneak up on you come exam time. If you don't have one already, buy an anatomy text as you'll refer to this constantly throughout the year. I'd also suggest reviewing the anatomy dissection tutorial videos (that are played during the anatomy labs) and perhaps compare with a dissection atlas if you really want to nail the OSPE
  • Renal (in contrast to HSFY) was in my opinion difficult to follow in lectures and required a lot of background reading to understand. I'd suggest reviewing the renal and acid-base chapters of Lecture Notes on Human Physiology as a starting point, then reading the glomerulopnephritis chapter in Robbins. I found using UpToDate for this module to be a huge help - for example the pictures in the renal essay are taken directly from this website. The major assessment as noted above is a renal essay where you have 1 hour to write an essay on 1 of 4 possible topics depending on what paper you sit down next to (which incidentally tend to repeat year to year so ask the above year groups for a copy of the questions). I prepared for this by writing and memorising model essays for each of the possible questions which worked out quite well
  • Endocrine was easily my favourite module of ELM with outstanding tutorials similar to the chemical pathology ones in ELM2. You'll have small group tutorial sessions and work through common and rare endocrinological disorders which translate directly into exam questions at the end of the year
  • RDA (reproductive, developement, and aging) is the last block module of ALM and again was a bit disorganised. A few things (like the PLISSIT model) tend to come up in exams more frequently than others, so I reviewed the exam questions as I went along the module and focused more on pelvis RCA which was more relevant to the impending OSPE
  • Same as in ELM2 , pathology tutorials and infection and immunity/pharmacology lectures remain high yield and a common occurrence in written exams.
  • Case and EPE are much the same as in second year. There is only 1 case test in ELM3 as the dreaded renal essay happens in second semester in its place
 
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Lego Man

Regular Member
Thank you! My understanding of the formulary is that ELM2s have to submit a formulary comprised of 10 drugs (from the Core Drug List), then at the end of ELM3 we must add to it and submit a second formulary consisting of 20 drugs (i.e. previous years' drugs plus 10). I was aware that we were expected to continually add to it through ALM, but I'm not aware of it being assessed in ALM - so that's news to me! That being said it could be something they tell us closer to the time.

We had to submit a formulary of all the drugs on the core drugs list in Dunedin at the end of ALM5. However, the medschool was super chill about groupworking it: my stream just divided up the core drug list into 4 or 5 drugs each and with our powers combined put it all together. As a word of warning, all drugs on the core drugs list are considered fair game in the 5th year exams (including the OSCEs): you may find that one or more OSCE stations involve drawing on your pharmacology knowledge to explain specific drug sor the treatment of certain conditions.

My advice for ALM pharmacology is to make the very most of your clinical attachments: ask questions about drugs you don't recognise (or look them up in your own time), ask why one drug is used instead of a different drug, and try to build up an understanding of "drug regimes" for treating common conditions (eg the pharmacology escalation pathways for things like blood pressure, type 2 diabetes, pain management, depression etc). Textbooks and online resources are really good at filling in the gaps of knowledge but clinical experience is both gold for memory and realistic.

Coming out the other side of medschool, the best things I found to prepare me for both 5th year exams and the realities of doctor life was building good relationships with your peers -- this becomes really important building up to exams too when everyone gets stressed, looking out for each other is essential and also because the further away from ELM you get the more you become work colleagues rather than just classmates; the power of observation -- gleaning as much as you can from different situations; asking the right questions at the right time and place; and building the confidence to not shy away from patient contact time if it's within your ability or its a realistic thing to do for someone at your level. I remember the first time I talked to a patient in ED, I was so nervous, but it gets better and better with each consult.

Good luck!! :)
 
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academedical

Otago MBChB V
ELM3 Year in Review

So here we are again! Exams finished a few days ago for ELM3, so here comes another year-in-review.

