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pi's review of Monash Med units

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pi

Junior doctor
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I wrote these reviews on the ATAR Notes forum, but they'd probably be of more use to people here so I'll transfer them over with some updates given retrospection. Happy to field questions about the course in this thread. Note that I started the degree while it was 'just' an MBBS, since then it's moved from MBBS(Hons), to a BMedSc/MD program, thus there may be some old information here, but most elements will still be relevant for the current students. I'll also provide bonus reviews on the BMedSc(Hons) which I was lucky to complete with first class honours in 2016.


Subject Code/Name: MED1011 - Medicine 1

Workload: per week: 12 x 1hr lectures + 1 x 2 hr prac + 4 x 2 hr tutorials + 3.5 hr PBL (Problem Based Learning tutorial) + occasional site visit

Assessment: For the semester - 25% Mid-Semester Test, 50% Case Commentary Assignment, 25% End of Semester Exam (formative assignments include practical write-ups and weekly quizzes). In terms of the year - 5% Mid-Semester Test, 10% Case Commentary Assignment, 5% End of Semester Exam

Recorded Lectures: Yes, with screen capture that includes lectures notes being written on (although some things were written on overhead slides)

Past exams available: No, the Faculty has published a document with threats to expel students from the course if they are caught compiling past questions or distributing or using past compilations. All past compilations have been removed from the MUMUS site.

Textbook Recommendation:
  • Clinical Examination A Systematic Guide 7th - O'Connor and Talley*
  • General Anatomy - Adams, Ahern, Briggs and Eizenberg*
  • Langman's Medical Embryology 11th - Sadler
  • Life The Science of Biology 9th - Berenbaum, Heller, Hillis and Sadva*
  • Medical Sciences 1st - Court, Naish, Revest
  • Microbes in Motion 3 - Delisle and Tomalty
  • Neuroscience Exploring the Brain 3rd - Bear, Connors and Pradiso
  • Rang and Dale's Pharmacology 7th - Dale, Flower, Henderson, Rang and Ritter*
  • Textbook of Medical Physiology 12th - Guyton and Hall
  • Wheater's Functional Histology A Text and Colour Atlas 5th - Heath, Lowe, Stevens and Young
* means essential

Lecturer(s): Many, depending on the series of lecture (biochemistry, cancer, pharmacology, haemotology, immunology, pathology, etc.)

Year & Semester of completion: Semester 1, 2012

Comments:
I'll say this from the onset, your first few weeks in the degree can often feel like this...
...and that is completely normal! It's worth realising now that uni is not like school, you won't breeze through uni like you did in school. You just won't. No one does. No one. Everyone here is as smart or smarter than you, and the Faculty knows it. So your exam and assignment results might not be hitting that 95%, or heck, might not even hit that 70%. And that is FINE. Transitioning to uni is different for everyone, some get used to it in weeks, others take years. First year, in comparison to the rest of the degree, is hardly worth anything at all. Your first exam and assignments are worth a fraction of that. Please don't stress too much if you end up being in the bottom quartile of students for a particular assessment, you're still smart and still deserve to be there. Focus on learning from your mistakes and mixing up your study routine, and eventually things will fall your way.

One more thing I'll add before I get into the nitty-gritty. Med students have a horrible habit of still caring about high school. It's not unusual for you to field silly questions about ATARs or UMATs or Bonded/ERC status. Let me tell you this: I came into the degree knowing I was in the bottom 25% (in fact, I was cheekily informed I had the lowest ATAR in my row in a lecture once, and my ATAR was still 99+), but I finished Year IV into the top 25%. How you did in school, is largely irrelevant. Uni is a clean slate, and no one should care about your ATAR and UMAT, especially you. Time to move on.

Alright with that mini-rant out of the way, let's talk about the nitty-gritty. For some, this actually starts with the Biology Bridging Course. I personally did VCE Biology, but I delved into the bridging course mainly out of boredom. In all honesty, it's a decent course, but it's much harder to retain knowledge online compared to others who had a whole semester or two to learn that same things during school. Therefore, if you haven't done high-school Biology, you will be at a disadvantage, but it's worth noting that this disadvantage is only evident for the biochem parts of MED1011. You're on level ground for the rest of the unit, and for the rest of the degree.

Speaking of the degree, it has a "general structure" and is divided into four parts (or themes of study):
  • Theme I: Personal and Professional Development
  • Theme II: Population, Society, Health and Illness
  • Theme III: Foundations of Medicine
  • Theme IV: Clinical Skills
Of the four themes, I (and the vast majority of the cohort) found themes III and IV to be the most enjoyable because they focus on knowledge and skills that have a direct and practical use in future life as a clinician. Themes I and II contain a lot of theory, a lot of which is very logical and dry. Luckily, majority of the course is focused on themes III and IV, and the exams reflect that too. Now let's get into this uni specifically.

The lectures during this unit are very good, with most of the lecturers being very captivating and interactive with the students. Questions are allowed to be asked before, during and after the lectures, and all lecturers are more than happy to respond to emails afterwards. The lecture notes/slides given are also of a decent standard and it is possible to pass the unit solely using these. There is no attendance requirement for this unit, however it is expected that students attend all lectures (most lectures are nearly full, so that shows the quality of what is given). Granted, if you cannot attend lectures, that's fine because they are recorded (with video) and posted online for your own perusal.

The tutorials during this unit are also very enjoyable. Each tutorial focusing on one aspect of the themes; for example, in the Clinical Skills tutes we learn how to take patient histories, give injections, take blood pressures and measure the vital signs. Most tutes encourage group discussions and teamwork, which is often good. The one exception to this are the Problem Based Learning (PBL) tutes. These tutes are famous around the world and are present in many unis in some form or another, but I really think they're over-rated. These tutes are student-led with a doctor overlooking the tute progress, and how much you learn is dependent on your group. If you have a few duds in your group, which is almost inevitable, then it's really annoying. Other than PBL though, all other tutes are led by doctors, GPs and registrars, and are of a good standard. Worth noting that there is a strict 80% attendance requirement for all tutes in this unit.

In addition to tutes and lectures, external site visits give this unit extra depth and enjoyment. During the unit, each student is able to have a hospital and a GP placement, which not only are necessary for the Case Commentary assignment, but are also valuable insight into the medical profession and the clinical years of the degree (years 3-5).

Just a word on the assessments. The Case Commentary causes a lot of stress. I'll re-emphasise from my first paragraph: first year, in the grander scheme of things, is hardly worth anything. The main goal should be learning. Remember that. Will you be asking your "case" patient the questions a seasoned physician or general practitioner would ask? No. Of course not. The Faculty knows you're a complete rookie at the bottom of the food chain. So just try your best, study from the samples provided, and accept and learn from the feedback you get from your clinician assessors. Didn't get HD? You'll survive. It's ok. As long as you're learning and improving, you're doing well. I'll echo that same advice for the mid-semester test (ie. exam) which can be a real shock to many. The mark isn't all that important because the exam hardly counts for anything, focus on improving and refining your study technique. Similarly for the formative Objective Structured Clinical Examination (OSCE), it's a learning experience.

Last word on academic aspects of the course: join a Vertically Enhanced Study Program Approach (VESPA) study group. These are inter-year study groups, so you'll receive informal weekly teaching from second year students. These are great tutes because these students JUST sat the exams that you'll be sitting, and they have invaluable tips. I'd recommend joining one, just one, as soon as possible. If you can organise this yourself with friends you may have from second year, that's ideal, because more formal organisation of these often takes a few weeks.

One more word on the administration requirements. My advice is simple: be on top of it. Get your police check done early. Get your working with childrens' check done early. Get your immunisations done early. Don't leave these things late because no one else is and the Faculty will chase you. So make sure you get all of that done as soon as possible because starting off your degree with a disciplinary hearing is far from ideal.

Now to tackle a couple of common FAQs I always get. A popular question I get asked is: what clinical equipment will I need? Honestly, nothing. Having said that, the vast majority of people will be armed with a brand new stethoscope. Why? Mainly because they can, but also because there are uses for the stethoscope later in the semester during clinical skills tutes. Most people opt for a Littmann Classic II/SE or III, with a smattering of Littmann Cardiology III or IVs for those with a bit more money lying around. I'd strongly advise against buying something without a turnable diaphragm (ie. any Littmann product with "Master" in the name). You don't need any other equipment for this unit. The second question I get is: will I need all these textbooks? Now Monash has this obscene booklist, buying everything on there will set you back about $3,000... so obviously don't buy all of it. In fact, don't buy any of it. Here's what I'd suggest: test out what books you like from the library or pdf copies (ask your seniors! *wink wink*), and if you're really bonding well with a book, then maybe buy a hard-copy. This is especially the case for anatomy atlases and textbooks. But if you can't bear to have an empty bookshelf because of your obsessive-compulsive personality traits, I'd pick up a copy of Talley and O'Connor, it'll serve you well for many years to come.

In addition to academia, you're also introduced to the Monash University Medical Undergraduates' Society (MUMUS) and the rest of the clubs and societies Monash has to offer. I strongly recommend you join and get involved with "uni life" as much as you can. Please don't feel that just because you're an "all-important medical student" now, that means you have to slave away in the libraries studying all the time. There's no point being in uni unless you're enjoying it, so I'd encourage you to go to uni events (MUMUS or otherwise), get a bit rowdy, make some friends outside of med (this is important!), and create some good times and memories for life.
 

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pi

Junior doctor
Admodistrator
Subject Code/Name: MED1022 - Medicine 2

Workload: per week: 9 x 1hr lectures + 3 x 2 hr prac + 2 x 2 hr tutorials + 3.5 hr PBL (Problem Based Learning tutorial) + occasional site visit

Assessment: For the semester - 18.75% Mid-Semester Test, 6.35% Rural Assignment, 12.5% Evaluating Popular Information Assignment, 37.5% End of Semester Exam (hurdle), 25% OSCE (hurdle), 0% Human Life-Span and Development Assignment (hurdle only) (formative assignments include practical write-ups, weekly quizzes, and the Injecting Competence Test). In terms of the year - 15% Mid-Semester Test, 5% Rural Assignment, 10% Evaluating Popular Information Assignment, 30% End of Semester Exam, 20% OSCE.

Recorded Lectures: Yes, with screen capture that includes lectures notes being written on

Past exams available: No, the Faculty has published a document with threats to expel students from the course if they are caught compiling past questions or distributing or using past compilations. All past compilations have been removed from the MUMUS site.

Textbook Recommendation:
  • Basic Epidemiology 2nd - Beaglehole, Bonita and Kjellstrom*
  • Clinical Examination A Systematic Guide 7th - O'Connor and Talley*
  • Clinically Oriented Anatomy 7th - Agur, Dalley and Moore*
  • Langman's Medical Embryology 11th - Sadler
  • Grant's Atlas of Anatomy 13th - Agur and Dalley^
  • Gray's Anatomy for Students 2nd - Drake, Mitchell and Vogl^
  • Mim's Medical Microbiology 4th - Dockrell, Goering, Mims, Roitt, Wakelin and Zuckerman
  • Netter's Clinical Anatomy 2nd - Hansen^
  • Neuroscience Exploring the Brain 3rd - Bear, Connors and Pradiso
  • Rang and Dale's Pharmacology 7th - Dale, Flower, Henderson, Rang and Ritter*
  • Textbook of Medical Physiology 12th - Guyton and Hall*
  • Thieme Atlas and Textbook of Anatomy General Anatomy and Musculoskeletal System 1st - Schuenke, Schulte and Schumaker^
* means essential
^ means choose one of these based on personal preference (personally I used "Thieme Atlas and Textbook of Anatomy General Anatomy and Musculoskeletal System 1st - Schuenke, et al.")

Lecturer(s): Many, depending on the series of lecture (cancer, pharmacology, pathology, upper limb, lower limb, cardiology, neurology, etc.)

Year & Semester of completion: Semester 2, 2012

Comments:
This unit is a logical step-up from MED1011. The workload is higher, but it's also much more interesting. There is a large focus on gross anatomy, clinical anatomy, and relevant physiology in this unit; especially in terms of musculoskeletal (MSK), peripheral neuro, and cardiology. This is not only reflected in the lectures and tutorials but also in new lab sessions: cadaver dissections and prosections supervised by surgical registrars and anatomists.

Cadavers are the subject of much angst among med students, and that's a perfectly reasonable and normal reaction to seeing a dead body. I'd be a tad worried if you were too keen about cadavers. Despite initially being a somewhat daunting and queasy moment, dissections and prosections were definitely the highlight of my academic week. This was a chance to learn by touch, something which is largely absent from the course until now. I personally found the dissections to be not that educational, mainly because no one really knows what is going on and it turns out to be more of a "who is gunning to be a surgeon" session rather than a "oo look, the tendon of muscle X, how cool" session. I much preferred prosection sessions where we dealt with specimens already dissected by anatomists. I've been told the anatomy teaching has changed significantly, for the better, since my time in the labs, so I'll hold off from any further irrelevant discussion. Just one piece of advice: don't be afraid to get involved and don't be afraid to ask questions; learning is the key here and most med students can afford to lose a bit of ego in the process ;)

In terms of lectures, much the same as in MED1011. I personally didn't find anatomy lectures to be all that useful, because the bulk of the learning needs to be done at home. I found MSK to be the toughest anatomy to learn, mainly because it was so dry and there was just so much to remember from the upper and lower limb. My main piece of advice is: find an atlas that best suits your learning. After a frustrating few weeks, I landed on Thieme's atlas and fell in love with how logically the anatomy was laid out for me. This almost made the MSK term bearable :p The physiology and other lectures are of a high standard though, but also need relevant readings from Guyton and Hall and other sources as dictated by the unit guide.

OSCE preparation becomes more intense in clinical skills tutes, with the clinical systems covered being: upper-limb musculoskeletal (shoulder, elbow and wrist), lower-limb musculoskeletal (hip, knee, ankle), upper-limb neurological, lower-limb neurological, and cardiovascular. This is daunting and overwhelming to many, but also probably the best part of the year as well. Why? Because clinical-correlation is a great thing and examining someone makes you feel very doctor-y! Group and team work becomes vital in these tutes and participation is the key to preparation for the eventual OSCE. Like, seriously, don't be that guy/gal who never volunteers for things in these tutes. Be the person who puts their hands up because regardless of how well/poorly you do, you'll learn way more than everyone else. You also need to be practicing your OSCE skills away from the tute room, and this is best done in groups of 2-3. Practice regularly and you'll look like a pro come OSCE time.

There are more external site visits in this semester! During the unit, each student is able to have two hospital site visits, and will get the opportunity to test their musculoskeletal and neurological exams on real patients, as well as practice their clinical deduction skills for the first time in a clinical environment. You'll be supervised by junior doctors or final year medical students while on the wards, and this is a great taster for the clinical years of the degree. Again, the expectation for you is incredibly low - so ask the 'dumb' questions without fear and be the one to volunteer. You're there to learn after all.

However, not all is so exciting. Epidemiology is introduced, a subject which I can safely say was the bane of my semester (second only to MSK anatomy!). The tutes were dull and far from engaging (I honestly fell asleep thrice) and seemed to largely be repetitions of the lecture content. The exact content of the tutes was, however, useful and will become important as you learn to read academic journals or when/if you conduct your own research. Posting this review as someone who has completed a BMedSc(Hons), I can really attest to that last sentence. Nailing some basic concepts now will help you for decades.

In terms of the hurdle requirements, there are three (compared to none from the previous semester): the HLSD assignment, the OSCE and the End of Year Exam. The HLSD is fairly easily marked, so no worries there, however the other two are of concern as they are tough assessments. And again, I strongly encourage you to read my advice regarding marks and learning from the previous review, it's a common theme I'll share throughout the degree! However with that said, the marks here do matter a tad more than last sem. This is because passing these assessments are compulsory to passing the unit, and hence the year, and failure to do so will result in your repeating of the year. This is not a good thing. Do not do this. This is bad. However there are a few students who are on the borderline who are given the opportunity to sit Supplementary Exams (~20 students in total) to redeem themselves to the Faculty and progress to Year II. Hopefully you'll have been refining your study techniques from MED1011 and your focus on LEARNING will get you through without needing these supplementary assessments! ;)

Once the year is done you may be keen to burn all your study notes in celebration, but DON'T DO IT. Next year, there is an exam that requires knowledge from Year I, so hang on to your study materials for at least the next year. But more on this during my subsequent reviews.
 
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pi

Junior doctor
Admodistrator
Subject Code/Name: MED2031 - Medicine 3

Workload: per week: 12 x 1hr lectures + 3 x 2 hr prac + 2 x 2 hr tutorials + 3.5 hr PBL (Problem Based Learning tutorial) + 6 hr CBP (Community Based Placement)

Assessment: For the year - 10% Mid-Semester Test, 6% Student Project Case Written Summary, 3% Rural Individual Assignment, 7% Rural Group Assignment, 6.8% Health Promotion Assignment, 4% Student Project Case Oral Presentation, 10% End of Semester Written Examination, 0% Breast Examination (hurdle), 0% CBP Placement Plan (hurdle) (formative assignments include practical write-ups, system quizzes, and the formative OSCE)

Recorded Lectures: Yes, with screen capture that includes lectures notes being written on

Past exams available: No, the Faculty has published a document with threats to expel students from the course if they are caught compiling past questions or distributing or using past compilations. All past compilations have been removed from the MUMUS site.

