The Ultimate Guide to Passing Clinical Medicine Finals

Mohammed Faysal Malik, Asiya Maula, Dominic Greenyer

• Verlag: CRC Press
• Jahr: 2021
• ISBN:
  9781000466713
• Auflage: 1
• Thema: Medicine
• Thema: Medical Theory, Practice & Reference

A well prepared student takes the initiative to create learning opportunities and propel themselves towards qualification; we find that the better prepared you are, the luckier you become. From the Preface The key to passing clinical finals is not a secret; adequate preparation and the ability to think logically and speak clearly are all hallmarks of a successful candidate. This unique guide gives final year students the knowledge and confidence required to pass their examinations with insiders' tips on particular information and skills required to be a top candidate. It is ideal as both a revision aid in the weeks leading up to the examination, and as an aide-memoire the night before.

CHAPTER 1

Introduction to finals, ethics & communication skills

1.1 INTRODUCTION TO CLINICAL FINALS

Clinical medicine finals present a unique challenge to medical students, in that compared to their counterpart, surgical finals, there is an increased emphasis on detailed medical knowledge as well as sound clinical examination skills. However, you must remember that despite what may initially seem to be a hostile environment, the examiners are indeed keen to pass you.

Learning whilst on attachments is ad hoc at best, often with very little time dedicated to teaching you the large number of history-taking, examination and practical skills required. This is primarily because internal medicine is such a busy specialty that teaching students tends to be less of a priority. However, this does not mean you waste your time; a lot of opportunity exists on the wards for you to see patients and examine them. The emphasis being to hone your clinical examination skills, particularly at being apt at picking up clinical signs and presenting your findings. Remember, you must use your time efficiently and effectively by concentrating on what you need to know to pass the exams. It is very obvious to an examiner when a candidate has never performed a respiratory examination.

Often, the candidates who seem to know the most in terms of knowledge, struggle during clinical examinations, whereas their colleagues who may not know as much are doing better. Their successful technique is no secret. The aim of this book is simple: to teach you how to think logically and communicate in a thoughtful but structured manner. This will enable you to not only demonstrate your breadth of knowledge but also your depth of knowledge.

It is necessary to pause here and emphasise this fundamental point to you: it is your breadth of knowledge that the examiner is interested in. There is no point in knowing the pathophysiology of digital clubbing when you cannot name the causes. We aim to teach you the basics and hopefully to enable you to know these well, because it is this that scores you the marks and helps you to pass finals.

Students often ask us what key skills they need to pass finals. While there are many skills that make a good candidate, for purposes of medical finals the most important factor is in knowing your basic core knowledge inside out and being able to communicate this knowledge to the examiner in a methodical manner, as well as being able to collate clinical exam findings into an overall unifying differential diagnosis. The differential diagnosis is a key point, as candidates often tend to commit themselves to a single diagnosis; while this may be the most likely diagnosis, you should still be aware of other possible causes. This is because in internal medicine, as is often the case, the initial presentation may not necessarily be the textbook signs and symptoms we are all well versed in. We emphasise these key skills throughout this revision guide, repeating ourselves as needed because we know it scores you marks and helps you to achieve your aims.

While the majority of topics we cover will be the basics, we will endeavour whenever possible throughout this book to demonstrate to you what constitutes an honours response compared to an average response to a viva question. In cases where we have described this, the honours response is in addition to what the average or good candidate had stated earlier, so you should aim to learn both responses. Further to this, we have highlighted questions or cases that are considered difficult or at honours level. And unless otherwise stated, the answers we provide to such cases will be at honours level. This way, we hope you can identify what is needed to score the top marks in finals.

Wherever possible, we describe to you exactly what you should say in the exam, as if we were in the exam with you. These descriptions are given in italics and take the first-person perspective.

1.1.1 Common reasons for exam failure

For those of you reading this, thinking that there is no way you will make the same mistakes we have highlighted throughout this book and feel that this is all common sense (‘Why would anyone do such a thing in their exam?’), take a step back and a moment to think of your predecessors who were in that very same situation and felt the exact same way before their exam. It was they who unknowingly made these same mistakes. That is the paradox here: common sense goes out the window when you are stressed, with the idea reverberating around in your head that 5 years of hard work may be thrown away in one swift afternoon. Fear is powerful, but it can be a powerful motivator too - use it to your advantage. You have an added advantage in that hopefully, with the aid of this revision guide, you will be able to fine-tune yourself to think logically, speak coherently and examine slickly - all key hallmarks of a good candidate. Needless to say, if you prepare for finals with this in mind, you will find that you will be at an advantage and will, we hope, be successful.

EXAMINER’S ANECDOTE

A candidate who performs a good clinical examination will almost certainly pass finals, even if his diagnosis is completely wrong! You can always improve your knowledge set upon qualification; however, once poor examination habits are set, these are very hard to shake.

Finals exams are not easy, so do not, like we once did, listen to your senior colleagues who said they were. They are only speaking in hindsight. While it is true that the purpose of finals is to pass as many of you as possible - as opposed to postgraduate exams, where the purpose is to pass as few as possible - the pressure of passing finals and becoming qualified doctors, coupled with the pressure of being matched to a likeable job, makes finals an all-or-nothing event. Hence the most important piece of advice we will give you is to prepare well, or you may find yourself on the losing end.

Poor communication

When a student is asked a question that they are unfamiliar with, they tend to display what is affectionately known as the goldfish’ sign. That is, they stand there in front of the examiner with their mouth opening intermittently, trying to speak, but with no words coming out. You cannot score any marks if you say nothing. This is a shame, as most examiners want to pass you and are often urging you to say something, anything that may score you points.

For those who do manage to speak, they often demonstrate what is colloquially known as ‘knight’s move thinking’, where they tend to talk on an unrelated topic and then randomly change to a completely different train of thought, almost as if plucking answers out of the sky. This is the classic case of a student who does not classify or structure their answers.

Likewise, examiners are not psychic and they do not know you have spotted a clinical sign unless you say so, even if to you it appears it must be blindingly obvious to everyone around you. You will only cost yourself marks by assuming this. You must therefore state the obvious.

Single-answer responses do not bode well with an examiner, as this will lead to the examiner and candidate playing what we call ‘exam tennis’. This is where the examiner asks for causes of a condition and the candidate answers by giving a single cause, then the examiner asks for another and the candidate replies with another single cause, and so on and so forth. As you can appreciate, this can be frustrating to the examiner, who wishes to go through as many questions as possible. Do not alienate the examiner; if you have them on your side, you will find the exam a more pleasant affair. If you demonstrate a structure to your answers with commonly known classification systems, you can always think of several diagnoses or causes of a certain condition, rather than relying on your memory to bail you out of a stressful viva situation.

Poor examination skills

There is no excuse for a candidate to attend finals having never examined the cardiovascular or cranial nerves before. There are ample opportunities on the wards and clinics. You must be competent in your examination technique and slick in its execution. While there are acceptable variations in technique, a poor clinical examination will lose you many marks.

Behavioural issues

Believe it or not, candidates have in the past and will continue to argue with the examiners. When an examiner says that you are wrong, even if you know that you are right, just accept the examiner’s will. It is far better to move onto a new topic and score points than to argue your case. The examiner will almost certainly not accept that you were right and will certainly not admit ...