ELM3 is pretty damn full and under Tony Zaharic’s input, ELM examinations are changing big time. The block modules for ELM3 are: neuro, metabolism, renal, endocrine, repro/development/ageing, and regional clinical anatomy. The modules aren’t so cleanly organised this year - RCA is more like a vertical module (head/neck is in first semester, then thorax/abdomen/pelvis run throughout second semester alongside endocrine and RDA) and much of second semester is a muddle.
  • Neuro is the first module of the year for good reason; there is a LOT of content. It lasts 8 weeks and really hits the ground running. I highly recommend keeping on top of the content right from the start. Do what you can to keep up with everything and learn everything well in that first half of semester because when final exams come, it’s neuro that overwhelms most people. I also wish someone had told me to do some prep before John Reynolds’ brainstem lectures. These are complicated lectures with a lot of info to take in and taking an hour to go over the content before the lecture will make a big difference.
  • Metabolism is four weeks and fairly straight-forward. Some people find it tedious; I didn’t really have any strong opinions on it. Learn all the stuff on diabetes and metabolic syndrome (plus sarcopenia - but that’s retaught in RDA) and you’ll be all good.
  • Renal - I quite like renal but Rob Walker’s teaching doesn’t really seem to be well-tailored to the level of understanding ELM3s already have of renal (that is to say… little understanding. He expects we know more than we actually do, so his lectures feel a bit disjointed). Spending a bit of time with Baby Robbins and going back over Walker's lectures is pretty important here; people tend to get pretty confused by him. As per usual, though, Matty B’s physiology lectures are great and explain renal content much better than the health sci guy. Make sure you spend a bit of time getting your head around the content during the module - don’t leave it to the end of the year! Possibly worth noting here that renal pharmacology is examined by Rob Walker in final exams, not Ivan Sammut, so you should tailor your answer according to the way Rob Walker taught ACE-Is and diuretics.
  • Endocrine only has two lectures, with the rest of the teaching done in tutorials that are run in the same way as Chem Path (it’s convened by the same person) and a couple of histology labs. Do your prep for the tutorials and all the quizzes and you’ll be all good. Past exam questions are pretty much repeated year-to-year and they’ve been put on Moodle in a quiz format with ideal answers; make sure you refer to these answers as the collaboration document on med drive has a lot of incorrect answers.
  • RDA - this is a bit disorganised, but in general it start with repro, then development (embryology, growth, puberty), then ageing. The ageing content it pretty high yield even through there aren’t that many lectures on it. This is one of the few block modules that has well-corresponding vertical module lectures; there are a bunch of psych med lectures on sex which are always examined at the end of the year.
  • RCA is divided into head/neck, thorax, abdomen, and pelvis. Each section has a few lectures followed by dissection labs. This year there was a lot of feedback about not having enough lab dems so hopefully these will be more guided from next year onwards.
Vertical modules are reasonably limited in ELM3; there are far fewer vertical lectures than there were in ELM2.
  • Blood only involves two (consecutive) lectures on blood transfusions. This isn’t necessarily what’s examined at the end of year, though - exams can and do involve questions from ELM2 content too.
  • Infection and Immunity had a few lectures taught by Bruce Russell for the first time this year (and he took the Lecturer of the Year award out from under Matty B by an absolute landslide). There aren’t many lectures but STIs and Immunity Through Life are pretty high yield. Bruce Russell tell you what he’s going to examine.
  • Professional Development covers medical law, which turns up in exams almost every year (usually Consumer Rights - it’s worth sticking those on flashcards and just memorising them - although occasionally the lecture on confidentiality and patient info is examined too).
  • The most important lecture from Ethics is Resource Allocation; there’s a tutorial on this too. Make sure you take away the key points on what determines ‘fair’ resource allocation, DALYs, etc.
  • Pacific Health was examined for the first time this year - there is a day on Pacific Women’s Health which covers the important things: the Fonofale model, cervical smears for Pacific women, and the factors leading to failure to arrive at appointments (recognising that most of the time it’s not a patient problem but a system problem).
  • Unlike in ELM2 where examination was only the Te Whare Tapa Whā model, Hauora Māori now examines a much wider scope of content. Understanding important cultural concepts and values is really important here (Tapu, Rongoa, Whakawhanaungatanga, Mana).
  • Palliative Care is really important and also covered in EPE. It’s corresponds well with the Ageing part of RDA, ethics, and the (new) final case of Integrated Cases.
  • Cancer only has 6-7 lectures but this year it was super high yield (more on that later). There is a new cancer module convener and she seems to expect us to take a health sci approach to study (i.e. knowing everything on every slide) so it’s definitely worth spending a fair bit of time with this content. It’s obviously really important for future practice but this year we weren’t expecting it to be so heavily examined!
  • Pathology is only taught as tutorials (no lectures) with lots of neuro right at the start, then mostly cancer content at the end. I found it really useful for my understanding of the rest of the content from other modules.
  • Pharmacology is almost entirely neuro - this is fairly important content but it’s worth being aware that they emphasise a fair few drugs that are no longer first-line in clinical practice (e.g. Haloperidol is prioritised in lectures while in practice atypical antipsychotics are used more (disclaimer: this is according to my GP, I don’t have this knowledge from direct experience) and they teach venlafaxine as the main SSRI without even mentioning ones like Citalopram which are more first-line).
    • Side note: there is a question in a 2017 (?) exam paper about atropine and a local anaesthetic. That question was redacted; don't worry about it if you come across it.
Placements

ELM3 involves Community Contact Week (CCW) where you’re sent to a community (usually rural) with around 8-12 people. This is before the second mid-semester break (the same time as the ELM2 Hauora Māori week) and you spend 5 days in your community with various placements to different organisations and healthcare settings. The idea of the placement is to get a good idea of primary health care and the challenges of rural health, and do a rapid assessment of public health needs in a particular community. The med school pays for your transport up to your community (for Wellington communities this will be flights, for other places they will cover fuel to get there) and your accommodation, but not your trip back (because some people do placements at their home town and you go straight into mid-semester break after placement). You can be pretty far out - I was in Westport, which meant a 10 hour drive up. It’s a pretty cool opportunity so make the most of it!
There’s also a Kindergarten placement (just 2hrs at a Kindergarten to observe developmental milestones) and a home visit for a lifestyle assessment.

Assessments

Internal

Internal assessments this year are fairly similar to ELM2 with an in-course OSPE, an OSCE (only a history station on neuro), one Cases SAQ (which as usually sparks fury with its controversial marking and time constraints), with a Renal Essay instead of another SAQ. For the first time this year, the in-course OSPE examined head and neck RCA as well as neuroanatomy. The Renal Essay is marked by Rob Walker and uses the same exam questions over and over again. Check out the med drive for the past exams and give them all a go. Usually they cover four of ASPGN, membranous nephropathy, diabetic nephropathy, chronic renal failure, and acute renal failure. This year it was at 3pm on the last day of Semester One and a few people were caught out when they booked flights too early.

Terms requirements also involve a 20-drug formulary (your ELM2 one plus 10 drugs). If you add a bunch of neuro drugs at the start of the year this will be a breeze; they didn’t remind us this year that it was due, so heaps of people ended up scraping one together on the last day. If you do it right at the start of the year, you can avoid getting stuck rushing it right before exams.