Textbook Recommendation:
  • Clinical Examination A Systematic Guide 7th - O'Connor and Talley*
  • Clinically Oriented Anatomy 7th - Agur, Dalley and Moore*
  • Functional Histology 2nd - Kerr
  • Guyton and Hall Textbook of Medical Physiology 12th - Guyton and Hall*
  • Langman's Medical Embrgy 11th - Sadler
  • Mim's Medical Microbiology 4th - Dockrell, Goering, Mims, Roitt, Wakelin and Zuckerman
  • Netter's Clinical Anatomy 2nd - Hansen*
  • Physiology 4th - Costanzo
  • Rang and Dale's Pharmacology 7th - Dale, Flower, Henderson, Rang and Ritter*
  • Respiratory Physiology The Essentials 9th - West
  • The ECG Made Easy 7th - Hampton
  • Wheater's Functional Histology A Text and Colour Atlas 5th - Heath, Lowe, Stevens and Young
* means essential

Lecturer(s): Many, depending on the series of lecture (respiratory, GIT, renal, urinary, endocrinology, pharmacology, pathology, etc.)

Year & Semester of completion: Semester 1, 2013

Comments:
As expected, this year begins with another step-up, in both contact hours (commonly 30+) and in workload. However, unlike first year, I found the content to be much more relevant clinically, which provides incentive to learn. From the outset, realise that everything you do in second year is worth a bit more than what you did last year. Don't worry about this, but we aware of it. Learning should still be your top priority.

This unit essentially focuses on a few bodily systems, namely: respiratory, gastrointestinal, renal, urinary, and endocrinology, in order of when you do them. Each system provides it's own challenges as you delve into the physiology, gross anatomy, pharmacology and clinical manifestations. The physiology is taught primarily in the lectures and it is expected that you take the initiative to fill in the blanks in your own time primarily using Guyton and Hall. It's important to keep on top of this, because there is a LOT of content to get through and once you're behind... you're really running uphill to catch up. The anatomy, similar to semester 2 of Year I, is taught through dissections and prossections with anatomists and surgical registrars. Again, I found prosections to be the pick of the two, but if you found the opposite last year, then your opinion of this semester is likely to not change.

Again, we pursue with clinical skills tutes and things become more intense. We cover more system reviews and more clinical examinations: respiratory, gastrointestinal, renal, obesity, dehydration assessment, and endocrinology (focus on thyroid and diabetes). Additionally, there are also special breast examination tutorials, with women who sign up to examined by small groups of students; this is a hurdle activity to complete. If you thought first year exams were tricky to remember, you were sadly mistaken. These exams are more complex and there is a great deal to remember. Again, I'd suggest practicing regularly, weekly is ideal, with a core group of 2-3 dedicated friends. You'll be thanking yourself so much come OSCE-season when you're slick with these physical exams without even trying.

There are two new aspects to this semester: Rural Weeks and Community Based Placements (CBP). Half the cohort goes on Rural Weeks in the first semester, the others go next semester in MED2042. The Rural Weeks (2 week placement in groups of 10-20) are arguably the best two weeks of the degree: simply amazing on so many levels. I was lucky to travel to Bairnsdale at stay at the luxurious Captains Cove. The placement, academically, consisted of placements at a GP, surgery, emergency department, district nursing, allied health, naturopathy, Indigenous, pharmacy, farm site visit and vets. So in terms of the healthcare aspect, we are given a very broad holistic experience. Personally, I found the district nursing placement to be the best of them, learning so much from a different perspective was very valuable. I really came out of this experience with a fresh appreciation for the allied health team, something that is very important to understand before hitting the wards next year. Throughout these placements you are able to refine your clinical skills: injections, examinations, histories, vital signs, etc. I'd strongly recommend you do as much of this as you possibly can. We are also given the opportunity to participate in a suturing workshop at Bairnsdale Regional Health Service, which was honestly a fun new experience!

On a social level, the rural placement is amazing too. After academic hours, you can expect a large party for all. The accommodation is simply stunning with large rooms and units and beautiful lakeside views when you wake up, perfect for a BBQ and some heavy partying. So, we did :p We also had the opportunity to socialise with the Year IV med students who were there too, so we partied hard together. In the weekend between the two weeks you are given the opportunity to go home but luckily no-one did, so we were able to road-trip to Lakes Entrance and many other touristy sites. Very enjoyable and many, many great memories.

However, there are two assignments to complete from this rural placement, one individual and one group, so being mindful of those is important too. This is one of the first group assignments of your degree and it's worth realising that not everyone is as keen as you are. I mean let's be perfectly honest, you're reading a review of a medicine uni, you're keen. It's quite likely that you'll have someone who doesn't want to pull their weight for the assignment, and you'll probably end up feeling like this...
...and that's to be expected. Grin and bear it, and use the experience as yet another unique learning experience. The marks don't matter for much, so be calm and just get through it.

Moving onto the CBP - it's a great experience! Unfortunately I've heard it has since been canned from the course, but I'd like to relive it here so you can feel jealous about what you missed :p ;) Basically, in a small group of 3-6 you go to special schools, youth services, retirement homes, etc and participate and get involved in what is going on once a week for 14 weeks (continues in MED2042). I was lucky to be based in a special school and I loved the opportunity. Whilst it's a little depressing at times about unlucky some of these kids are, it's really enjoying playing and teaching students, and learning from them. I really commend Monash for having a program like this, it really brings issues like health to our own backyards, where many health issues really lie.

However, there is always a downside to a semester. He have a "Health Promotion" series of lectures and tutes. In addition, there is also an assignment attached to this. Personally, I gave up on attending the lectures after the first one, honestly not worth the time. However, tutes were enjoyable. Not so much because the learning was beneficial or useful in any way (it isn't), but because my tutor was very engaging and spun the coursework into fun group tasks with opportunities for lots of laughs. These laughs soon diminish when the assignment comes up though, which is a great example of forcing yourself to work despite how much your brain wills against it. Again, a learning experience :p

Another downside was the Student Project Case (SPC), which is another group project. Essentially it has two parts: a written summary of your assigned condition (asbestos-related lung diseases, haemochromatosis, Dengue fever, or breast cancer), and then a 30 minute oral (word used loosely as you can use technological aids - my group for example made short video clips and a powerpoint presentation) presentation. The downsides I found with this were how much of your time it consumes and the fact that the oral presentations are a couple of days before the End of Semester Exam. Other than the stress, the learning is somewhat enjoyable and it's a fairly unique assessment.

On word of caution is that if you are lucky to go on rural in this semester, the workload piles up at the end of the semester. Both rural assignments, the SPC oral presentations, the Health Promotion assignment and the End of Semester exam are within 3 weeks of each other. This is a stressful time, but I guess it's better to get this whammy of assessments now that at the end of the year when there are even more exams (additional written exam and a summative OSCE). Better end of a bad deal.

Now, coming back to broader studying. Last year, if you heeded my advice from MED1011, you may have been part of a VESPA. Now, it's your time to be the VESPA leaders! Get organised early, and start teaching some first years. Furthermore, join a Years II/III VESPA as well. More often than not, the Year IIs you tutored you last year will be more than happy to keep their tutes going.

The elephant in the room for second year is the Vertically Integrated Assessment (VIA) which is at the end of the year and disguised as the MED2000 unit. This is an exam worth having an eye on during MED2031, because it examines anything that you've learnt during the first two years. It's grueling and difficult to study for, given how much new stuff is already going on in the semester. The best way I found to study for it was via Year I/II VESPA groups, as above. These groups will force you to revise Year I content, which is incredibly useful. The other piece of advice I have, which is reiterated in my MED2000 review, is to revise one Year I topic a week throughout Year II. This is a good way to space the study out and you'll probably end up going through each topic once or twice during the year this way. Keep up to date and have an eye on the VIA at all times. It's the most important thing you'll do in pre-clin years in terms of assessments.
 
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pi

Junior doctor
Admodistrator
Subject Code/Name: MED2042 - Medicine 4

Workload: per week: 10 x 1hr lectures + 3 x 2 hr prac + 2 x 2 hr tutorials + 3.5 hr PBL (Problem Based Learning tutoria) + 6 hr CBP (Community Based Placement - ends at around Week 10)

Assessment: For the year - 10% Mid-Semester Test, 6.8% Social Determinants of Health Group Assignment, 2.55% CBP Reflective Essay and Learning Journal, 0.85% CBP Academic Advisor Assessment, 10% End of Year Written Examination, 20% OSCE Examination (formative assignments include practical write-ups, anatomy "flag races" and system quizzes). Important to note that there is also another examination, the dreaded VIA, but this will be covered in my review of MED2000.

Recorded Lectures: Yes, with screen capture that includes lectures notes being written on

Past exams available: No, the Faculty has published a document with threats to expel students from the course if they are caught compiling past questions or distributing or using past compilations. All past compilations have been removed from the MUMUS site.

Textbook Recommendation:
  • Clinical Examination A Systematic Guide 7th - O'Connor and Talley*
  • Clinical Neuroanatomy Made Ridiculously Simple 1st - Goldberg
  • Clinically Oriented Anatomy 7th - Agur, Dalley and Moore
  • Guyton and Hall Textbook of Medical Physiology 12th - Guyton and Hall*
  • Langman's Medical Embryology 12th - Sadler
  • Mim's Medical Microbiology 4th - Dockrell, Goering, Mims, Roitt, Wakelin and Zuckerman
  • Netter's Clinical Anatomy 2nd - Hansen*
  • Neuroscience Exploring the Brain 4th - Bear, Connors and Pradiso
  • Physiology 5th - Costanzo
  • Rang and Dale's Pharmacology 7th - Dale, Flower, Henderson, Rang and Ritter*
  • The ECG Made Easy 7th - Hampton
  • Thieme Atlas of Anatomy Head and Neuroanatomy 1st - Schuenke, Schulte and Schumaker
* means essential

Lecturer(s): Many, depending on the series of lecture (reproductive, haematology, neurology, psychiatry, pharmacology, pathology, etc.)

Year & Semester of completion: Semester 2, 2013

Comments:
The workload is similar to last semester (30+ contact hours and so forth), but this is by far the most interesting unit, and also the last unit at the Clayton Campus.

This unit essentially focuses on a few more bodily systems, namely: reproductive, haematology, psychiatry, and neurology. Each system provides it's own challenges as you delve into the physiology, gross anatomy, pharmacology and clinical manifestations, however it was well agreed upon that neurology was by far the most content heavy and the End of Year examination is nearly entirely neurology. Personally, I found that to be perfectly ideal ;)

As with previous units, the bulk of the physiology is taught in the lectures and it is expected that students take the initiative to fill in the blanks in your own time. The anatomy is taught much the same as previous semesters, through dissections and prosections, with associated lectures. A new inclusion this semester was "flag races" during prosections, which are formative and test your understanding of the anatomy, but as said in a precious unit review, the anatomy teaching has changed so much since 2013 that I'm not sure if it's still relevant.

Neuroanatomy is often found to be extremely challenging for students, so I thought I'd spend a paragraph on it. The other systems are fairly straightforward in that studying for them is similar to MED1022 and MED2031 - no biggie. Neuroanatomy is a biggie. I'd strongly suggest that if you read through "Clinical Neuroanatomy Made Ridiculously Simple" by Goldberg, you'll be miles and miles ahead of everyone else. This book is readable in a day, and not only is it very engaging and informative, it's also comedy gold. Here's a quick example of what I'm talking about:
I can honestly say that reading that book was the best decision I made during my pre-clin years. Just one issue I have with it: is their chapter on the spinal cord. I'd suggest you supplement that with this (or from here instead). The Rule of 4's for the Brainstem, an Aussie creation (and I had the pleasure of meeting Prof Gates only months ago, lovely person!), is far superior to Goldberg's chapter. You can then supplement your learnings here with lecture content and with Waxman's more dense text.

In this unit we "finalise" our basic set of clinical skills, learning: haematology (history and examination), reproductive (history), cranial nerves (examination), mental state examination, eye examination, ear and throat examination, and interpretation of ECGs. There is also a large amount of revision of previous examinations in preparation for the final OSCE. As previously mentioned, group and team work becomes vital in these tutes and participation is the key to learning and preparation for the eventual OSCE. If you've been practicing weekly along the way, as I've suggested, you'll be fine for the OSCE.

This semester marks the end of the Community Based Placements (CBP), and I personally count this as one of the major pluses of my degree so far: enjoyed it to bits! As mentioned in my MED2031 review, I was at a special school and coming back from the full 14 weeks of the placement, I was really glad I was there. So much practical learning and some amazing and touching memories that I will hold close forever. Definitely recommend taking full advantage of these placements and enjoy them... Oh wait, they canned the program! Oh well, now you know what you've missed :p

An academic downside for me this semester was a series of lectures on "Knowledge Management". Although I didn't actually attend any of them or watch/listen to them online or read the slides, I hear they were largely useless. In fact, let's be honest, I don't even know what they were about so I'm not sure why I'm complaining, but I am anyway. Any questions from here can be winged on the exam with no troubles. Otherwise lectures are still at a high standard, and as captivating and interactive (except for Knowledge Management) as ever. I particularly enjoyed the neurophysiology lectures, definitely recommended to attend those if Dr Price is still involved. If he is still involved, ask him about juggling knives (just do it ok!);)

In terms of the hurdle requirements, there are two: the End of Year Exam and the final OSCE. The MED2000 component is also a hurdle, which I'll come to in my review of that unit (next post). Passing these are compulsory to passing the unit (and hence the year) and failure to do so will result in your repeating of the year (although there are some supplementary exams as with MED1022!).
 

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pi

Junior doctor
Admodistrator
Subject Code/Name: MED2000 - Year 1 and 2 Final Grade

Workload: N/A, this unit consists of a single examination and occurs throughout the first two years. There is a VIA revision lecture every week run by MUMUS.

Assessment: As per the name of this unit, it combines the first two years of the MBBS into one grade:
  • MED1011: 12.5%
  • MED1022: 12.5%
  • MED2031: 27.5%
  • MED2042: 27.5%
  • First VIA (Integrated Vertical Assessment) Examination: 20%

Recorded Lectures: Yes, with screen capture.

Past exams available: No, the Faculty has published a document with threats to expel students from the course if they are caught compiling past questions or distributing or using past compilations. All past compilations have been removed from the MUMUS site.

Textbook Recommendation: see reviews on MED1011, MED1022, MED2031, and MED2042

Lecturer(s): Various presenters depending on revision topic being discussed.

Year & Semester of completion: Semester 2, 2013

Comments:
This is an unconventional "unit", and this is something that really "matters" when looking at the grander scheme of things. Essentially, this unit consists of the dreaded VIA (well... the first VIA anyway): one exam that demonstrates knowledge from Years I and II, so it's a pretty important exam.

Preparation for the VIA is essential as it has a massive weighting, and everyone had a different style and approach. I think the most useful things were:
  • VESPA study groups: both being taught and teaching others.
  • Revising notes/flashcards/anki/whatever regularly: do one Year I topic a week throughout Year II, that's a good way to space it out and you'll probably end up going through each topic once or twice during the year this way.
Please do not leave studying for the VIA until the week before. It's just not that possible, there's too much to remember and you'll feel like you just got hit by a bus on the day. Studying throughout the year, starting with week 1 of MED2031, is the key here.

Having said that, this is the last pre-clinical unit, and you'll be more than glad to move onto the clinical years :)
 
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pi

Junior doctor
Admodistrator
Subject Code/Name: MED3051 - Medicine and Surgery 1

Workload: per week: varies between sites, you're expected to stay between 7-8am (former for surgery, latter for medicine) to 4-5pm each day giving a total of ~50 contact hours per week, whether you stay that whole time depends on how you study and what you want to get out of being on the wards. Each site usually has lectures on Wednesday and it varies between sites how many lectures there are.

Assessment: 70% Mini Case Records (MCRs - two formative and two summative in this unit), 30% Evidence Based Clinical Practice "Therapy" Task, attendance (80% hurdle), completion of online pathology quizzes (14 in all - hurdle), complete submission of portfolio (hurdle), formative end of semester exam (non-hurdle or hurdle depending on site) .

Recorded Lectures: No.

Past exams available: No, the Faculty has published a document with threats to expel students from the course if they are caught compiling past questions or distributing or using past compilations. All past compilations have been removed from the MUMUS site.. Many EMQ/MCQ books can substitute for official exams though.

Textbook Recommendation:
  • Browse’s Introduction to the Symptoms and Signs of Surgical Disease 4th - Black, Browse, Burnand and Thomas
  • Clinical Examination A Systematic Guide 7th - O'Connor and Talley
  • Davidson's Principles and Practice of Medicine 22nd - Colledge, Ralston, Penman and Walker*
  • Harrison's Principles of Internal Medicine 18th - Fauci, Hanser, Jameson, Kasper, Longo and Loscalzo*
  • Kumar and Clark's Clinical Medicine 8th - Clark and Kumar*
  • Netter's Clinical Anatomy 2nd - Hansen
  • Oxford American Handbook of Clinical Examination and Practical Skills 1st - Burns, Korn and Whyte
  • Oxford Handbook of Clinical Medicine 9th - Baldwin, Longmore, Wallin and Wilkinson
  • The ECG Made Easy 7th - Hampton
  • Toronto Notes (latest edition)*
  • Underwood's General and Systematic Pathology 5th - Cross and Underwood
*Pick one depending on how keen or lazy you are

I'd also recommend utilising UpToDate, eTG, and Radiopaedia.org, the wiki-based collaborative Radiology resource as much as possible.

