Otago MBChB - Overview of the Years

Discussion in 'MBChB' started by academedical, Dec 6, 2018.

  1. academedical

    academedical Otago MBChB III

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    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
     
    Last edited: Dec 6, 2018
  2. travellingspaceman

    travellingspaceman New Member

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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)
     
  3. academedical

    academedical Otago MBChB III

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    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.
     
  4. travellingspaceman

    travellingspaceman New Member

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    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
     
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