There is an ELM3 Reflective Essay (worth 5% or so) in second semester, which is on grief and suffering. It is semi-academic, so it needs to be a reflective essay with some degree of academic formatting and ~5 references to books or academic papers.

There is also an independent report and a group report on CCW which needs to be satisfactory or you’ll be asked to do it again. Be aware that the group reports are often sent back to the communities you stayed at, so keep that in mind while writing them!

Retained Knowledge Tests are still terms requirements of course. It’s definitely worth having an honest attempt and completing it without looking up answers because it’s cool to watch your score go up as time goes on.

End-of-year
  • SAQs - these are done first in ELM3, with three papers as in ELM2. This time there is no public health/EBP paper to analyse. Previous years have had super repetitive questions, but with Tony Zaharic as the assessment convener there has been a big drive to change up exam questions. This is good in terms of making sure people learn things properly instead of just learning exam questions, but it turned a few things to chaos this year. In our SAQs, cancer was examined in every paper and there was examination of the cancer module than neuro or renal (which only had one question each - a brainstem question and a diabetic nephropathy question). Paper A had people pretty riled up after they examined chemotherapy drugs that hadn’t been mentioned by the lecturer; the topoisomerase inhibitor they taught was doxorubicin but the one they asked was mitoxantrone, which no-one had heard of. It will be interesting to see what they do in future years because the marks will be pretty low.
    Usually one of the exam papers just has one long (~170 minute) case - this is the RDA case.
  • OSPE - this is basically the same every year. Do the past exams on the drive and you’ll be all good because a good 70% of the questions are repeated year-to-year.
  • OSCE - these are done after writtens. After the cheating scandal last year, they changed up how it’s run. OSCEs have now been divided into examination stations on day one with history stations on day two (and then phase 2 is a mix of both for those called back on the Friday).
    • Examination station day - there are four groups run in the day; two morning groups and two afternoon groups. Each group has two examination stations and the stations are different between groups to prevent people from being able to tell others what they had. So for example, this year one group had ocular movements and GI exam while another group had coordination tests and cardio exam. It was a bit of a mess this year because one of the stations (the one assessing ELM2 content - cardio, resp, GI) involved much more than is usually expected in an examination station: for the GI one we were asked to take pulse, BP, palpate the abdomen, and percuss the liver. Many people weren’t able to complete this station, so they were called back for phase 2. They may change things up again next year as they try to make the OSCEs as fair as possible.
    • History station day - this was just divided into two; the morning group got dizziness and carpal tunnel while the afternoon group got tiredness (hyperthyroidism) and jaw pain (trigeminal neuralgia). Splitting people up into groups just means we don’t have to be held for as long and there is less opportunity to communicate with students who are sitting later. They also take everyone’s phones/devices now (you can’t keep it in your bag) and count who handed in a phone and who didn’t bring a phone. There are heaps of supervisors in the holding room watching everyone too.
I think the overall breakdown of marks was pretty much the same as ELM2. For OSCEs, the mid-year OSCE itself isn't worth anything but the assignment you write on it is worth 10% of the total OSCE grade. For writtens, it is: Cases SAQ (4%), OSPE (5%), renal essay (6%), and reflective essay (5%). I can't remember what proportion of the remaining 75% is end-of-year OSPE vs. SAQ, but OSPE is usually fairly small (~10-15%).

Resources
I limited my resources pretty heavily this year, sticking mostly to content provided by the course. Here are some of the things I did use:
  • Baby Robbins - I find this really helpful as pre-readings for pathology. It aligns really well with pathology content and describes things really well, but most people barely bothered with the intro slides for path so the textbook won't be up everyone's alley. 9/10
  • Grey’s Anatomy - this is referenced a lot in RCA lab books but I personally found it pretty unhelpful. It didn’t really have enough detail for much of the course; in general I found the lectures to be more helpful. I generally only used it to figure out answers to clinical-based questions in the lab books. 4/10
  • Netter’s Anatomy Flashcards - much to my surprise, I didn’t use this a huge amount this year. Some people swear by them, but I only used them a bit for head/neck RCA. My study was more based around making my own diagrams and quizlet flashcards. 5/10
  • Focused History Taking for OSCEs - the further I get through the course, the more helpful this book gets. It’s really good for making sure you’re asking all the right things in OSCEs. For the first time ever, I felt really good about the history I took in end-of-year OSCEs and that is at least partially attributable to this book. I still think it will be more helpful for ALM when there is more emphasis on diagnosis, investigations, and treatment, but it’s still useful in ELM.
  • OUMSA Case Book Level 2 - I’m really iffy about this book. There are a lot of inaccurate things and stuff that is straight up wrong, so if you use it make sure you use in in conjunction with lecture/lab/tutorial notes and edit things as you go. Don’t use it as a book of facts or a reference book. I bought it again this year just because I wanted a guide to make sure I was covering all the content I needed to - it covers the key stuff from every block module (except anatomy - the anatomy in it is very insufficient) and has a section on cancer as well. Its EPE content is pretty solid in terms of what’s high yield. Basically: use it if you want, but be aware that there are plenty of things in there that are incorrect, so you need to be editing and adding to it as you go.