Lecturer(s): Many, depending on the series of lecture.

Year & Semester of completion: Semester 1, 2014

Comments:
N.B. since I completed Year III, major changes have been made to the teaching of Pathology, Law, and Ethics. Thus, I won't be covering these in my review.

This unit is something completely new! I'll keep this general given that every student will have their own unique experience depending on their site, their rotations, their group, and how keen they are to get what they can out of it.

Basically the sites Monash have are (I may be missing some!):
- Central: Alfred, Cabrini, Epworth Richmond, Peninsula
- Monash (formerly "Southern"): Monash Medical Center, Dandenong, Casey
- Eastern: Box Hill, Maroondah, Angliss
- A bunch of rural sites such as Bendigo, Mildura, Bairnsdale, Traralgon, etc

In terms of where you go, you get a preference (not a choice) between metro and rural sites, but otherwise it is completely randomised as to which hospital/site you get. It should be noted that even though you may not be an ERC student, you may end up with a rural spot. That's just bad/good luck, and you'll have to grin and bear it. The Faculty rarely lets people off the hook without an exceptional reason.

Each site has their ups and downs in terms of a balance between practical skills and teaching and it's probably not up to me to make a comment on this, but the feedback I get back form peers is that the clinical years (so far) are SO MUCH better than the preclinical ones regardless of the site you're in, and I'd agree with that 100% percent. Each student will have their own medical (gen med, oncology, cardio, neuro, rheum, etc) and surgical (gen surg, neurosurg, cardiothoracics, bariatric, vascular, etc.) rotations depending on luck and where they are placed.

Similar to how you might have felt at the start of MED1011, it's commonplace to feel like this for a while...
...so don't get worried! I'll try and use this and subsequent posts to give you a general feel for what lies ahead. But ultimately, no amount of reading prepares you for your own individual experiences.

The gist of a day on either surg or med plays out like this:
  • Ward round starts at 7-8am depending on your team, this may be with a big team (think Alfred, MMC, etc.) or a small team (think Angliss, Casey, etc). Med students can write the ward notes, they may be asked questions by the consultant or registrar (daunting but high yield learning!), they may be asked to see the patient later and report the case back to someone, etc. Always good to try and be helpful (getting the patient files in advance, having a look at the obs chart, etc.) because they'll like and appreciate you more and you'll probably get to do more things as a consequence.
  • After the ward round there will be an allocation of tasks (more-so in medical rotations). If you're in the good books with the team you may be asked to do a few tasks such as "cannulate the gentlemen in Beds 3, 14 and 25 for us, and we'll need bloods from Bed 13, 15 and 17, oh and also if you could chase up 17's GP and get them to fax over her lung function tests that'd be great". Simple stuff and they'll love you if you can help out, plus practical skills are so exciting! If you do take on some tasks though, please make sure you either do them or let someone know in a timely manner when you can't.
  • Your team might have various clinics. These are excellent learning opportunities to see "out-patients", so I strongly recommend you attend these where you can after asking the leading consultant. If you're gifted your own consulting room, take up that opportunity quickly!
  • In among the ward work and clinics, you'll have down-time to clerk patients or go into surgery. THIS IS THE MAIN REASON YOU ARE HERE. Take histories, examine patients, present back to registrars or consultants, ask questions. This is your job as a clinical student: to LEARN. Don't even forget that.
  • You'll also have spots of formal teaching in the day, including lectures and bedside tutes, as I'll touch on later in this post. Politely excuse yourself from the team before attending these. It's just common courtesy.
  • Repeat.

So I mentioned a few practical skills above. The new ones to clinical years include: cannulation (putting in a "drip"/"bung"), venipuncture (taking bloods), urinary catheters, rectal examinations, injections, performing lung function tests, and some unofficial ones that your team might teach you such as taking arterial blood gases, taking blood cultures, and so forth. You also may be able to help out and learn about more complex procedures such as ascitic taps, pleural drains, and lumbar punctures. Some sites it may be very difficult to get any practice but in other sites you may be able to do a few of each practical skill a day (think smaller hospitals). The practical skills I mentioned (the "official ones) are important to do because you need to mark them off in a "logbook", a small book which has a list of skills which need to be done including histories and exams from all systems and a bunch of practical skills as aforementioned. This needs to be handed in as talked about later.

To further your skills, and if you're on a good standing with your team, is to get involved with doing admissions, ie. admitting patients to the ward or to the hospital (sneak into ED!). I've had the opportunity to do this a few times both supervised and unsupervised and it's a really great learning experience. If you ever get a chance be sure to put your hand up first and take it! This stuff often happens outside 8am-6pm hours, so it's worth staying behind every now again to get a chance to be involved in this high-yield learning. Be keen and you will be rewarded.

In terms of tutes, there are may kinds and the amount of them depends on your site. Medical and surgical bedside tutes are commonplace, here you have a small group and a consultant and as the name suggests, you have a tute at a patient's bedside learning about their condition and examining them. As with previous reviews, be the one to volunteer for these tutes. You'll get great feedback and you'll learn heaps. Other tutes include PBLs, specialty tutes, practical skills tutes, clinical skills tutes, epidemiology tutes, law and ethics tutes, etc. Some sites have an attendance that includes these tutes, others do not. Don't play a risky game though, just attend all teaching. You'll also get informal tutes from final year students, and these can often be the most high-yield tutes for the exams, so make sure you make the most of your final year mentor.

Another thing I want to touch on are a few of the assessments:
  • MCRs: These are basically mini-OSCEs and resemble short-cases in the FRACP clinical exams. Either a history or an examination on a patient where you're getting marked by a senior doctor such as a registrar or consultant. They count for a lot of the year and are a really good place to put your clerking of patients into practice to show off your skills and demonstrate your clinical knowledge (they'll ask you questions wither throughout or afterwards).
  • ECBP task: This is a very similar task to the epidemiology assignment from Year II. Personally, not the most exciting task out there.
  • Portfolio: This is a bit of a pain, it's a checklist of things you have to submit at the end of the semester: group assessments (such a any PBLs your group may take), feedback sheets you get marked off by your seniors so that the Faculty knows you actually come to ward rounds, the EBCP assignment and the logbook.

Now with so many differences between sites and hospitals and student experiences, a fair question to ask is: "how do they examine this theory later?". The simple answer: "The Matrix". It's a huge table of conditions, a total of OVER 250 conditions that are examinable. If it sounds scary and daunting, it's because it damn well is. There are a few ways to tackle the matrix. I found it best to do a bit every day, such as one condition every day, especially a condition relevant to my current rotation. That was a good balance for me, and meant I had a few weeks left-over to revise the whole lot of my notes at the end of the year. If you want to see how I went about structuring my notes, scroll down to my MED4190 review :)

Just at the end I feel I should mention some of the areas of clinical medicine which are often overlooked by all the exciting things. It's important to remember that you're in hospitals and that people are sick. Some sicker than others, and some of your patients may pass away whilst you are there. We get taught about this sort of thing during preclinical years but it's something completely different to experience it in real life. It's hard to deal with, and if you need some help with it seek assistance from your seniors, they'll always have a handy word or two. Here's something I wrote about this on MSO earlier, copied here for convenience:
My introduction to clinical years
Not sure how to feel, but my first few weeks on the wards have been interesting. Being on an oncology rotation first-up I can't say I didn't expect it (I certainly did), but I don't think any amount of pre-contemplation prepared me for the real deal: when a patient passes away in front of your eyes.

Now in the "predictable" pre-clinical environment I wasn't really phased emotionally by much, the Aussie notion of "grin and bear it" was really the way to get through. Everything was simply just theory and more facts to understand and remember. As morbid as it might sound, I even had no issues with cadavers, as it was all part of this "learning environment" and dissections were very much academic and not at all patient-orientated.

On the wards and in clinics, it's a different ball-game altogether. Being a medical student here isn't all about the exams and the textbooks, it's about being part of the healthcare team and learning from their expertise so you can be the best that you can be. I have a great and supportive team, and being their junior is an exciting privilege, however being part of the team is only a minor aspect in comparison to what the team actually does: manage patients.

From Day 1, it was confronting. I have never seen so much suffering, so much pain, so many tears. From the pre-clin years I guess one could say I was disillusioned by what some doctors have to deal with, I didn't think some things could be "that" tough in real life. What if the patient doesn't want to undergo the advised treatment? What if the patient's treatment options are at an end and they're looking to you as to what is next? What if things are far worse than the patient had hoped for? What if a patient you have seen for weeks unexpectedly passes away?

As only a student I guess I don't have to have answers to those questions, but there's always that feeling that I should? It's tough, when reality hits that doctors have limitations from all areas whether that be from their patient's decisions, from treatment options, from financial stand-points, and the list goes on. We learnt about this, but it doesn't come close at all to seeing it in real life - patients do make decisions and do pass away and sometimes there is nothing we can do about it.

So early onto my clinical experience, it's been a roller-coaster taking this all in. Learning with how to approach different situations has been very helpful, from what I gather it's like desensitising yourself from the patient in an emotional sense. Having said that, one of my greatest fears is being one of those people who don't say "John, the fellow with <x> in Bed 14, needs some fluids" but instead say "Bed 14 needs some fluids". I'd hate to lose the personallness (is that a word?) of it all - it's my greatest fear and I have seen in it on the wards and I don't like it at all.

This beings me back to the patient passing away in front of me last week. That patient was in pain, they had multi-organ failure, mets from their primary cancer, and suspected infection. There was part of me that hoped they would pass away as they would be in a much better place, but there was also part of me that wanted them to keep fighting it all. When it happened though, when they passed away, I was just lost. I felt bad, almost wanted to cry, not sure what to do. We couldn't save them. Did I care too much? Am I just "weak" as a person? Is this just me being a novice medical student?

I guess it's all about finding that professional balance between being too affected and not being affected at all. I want to care, but I don't want to care "too much" as I think that'll hurt me and I won't be able to function to my best, if that makes sense.

Hopefully that balance comes with time.

Thanks for reading, sorry about this slightly depressing blog post (my first) and I'm betting there are some incoherent lines in there - was just typing my mood and thoughts.
Having said that, it's always a great feeling seeing one of your sicker patients get discharged cancer-free or in better health, you don't get a feeling like that anywhere else and it's one of the best feelings I've ever had. It's even better if you took up an opportunity and did an admission on that patient, you can see them from admission to discharge and it's really rewarding to see the health system at work!

Just a note on VESPAs, keep it going! Keep the same group of Year IIs you had, and try and fit in some time to see them at Clayton. Having this relationship will be so important for next year. You'll thank yourself later for keeping this group going. Furthermore, get involved in a Year III/IV VESPA study group too.
 
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pi

Junior doctor
Admodistrator
Subject Code/Name: MED3062 - Medicine and Surgery 2

Workload: per week: varies between sites, you're expected to stay between 7-8am (former for surgery, latter for medicine) to 4-5pm each day giving a total of ~50 contact hours per week, whether you stay that whole time depends on how you study and what you want to get out of being on the wards. Each site usually has lectures on Wednesday and it varies between sites how many lectures there are. This is identical to MED3051.

Assessment: 70% Mini Case Records (MCRs - four summative in this unit), 30% Evidence Based Clinical Practice "Therapy" Task, attendance (80% hurdle), completion of online pathology quizzes (14 in all - hurdle), complete submission of portfolio (hurdle).

Recorded Lectures: No.

Past exams available: No, the Faculty has published a document with threats to expel students from the course if they are caught compiling past questions or distributing or using past compilations. All past compilations have been removed from the MUMUS site. Many EMQ/MCQ books can substitute for official exams though.

Textbook Recommendation: same as MED3051

Lecturer(s): Many, depending on the series of lecture.

Year & Semester of completion: Semester 2, 2014

Comments:
N.B. since I completed Year III, major changes have been made to the teaching of Pathology, Law, and Ethics. Thus, I won't be covering these in my review.

So this unit follows on from and is almost identical to MED3051. It's a continuation of the Monash med clinical training, and I'd advise you read up on my previous review for how typical days entail for medicine and surgery tend to pan out.

If I were to add an additional piece of advice to prospective students taking this unit, it would be: "don't be afraid to wander out of your ward a bit". At this stage in the year, you'll be fairly used to how hospitals work, and you'll know what you're going to miss out on compared to your peers in other sites. This unit is a good opportunity to stray from your ward, without neglecting your duties of course, and seeing if you can get involved a little with those other rotations you won't get exposure to. However, it's important to NOT sacrifice the learning of other students while you go gallivanting around the hospital - the people allocated to a rotation obviously come first. But who knows, you might find a team without a student who are happy to take you once you ask nicely. I personally did this and found the rewards to be really awesome.

I guess with this unit, comes the big assessments of MED3200 (next review!) so I think whilst MED3051 is more of an "intro to the wards, have some fun with procedures, etc", this unit is more about "knuckling down and trying to learn as much as possible". Practice is the key here, and I'll be talking more about this in the MED3200 review.

With the format being the same as MED3051, there really isn't a great deal more to add. Make sure you stay on top of your assessments and you stay on top of your study, it's difficult to cram a year's worth of material into SWOTVAC.

Just a special note. I think it's really important to get involved with medicine outside of the teaching periods too. Something I did which I found amazing, was volunteer for the practice and real FRACP clinical exams. These are exams sat by medical registrars, who have passed the FRACP written exam, in order to progress to become advanced trainees in their desired specialty, so the stakes are very very high :p In some ways they are OSCE-esque, and I found helping out to be useful on two fronts:
1) I'm interested in the Physician pathway myself, so found this to be really informative!
2) You get to see high-standard clinical examinations, and get to see what the required knowledge it like, it's really amazing and I picked up a lot of tips.
 

pi

Junior doctor
Admodistrator
Subject Code/Name: MED3200 - Introductory clinical studies

Workload: N/A, this unit consists of an OSCE and a written examination and occurs throughout this Year III. There are revision lectures held every 2 weeks run by MUMUS.

Assessment: 55% OSCE, 45% End of year written examination.

Recorded Lectures: N/A

Past exams available: No, the Faculty has published a document with threats to expel students from the course if they are caught compiling past questions or distributing or using past compilations. All past compilations have been removed from the MUMUS site.. Many EMQ/MCQ books can substitute for official exams though.

Textbook Recommendation: (specific to OSCE and written exam)
OSCE:
  • Browse’s Introduction to the Symptoms and Signs of Surgical Disease 4th - Black, Browse, Burnand and Thomas
  • Clinical Examination A Systematic Guide 7th - O'Connor and Talley
  • Clinical Orthopaedic Examination 5th - McRae
  • Examination Medicine A Guide to Physician Training 7th - O'Connor and Talley
  • Examination Surgery A Guide to Passing the Fellowship Examination in General Surgery 1st - Gladman and Young
  • Robbins Basic Pathology 9th - Abbas, Aster and Kumar
  • The ECG Made Easy 8th - Hampton
  • Radiopaedia.org
Written exam:
  • 500 Single Best Answers in Medicine 1st - Dugg, Koppel, Patten, Schachter and Shanmugarajah
  • EMQs and Data Interpretation Questions in Surgery 1st - Keshtgar and Syed
  • EMQs and MCQs for Medical Finals 1st - Bath and Morgan
  • EMQS in Clinical Medicine 1st - Syed
  • Anything by PasTest (including the online 6 month question package)
  • BMJ OnExamination (online)
  • If you're keen, I found some MKSAP 16 books to be of use too

Lecturer(s): Various presenters depending on revision topic being discussed.

Year & Semester of completion: Semester 2, 2014

Comments:
N.B. since I completed Year III, major changes have been made to the teaching of Pathology, Law, and Ethics. Thus, I won't be covering these in my review.

This is an unconventional "unit", like MED2000. It runs "throughout" the year and is essentially the bulk of assessment for Year III. The OSCE, unlike pre-clinical ones, is 10 stations (+ 2 rest stations) in a single day, held at clinical sites (not your own) or on campus. The written exam is a 3 hour examination with 100 MCQ and EMQ questions only.

The key to doing well, is consistent practice.

For the OSCE, try and take as many histories and exams as you can, practice in study groups, practice on patients (ie. the clerking you've been doing since Day 1 of MED3051, right!?), practice in bedside tutes. As I've said, be that guy/gal who sticks up their hand and volunteers to see the patient in the group, you'll get a lot out of it even if it does mean a few minutes in the hot-seat. I'd also recommend, when practicing in groups, to throw a lot of "curve-balls" as stations as this is what Monash likes to do. Make sure you can perform every clinical exam, do every procedure, explain consent for anything, describe pathology specimens, interpret ECGs, etc.

For the written exam, I think there are really two ways to go about this (alluding to, but expanding on what I said in my MED3051 review):
1) The "proper" way - consulting textbooks and learning a huge amount of detail. You'll be very well versed in pretty much anything Monash can throw at your but it will take a lot of time and patience.
2) The "lazy" way - learning how Monash writes exam questions. Do MCQ/EMQ books or online databases (BMJ OnExamination is the best there is), learn what the "buzzwords" are for various conditions. You may struggle if a consultant asks you a detailed question, but you should be alright for the exam.