All the other things (textbooks for physiology, clinical examination, pharmacology) are pretty pointless so I don’t recommend them. I bought Netter’s physiology flashcards before ELM2 because I was overly keen and I’ve never touched them. I did try to use the PDF version of First Aid Step 1 but I never did much with it. I suspect the physical version is more helpful - I just didn't find it added a huge amount to neuro (but I didn't try to use it beyond neuro, so for all I know it could be super beneficial for later on in the year).
For end of year practice, having your own pen light and tendon hammer is cool if you can spare the thirty bucks but they’re definitely not necessary. I made use of my sphyg too, but again enough people have them that there are usually one or two available for practice within a group.

Things That Work and Things That Didn’t
  • Flashcards were my best friend this year. I used both Anki and Quizlet; making neuro and RCA head/neck flashcards in first semester turned out to be really valuable at the end of the year when I needed to review key info without spending ages on it. Plus, as I went through past exams, I made an Anki deck called 'Things I Don't Know' and added stuff to it as I found information that wasn't really sticking. I reviewed that deck every day in the week or two leading up to SAQs and it definitely got me some extra points.
  • Past exam papers used to be really valuable and they’re still definitely useful for reviewing that content that will become really important in future, but with Tony Zaharic’s changes they may not be as useful as predictors for SAQ questions now. I still recommend doing them because there is some content that will always be high yield or won’t change much (brainstem content, endocrine, palliative care, and ethics have all remained repetitive) but I don’t think we can rely on them anymore.
    • Note: there are answers on the med drive for various past SAQs - fair warning that there are plenty of incorrect answers in these (not everything, but enough that you need to be aware of it and refer to lectures/notes rather than relying on what other people are saying).
  • I found it really helpful to make my own notes with diagrams/drawings on the key anatomy and physiology content from each of the block modules during the year. Doing this meant that all the key content was compiled in an organised manner so that it was easier to access and review at the end of the year.
  • There was a three day break between SAQ C and OSCE day 1, which most people used to do OSCE practice with friends. These three days were enough to cover all examinable content (which is actually quite limited - a lot of ELM3 clinical skills content is ‘knows how’ rather than ‘shows how’) multiple times, which took the pressure off doing OSCE practice before SAQs.
  • Be really careful when it comes to getting information from other people. There has been an awful lot of inaccurate information going around this year that has screwed a few people over - people saying things that aren’t accurate or using OSCE techniques that aren’t correct (the clinical skills team has emphasised that you must do the technique as described in the book, not how tutors might teach it). Only trust official content like lectures, lab books, and tutorial books!

Just as a side note, I want to point out that my summary is very assessment-focused because that’s where the emphasis is placed in ELM, but it’s worth trying to keep perspective during ELM and remember that we’re learning to look after patients in the future. Obviously that means all of the content is important, not just the stuff that gets assessed. And of course here's the disclaimer that this is just my perspective on things, it may not correspond to what other people think!

All-in-all, this year went by really fast. Lots of people burned out around mid-year and people lose motivation in ELM3 (the med school complains about ELM3 lecture attendance every year). Try to break down your study into bits throughout the year to avoid getting overwhelmed at the end of the year. You don’t want to get left behind if you can help it because stuff piles up super fast.
 

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Cathay

🚂Train Driver🚆
Emeritus Staff
What is the daily structure of med school like, like how many contact hours are there? Thanks!
Assuming they haven't changed it since 2013, things come in 2-hour slots, 9am-11am, 11am-1pm, 2pm-4pm, 4pm-6pm. (This means 1pm-2pm is the guaranteed lunch break.)

There are 8-10 lectures per week (which are whole-class), and lectures are usually 2x back to back 1-hour lectures to fit into the 2-hour timeslot. For everything else, the class is divided into 4 streams, A1, A2, B1, B2; each stream will have labs and tutorials at the same time (but is further divided into smaller tutorial groups for said tutorials).

Each week there would be the 3 regular tutorials, Clinical Skills, Case Tutorial, and HIC (now EPE or something). There tends to be a fairly regular pathology tutorial (and even when it doesn't run, another tutorial tends to go in the same slot with the same group). Otherwise various labs and other tutorials are dotted all over the timetable, and med school will put out a spread sheet on Moodle (updating as they go) with what each week looks like. I think there was a tech-magic way to get up-to-date schedules to your phone via iCalendar and Google Calendar, even then.

Contact hours wise, out of the total 40 available hours (20 slots - excluding any 8ams) they tend to schedule 20-24 hours (a "typical" week might have 22 hours worth), but from one such old spreadsheet in my dropbox I see there was at least one week where it was 28 hours. The unoccupied slots are labelled "Independent/Group Work" to encourage, you know, studying.

I vaguely remember something about a guideline that the scheduled "independent/group work" sessions correspond to how many hours you were expected to spend studying (about 18 hours a week). I think this means if you fully utilised those independent/group work hours to study, you would theoretically not have to do anything in the evenings or the weekend - I'm not sure if any of us were quite disciplined enough to actually try this out, though.

The workload is meant to be approximately 4 hours a day with some 6-hour days, but it's not distributed evenly, so some streams will have regular 8-hour days with some less busy 2-hour days. My stream in 2nd year, B1, had regular 8-hour Thursdays, but this also meant some Fridays were free (*ahem* Independent/Group Work-only) days.

Occasionally there might be an 8am class (we used to have patients coming in at 8am Monday now and then by way of "Case Introduction" - introduces the Integrated Cases scenario for the fortnight by talking to a patient to whom a particular condition has happened), so that's a thing too.
 

stresso

Otago MBChB BMedSc(Hons)
Assuming they haven't changed it since 2013, things come in 2-hour slots, 9am-11am, 11am-1pm, 2pm-4pm, 4pm-6pm. (This means 1pm-2pm is the guaranteed lunch break.)