In the end, I think most people start off with Option 1 and during the tail-end of the year end up falling onto Option 2. Not a bad way to go about it. Either way, finding which way works for you is something you should have discovered in your prep for pre-clinical exams, but make sure you don't fall behind and leave too much to do in the last moment. Fortunately, you'll find that the assessments of this unit are much kinder than those from MED2000.
 

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pi

Junior doctor
Admodistrator
Subject Code/Name: MED4190 - Specialty clinical practices

Workload: per week: varies between rotations and sites
  • Paediatrics (perspective from MMC and Casey): get there at 8.30am for ward rounds and you can probably leave at around 2pm
  • Women's health (perspective from Angliss): depends what you're doing, days can be long (including night shifts for delivering babies!), days can start early (for surgery), days can be short; highly variable
  • Psychiatry (perspective from MMC and Kingston): get there at 8.30am for ward rounds and you can probably leave at around 12pm
  • General practice: expected to do two full days of GP a week, there is 9-5 teaching two days a week, and one day off

Assessment:
  • Paediatrics: tutor assessments (11%), written case report (4.6%), oral case report (4.6%), contemporary issues in health group oral presentation (2.8%), logbook tasks (hurdle)
  • Women's health: written case report (4.6%), oral case report (4.6%), observed clinical encounters (2.2% x 5), contemporary issues in health group oral presentation (2.8%), logbook tasks (hurdle)
  • Psychiatry: written case report (23%)
  • General practice: chronic disease assignment (23%)
  • Other: attendance of 80% for all rotations (hurdle), evidence-based clinical practice quizzes (1% x 8 ) and forum posts (hurdle), health services management forum posts (hurdle, semester 1), health economics forum posts (hurdle, semester 2)

Recorded Lectures: No.

Past exams available: N/A, exams fall under MED4200, but I'll be discussing some exam study in this review too

Textbook and Website Recommendation:
Paediatrics:

Women's health:

Psychiatry:

General practice:
I'd also recommend utilising UpToDate, eTG, and Radiopaedia.org, the wiki-based collaborative Radiology resource as much as possible.

Lecturer(s): Many, depending on the series of lecture

Year & Semester of completion: Semester 1 and 2, 2015

Comments:
This is a very challenging year and unit. It is essentially one big unit divided into four topics: paediatrics, women's health (obstetrics and gynaecology), psychiatry, and general practice. I'll keep this general given that every student will have their own unique experience depending on their site, their rotations, their group, and how keen they are to get what they can out of it.

Basically the sites Monash have are (I may be missing some!):
  • Central: Alfred (psychiatry), Cabrini (paediatrics), Peninsula (paediatrics, women's health, psychiatry)
  • Monash: Monash Medical Center (paediatrics, women's health, psychiatry), Dandenong (paediatrics, women's health,psychiatry), Casey (paediatrics, women's health,psychiatry)
  • Eastern: Box Hill (paediatrics, women's health), Maroondah (paediatrics, psychiatry), Angliss (paediatrics, women's health)
  • A bunch of rural sites such as Bendigo, Mildura, Bairnsdale, Traralgon, etc
  • Hundreds of GPs, although the teaching home base is in Notting Hill

Basically how rotations are allocated is that after giving preferences, the cohort is divided into three groups: metro, rural, Peninsula. Metro students have access to rotations in all metro hospitals other than Peninsula, rural students have access to rotations in the rural hospitals, and Peninsula students are at Peninsula for the year. I was a metro student who had rotations at MMC, Angliss, and Casey. Each site has their ups and downs in terms of a balance between practical skills and teaching and it's probably not up to me to make a comment on this for each site, but I think I was pretty lucky in getting good rotations.

The year is divided into two 18 week semesters, followed by one week SWOTVAC and then 5 exams in 5 days (more on that hell-hole in my MED4200 review!). Each semester you do two rotations, either paediatrics and women's health, or psychiatry and GP, each of 9 weeks duration. Some people may be in multiple hospitals during a rotation (especially psychiatry at MMC, or metro paediatrics), others might be at just the one (more-so in women's health), really depends.

From the outset, I want to make it clear that this unit is bloody hard work and it's really important to study smart and keep on top of your study to make sure you don't fall behind. This sounds obvious, but this unit has a lot of assignments and Moodle tasks, and if you get caught up in them then it's very easy to lose track of your study. Personally, I made notes for my rotation before it started, and then added to them once I was in the rotation. So how my study went:
  • Summer holidays: make paediatrics notes, also decided to make notes on ophthalmology, dermatology, and ENT because I knew GP was my last rotation and I wanted to ease off pressure as it was so close to exams
  • Paediatrics: refine paediatrics notes, make women's health notes
  • Women's health: refine women's health notes, make psychiatry notes
  • Mid-year holiday: refine all notes thus far and start to revise third year material for MED4200
  • Psychiatry: refine psychiatry notes, make general practice notes, continue revising third year material
  • General practice: refine general practice notes, revise all notes from this and last year
  • SWOTVAC: cram everything like there's no tomorrow, maybe consider revising clinically-relevant things year 1 and 2 if you have time for MED4200

To aid with the study, the Faculty provides you with a matrix, similar to the one in third year except about double in size. However, as I'll touch on later, I think that's the bare minimum to know. To enhance your knowledge, I'd strongly recommend a purchase of some sort of online MCQ/EMQ question bank. Some of the ones I have used over the years include:

Here are some properties from my combined years 3 and 4 notes, the study is very much real this year:

I structured my notes for clinical years by topic (eg. cardio, resp, gastro, neuro, o+g, etc.) in a colour-coded table. I'll describe my colour-coding first and then the table screenshot will make sense. I organised conditions by how important they were to know: high yield, average yield, low yield, and then basically a few zebras and unicorns because I enjoyed learning about them. Each of these had a different colour. I added paediatric conditions to the overall topics I had (eg. paeds cardio went into 'cardio'), thus I had a special purple colour to let me know when a topic was paeds. My colour scheme was as follows:

I then used a 2-column table to write all my notes, using dot points and including key information only. Conditions were organised alphabetically in each section. I loved images, so I had lots of diagrams, ECGs, radiology, etc. The point of dot-points was to keep things concise, so I could easily read through my notes from my phone whenever I had down-time. So this is what they'd look like (unfortunately the pages I chose were light on "management", I can assure you that management dot-points for some conditions were pages long haha):

As you can see, it looked fairly organised, and I could easily tell how important a condition was. Because it was all alphabetical per system, it was easy to find conditions. But I also had an index at the end anyway (my obsessive-compulsive personality traits haha). This is just *one* way of organising notes though, and I encourage you to experiment with other forms to find one that floats your boat :)

As aforementioned, this unit has a few Moodle quizzes, these are evidence-based clinical practice quizzes and forum posts, health services management forum posts (semester 1), and health economics forum posts (semester 2). These are terrible, absolute pain in the asses to do every week. Definitely the bane of fourth year. However, as boring and tedious as these tasks are, they're hurdles and people have failed the whole year because of missing even a single quiz. Quick run-down of them:
  • Evidence-based clinical practice: consists of four three-week blocks per semester. Each block consists of doing some readings (don't bother) and a video lecture (I'd recommend watching these, actually useful), answering a question in a Moodle forum about said readings (tactically pick a question that isn't about the readings, or one that is otherwise straightforward), and doing a quiz (usually about 10 questions).
  • Health services management: even after making weekly Moodle posts about this, I still don't know what it is or why we did it. Basically there is a weekly topic, and you're supposed to ask a senior clinician for their thoughts and then write a Moodle forum post summarising their thoughts and your own. As for how many people ever asked a clinician, I'd say <5%. Pointless waste of an hour a week imo.
  • Health economics: this was a little better than health services management, although more tedious. Basically there are weekly readings about some economic issue in health that you have to make a Moodle forum post about. Some were interesting, others very dry. Not my cup of tea.

Now I'll go through the different rotations in the order I had them, and share my experiences, give some advice, and give you a taste of fourth year med :p

Paediatrics
If you like kids, this rotation can be really fun; if you don't, too bad :p I enjoyed this rotation, spending four weeks of it at Casey and the other four at MMC. I had subrotations in general paediatrics, neonatology (ie. special care unit), rheumatology, nephrology, adolescent medicine, and emergency medicine.

The other week of this rotation, the first week, is a week of 9-5 lectures at MMC. This can be VERY overwhelming if you're not prepared, which is why I recommend pre-reading for your rotations so you can make the most out of them, especially because the quality of the lectures was very high and it'd be a shame to miss that opportunity. Furthermore, paediatrics is a rotation that has a LOT of content; it's essentially third year condensed (get it? because kids are smaller than adults hahahaha) into 9 weeks. The Faculty provides a list of conditions to know, but I honestly feel that you need to know much more than that unfortunately. The best way to fill in gaps in your knowledge is to do questions, there shouldn't ever be a case where you don't know anything about an option in an MCQ/EMQ.

In terms of other teaching, there are biweekly tutes, one discussing content and the other a bedside tutorial (of the same vein as third year bedside tutorials). These are run by senior paediatricians and are a bit of a mixed bag depending on who you get. I was extremely fortunate to have four weeks of tutes with Dr Hinds, who is a bit of a celebrity among us medical medical students, and I found them to be very useful.

Other than the intense workload of study, this rotation also has a few assignments:
  • Oral case report: fairly straightforward, the more interesting the better
  • Written case report: fairly straightforward, the more interesting the better
  • Contemporary issues in health group oral presentation: this is an absolute pain, as you'd probably guess from my previous reviews of group assignments. You don't choose your group and hence this can cause a few issues if you're with people who aren't keen to do well (I may or may not have had this issue...). This is essentially a presentation based on a topic, eg. childhood obesity, that you deliver to all the metro students in paediatrics and women's health. Hence, you either do this assignment during paediatrics or women's health, and the mark is used for both.

Now, moving on from study and assessment and onto my experiences. This was a really cool rotation if you're keen to stay late and get involved!
  • Casey: spent a lot of time in general paediatrics, neonatology, and the emergency medicine. General paediatrics was a little dull, lots of common conditions such as bronchiolitis, exacerbations of asthma, urinary tract infections, etc. Neonatology was awesome! It was pretty much my first experience with babies and I guess what I got out of this was that "babies are saaahhhhhhh cute!" Most of the babies were fairly healthy, a few had sepsis and jaundice for investigation, but it was a great experience. Emergency medicine wasn't really supposed to be a rotation for us, but I was keen and decided to do some after-hours stuff with the registrar a few times, very rewarding experience! You get the chance to clerk kids, diagnose them, and recommend some investigations to the registrar. I'd highly recommend going out of your way to do more stuff if you're keen on it, there are heaps of opportunities.
  • MMC: subrotations in rheumatology and nephrology, adolescent medicine, and emergency medicine. Rheumatology and nephrology had a reputation for not having many patients and hence having the med student leave at about 10am, however I was there on a pretty busy week. Saw cases of glomerulonephritis needing renal transplant, congenital nephrotic syndrome, acute rheumatic fever, hypermobility syndrome, pyelonephritis, etc. The team was also fantastic and I had a great time. Adolescent medicine, on the other hand, wasn't so great. Essentially the patients here have eating disorders, and whilst it was great to get exposure to these patients, there wasn't much I could contribute to what was going on; the team was nice though. The best thing about paediatrics at MMC is the emergency medicine week. Here, you pick 4-hour shifts and then pretty much work as a paediatric resident! Amazing opportunity to take histories, perform physical examinations, make diagnoses, and initiate management and treatment with the guidance of a senior physician. Saw a variety of cases, and as with Casey, I went out of my way to go on weekends and after 12am, had an absolute ball!

To guide your clinical experiences, there is also a hurdle logbook. However this is only one page in length and most of it can easily be done during the emergency medicine subrotation. Not really a stress.

Overall, paediatrics was very good! Probably not as good as some of my rotations last year, but still very interesting and exciting. And babies, so darn cute!

Women's health
I was expecting to hate this rotation, but I was blown away by how interesting it was! There are really two parts to women's health: obstetrics and gynaecology. The former deals with pregnancies, births, and the postpartum period; whilst the latter deals with non-baby related conditions (endometriosis, fibroids, cancers, etc.). I got pretty good exposure to both, and similarly with paediatrics, the more time you put in to this rotation, the more you can get out of it. This rotation had a similarly bulky week of lectures to start it off, and again I can't emphasise enough how important it is to not get lost during this valuable teaching period.

Being in a small outer-suburban hospital at Angliss, I got to know all the consultants and registrars quite well, which made the atmosphere a really friendly one. The teaching, which consisted of tutes and clinics, was excellent. They were very informal and we could discuss everything and anything, which was great for focusing on tougher areas of the course and having a bit of fun at the same time.

Unlike my surgical experiences in third year, I enjoyed surgery in this rotation! There weren't many different types of procedures and there was plenty of opportunity to get involved in assisting in both gynaecological surgery and in Caesarean sections. Speaking (or writing) of which, this rotation presented a unique privilege: being present at births. Surprisingly, having a baby seems nothing like it's made out to be in movies, labour can last hours (or even days!) and honestly I don't see how men can complain about ever being in pain haha. It was amazing to see births and even deliver a baby, a room full of anxiousness and worry becomes one of complete elation, it's almost magical to witness. I was fortunate to see normal vaginal births, forceps assisted, and ventouse assisted; would highly recommend trying seeing all three as it really ties a knot in the theory. The best way to achieve this is to be nice to the midwives, as they pretty much control the show!

One of the best parts of this rotation is "mentor week". During this week we stray from Angliss and join a private obstetrician and gynaecologist in their rooms for a week. I had the privilege of joining a doctor at a private hospital who did a lot of work with IVF, and had a fantastic time learning about it and assisting in his surgeries. It was very eye-opening to see how private practice work and we had a lot of interesting conversations about medicine and life. He's probably the reason I'm choosing to do an Honours degree next year (if I pass!). I kinda wish we were allowed to do a "mentor week" for every rotation for years 3 and 4.

In terms of assessment, it's very similar to paediatrics with the written and oral case reports. The addition are the observed clinical encounters. These are very similar to the MCRs of third year, except with an obstetric and gynaecology focus. The "encounters" are an antenatal check, postnatal check, bimanual vaginal examination, speculum, and Pap smear. These were sometimes stressful to get done, but otherwise all part of good learning.

The big downsides to this rotation were the logbook and the attendance requirements. The logbook is a little insane and a big stressor, there are a lot of components to it and there can be a lot of luck in terms of getting things done. For example, during my night shifts on the birth suites, I had 5 consecutive days without any births, which was apparently a record according to a senior midwife there haha. As for attendance, you had to record morning and afternoon attendance every day. This was a little ridiculous because sometimes there was just nothing happening and you had to stay around to get a signature, bit of a waste of time.

Overall, a good rotation, much to my surprise! Being in a small hospital was a good thing for this rotation, we got to know everyone well and it was a really good environment.

Psychiatry
Probably my least favourite rotation of the year, but probably the one that I felt I most needed to have. Mental illness is something of a "hidden" burden in our society, it's an umbrella for multiple conditions that effect more people than we can imagine, and it was a very valuable and enlightening experience to see it at its extremes.

My rotation was divided into three subrotations: acute ward, aged care, and adolescent medicine, although other people had different rotations.
  • Acute ward: this is eye-opening. The patients here are acutely unwell with a variety of psychiatric illnesses such as major depressive disorder with suicidal features, acute mania as part of bipolar I disorder, psychosis as part of schizophrenia, etc. It's a confronting place to be and I honestly couldn't wish admission there to my worst enemy. There are times where you feel a little unsafe (even not in the seclusion areas, although luckily police were nearby) and times where you feel out of your depth, I was told that was to be expected and was normal. It was a good learning experience to see how psychiatrists managed patients who were acutely suicidal or manic (or whatever else), as it's something that is incredibly difficult to do. Unlike most areas in medicine, many patients in psychiatry here don't want to take their medications because they don't know that they're not well, this poses a unique challenge and it was fascinating to see how they dealt with this problem (with a variety of outcomes haha). Another issue worth mentioning here is drugs. The ward was infested with amphetamines, and it was startling to find out how they got there. For example, smuggling drugs inside of McDonalds burgers!?! The problem with drugs was very evident, with many patients suffering from addiction. This is a real issue as it prevents them from recovering from their mental illness and in fact makes things worse, which is a terrible vicious circle to get trapped into.
  • Aged care: this is pretty much acute medicine but for the elderly. Given the demographics, there was less mania and more dementia-ish presentations mixed in with some depression and psychosis. I was really lucky during my rotation here because the registrar transitioned to becoming a consultant, so because we were already friendly beforehand nothing changed when she became the boss! We were able to get a bit more involved with the team here, able to talk to more patients (and by ourselves, something they don't let you do for safety reasons on the acute ward) and join them for walks and stuff. Had opportunities to see electroconvulsive therapy (ECT) here, which busted all the myths I had heard about it; it's actually a very safe method of treatment with a lot of evidence of efficacy. Overall, not as confronting, but it was valuable to experience some issues the elderly face and how to overcome or prevent them.
  • Adolescent medicine: covered older people, younger adults, and now kids. These patients had similar issues to those I saw on adolescent medicine in paediatrics, except they were medically stable. Conditions encountered include borderline personality disorder, major depressive disorder, drug-induced psychosis, and various eating disorders. The frustrating thing about this part of the rotation was interacting with the patients was difficult for a bunch of legal reasons, which was completely fair enough and understandable, but puzzling as to why they sent us down there for three weeks if we weren't going to do anything. In the end we found that the best way to interact with them was by playing table tennis with them and getting to know them that way, which kinda worked out. Something important to mention in this subrotation was how eye-opening and shocking some of the stories these children had. It's absolutely horrible what some of them had been through, and there were definitely days when you left hospital feeling pretty down just from hearing about what they had to endure.

I guess the one thing I really didn't like about psychiatry, other than the limited patient interaction, was just how under-resourced it is. Despite all these feel-good R U OK? days and whatnot (which in all honesty, I feel don't help that much), there isn't enough funding for research into new drugs and we're still using medications that were made too many year ago. Furthermore, despite having acute wards, many of these patients don't get better, which is a really sad thing.

In terms of teaching, this unit was focused around intermittent lectures spaced throughout the rotation and tutes which ended up being discussions on whatever came to mind. There was little structure, but I thought that worked pretty well. Our supervising doctor was pretty amazing and had a lot of fascinating insights into the world of psychiatry.

The assessment in psychiatry is daunting, it's a massive 5000 word case report. This is a mammoth compared to the 1500 word case reports in paediatrics and women's health. It's stressful finding suitable patients and then even more stressful trying to interview them. Took me a good week to get it done (with trademark procrastination), but I'd advise people to try and get it done as early as possible in the rotation. Get it out of the way!

Overall, my least enjoyable rotation, but as mentioned, the one I needed to have. Not just as a medical student, but as a human being. Very important knowledge gained from this experience.

General practice
Honestly a great way to end the year, my favourite rotation! General practice was awesome to have at the end of the year because I was theoretically at the peak of my knowledge and could apply it to the wider community haha!

This rotation was the best for a number of reasons:
  1. It was very well organised. Everything was perfected.
  2. The teaching was outstanding. Teaching throughout the year was very good, but in this rotation it was just better.
  3. The days at GP were fantastic.

Touching upon the teaching in a bit more detail. The rotation was divided into 9 topics (eg. emergenices, palliative care, ophthlmology, dermatology, etc.), each a week in length. The tutes were run by senior GPs and were very good, a mixture of case studies and mock patient interactions. The best tutes were in the week based upon emergency medicine, whereby we had an interaction with a mock patient (an actor) in our own room and our tute group watched us live via a video stream. It was fascinating to see how we each handled the pressure! Lectures were also very thorough, delivered by either GPs or specialists (eg. ophthalmologists, dermatologists). Lectures in this rotation were held Monday and Wednesday mornings, with tutes based on them in the afternoon. Hectic full days, but well worth it.

I'd strongly recommend attending the John Colvin Lecture Series as an adjunct to the teaching here. These are held at the start of the year at the Royal Eye and Ear Hospital in the city and are run by ophthalmologists on Saturday mornings. Fantastic teaching and all the students there are clearly keen to learn. A very good learning environment if you can be bothered going. More information here or here. There are also dermatology and ENT lectures (Brian Pyman Otolaryngology and The Victorian Faculty of Australasian College of Dermatologists Lecture Series) held on later Saturdays, but I unfortunately couldn't go to them.

On Tuesday and Friday I had my GP placements. Similar to mentor week of women's health, you're with a GP in their private rooms and seeing patients. I had a great time! One of my GPs allowed me to have my own room for parallel consulting, which was an invaluable experience. The only issue I found with this is that because I was so close to exams and in a rotation with a couple of public holidays (a holiday for an AFL match? I mean, really?), it was stressful trying to do the required 108 hours of clinic time, but I managed it in the end. The best thing about clinic is the opportunity to weave all your knowledge together, and it's rewarding when you realise how far you've come and have learnt.

In terms of assessment in this rotation, there was yet another case report. Here you choose a patient, interview them a few times and then write up ANOTHER 5000 words. Because this was my last rotation, I tried to get this done as soon as possible, just so I could focus on the study. Frustrating assignment, but my patient was lovely and she had a very interesting story to tell, so it was ok haha.

Overall, another great rotation! Felt like everything "came together" as I applied my knowledge and skills from my last 4 years, something which I enjoyed doing :)

Overall impression
Fantastic year, so many amazing memories and so much knowledge acquired. I think the year would be better if there were less assignments given the exams at the end of the year (more on that in my next MED4200 review), but still a really fun year.
 
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pi

Junior doctor
Admodistrator
Subject Code/Name: MED4200 - Integrated clinical studies

Workload: varies as it depends on how much you want to study, I'd recommend at least 3 hours a night. This unit consists of a four examinations and occurs throughout the year. There are revision lectures run fortnightly by MUMUS.

Assessment: OSCEs (40%), written examinations (40%), written VIA (20%)

Recorded Lectures: MUMUS lectures are recorded with screen capture.

Past exams available: Yes, 7 papers were released by the Faculty, although the Faculty still maintains threats to expel students from the course if they are caught compiling past questions or distributing or using unofficial past compilations. All past compilations have been removed from the MUMUS site. Many EMQ/MCQ books can adjunct exam preparation.

Textbook Recommendation: as with my previous reviews of units thus far in the degree. You'll need to combine your resources from those years and pick and choose what you need most, ideally you'll have noted from which you can study from instead.

Lecturer(s): Many, depending on the series of lecture

Year & Semester of completion: Semester 1 and 2, 2015

Comments:
This unit is an absolute nightmare. It creeps up on you and is not much fun. Basically this unit consists of four exam:
  • OSCE, held over two days
  • Written exam on paediatrics and women's health
  • Written exam on psychiatry and general practice
  • Second VIA, the mammoth exam that can assess anything you learnt over the least four years
These exams are worth about 30% of the degree. Let me repeat that: 30% of the degree. Let that sink in. This is a f*cking big deal. The VIA itself weighs in at 20% (more on this in a review on MED4000 where it will make more sense). Wow. And to make matters worse, all of these exams happen on consecutive days in the fabled and brutal "week of hell".

The key to this unit is preparation, you NEED to be well prepared in advance. If you're the type of person who's left things until SWOTVAC until now, you're destined to fail. That is without a doubt. Cramming will not work given the SWOTVAC is only 1 week and the rotations may be working you hard until the last Friday of semester. Hence, you need to be studying consistently throughout the year.

How I went about things was detailed in my MED4190 review, so I'm not going to bother repeating things, but in terms of prioritising study, I think the following are useful tips:
  • Year IV is the most important year to study, then Year III, then pre-clinical years; the VIA is 80% Years III and IV, so that's where the money is at
  • Try and cover a year 3 topic every week, eg. cardiology; you should have enough time to cover each topic twice before directing focus to the big topics of cardiology, respiratory medicine, gastroenterology, and endocrinology towards the end of the year
  • If you're going to study pre-clinical content, keep it to epidemiology and clinically relevant anatomy, those are important topics
  • Make notes, you won't remember things and notes can help to jog your memory, use your bag of studying tricks for this one
  • Don't neglect ECGs and radiology
  • Make sure you practice OSCEs with mates, make lists about likely conditions to come up and practice to time!
  • If you are feeling stressed and feel like you need a break, please take one; your mental health is the most important thing this year and you need to be at your best to survive the "week of hell"

Unfortunately I can't give specific details on the exams due to Faculty rulings, so that's basically it. I've mentioned how I went about my units that make up these exams in previous reviews, so anyone wanting to know more about it should peruse those. To anyone who has to do this unit, I wish you the best of luck, it's probably the toughest unit Monash offers to anyone from any degree. So very glad it is over :p
 

pi

Junior doctor
Admodistrator
Subject Code/Name: MED4000 - Year 3B and 4C final grade

Workload: N/A, this unit is essentially a grade for Years 3 and 4.

Assessment:
  • MED3051 (6.125%)
  • MED3062 (6.125%)
  • MED3200 (22.75%)
  • MED4190 (10.0%)
  • VIA Exam (30.0%)
  • MED4200 (OSCE & EMQ component, excluding VIA) (25.0%)

Recorded Lectures: N/A

Past exams available: N/A

Textbook Recommendation: N/A

Lecturer(s): N/A

Year & Semester of completion: Semester 1 and 2, 2014-15

Comments:
Not sure how to feel about this unit given it doesn't really play an active role in what you do, it's more of an administrative unit. It's similar to MED2000, in that it's just a grade for your efforts in the last 2 years. As you can see, the VIA is given a huge weighting, and the internal assessment is not worth that much. Hence, my final recommendation from my three fourth year reviews, is to prioritise your study over the assignments. The study is worth wayyyy more and it's important to realise that. Sure, the assignments of MED4190 are important, but in the grand scheme of things, they're not that important. Study smart and hard ;)
 

pi

Junior doctor
Admodistrator
Subject Code/Name: MED4301 - Medical science honours research skills

Workload: completely varies depending on your project, but expect to be doing fairly full-on days for 5 days a week.

Assessment:
  • Progress report (Hurdle)
  • Literature review (75%) (Hurdle)
  • Department oral presentation (25%)

Recorded Lectures: No. There are some intro lectures only at the start of the unit.

Past exams available: N/A.

Textbook and Website Recommendation: None needed, although some choose to peruse statistics books as well as textbooks specific to their field of research as the year progresses.

Lecturer(s): Many, but only in the first week.

Year & Semester of completion: Semester 1, 2016

Comments:
N.B. this is different to the BMedSc degree as part of the BMedSc/MD program at Monash.

Alright, so this unit is code for "Medical Honours year"; it's an optional year available to students of the Monash MBBS(Hons), and in the new Monash MD, as part of the Bachelor of Medical Science (Honours). The degree can be completed any time after second year, provided you have an average above Credit and have a worthy application. Most people do the year after fourth year, but there are also a smattering of people who brave the year after second and third year too. Since 2016 there has been a limit on the number of students who can take a BMedSc(Hons), and the current limit is hovering at around 65 students; this includes both domestic and international students. Therefore, there is a little competition to get a place in this additional degree and people have been missing out. The exact criteria of who gets selected for the degree is not well known, but it's thought that marks from previous years of the medical course play an important role, as well as the strength of the written application.

Everyone has their own reason(s) for taking a year off med to do a degree like this, but I had several reasons that were important to me:
  1. I had just finished my major exams for med school and I know that pretty much every year forward was going to be progressively more intense with more responsibility. That's something that I look forward to, but I felt a break from all of that was also in order. This seemed like the perfect time.
  2. I hadn't had much opportunity to do research during med school. Often doing research in med school means being in the right place at the right time with the right people - that unfortunately didn't click for me during my first two clinical years. Oh well, that happens, so I decided to do so some more formal research and gain some much-needed experience.
  3. Looking forwards, it seems a PhD could become almost mandatory in the fields I am becoming keen in, and I honestly wanted to test the waters and see if I could handle one research year before jumping into the deep end later in my career with ~3 years of research.
  4. I was really interested in two different fields of medicine and wanted a bit more exposure (research AND clinical) to both, so I found a project that involved that, and now I have a better idea about what I want to do in life. Will that change in 6 months when I'm back in final year? Perhaps, but it's peace of mind right now :)
  5. In the back of my mind was always getting an Intern job for 2018. In Vic we don't have random allocations for intern spots like they do in many other states (eg. NSW), so I thought having some research on my CV can't hurt ;)
I think it's worth noting, that despite having so many reasons, I was about 0% keen on doing an Hons year for probably 3.25 years of my medical degree. I was lucky to have an awesome mentor during my Obs/Gyn rotation who talked to me a lot about the importance of doing other things. He himself did a BMedSc(Hons) during his medical degree, and even though the subject of his minor thesis was as far from Obs/Gyn as could be possible, he still found it to be a very rewarding and educational experience. It was only really after his inspirational words of wisdom that I also entertained the thought of the degree. As said, there's always a bit of luck involved with opportunities presenting themselves, and I was lucky that this doctor and I had those chats.

Before launching into the content of the unit, which mainly comprises of the literature review, I think it's worth discussing a few important things one should consider before embarking on an Hons year of any sort (even relevant to the scholarly elective offered in Melbourne and Monash MD programs!). A lot of people get hung up on 'how cool is my project', or 'will I get published', or 'is this too intense' and so forth. While those are all important questions, I believe the most important thing in a successful Hons campaign will be your supervisor.

Choosing the right supervisor is more important than choosing the right project. When I was told this by a BMedSc(Hons) alumni before I embarked on my supervisor-hunt, I was skeptical, but in hind-sight I am really glad that I heeded that advice because the supervisor can really make or break the year. So here are couple of pointers that I think are really important about finding the right supervisor in the field of your interest.
  1. You don't have to know someone to do a project with them. I stumbled upon my supervisor by luck. Once while I was doing my aforementioned Obs/Gyn rotation, I got to my clinic a little early and ended up googling some of the other doctors on the same floor. I managed to find a Professor, who I had never met before, but who had been involved in some really interesting work and who has supervised students in the past. I decided then and there to start drafting an email. I was perhaps a little too fastidious, maybe to the point of obsessional, with how my email looked and what type of vibe it gave off, so I probably went through 2-3 drafts! But I was lucky to get a quick response and we arranged a face-to-face meeting in his office soon afterwards.
  2. Now that you've found a few people that you think might make good supervisors, you have to think: what actually makes a good supervisor? Here some some important questions you want to be seeking answers to:
  • Have they supervised Hons students before? What did those students think of their years? I found it to be really useful, as per my email, to get in contact and seek the thoughts from previous students. You may have to do a bit of 'stalking' to find these things, but they'll forgive you for being keen in their Hons year experience; people are often very keen to discuss how they went! You want to be knowing not only how they went in terms of grades (obviously H1 is ideal), but also the other things which will be covered in this list. If your prospective supervisor has never supervised before, that's not a deal-breaker imo, everyone has to have a first student to supervise, and you'll often find first-time supervisors tend to err on the side of over-supervision rather than under-supervision, which is good. They'll often also provide a senior researcher/clinician as the co-supervisor, to help them as well as you - again a good thing.
  • How much time will your supervisor have for you? I was lucky to have an amazing supervisor, who I could meet virtually any day, and who I could call or text or email any time. Obviously meeting every day is over-kill, but having that level of support was something that not many of my colleagues had. The more support you have - the better. You should have meetings face-to-face at least once a week, even if it's just to touch-base over lunch or something. Ensuring that you're guaranteed at least one meeting a week is really mandatory for you, and I'd be very wary of choosing a supervisor who couldn't guarantee that.
  • How busy are they? Are they supervising other Hons or PhD students? Will they be on lots of leave? These things are important. Your supervisor needs to be able to actually supervise you, and that implies that they need to be there. While in all honesty, they've got lots of more important things to do with their life than read a draft or listen to an oral presentation, they kinda should be doing that and if they don't seem like they have the time then maybe they've got enough on their plate already. I was lucky to have a supervisor and a co-supervisor who both took an interest in reading my drafts and listening to me practice my oral presentations, and again, I can't thank them enough for that level of support.
  • If you're doing a lab project, what's the lab like? What will your hours be like? Best to know what you're getting yourself into before the year starts and you've signed a year away, rather than coming in Day 1 with a bunch of assumptions and getting a rude shock. Lab work, which wasn't the focus of my project (thankfully!), can be a nightmare in terms of hours and stress, and this can start well before your lit review is due! It can also be incredibly rewarding and interesting, but it's never easy work. Be warned.
  • What's their publication history like? They don't have to be pumping out papers every other month in high-impact journals, but it's probably ideal to have a supervisor who has some publication experience with regular publications in decent journals. This can be checked by sussing them out in Google Scholar or their faculty bio page, rather than asking them about their professional career which can be awkward. Again, not a make or break for the Hons year itself, but might help once the year is done and you're thinking of publishing (if your project persists!).
  • See what resources you'll have access to. Will you have access to a statistician? Will you have a desk and computer? Will you have stats software? I was lucky to have all three, and it made life considerably more comfortable. Again, you don't want the rude shock of coming to Day 1 with no place of your own, get these things organised before you sign the papers.
  • What other things can you do during the year? Will you be able to present a poster or go to a conference? Will you be able to attend teachings? I was fortunate to not only attend clinical teachings in neuroradiology, I was also able to GIVE my own tutes to the local Monash MBBS(Hons) year 3 students and the Melbourne MD year 2 students. This was awesome because these activities really broke up my day, kept things interesting, and was amazing revision for me.
For the record, here is a copy (de-identified to name and place) of my email from Point 1 for anyone interested (it almost looks creditworthy as I look back on it now haha):
Dear Prof <removed>,

My name is <removed> and I am a current undergraduate fourth year Monash medical student, based primarily around <removed> and <removed> for this year, with an additional week-long stint at <removed>. So far in my studies, I haven’t done any research and hence, have become interested in completing a Bachelor of Medical Science honours year in 2016.

One of my friends, <removed>, completed a BMedSc under your supervision last year and through conversations with him, I found out about you and the very positive experience he had! Similar positive sentiments were discovered when I read about another student who featured in the '<removed>', <removed>, who also had a very enjoyable year under your supervision. Following in their footsteps, I was wondering if you would be willing to take on a medical student for an Honours year next year?