There are 8-10 lectures per week (which are whole-class), and lectures are usually 2x back to back 1-hour lectures to fit into the 2-hour timeslot. For everything else, the class is divided into 4 streams, A1, A2, B1, B2; each stream will have labs and tutorials at the same time (but is further divided into smaller tutorial groups for said tutorials).

Each week there would be the 3 regular tutorials, Clinical Skills, Case Tutorial, and HIC (now EPE or something). There tends to be a fairly regular pathology tutorial (and even when it doesn't run, another tutorial tends to go in the same slot with the same group). Otherwise various labs and other tutorials are dotted all over the timetable, and med school will put out a spread sheet on Moodle (updating as they go) with what each week looks like. I think there was a tech-magic way to get up-to-date schedules to your phone via iCalendar and Google Calendar, even then.

Contact hours wise, out of the total 40 available hours (20 slots - excluding any 8ams) they tend to schedule 20-24 hours (a "typical" week might have 22 hours worth), but from one such old spreadsheet in my dropbox I see there was at least one week where it was 28 hours. The unoccupied slots are labelled "Independent/Group Work" to encourage, you know, studying.

I vaguely remember something about a guideline that the scheduled "independent/group work" sessions correspond to how many hours you were expected to spend studying (about 18 hours a week). I think this means if you fully utilised those independent/group work hours to study, you would theoretically not have to do anything in the evenings or the weekend - I'm not sure if any of us were quite disciplined enough to actually try this out, though.

The workload is meant to be approximately 4 hours a day with some 6-hour days, but it's not distributed evenly, so some streams will have regular 8-hour days with some less busy 2-hour days. My stream in 2nd year, B1, had regular 8-hour Thursdays, but this also meant some Fridays were free (*ahem* Independent/Group Work-only) days.

Occasionally there might be an 8am class (we used to have patients coming in at 8am Monday now and then by way of "Case Introduction" - introduces the Integrated Cases scenario for the fortnight by talking to a patient to whom a particular condition has happened), so that's a thing too.

I was in ELM2 last year and can confirm that everything is still pretty much the same :)
 

academedical

Otago MBChB V
Here we are again! I finished fourth year a month or so ago, so I’m here to give a run-down of it for anyone who’s interested. It’s pretty long but hopefully useful for up-and-coming fourth years. There is a lot of info on MSO about ALM in Christchurch and unfortunately I can’t expand this to the other schools because I’m also in Christchurch (best decision IMO), but with a bit of luck some of it can be generalised to the other school. Bear in mind that this year was super disrupted due to COVID, but I’ll do my best to explain what you can expect.

Before starting fourth year I was a little confused about the concept of ‘sister groups’ in ALM. The idea is that your year is split into groups of 12-13 people, which is your group for the year (assigned a letter A-H). You can think of ALM4 as four 8-week runs: SEGO, GP, Public Health + OPH, and Cardioresp + CVPD. Some of the runs will go for the whole 8 weeks (e.g. GP and surgery) but others are only 4 weeks and therefore are paired together. Two groups (you and your sister group) will be on an 8 week cycle any one point in time – this means you might both be doing GP, or you might do public health while your sister group does OPH (then you swap over). You’ll get to know your own group and your sister group really well over the year.

Block Modules

SEGO


SEGO stands for Surgery, Emergency Med, Gastroenterology, Oncology. It’s an 8-week run and is probably the most intense of the 4th year runs. I had it as my first run, which suited me really well because I’m not sure I would’ve had the motivation to complete all the assignments by the end of the year! It definitely throws you in the deep end though – it’s normal to be pretty overwhelmed and confused at the start.

Both you and your sister group will be on Surgery, but you’ll be split up for Gastro and Onc (one group will do Gastro for 4 weeks while the other does Onc, then you swap). You have to schedule at least 4 Emergency Medicine shifts over the 8 weeks, each shift being 4 hours long.

For surgery, 3-4 of you will be assigned to a surgical team that consists of ~3 consultants, a senior registrar, junior registrar, house officer, and TI. Your consultants determine your grade for the run in discussion with your registrars. In general, you do whatever your registrars are doing, with the exception of any formal teaching. This means for the most part you will be in elective surgeries, on ward rounds, in outpatient clinics, or in endoscopy. The surgeries are spread across Christchurch Hospital, St George’s, and Southern Cross – you may be asked to go to any of these hospitals. When you’re on ward rounds, it’s a good idea to get a nurse and the patients’ fluid charts each time you get to a new ward; this is helpful for the registrars.

Your team will also be assigned to ‘acute days’ – these are days where the team looks after people who have come in acutely through ED. These are long days, expect to be there ‘til late in the evening. This is also your best chance to take histories, take blood, put lines in, and scrub in + assist in surgery. They’re really valuable days, so make the most of them.

Gastro consists of weekly outpatient clinics (half-days) and bedside teaching on Fridays. You’re also meant to attend at least one gastroenterology endoscopy and complete an assignment based on that. Oncology consists of weekly outpatient clinics and formal tutorials on Fridays. With Covid-19 I never actually got to do Oncology (only caught one outpatient clinic before they were closed to students) so there may be more to it, but I wouldn’t know!

There is also formal teaching every Friday afternoon that consists of a tutorial each from Surgery, Gastro, and EM.