Although I realise it is “early days” for my learning and journey through medicine, I have developed a liking and an interest in neurology, especially after a rotation I did last year at <removed> under the guidance of Prof <removed>, among other consultants physicians. Given their stroke unit, I’ve been particularly fascinated by strokes, their symptomology and their management, and would be keen to learn more about and participate in the research that happens behind the clinical scenes regarding this condition. However, I am also very open to part-taking in research in other areas of neurology as well.

If you would be willing to take on a medical student and have any suggestions for potential projects that might be suitable, I would be very keen to have a chat and learn more. Unfortunately I am currently based at the <removed> (and for another 3 weeks!) so won’t available for any direct face-to-face contact until my term is finished here, due to very strict attendance regimes imposed on us. However, I am contactable via email, and if you have any free time after that 3 week period I would be very keen for a quick chat regarding any possible opportunities for research in 2016 under your supervision.

Thank-you for taking the time to read this, and I look forward to hearing from you.

Kind regards,

<removed>
So now that you've got a supervisor in a field of your interest and filled in the paperwork, the year is starting. And I mean that literally, time to get off your backside and start preparing for this unit in the holidays. No time to slack off. Without giving too much away (for privacy), my project was in the field of neuroradiology (neurology + radiology) and involved interpretation of various brain MRI sequences in patients who had a condition that causes a type of stroke. During medical school, we learn that MRIs are a useful thing - but that's about it. So I took it upon myself to use the holidays to get familiar with all the background "assumed knowledge" so that when I was reading papers that talked about "susceptibility artifact" or "field inhomogenieties" or "time to echo", I'd know exactly what they meant. I found it really useful to do this early, before my year formally started, because once the year did formally start I could easily sift through the literature. I also found using textbooks at this point in time was also ideal, they provided good summaries and overviews, and were also fairly up-to-date without being cutting edge and confusing.

Being prepared early is important for stress. The year tends to pan out a little like this...
If you can do a bit to bring that graph down a little, should you? Absolutely! Be a little proactive, sacrifice some time "with the lads", and do some of this basic reading. It's not taxing, and it'll put you in really good stead for the year.

Once the year starts, start reading more in-depth about your foci of research. Start with reading Review articles from top-notch journals. These often provide amazing overviews and lots of quality references to then sift through depending on your area of interest. I used these references (and references from references!), as well as generic Google Scholar searches, to stumble upon most of the articles I read and cited in my own lit review. What you want to be doing in your readings, and ultimately in your literature review, should resemble an upside-down pyramid. You want to be starting off reading broadly (ie. textbooks to gain assumed knowledge, then Reviews) and then delve deeply into your area of research (ie. individual studies) to see what gaps your study might be able to fill or contribute to. I'll come back to this pyramid later, it's important.

Keeping up to date with the research in your field is also really important, and there are a few ways to do this:
  • Sign up to the journal mailing list. Often journals will email their table of contents to your inbox for free, and you'll then need your uni proxy to access the article free of charge. This is useful, but not every journal does this.
  • Doing regular Google Scholar (or similar) searches with a truncated time element (eg. "since 2016"), this is tedious.
  • Physically checking each journal, either online or as a hard-copy, to see what's new. Again, incredibly tedious.
  • Sign up to Twitter. Now you may be asking "has pi finally gone crazy? sign up to social media used by Donald Trump?!?" While I can neither confirm or deny that first question, Twitter is actually a modern gift to academia. Most journals have Twitter accounts and they post many updates about new articles. Not only that, but active researchers in my field also had accounts and posted regular updates. Being involved by following these journals and clinicians was the best way for me to be up-to-date with advances in the field. I also discovered so many other cool educational accounts to follow, but that's a story for another day ;)
It's useful to download the papers you're looking at, and there are several ways to organise your downloaded studies. My supervisor used a program called Papers which I would probably use if I was to do the year again, but I personally resorted to just an ordinary folder on my hard-drive and having descriptive names of the papers I downloaded. No rights and wrongs here, as long as you're organised and you know where you read something for the purposes of referencing. Papers can also do referencing for you, so it saves you having to use a program like EndNote (which is what I ended up using).

Once you're doing some reading, make some goals. My supervisor wanted me to have a page of my literature review ready by the first week for him to look over. He later told me that he did this for a couple of reasons. Firstly, he wanted to see if I could write, and luckily my writing was passable! Secondly, he wanted to see if I could meet deadlines. In retrospect, that was a really good plan! Writing bits, regularly, was the key for me. Some people liked to make semi-detailed summaries of studies in an Excel spreadsheet organsied by topic, and then spent a week or two towards the end of the semester writing the literature review, and that's also a fine strategy. I preferred to knock off little bits of the review every day or so. It really depends on your field of research and your own personal preference of how you want to structure the literature review. I was fortunate to have a plan of the review in my head which I could segmentalise really easily, but if your foci of research is a bit more obscure you may need to do a lot more reading before you can start to collect your thoughts. I'd suggest you try doing bits every now and again, and then if that's not working, to then try just reading more to collect your thoughts. Just make sure you have an overall plan before you start writing; your literature review should start off broad, and then should delve in, just like your readings it should resemble an upside-down pyramid. You'll find that this is reflected in the lit review marking sheets too, which you should always have one eye on too.


I'd strongly recommend you don't leave it until you're 'finished' with the lit review before showing your supervisor. Get their input early on. As said, my supervisor wanted to even see the first page that I wrote. I think showing your supervisor bite-size chunks of work and then the whole thing at the end is ideal because they may have suggestions about improvements and directions your lit review should be taking. Last thing you want is for you to produce this 7,500 word-long piece of work only for your supervisor to think you missed out on discussing some really crucial things. So ensure you keep in touch with your supervisor, regularly show them bits and ask for their general advice. Don't go overboard and get them to read every new paragraph you string together, but regular chunks are probably fine. They'll probably take a greater interest in your work if they know what you've been up to, and correcting or looking over a couple of pages of your writing isn't too onerous either. The other reason I mention this, is because your lit review will often include a summary of your project at the end. For me, this was a strict two-page summary of my aims, hypotheses, and methods. While you will have most likely started your project already at this point (especially if lab-based), you will still need some help to develop this and refine your goals for the next semester. So: show keenness, but be respectful.

As I mentioned in the previous paragraph - there is a word limit to this beast. 7,500 words, coming out of VCE or even med school, might sound like a mountain, but let me tell you that it is just never enough! Often your uni will give you a +/- 10% leeway, but even that's not enough! Some tips and tricks for getting through the word limit:
  • Supervisors are excellent at cutting the crap from your work. If you have words that need slaughtering, let them know and they'll draw red all over it! My younger sibling was also very fond of cutting down my words, for which I am very grateful.
  • Use tables to your advantage. Tables do NOT count towards word counts, so use them a lot if you can. Don't do it for the sake of it and have all these dodgy tables with two or three rows, but be tactful about it and use them when you can. I had a fair few tables in my lit review and didn't get penalised for it.
  • Use figure and table legends to your advantage. Again, these do NOT count towards word counts, and you can add a lot of detailed information into these. Personally, because I felt I was abusing the table hack, I didn't do this as well. But I know people who did both to great success - power to them!
  • You can pay for professional editors. I did not do this and I don't know anyone who did, but it was offered as an option on our handbook, so I thought it was worthy of a mention in this list.

You should aim to show a final draft of your lit review to your supervisors approximately 2 weeks before it's due. This gives them plenty of time to give some last-minute changes, and they'll thank you for not putting them under pressure given they probably have many other important things to do. This also gives you an opportunity to make sure you've ticked all the right boxes in the marking sheet, and to format your lit review into looking a bit nice. Include preface pages such as a Table of Contents (make sure this is automated with MS word!), a signed Declaration of Originality, a Declaration of Contributors, an Acknowledgements page, a List of Abbreviations, a List of Tables, and a List of Figures. These formalities are not only nice gestures to those who helped you along the way, but are also incredibly useful for an assessor who might be reading your lit review in chunks and/or is not overly familiar with the field. For your font, we had to use Arial 11 point with double spacing, although apparently fonts with serifs are inherently more readible. Don't be afraid to add a splash of colour to your subtitles too, nothing breaks up a page full of black text than a nice orange or blue subtitle! Just regarding these subtitles, some of my colleagues liked to number all their headings, but I found that this often looked a little ridiculous when it got to "1.2.3.3.4 Pathogenesis of X", so I preferred to abandon such numbering and stagger the tier of my plethora of subtitles with font size and italics. It looked cleaner imo.

Once you're done and dusted with the lit review, the ever-tedious process of TurnItIn is back in play. This program... well no one likes it and no one really understands how it works. We were only allowed to submit once, and thankfully my submission was <15% which was fine. You'll often find TurnItIn picks up the most random nonsensical things (eg. your name, or page numbers), and my Faculty didn't bother inspecting a script for plagiarism unless the similarity index was >20%. Most Faculties would likely have similar policies. Once this is done, we have submission, and then freedom?

Not quite - there is still an oral presentation. Some Hons do this before the lit review is done, other do it afterwards. I did mine beforehand. Basically this oral presentation gives you the chance to talk about the field, what you've learnt, where the gaps are in the literature, and how your project will aid the field. In terms of slide content, the adage is 'less is more', only include the important details and keep your slides neat and tidy. If you haven't done oral presentations before, this may be a bit of a shock because not only do you have to present to a time limit, you also field some questions from an intimidating audience of senior researchers who have been making these presentations since before you were born. The questions can come from anyone and can be about anything. Many of my questions weren't even directly relevant to my project... But this happens to everyone, and everyone is nervous and has some questions they answer well and others they answer less well. It's even ok to say "I don't know", better to be honest than ramble about like an idiot. The best thing you can do to prepare for this is to practice with your supervisors and ask them to be savage in asking questions, and to practice with fellow students who are going through the same thing. It's a daunting process, but also one I found to be useful in giving me ideas for my actual research project.

As with previous years, there are still the same old med soc events. For Monash med students, there is a society for research that looks after us (Medical Research Student Society) and we had a couple of boozey get-togethers to de-stress. Highly recommend keeping in touch with fellow students throughout the year, it's really important to not get isolated throughout the year. I was perhaps unlucky to be the only one at my hospital doing a BMedSc(Hons), so I would often either banter with the Melbourne MD (were my age) or Monash MBBS(Hons) students who were there, or travel to a nearby hospital to meet up with my research peers for brunch or something. Keep in touch with others, it's really important to not become a recluse during the year. And this becomes more important as the year goes on.

The last thing I'll recommend is to do other things during the research day. Research can be is stressful and can be is monotonous at times. We all need a break, and never feel guilty for stepping away for an hour or so to reflect on your progress and take your mind off things. For me, I took time off to attend teachings, teach others, and to just walk around nice Melbourne parks (maybe to also catch Pokemon on Pokemon Go ::)). Also do things after-hours, but taking good and productive breaks during the day was something I found to be really awesome for my physical and mental well-being.

This is a tough unit, but is really only the taster for the next unit and the minor thesis :p
 
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pi

Junior doctor
Admodistrator
Subject Code/Name: MED4302 - Medical science honours research project

Workload: completely varies depending on your project, but expect to be doing fairly full-on days for 5 days a week.

Assessment:
  • Department oral presentation (5%)
  • Minor thesis (80%) (Hurdle)
  • Faculty oral presentation (7.5%)
  • Faculty poster presentation (7.5%)
Recorded Lectures: N/A.

Past exams available: N/A.

Textbook and Website Recommendation: None needed, although some choose to peruse statistics books as well as textbooks specific to their field of research as the year progresses.

Lecturer(s): N/A.

Year & Semester of completion: Semester 2, 2016

Comments:
This is the other unit as part of the "Medical Honours year" - and it's the big one. This unit is weighted as 75% for the whole BMedSc(Hons) year, while MED4301 was only 25%. So... It's a really big deal and can make or break your final grade. There's a bit less for me to say here, given everyone will have their own unique projects with their own unique challenges, but I'd like to echo some points from my previous post on MED4301, and give some other pointers where I can.

Being organised is so important. Force yourself to do little bits of the minor thesis every single day. Even if you're slaving away with your experiments or analyses and don't have results yet, you can always be refining your lit review for the 'Background' section of your minor thesis, refining your Aims and Hypotheses, or writing up your Methodology section. There are always bits you can be writing or doing. Doing these little bits will give each day some sort of rudimentary purpose, and will definitely reduce the stress coming towards the end of the semester.

When doing your experiments or analyses, just be aware that even with your careful and meticulous planning... Sometimes shit just happens. Maybe your results won't turn out they way you expected, maybe someone threw away something super important, maybe you get sick, maybe you find someone who has done your exact study but its better than yours, maybe your computer dies and you can't find your back-ups, etc etc. These things can just happen. Don't expect the unexpected, but keep it in the back of your mind that although it might be smooth sailing now, it might not be smooth sailing in 2 months time. This is why it's so important to do work as you go, because a big setback can really increase the work you have to do before submission, and if you've got large chunks of your minor thesis done and dusted, you'll be thanking yourself a lot.

If something happens, make sure "official" people are aware early: get your supervisor(s) and the faculty on board as soon as possible. I know people who had their projects completely fall apart, to the point where many of their analyses could not be performed and those that could be were massively under-powered - and that's ok. You can still score an H1 if you explain what happened and why in your minor thesis, and if you let the right "official" people know. The people marking your minor thesis know that this could be your first exposure to research, and they know research is always a bit of a gamble. Stay calm and seek support and you'll be right.

Jumping into the nitty-gritty of it all, the format of your minor thesis will be a fairly standard one that should be guided by your marking sheets. Mine was:
  • Title page
  • Table of contents
  • Preface pages: Declaration of originality, Acknowledgements, List of abbreviations, List of tables, List of figures
  • Abstract
  • Introduction
  • Background (ie. altered lit review)
  • Aims
  • Hypotheses
  • Methodology (including study design, ethics approval, data collection, statistical analysis)
  • Results
  • Discussion (including limitations, strengths, implications for future research)
  • Conclusion
  • Appendix (including actual ethics approval forms)
  • References

Now some of that should look familiar from your lit review, especially the "Background" section ;) However, I would refrain from copy and pasting your lit review into this section. This is because as you progress through your project, you'll find that some parts just aren't that relevant, and you'll find that the assessors of your lit review provided some feedback. This feedback is important, because it's highly likely the same people will be marking your minor thesis, so not taking into account their feedback is a bit of a bold and arrogant move. Furthermore, you may want to cut back on some parts for the dreaded word limit. Lastly, you may also want to update your literature review with advances in the field that have happened since you submitted it, so make sure you're keeping on top of your Twitter feed or whatever else, to ensure you don't miss anything major.

The word limit of the minor thesis is set at 15,000 words, again it might have a +/- 10% leeway. Now, as I said in my MED4301 review, the word count is NEVER enough. You can use the same cheeky tactics as from the lit review to combat this word limit, but you can additionally cut from the Background section (it should still be about 40% of the minor thesis imo) and you can add excess info to the Appendix.

Just a few words of advice on some of the sections. The Aims and Hypotheses might also need updating from your "ideal" ones you had in your lit review. Don't feel bad about chucking some out, or adding some, that's all part of the scientific process. Ensure your Aims and Hypotheses are specific and address what you actually did or tried to do. Some of my colleagues included a "global aim" and a "global hypothesis", I didn't really think that floated my boat, but it's a fair idea if it matches your project.

Your Methodology section should be so detailed and clear, that someone could literally repeat your project. You may have read over a hundred papers at this point and each has a detailed methodology section, yours needs to be MORE detailed than that. This can take a few thousand words. Use figures and flow-charts to your advantage here to demonstrate pieces of equipment or patient selection protocols, or whatever else. Ensure it's crystal clear. Furthermore, don't forget about ethics and a section on statistics, these little things earn you those hidden marks.

The Results section should be concise. I actually got marked down from both my assessors, fortunately not enough to keep me from that sweet H1, for having a verbose and lengthy Results section. Ideally, your tables and figures should be relevant, and there should be a matter-of-fact tone about the section where you're just stating this and that, without delving into what it means at all. Your Results should follow a logical order, and that might be dictated by your Aims and Hypotheses (*hint hint*). You may need some help with the Results section, particularly with the stats, and you should get that organised EARLY. The resident statistician isn't sitting in his/her office waiting for the lowly Hons student to come knocking - they're serving the whole Clinical School and are busy. You need to make an early appointment and be polite and patient. Their advice is very valuable and you're lucky to get it free of charge!

Your Discussion shouldn't be a surprise for your assessor, it should naturally make sense from reading the the preceding parts of the minor thesis. Having said that, that doesn't mean your Discussion should be bland and boring - this is your chance to really let the assessor know why your project was worth spending a year on. The core of your Discussion should answer "why should I care about this project?" in the assessor's mind. The only way to answer that question for the assessor, is by answering it for yourself first. For some, that might be easier than others, and writing this section is arguably the most important and hardest thing you're going to do in the year. You need to think a LOT about what you're going to write here and how you're going to do it. Remember to think broadly, and don't jump to one conclusion. There are often multiple reasons why something could be what you've found, so explore these things. Think outside the box.