The assignments are:
  • 2 Surgical Long Case Histories
  • Surgical Pathology Presentation
  • Attend a session in the path lab
  • Surgical Log Book (~25 Surgeries)
  • 1 Gastro Case History
  • 1 Gastro Endoscopy Log
  • 1 Onc Case History
  • 1 Onc Log
  • 4 ED Shift Logs
  • End-of-run OSCE (one OSCE for each of the specialties)
There’s a lot to keep up with so you should definitely start early. I highly recommend doing your surgical log book as you go, in any free time you get. Talk to your team early to get a patient for the surgical long cases because those come up super fast.

The OSCEs are meant to be super predictable – I personally didn’t do them because the lockdown meant they were cancelled. However you can be pretty confident that it’ll include:
  • Abdominal exam for the surgical OSCE
  • Gastro history
  • Airway management for EM (the guy who runs this is super nice, pretty much never fails anyone)
  • Questions about management of one of the oncology emergencies (neutropenic fever, spinal cord compression, hypercalcaemia)
Honestly this run was a big eye-opener for me in a lot of ways. Being enthusiastic about learning and asking lots of questions is more important than knowing absolutely everything (honestly most of the consultants and registrars expect very little from fourth years). I put a lot of time into each of the assignments and never felt like the marks/feedback I received reflected that effort. That was probably the first indicator I received that I needed to change my approach and perspective from ELM. I also burned out really quickly. This happens to a lot of people; make sure you get help early (chat to Tania from student affairs) if it happens to you. Your TI will likely be your best go-to in terms of finding your way around the run, figuring out assignments, and coping with the demands of the run.


Older Person’s Health

In OPH you attend placements at Burwood Hospital, which I understand involves very long days of rounding. Tutorials are also at Burwood; these include common conditions in OPH (frailty, stroke, falls, etc.) and three psych tutorials. This part of the year was during peak COVID time for me, so everything we did was on Zoom. It’s very focused on holistic medicine and considering the wider aspects of patients’ lives. One of the key skills you learn here is the Neurological exam – you’ll cover this again in ALM5, but the neuro exam will be assessed in the OPH OSCE.

The assessments for this run are:
  • Long Case (which is VERY long – find a patient early)
  • Complete a MOCA on someone
  • Confused Patient Short Case
There is potentially also some form of written assessment; we had to do a number of short answer questions, but I’m not sure if those were purely as an addition due to our lack of placements.

I personally quite enjoyed the run; the people are lovely and it’s quite a different perspective from the usual busy hospital medicine. That said, I didn’t get to be on the wards. I hear you sometimes get stuck doing wards rounds until 3pm! My main recommendation is that you get started on your long case early – it’s very comprehensive and can’t be done as a last-minute thing.



Public Health + Addiction Medicine

The first three weeks of this run are Public Health, followed by a week of Addiction Med. Again, I did this during lockdown (which was ideal – everything was just converted to Zoom tutorials and online activities). It’s primarily lectures and tutorials, although there are a few visits to different agencies. Lots of people find this module boring but I didn’t particularly mind it. Different tutorials are taken by different people, so there’s a lot of variance in how engaging they are.

The assessments are:
  • Advocacy Presentation (as a group)
  • Clinical Presentation (on the addiction recovery centre you attended)
  • Recovery Group Meeting Report (after attending an AA session or similar)
  • Addiction Medicine OSCE
  • We did this over zoom and it was effectively a series of questions relating to alcohol use disorder. Usually you would talk to a patient about their alcohol use and have a chat about ways they can start to change their drinking.
  • Letter To The Editor (in pairs)
We also had to complete written activities for most of the online tutorials – I’m not sure if this will continue next year.

The main disappointment for me in this run is that you don’t learn much about the science side of addiction medicine. I thought we’d learn about things like overdosing, how different drugs work, etc. but it primarily focused on the lifestyle side of Cannabis and Alcohol use. Obviously those are super important too, it just wasn't at all what I was anticipating.



General Practice

This is an eight week run and definitely the least-intensive run of the year. You get assigned to two half-days (afternoons) with GPs and have a few tutorials each week. This includes common conditions in the community (things like asthma, UTIs) as well as alternating three hour tutorials on history taking and clinical examination skills (mostly MSK, although they also cover use of an otoscope and ophthalmoscope, and vaginal exam). The people running this rotation are super lovely!

What to expect from GP clinics varies greatly according to who you are with. For example, one of my placements was in the Sexual Health Clinic – so we had a lot of fairly long appointments that were all focused around diagnosing and treating STIs, plus plenty of patients requested not to have a student in the room. In my other clinic, my GP mostly had me observe and take patients’ blood pressures. Other GPs may ask you to take a history from patients.

The assessments for this run are:
  • Clinical Question Project
    • You will get a lot of guidance around the specific of this, but it’s basically about using up to date research to answer a question about a patients’ healthcare/treatment.
  • OSCE
    • This is done in pairs on the MSK system. You perform a selected exam on your colleague, they perform it on you, and then you swap over and do a different exam. You will get two of: shoulder, spine, hip, knee. It’s pretty hard to fail these.
  • Written test
    • This is done online (and open book, at least for us) and consists of ~5 clinical scenarios based on the core topics you have covered in tutorials. It’s basically about being comprehensive and considering the whole picture.
History taking skills are supposedly assessed by your GPs, although mine didn’t do that. Everything else comes down to professionalism and being willing to learn.

Overall, this was a fun run with lots of friendly people and lots of down time (ideal for the end of the year when you have vertical module exams coming up!).