Some suggest the rule of thumb that the Discussion should be as long as the Background - personally I disagree. I don't think it needs to be that long at all. If your project lends itself to a 3,000-4,000 word discussion naturally, then go for it, but many people I know had a more truncated discussion at around 2,000-3,000 words. The old adage of "quality over quantity" strikes again. Personally I erred on the lengthy side for my Background instead, just because I expected at least one of my assessors to know absolutely nothing about my field of study.

The Conclusion is pretty self-explanatory. It should answer the Introduction, so much so, that if someone only read those two paragraphs, they'd get the gist of your project. Having this sort of readability is really important, because it's the expected standard.

Just as with the lit review, the deadlines in this unit always appear far away, but are here before you know it. Hence, I cannot stress enough, do a bit every day. EVERY SINGLE DAY. Keep your supervisor in the loop, while you're working on the Results, maybe they can be giving your feedback on your Methodology, and so forth. Again, chunking it for them to correct is good for you and good for you. It's a win-win. Use your discussions with your supervisor to bounce ideas regarding the actual Discussion section of the thesis - they're the ones who know the overall field well and have the experience, and their thoughts are very valuable. But at the end of the day, the ideas are supposed to come from you, so you really need to be thinking often and deeply about your project during this unit. Like the lit review, you should aim to to be done with it 2 weeks before it's due with one eye on the marking sheet; the same TurnItIn crap still happens too.

Now let's take a step back. Remember that graph I had in my MED4301 review? Remember where that highest stress peak was? Yup, nearing minor thesis submission. Therefore I cannot emphasise this advice enough:You need to be in top physical and mental shape to cope with everything that is happening, and that sort of fitness comes from endeavors away from the project. It's important and you'll thank yourself for it once you've hit that submission button.

Once your minor thesis is done and dusted (yay, congrats!), there are a few other bits and bobs to take care of. In light of the minor thesis, these are going to seem like child's play, but it's important to still give them your all and end on a high note. There are two more oral presentations, each being very similar to the one you did last semester. Again, you'll get some nice questions and some hard random ones, just be honest and back yourself, and you should be fine. You've done this before, and you can do it again.

The other bit that's new is the poster. Now they aren't kidding when they say 'poster', this is a big piece of paper - 120cm x 90cm. The poster should outline what you've done in the year. It needs to be concise. I almost copied my Abstract into the poster, and then added some relevant figures and illustrated a few of my points. In retrospect, this worked well, but perhaps I still had a bit too much text. Even at size 31 font, it was probably a little too much, and the assessors made a comment to that effect as well. You won't just be making the poster though, you'll be presenting it. So sacrifice some text on the poster and replace it with spoken words is probably my advice. Again, you can get some questions from the 2-3 assessors that come to see your presentation, but I found these questions to be a lot more general and fairer. This is the last time you'll have to tell someone why what you did matters, so make it count :)

With all of that said, the unit comes to a close, usually with a few Faculty drinks and a more boozey party later on. Having finished a few months ago now, I've had a good chance to reflect on my year. I've got to say - it's an incredibly rewarding year to be involved in. I was so lucky to have amazing support from my supervisor and co-supervisor, amazing company from the local Melbourne MD2s (thanks for the farewell presentation and gifts!) and Monash MBBS(Hons) Year 3s (thanks for the card and chocolates!), and amazing fun along the way! The process of delving deeply into a certain area of medicine, essentially becoming an expert about something, is a really wonderful and rewarding experience. I definitely had some doubts coming into the year, not knowing what to expect or not knowing how I'd cope, but I'm really glad I did the year because I feel like I gained an incredible amount from it. You'll find most students who complete the BMedSc(Hons) also echo my sentiments, it's quite a remarkable opportunity to have and I am very lucky to have made the cut to be part of it.

So, what's next? After completing the year, many start to think about publications and maybe future research. I'm working on all of the jazz right now, so can't speak to how difficult that may be until I'm done with it, but it's another unique learning process. I've already presented a poster outside of the course, but maybe I'll be lucky enough to present at a conference too. Some of my colleagues needed to do a few more experiments in order to have results suitable for publication, but most people will find their place in a journal somewhere if they try hard enough. This is the advantage of having a research year over a smaller scholarly elective (from the Melbourne MD or new Monash MD), there's just more time to do things which often results in more meaningful work. But hopefully before you start doing more work, you reward your efforts with a cheeky trip overseas or something, I can confirm Hawaii and South East Asia are still nice this time of the year ;)


To anyone considering taking a BMedSc(Hons), I can't recommend it enough. You'll have a very different year compared to your other medical years, but it'll be an educational, enjoyable, and rewarding year in any case. Good luck! :)
 

pi

Junior doctor
Admodistrator
Subject Code/Name: MED5091 - Advanced clinical practice 1 and MED5092 - Advanced clinical practice 2

Workload:
Varies between rotations and sites, but expect to be at your site the same hours as your intern or junior doctor. That generally means 8am - 5+pm for medical rotations, 7am - 5+pm for surgical rotations, and 8-10 hour shift rotations if in the emergency department.

Assessment:
- Pre-Intern Appraisals (PIA) (hurdle): there are five of these that need to be filled out by a supervising consultant doctor, one for each rotation (none for the elective rotation) and each worth 18% of Year 5
- Clinical Knowledge Test (CKT): the only exam for the year, is MCQ/EMQ format and is done at the end of the year, not a hurdle to pass but a hurdle to attend (which is unusual), worth 10% of Year 5
- Modules: a variety of paper, online, and in-person module tasks aimed to supplement clinical learning, many of which are hurdles, for each rotation; the sites and supervisors choose how exactly they want these done (more on this later), none of these count towards the final Year 5 score
- Attendance: a very strict expectation of 100% attendance, although technically the lower bound is 80%

Recorded Lectures: Yes.

Past exams available: Yes there is a practice CKT available from the Faculty.

Textbook and Website Recommendation:
This is a year where textbooks should be utilised only if you really need to, as most of the learning should be occurring during working hours and not at the desk (unlike Year 4!). Personally, I'd strongly recommend at least having a look at the Australian version of "Marshall & Ruedy's On Call: Principles & Protocols", as it is a relatively succinct text on everything practical than an intern will be doing for patients on the ward (minus the paperwork!). As for other resources, as per my reviews of previous units and years, I'd also recommend utilising UpToDate, eTG, and Radiopaedia.org, the wiki-based collaborative Radiology resource as much as possible.

Lecturer(s): Many, depending on the series of lecture

Year & Semester of completion: Semester 1 and 2, 2017

Rating: 5/5

Comments:
These units are code for a "pre-internship" year. In my opinion, I found this to be the best year of medicine, but undoubtedly, it comes with many challenges. I'll try to order my comments here in a logical fashion.

Structure of the year
So Year 5, of which these units account for the vast majority of (so I'll use them synonymously with 'Year 5' for my ease), is divided into 6 rotations, each 6 weeks long, with a week of lectures (and the CKT) at the end of the year. There is a three week gap after the first three rotations, for reasons that will become apparent later in this review, I wouldn't call these a holidays. There is only the weekend in between each of the other rotations.

The six rotations are:
1. Medicine
2. Surgery
3. Emergency
4. Aged care
5. Specialty
6. Elective

Obviously, these rotations are not necessarily in this order. Speaking of which, it's worth touching upon how you get to choose your rotations and what my tips and tricks are. The Faculty sends out an email with your rotation allocations towards the middle of Year 4, this will be a generic email saying that you got your Medicine rotation (for example) at Rotation 5 and so forth. These rotations are not set in stone, and you can swap them. My tip is to NOT have your elective in the first two rotations of the year, and ideally not in the first half of the year. This is because, internships, which I'll touch upon towards the end of my review, need referees and these need to be from Australia (preferably: Victoria) so best to have some Victorian rotations before those intern applications are due.

After this initial allocation you are allowed to preference for individual rotations, which occurs towards the end of Year 4. The exact process has escaped my memory, but I think you get to preference 10 rotations for each allocation, but only a maximum of two rotations from the one site. So for example, you can only preference The Alfred twice for a medical rotation. As with any preference system, the highest one should be the one you want the most. The specialty rotation I'll talk about later, but it's essentially a mix of the more obscure medical specialties, surgical specialties, and other specialties (including the weird and wonderful such as a rotation at the Victorian Institute of Forensic Medicine). The Elective rotation is left for later,and can essentially be done anywhere that offers a 6 week rotation with a single supervisor.

The only caveat with rotations for domestic students to be aware of, is that if you haven't done a rural year in Years 3 or 4, then you have to do a least one 6 week rotation in a rural area. What I'd advise is, choose which of the 5 rotations you would want to do in a rural area, and for preferencing in that rotation, ONLY list rural sites. For the other 4 rotations, list NO rural sites unless you want to do more time rurally. The rule of thumb is: if you preference it rural anywhere in your list, you'll get it, so be aware of this. Personally, I chose to do my Surgical rotation in rural Mildura to escape early wake-ups and Melbourne winter, and I also did my Aged care rotation in Bendigo in the brand new hospital - I loved both rotations and would therefore recommend rural rotations to everyone.

As for what preferences most people got, I think I got four first preferences, and one that was somewhere else on my list. Most people probably aren't so lucky, but generally do get at least one top preference in their final allocation. These final allocations are revealed to you via email in late September.

Before starting each individual rotation, it's worth checking the handover sheet. This is a Google spreadsheet that students are encouraged to fill out once they have completed a rotation, and provides tips and tricks about the rotation. Ideally, every student would fill this out, but in reality it's probably less than 25% per rotation, which is a real shame. Regardless, hopefully you find that some decent soul has filled in something for your upcoming rotation, so you know what you're heading into.


Medical rotation
Medical rotations are my love, so I thoroughly enjoyed my rotation. I was fortunate enough to do a rotation at one of the large tertiary networks in an area that I am super interested in, and I tried to make the most of it. Obviously detailing my rotation would be of very limited use to most of the people in the degree, so here is my general advice:
- This is a rotation where you can really hone in on your intern skills. There will be plenty of opportunities to make the intern's life easier by doing procedures on the ward, doing discharge summaries, writing the ward notes, making referrals, etc. Try and do as much of this as possible as you'll inevitably have to do a Gen Med rotation next year where all of this is bread and butter. Should be noted, that anything you do should be run by your intern and should be checked by your intern, especially official hospital documentation. Technically, you should not be writing on drug charts or writing scripts, but definitely try and get some exposure to them.
- Just to reinforce this: for all the above, it's unlikely you'll have an intern who will hand you these opportunities on a platter. You have to seek them out, you have to be keen. I promise you that it will pay dividends for not only your transition into next year, but also how the consultants are registrars will view you. You want to be viewed as a member of the team, not another medical student. This is the key. I tended to stay doing jobs until 7pm some days, and as a result I had an amazing rapport with the team and was always invited to join out-of-hours rounds on interesting cases, Friday evening beers, extra clinics, and so forth. Be keen and helpful, and you'll learn way more.
- With that said... you are still a student. So don't be a slave. You're there to learn, not do all the boring work while your intern deals with the fun stuff. It's a fine balance between pulling your weight and learning. One way to make sure you get enough of the latter is to do what med students do: see patients. Try and be at the admissions (or do them yourself!), report back cases to your registrars when they have time, and ask questions. This is the last time you have to ask questions without feeling too stupid, so make the most of it!
- Do your pre-readings. It should be obvious, but if you're entering a rotation on Lung Transplants, and you haven't got a clue what they're about, you should really smash out some readings on the weekend before. UpToDate is my personal fav for seeking out information in a rush, so that's what I'll recommend. But seriously, you'll look like an idiot if you can't answer the basic questions you may be asked, and you'll also be lost for a good chunk of the rotation which negatively impacts on your learning opportunities.
- Onto something particular: discharge summaries. These are something that I wasn't taught how to approach, and it really took me reading a lot of summaries and doing heaps myself until I developed a format which I found to be reproducible across simple and complex patients in multiple medical and surgical specialties. Here's how I like to go about tackling these pesky beasts:
N.B. in retrospect and from discussion with more experienced MSO members, this is likely too detailed for a discharge summary. Key features should be: concise, relevant, and clear, for a GP audience.

Mr/Ms <name> is a <age> year-old male/female, from <home situation>, who presented to <hospital> emergency department on <date> with <presenting complaint>, this is in the setting of <anything recent>, and on an active background of <relevant past medical history>.

Presenting
- In dot points, briefly describe the presentation
- Include a dot point of pertinent negative findings (eg. clinically ruling out sepsis, or APO, or an ischaemic limb, etc.)
- In dot points, describe what was done in emergency, including summarising relevant examination (including vitals) and investigations
- Sample line 1: "Although previously well, developed sudden-onset weakness of L) hand and arm while driving at 12.14 pm"
- Sample line 2: "Immediately pulled car on side of road, and called for an ambulance, which arrived at 12.35pm and brought him to hospital"
- Sample line 3: "He reported no infective symptoms (cough/dysuria/neck stiffness/fevers/rigours), no pain, no headache, no loss of consciousness, no visual symptoms, no recent surgery or trauma"
- Sample line 4: "Notably, he had not been taking his aspirin or antihypertensive medications for the last week"
- Sample line 5: "At presentation, he was haemodynamically stable with a regular pulse and manual blood pressure of 150/85 mmHg, he was afebrile and emergency doctors only noted 4/5 weakness in his L) upper limb with an otherwise unremarkable examination"

Admission
- In dot points again, just describing what happened when your team met the patient, I don't always include this section but do if it's a complex case
- Include any new findings on the physical examination (relevant only) and what management took place from your team
- Sample line 1: "On examination, Mr Smith was haemodynamically stable with a regular pulse, and afebrile with a GCS of 15; as noted earlier, he had reduced 4/5 power in his L) upper limb across all movements when compared to the contralateral side, accompanied with brisk reflexes and a subtle increase of tone, notably his cranial nerve and lower limb neurological examinations were unremarkable, as were his chest/heart/abdominal examinations"
- Sample line 2: "Given his presentation suggested an acute stroke, a CT brain was performed which was unremarkable, followed by a CTA whcih demonstrated an occlusion of the R) M2, and a CTP which demonstrated a perfusion mismatch in the R) hemisphere with a large penumbra, features which all suggest an acute ischaemic stroke"
- Sample line 3: "After consultant discussion, it was decided that alteplase be given as per protocol, and this infusion was started at 1.06 pm when Mr Smith's blood pressure was 140/80 mmHg, he tolerated the infusion well in the emergency department"
- Last line of this section should be "Admitted under <home team> on <date> after discussion with consultant Dr <name>"

Progress
# Issue 1
- Dot points again, just detail what happened for each individual issue, give the issue the best medical name possible (eg. Hypertension is better than "Increased blood pressure")
- Include clinical improvements, deteriorations (eg. MET calls, code blues), trends in investigations, impressions by allied health staff
- Sample line 1: "He/She progressed well on the ward, tolerating the increased dose of frusemide well, with a clear chest noted by 29/11 and a clear CXR noted by 30/11."
- Sample line 2: "Allied health input was sought, and Ms Smith began hand exercises and rehabilitation with the physiotherapists on the ward, her strength in that R) hand improved to 4+/5, which was close to her reported baseline"

# Issue 2
- Same deal, for as many issues as is required

Discharge
- Brief, stating discharge rationale, destination, and plan for patient and the GP
- Sample line 1: "With good progress from Neurology and Allied Health points of view, Mr Smith was discharged home"
- Sample line 2: "Several changes were made to Mr Smith's medication regimen, including the addition of <medications and doses and frequency>, and these were explained to Mr Smith by our pharmacist on the ward"
- Sample line 3: "Mr Smith is to follow-up in our Stroke clinic in 4 weeks time and is to have a brain MRI beforehand, and is advised to follow-up with his GP in one week to reassess his hypertension"

There are often other sections of the discharge summary form, depending on where you are, but at some point (after all the above if there isn't a specific area for this), you should mention:
- All the medications to take upon discharge: name, dose, frequency and why
- Which medications have been ceased and why
- Past medical history - often this can be copied from a previous summary, but obviously read and update this
- Actual results, I personally liked to attach scan results verbatim, the latest bloods, and any other important investigations (eg. nerve conduction tests, EEGs, HbA1c, etc.)
- Smoking and alcohol status
- Relevant social history
- Your name and role, your registrars' and consultants' names and roles
- A final note about the modules for this rotation: it depends on your team. There are NO hurdle modules for medicine, so do whatever your supervising consultant wants you to do. Keep in mind, that if you do need to do some, they're quite time-intensive so don't leave them until the last day because you'll struggle.