Cardiorespiratory + CVPD

These 8 weeks are divided into a CR half and a CVPD half, but the tutorials run over the whole 8 weeks and most of the assessments are done at the end of the 8 weeks.

Cardioresp

In this four-week run you will be assigned either to a cardiology team or a respiratory team. You attend ward rounds every day at 8am, go to formal teaching, and schedule a few activities (spirometry, cath lab) for whenever you have free time. You will have a total of 12 bedside tutorials throughout the full 8 week period (they can’t fit them all into the 4 weeks of Cardioresp so 4 of the tutorials run through the CVPD half of the module) where you learn history and examination skills. There are three ECG tutorials which I personally really enjoyed – it is definitely worth doing prep for these and at least trying to interpret the ECGs in your workbook in advance.

If you get assigned to a cardiology team, you can swap with a respiratory person in week four if you like (and vice versa).

CVPD

CVPD stands for cardiovascular, plastics, and dermatology. Here you have most of your activities scheduled for you and you can do as many additional activities as you like. You also get a suturing session where you learn to suture on pig’s feet. This is run by Jeremy Simcock, a plastic surgeon, who is very down-to-earth. I highly recommend attending his plastics theatre if you can – he will let you do as much suturing as possible (don’t worry about messing it up – he’ll pull out the sutures and re-do them if he has to).

Unfortunately there is pretty much no dermatology teaching – that aspect of the module basically comes down to one half-day in outpatients clinic and your own learning at home. They don’t tell you this to your face (you pretty much have to go looking for it) but there are a bunch of online modules you are expected to do as part of this module. Spend some time before your dermatology clinic learning about the core conditions listed somewhere in the depths of Moodle.


The assessments for CR/CVPD are:
  • Cardiorespiratory Critical Appraisal presentation
    • Find a recent pivotal paper on a cardiorespiratory topic, critically appraise it, and present it.
  • Cardiorespiratory “short” case history (it’s about 7 pages. You can submit 2 practice ones per week in the lead-up to the final one and you’ll get lots of feedback on them)
  • MCQ
    • This is really dumb. The questions are taken from a question bank on Moodle, written by other students (resulting in a few very confusing and some blatantly incorrect questions). My recommendation is to do the practice quiz 10-20 times (it’s composed of 30 questions from a bank of ~150) to make sure you cover all possible questions, then you’ll know the answers to the test itself. I’m not really sure what the point of this is to be honest, it didn’t teach me much. Most people did that and finished the test in 3 minutes.
  • E-Poster
    • On any CVPD topic – A0 e-Poster with details about a very specific condition or treatment for a condition. Check your topic with Jeremy Simcock before you start this!
  • Bronchiectasis Online Module (easy to forget – do it early)
  • Workbook (records your learning points from activities – due at the OSCE)
  • OSCE
    • You do 3 stations and there are 1 stations running simultaneously (usually – mine had 14 because we had an extra person). Usually you will get a history, exam, and education station, but one of those could be replaced with an MCQ station. Our stations were as follows:
      • Vascular, respiratory, or cardiology history
      • Vascular, respiratory, or cardiology exam
      • Dermatology history and exam (in one station – note you never actually get taught how to do this, you have to learn it yourself)
      • Asthma/inhaler patient education
      • Sun-smart patient education (Jeremy pretends to be the patient – he was really nice about it)
      • Smoking cessation education
      • GTN patient education
      • Cardioresp MCQ (on a computer – heart sounds, X-rays)
      • CVPD MCQ (this was a surprise one – and most people failed it. You had to diagnose skin lesions, identify the location of tendons in the wrist, etc.)
Make sure you develop some sort of structure for how you’re going to do patient education stations – this is the first time you will come across these. Approach it as a conversation with the patient. Take a brief history about the relevant topic (e.g. their asthma, what it’s triggered by, how often they use their inhalers, etc.) and find out what they know. Make it interactive – it’s not meant to be a monologue!

You also have to submit four MCQs to Moodle – these aren’t marked but they do need to be completed for terms.

This whole run can be as quiet or as busy as you want it to be. There is a lot to learn from it if you have a good shot at it and it can be really interesting.


Vertical Modules

The main vertical modules in ALM4 are pathology ones: Anatomical Pathology (grouped in with Radiology), Haematology, Clinical Chemistry, Immunology, and Microbiology. There are also other smaller modules like Hauora Maori, ethics, palliative care, quality and safety, and professional development. Most of these have some form of assessment. The most important ones are the pathology exams at the end of the year. These are one-hour written exams with two weeks between each one.
  • Clinical chemistry – MCQ, covers the clin chem lecture material. He’ll tell you which lectures to focus on. A few of the questions were on small niggly details.
  • Microbiology – this is known for being the one that most people fail. It is MCQ but multiple answers can be correct – so it’s more like 125 true/false questions. These assess things in a lot more detail and there have been a lot of complaints about the department assessing things that weren’t taught.
  • Haematology – MCQ, much more straight forward. Séan MacPherson is very entertaining and great at teaching.
  • Anatomical Path/Radiology – this is an OSPE but you’re all in the lecture theatre looking at images on a projector. All images are taken from your tutorials (lecture material isn’t explicitly assessed), 12 are on anatomical path and 3 are on radiology. Any questions you get wrong will be sent to you for you to correct via email.