Surgical rotation
An area of medicine I appreciate, but not one I enjoy at all. As aforementioned, I did this rotation in a rural setting, and for someone who doesn't love surgery, I think this was ideal for seeing a good variety of things, and to nail some of the basics. Obviously again, detailing my rotation would be of very limited use to most of the people in the degree, so here is my general advice:
- Again, be keen. This is how you get things done, this is how you learn heaps, this is how you score well on your PIA. In surgery, the best way to show you're keen is to make it into theatre. I probably scrubbed up more in this single rotation than in the entirety of my previous medical schooling! On some days I was in theatre helping out with cases until 9.30pm. Even though I'm not a fan of surgery, this was enjoyable and the surgeon could see that I wanted to learn and as a result, got me involved in whatever she was doing. Because I was so keen, I even got to present at the Grand Round with my ward partner which was a great experience. Awesome.
- Again, this is another perfect rotation to nail down those basic intern skills. Get the procedures in, get the ward notes in, get the discharge sumamries done. I was a bit of a discharge summary fiend in this rotation and probably did around 35. Amazing practice for the next year, I feel really comfortable about efficiently doing them now. Oh, and the intern was super thankful because it was a very busy unit.
- I feel like I'm repeating myself here a bit, but do your pre-readings! The first and foremost in surgery is the anatomy. Look at the list of cases the day before they happen and read up on the procedures that will happen, and read up about the relevant anatomy. Don't be that guy that walks into a lap cholecystectomy and doesn't know what Calot's triangle is... Never be that guy. As with my advice in third year, worst that happens is that you don't know and say "Honestly not too sure, how about I read up on it tonight and briefly tell you the answer tomorrow?". A response like that shows initiative and shows a certain desire to improve and learn.
- A final note about the modules for this rotation: they are all hurdles. This means you HAVE to do ALL of them. They are actually quite time-intensive so don't leave them until the last day because you'll struggle.


Emergency rotation
- This rotation is the traditional favourite for medical students. Wasn't my favourite, but that's not because it wasn't amazing (it was!), but just because I felt I had so many great rotations that this one didn't manage to top the list. Students love it because you get freedom to actually practice medicine. Generally, shifts are 8-10 hours long, and 3-4 shifts per week, although if you're keen you can do more shifts as long as it doesn't impede on the learning of others.
- Just a note on the format of EDs, each is different (of course), but generally there are different streams, some more acute than others. Get a good taste of each stream as you do your rotation. Personally, I found the acute streams (but not the super acute/trauma) streams really good for learning as I did a lot there.
- That leads me what you do in the ED. I think what you do exactly depends on where you are. If you're at a fancy big tertiary centre, you'll be doing a bit of ED work and a bit of shadowing work. If you're at a smaller centre, you'll be doing way more ED work.
- The other factor that alters how much freedom you have is what your consultant thinks of you. If your consultant rates you highly, you'll have free reign, if they think you're a bit of a battler, you'll be reeled in a bit. I think that judgement is made over the first few shifts, and is generally a fair assessment. Nothing wrong with more supervision so don't take it the wrong way.
- Personally, I was fortunate to be treated like a resident. I would pick up my own patients (letting the in-charge consultant know of course!), clerk them, examine them, and report back to the in-charge consultant with my management plan. This is not dissimilar to what any junior doctor would be doing, and is a really good chance to learn. Again, a great chance to refine your procedural, history, and examination skills; you should be busy doing something all the time in the shift!
- As part of your management plan, you may be required to make referrals or ask specialties for advice. I always volunteered to take this job on, because again, it's great learning and experience. There are ways to handover patients, and ways to handover patients, and we're all pretty pathetic at it when we start off (and perhaps I'm still not great!), but what is essential is that you're prepared and have a format. By prepared, I mean have the patients' details and results in front of you and ready to go, know the case, know what you're asking of the person you're talking to, and realise that their time is valuable. By having a format, I mean something like ISBAR. This is great, and I use it often. However, there are variations, and I'll attach a couple of useful slides below to guide you. Practice makes better when it comes to referrals.
- A final note about the modules for this rotation: they are all hurdles. This means you HAVE to do ALL of them. They are actually quite time-intensive so don't leave them until the last day because you'll struggle (see the pattern yet?).


Aged care rotation
- Not going to post much advice for this rotation, because it's essentially just a medical rotation with elderly patients. The same rules apply.
- Where this rotation differs is in some of the extra-hospital placements you have to do. This includes a visit to the Alzheimer's Association, attending a VCAT hearing, an Aged Care Services visit, and a visit to an aged care facility. Each of these has a worksheet to complete, and these are all hurdle tasks.
- In addition to these extra-hospital visits, there is also the "Interprofessional Learning Day" which is a full day where you learn some aged care bread and butter alongside nursing students. I actually found this day to be pretty useful, despite the doubts I had about it beforehand. So keep an open mind and be kind to each other. It's a good initiative from the Faculty and also a hurdle task.
- The modules in this rotation are also all hurdles, and require you to seek out patients and present them to a consultant. So naturally, these need to be planned in advance with your supervisor. Worth getting on top of finding cases early, especially if your rotation is at a specialised service.


Specialty rotation
- Specialty rotations can be anything from a medical rotation, to a surgical rotation, to psychiatry, to paediatrics, to radiology, to pathology, to the weird and wonderful like the Victorian Institute of Forensic Medicine. Hopefully you're allocated something that you enjoy. :)
- No specific advice for this, it all comes together with the advice from the previous rotations.
- The modules for this rotation are odd. Regardless of whatever you do, there is a Women's Health quiz that needs to be passed on Moodle; this isn't an easy quiz and there are pre-recorded lectures you should watch before attempting it. There is also an essay on HIV that needs to be written, this can be an opinionated piece or a creative piece (I chose the latter) and is quite an interesting task if truth be told. Both of those tasks are hurdle requirements. There are other non-hurdle modules that you may be asked to do by your supervising consultant, such as dermatology and so forth. Fortunately, I wasn't required to do any of that.


Elective rotation
- Hopefully you've left this towards the back half of the year as per my earlier advice! Why will become apparent in the next section.
- This is a rotation with a lot of freedom, you can go virtually anywhere in the world that offers a 6 week rotation with a single supervisor. If you're not keen to travel, that's more than fine, Monash offers many rotations that students can choose from in order to do their elective in Victoria.
- If you're going overseas, plan it early. Many places, especially the UK, have very early deadlines for applications, often before the year has even started. So get organised early to avoid disappointment.
- If you're choosing a Monash elective, a list of available rotations will be emailed to you and you then choose which one you want. Time is key here as these are offered on a first-come-first-serve basis.
- No modules for this rotation and no PIA for this rotation, but there is an "Elective Report" that needs to be submitted as a hurdle. This can literally be be on anything as long as it's relevant to your experience. Furthermore, instead of the PIA, there is a "Supervisor's Report", which needs to also be submitted before a deadline date.


Back-to-base and the CKT
- 'Back-to-base' describes the phenomenon of coming back to Monash Clayton for some lectures that contain useful knowledge for any junior doctor. In general, I found them to be worthwhile and high-yield.
- These happen on the last Friday of every rotation for a half-day. If you can't make them, they're recorded, however the expectation is that you will be there.
- These lectures also occur at the end of the year for one week, known as the 'Back-to-base week'. This is a jam-packed week, with lectures from a variety of senior and junior doctors on core topics. Excellent revision, lunch included, and note that the roll was taken one day so be sure to turn up!
- During the back-to-base week, there is the CKT. This is really just like the Year 3 exam, but includes more pre-intern knowledge. It's a hurdle to attend, but not to pass (which is strange!). I didn't do any particular study for it, and I think I did fine. Wouldn't lose sleep over it.


That three week gap and internship applications
- I've left this to last because technically this isn't part of the units, but it's part of the year, and is arguably the most important part of the year.
- Three weeks off between semesters sounds like a great time to jet of to Europe to discover yourself, right? Wrong.
- This three weeks isn't for holidays, it is when intern interviews occur.
- Now let me back-track a little to explain how this process works. The whole process is mediated by an organisation called the Postgraduate Medical Council of Victoria (PMCV). Consider this the VTAC of medicine. PMCV provides a medium where you can upload your CV and order up to 15 hospitals in a list of preferences. But this is not all you have to do, as each hospital network ALSO requires you to apply to them as well. So it's like VTAC and if you had to apply to each uni as well. It's annoying, I know, but it's what it is.

PMCV
- So firstly, what does PMCV require. They need: a standardised CV, your InternZ score, your two referees, and your list of preferences.
- 'Standardised CV' refers to a CV that follows a template created by PMCV. It has fixed sections that need to be filled in and no part of it can be deleted. It can become pretty long (mine was 7 pages I think) if you fill it in correctly. My advice: fill this in at the start of the year, well before any of the internship applications actually open. Refine it as the year progresses. One tip I have is to add subsections to each of their templated tables, for example under the "Leadership roles and extracurricular achievements" section I divided that into the four sections of Leadership, Professional development, Professional memberships, and Extra-curricular; which I felt helped a reader to understand everything that I had done. You can do this, but do not delete anything. The CV also requires a photo (god knows why...), so get this sorted too, it should look professional.
- The 'InternZ score' is hopefully something you're already familiar with. In short, it's calculated using your MED2000 and MED4000 marks such that you're fit along a normal distribution curve that has a median of 3.5. Hopefully, for your sake, you're above 3.5! You get your score towards Rotation 3 time, which is when all the applications start to open up for each hospital.
- The two referees are a source of much stress. PMCV recommends that these be consultants (and indeed some health services will not accept them if they are 'just' Fellows or Registrars!) who have supervised you CLINICALLY in the last 18 months. So basically, from the start of Year 4 until applications are due. Most people get their referees from Year 5, and from Rotations 1-3. This is why I strongly suggest having your exotic elective AFTER these rotations, so you can maximise your chances of having great referees. How to choose a referee is tricky, but generally your consultant supervisor is the best bet. My approach was to ask them towards the end of the rotation if they'd be willing to be your referee (they invariably say 'yes' if you did well on the rotation), and ask for their contact details and ask if they don't mind you sending them a reminder email closer to when applications are due (again, they say 'yes'). I'd then email them a couple of weeks after the rotation is over to thank them profusely and to also attach a mock-PMCV referee template. This template is essentially the assessment that they'll fill out about you once you nominate them as your referee in the PMCV system. The assessment has boxes to tick but also has a comments section, strongly recommend them to write in the comments as health services love the comments. Sending them this early allows them to know what to expect, indeed some keen beans actually printed out the mock template and asked prospective supervisors to fill it out in front of them to see how well they'd give them. Personally, that latter approach is too far, but the email is a nice courtesy. Following this, email them again just before you officially nominate them in the PMCV system, telling them that they'll receive an email from PMCV shortly with a link to a similar form, if they could fill it out promptly AND fill in the comments that would be much appreciated (or something along those lines!). Once they've completed the official form from the PMCV link, you will be notified via email. You do not get to see what scores or comments they gave you, and that's probably for the best. You cannot un-nominate a referee, so choose wisely! To repeat, you need two such referees.
- Finally, the list of preferences. This is straightforward. Essentially just list up to 15 health networks (I did 12) that you'd like to work in. No tricks here, preference the one you want most as #1, the next at #2, and so forth. Victoria has a merit-based system so there's no way to give yourself an advantage of getting a job anywhere through your preferences. The individual hospitals do NOT know where you have preferenced them, and they don't ask either. I wouldn't volunteer the information to them as well.

Health services
- Ok that's the PMCV side of it. Now let's talk about the hospital side of it. Each hospital network will have their own online application. You must submit an application for each hospital you preference in PMCV (otherwise... why bother?). The applications vary considerably; some require cover letters, some require you to answer questions, some have extensive forms, etc. You need to actually take some time with each application, and especially take time with the cover letter. Ensure your cover letters are addressed to the right people from each hospital, and ensure that they actually address what the hospital is looking for in an intern. What they're looking for is generally obvious - look at the position descriptions and look at the values of the health service. This all takes a LOT of time, so get onto it when it opens. Worth noting that once you have submitted an application to a health service, you can edit and change it until the deadline, so don't worry too much about getting it perfect the first time, just make sure it's perfect by the deadline.
- One thing to note for the hospitals is that they each run an information session and/or have a stall at the AMA Careers Expo. Worth going to these if you can, you'll have a chance to talk to current staff (senior and junior), learn about the health service, and get tips about applications from them. Some of these require booking in advance (and do sell out!), so be on top of things.
- This whole application process take a LOT of time, and is quite stressful. The best tips I have is to be organised, understand the process, and do things earlier rather than later. When you think you're done with an application, double-check it, and then triple-check it, and then finally check that you've actually submitted it (hint: you'll get an email saying you have).
- Once all of this is due, which is usually towards the end of Rotation 3, you have a peaceful few weeks until interviews are offered. Those few weeks are not a fun time.

Interviews
- Onto the interviews. Not all hospitals have them, those that do all do them differently, and they each have mysterious selection criteria. Here are a few hospitals that do them (with style of interview in brackets): Alfred Health (panel interview with HR and consultant doctor, followed by SJT), Austin Health (MMI-style interview with two one-on-one stations, one with a consultant doctor and one with HR), Melbourne Health (group interview), St Vincents Health (panel interview with HR and consultant doctor), Monash Health (video interview, 1 min per question with 2 mins reading). These are generally announced in the first week of the three week break, and depending on the health service, you may get to allocate an interview time slot or it may be auto-allocated. For the interviews, dress formally (more formal than med school interviews in any case), know the health service, know why you want to work there, and have an armamentarium of personal anecdotes that you can slide into answers (eg. about leadership, teamwork, working with difficult staff/patients, etc.).
- Job offers come out towards the end of July, and the wait is generally an unpleasant one!


Overall impression
What a year it is. What a fantastic year. You really do feel like you're practicing medicine and making a difference. Yes there are the stresses associated with intern applications and interviews, but I really do think I learnt a great deal from that experience. I think I was fortunate to have a stellar year in terms of rotations, not a rotation I didn't love (even Surgery!), so no complaints from me. That was coupled with me getting decent grades throughout the year, and getting the internship spot I wanted. What a damn good year to be part of. It's been an absolute privelege to end my time at Monash Uni on such a high note. Hopefully you have a similarly amazing year too :)

Feel free to ask me any questions!
 

pi

Junior doctor
Admodistrator
Subject Code/Name: MED5102 - Contemporary developments in clinical practice: Patient safety

Workload: Not much at all; just simulation sessions, three half-day lectures, and some time dedicated to online tasks.

Assessment:
- Simulation sessions: these are a hurdle to attend, not worth any part of Year 5
- Eight Moodle posts: four posts per semester, hurdle to complete to a satisfactory level, but not worth any part of Year 5
- Four lectures: a half-day each and a hurdle to attend, not worth any part of Year 5
- Attendance: a very strict expectation of 100% attendance for all the sessions and lectures

Recorded Lectures: No.

Past exams available: N/A.

Textbook and Website Recommendation:
None needed (what a change!), all readings are provided via Moodle.

Lecturer(s): Several, as described.

Year & Semester of completion: Semester 1 and 2, 2017

Rating: 5/5

Comments:
This unit is a bit of an odd-ball. A mix of bits and pieces that the Faculty thinks are useful for internship that don't fit into the nice rotations of MED5091 and MED5092. Given it's not a major player in Year 5, I'll keep this short.

Simulation sessions
These are amazing sessions. There are a minimum of two full days of simulation sessions, although depending on where you are allocated to do them you may get more time (especially in rural centres). In these sessions you work as teams in a variety of acute scenarios, using a fancy dummy as a mock patient. This dummy has signs on examination, can speak, has an ECG trace, can take intravenous therapy, and so forth. It's got all the bangs and whistles, which is pretty awesome for learning. The scenarios themselves are supervised by consultant emergency and ICU physicians, who provide detailed constructive feedback. The sessions are honestly one of the best parts of Year 5 without a doubt, I wish we had more of them!

Moodle posts
What can I say about Moodle posts that hasn't been covered in my previous views? I'm not a fan. The Faculty means well by making us do these tasks, but honestly as per the ones in Year 4, I found them to be a bit mind-numbing and dull. Thankfully, there are only a handful to make per semester so it's not too demanding. In all honestly, some of the readings are actually quite interesting, so that's one positive.

Lectures
The lectures I found to be of mixed value. The lecture I enjoyed the most was regarding Prescribing, and was run by consultant doctors as well as hospital pharmacists. That day was particularly memorable because it was filled with lots of really good advice about how to be a safe and efficient prescribed - traits that are obviously valuable as a junior doctor. Another memorable lecture series was the Palliative Care lecture day, again filled with very practical information and delivered by superb presenters.

Overall impression
A nice unit to supplement the workhorse units MED5091 and MED5092. Definitely gained some key pearls of wisdom while completing this unit, and particularly enjoyed the simulation sessions which turned out to be one of the (many) highlights of the year for me.

Feel free to ask me any questions!
 

pi

Junior doctor
Admodistrator
Subject Code/Name: MED5100 - Final MBBS grade

Workload: N/A, this unit is essentially a grade for the entire degree.

Assessment:
- MED2000 (30%)
- MED4000 (60%)
- Year 5 (10%)

Recorded Lectures: N/A

Past exams available: N/A

Textbook Recommendation: N/A

Lecturer(s): N/A

Year & Semester of completion: Semester 1 and 2, 2012-15, 2017

Rating: 3/5

Comments:
Similar to my memorable MED4000 review, not sure how to feel about this unit given it's just a grade. Like your ATAR, this is one number that signifies how you did in the degree. The caveat: you've already got your jobs so no one really cares too much! As you can see, the bulk of the grade is in the work you've put into MED4000, which further highlights the importance of Years 3 and 4, however Year 5 is still important to do well in. Indeed, the vast majority of awards presented at graduation involve Year 5 in some way or another, so doing well should be your focus :)

From me, it's been a pleasure writing these reviews for MedStudentsOnline :) If you're reading this, hopefully this means you're towards the end of the degree, so best of luck with it and hopefully we run into each other one day on the wards :)
 

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