Clinical Skills

This is run in the Sim Centre, which is really cool. You’ll get a book at the start of the year; use this as a reference and do prep for each of the sessions (from 2021 onwards they’ll be checking if you’ve done the prep and it’ll be a terms requirement). You learn a lot of clinical skills on the wards as well (especially SEGO acute days – take all the opportunities you can get to practice those skills!). The main 4th year clinical skills are venepuncture and cannulation, airways + breathing, digital rectal exam, catheterisation, and safe patient handling. There are also other clinical skills tutorials throughout the runs (e.g. CPR in CR/CVPD, pelvic exam and MSK exams in GP, etc.).

At the end of the year there is an ESLO – this is kind of like a four-station OSCE except it isn’t actually marked. You basically walk into the room in pairs, one student conducts the clinical skill in question while the other marks off the steps on a checklist. A tutor observes and provides feedback at the end. Most of the tutors are super chill. Our stations were: IV cannulation, venepuncture, airways/breathing in a man with COPD exacerbation, and digital rectal exam.


What Worked and What Didn’t

Unfortunately, COVID interrupted most of my plans (of course). But my general recommendation would be to do the prep wherever possible and get hands-on experience whenever the opportunity presents itself. I never felt like I was covering all the right material while studying, so I ended up getting Master the Boards and worked through each section during the relevant block module. It worked surprisingly well as prep work for the GP tutorials, too.

I don’t recommend burying yourself in study during fourth year. Keep up with things as they happen (Master the Boards just happens to be my personal method) but leave the full-blown study to fifth year. Focus on getting used to the clinical environment and getting as much clinical experience in as possible.


Resources

As I’ve already said, Master the Boards was my main textbook. I also have my ELM textbooks (specified in previous posts here) – the main one I used was Focused History Taking for OSCEs. I also invested in Oxford Handbook of Clinical Medicine (which I used a fair bit during SEGO) and Data Interpretation for Medical Students (which I found super useful throughout the entire year). Most of the other textbooks I’ve mentioned in previous posts were either left untouched or only picked up once/twice.


The rest of the resources I used during fourth year were online resources:
  • healthpathways is super helpful and I recommend getting used to using it early on (you get access to it via Moodle, don’t try to make an account!)
  • geekymedics has a few good run-downs for OSCEs
  • Liftl.com and almostadoctor.co.uk were introduced to me by one of the registrars I worked with; they’re pretty good for looking up certain topics
  • Pubmed was my go-to for anything research related
I decided not to invest in any paid subscriptions to learning sites or question banks (like Sketchy or Passmed) until 5th year.

Obviously you also need a steth; as discussed before, cardiology steths are overkill and most of the cardiology registrars don’t even use them. I liked having a sphyg, pupil torch, and tendon hammer as well for practice purposes.

Have some way to jot down notes during your runs as well; I had a mini notebook that fit in my pocket. Every time I came across a condition or drug I didn’t know, I wrote it down to look up later. Occasionally the house officers or registrars your work with will give you mini teaching sessions too, and a little notebook will come in handy for those, too.

My other recommendation is to get some sort of filing system for all the paper-based stuff you get throughout the runs. I personally have a folder for vertical modules and one for block modules (with tabs dividing each of the modules) and that has worked well for me. I take most of my notes on OneNote, but a lot of Path lectures provide printed versions of the slides and extra notes as well.





As per usual, this is ridiculously long, but congrats on making it to the end. I have yet to proof-read it (I’ll get to it, I promise), so apologies for any mistakes throughout. I also imagine I've missed a few things, I'll add to it as they come to me. Feel free to ask any questions and I’ll do my best to answer them. I hope this has been helpful!
 

LMG!

MBBS IV
Administrator
Probably a super random question given the length and breadth of this post, but just a quick one: did you do the certification for the MOCA? I have previously registered to use it, but it has recently undergone an update that requires a certification in order to use it and the certification has a cost attached. I keep getting reminders from the company that my authorisation is pre-certification and I need to update it, but I keep putting it off. I'm obviously not in NZ, but it's still very widely used here in Aus, too, so just wondering how likely I am to need to do this anyway, so may as well just do it now?

More broadly, this is a great post! Thank you for your contribution!
 

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Probably a super random question given the length and breadth of this post, but just a quick one: did you do the certification for the MOCA? I have previously registered to use it, but it has recently undergone an update that requires a certification in order to use it and the certification has a cost attached. I keep getting reminders from the company that my authorisation is pre-certification and I need to update it, but I keep putting it off. I'm obviously not in NZ, but it's still very widely used here in Aus, too, so just wondering how likely I am to need to do this anyway, so may as well just do it now?

More broadly, this is a great post! Thank you for your contribution!

NZ Hospitals are phasing out the MOCA and using the Mini-Ace instead
 

LMG!

MBBS IV
Administrator
NZ Hospitals are phasing out the MOCA and using the Mini-Ace instead

This is happening in the hospital that I work at too (we are moving to the Mini-Cog, I think) which is why I was interested to see it mentioned here. Good to know it seems to be a broad change. Thank you.

(I do have more thoughts about this but they're totally off-topic for here!!)
 

academedical

Otago MBChB V
Probably a super random question given the length and breadth of this post, but just a quick one: did you do the certification for the MOCA? I have previously registered to use it, but it has recently undergone an update that requires a certification in order to use it and the certification has a cost attached. I keep getting reminders from the company that my authorisation is pre-certification and I need to update it, but I keep putting it off. I'm obviously not in NZ, but it's still very widely used here in Aus, too, so just wondering how likely I am to need to do this anyway, so may as well just do it now?

More broadly, this is a great post! Thank you for your contribution!
They taught us how to administer it, but we didn't do any formal certification.
 
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