Year 4: Clerkship Starts Here! - Part 1

That is the general outline of your year! Yes those are back to back 10 weeks...get used to this life :D

You will have 4 rotations, each rotation is 10 weeks long. Absolutely no vacations in between. 9 weeks in the hospital and the 10^th week is exam week.

BUT YOU ALREADY KNEW THAT!!

The 9 weeks:

• 8 weeks in the hospital
• Usually the entire 9^th week or half of it are taken as study-break. You must take the permission of your responsible doctor to go on this study break (sometimes it may require begging depending on the doctor. And 1 doctor in specific may give you only 1 day – Thursday – as a study break from this 9^th week). I'm not sure if the university is aware of this trend among students.....

The exam week usually starts with the DOCEE followed by the OSCE and finally the written is always on Thursday for all rotations together. (The DOCEE and OSCE may be interchangeable in OBG and Pediatrics.)

DOCEE: (I still don’t know if it is with a double ‘E’ or one ‘E’ -_-) is a hospital based exam. In surgery and internal medicine, the doctor will usually ask you to choose a day in the 9^th week or 10^th week that you would like to do your exam (some doctors may decide on their own). Certain doctors do this differently. However, generally, you come at the designated time to the hospital and are taken in turns to the same/different patients. Usually each student has 1 patient (certain doctors put multiple patients where you do history on one and physical exam on the next…etc.). You are told to take a full history, do a relevant physical exam on the patient. It is not as hard as it sounds as you would have had 8-9  weeks of experience in observing the doctors and doing it yourself. They allot you a time, however it is not as strict a timing as the DOCEE. They are lenient with it. Doctors may pause you to ask about why you are asking such or why you are doing such. The key is confidence. You either know or you confidently can say: I don’t know. I will consult with my senior doctor or read up on this matter and let you know.

Then they will ask you about your differential/provisional diagnosis. After which you will be asked to plan a management line for the patient along with investigations. Basics. Basics. Basics. Vague. Vague. Vague. That is all I can say with management. Eg.: Do not jump to MRIs and CTs before doing the easy stuff (or unless it is absolutely indicated). Another eg.: Do not say “metronidazole” for a disease unless you are prepared to answer the array of questions that will be fired at you when you could have easily said “antibiotics” and breezed by the answer without the teacher second-guessing you. Then you may or may not be asked to exclude the differentials based on the investigation results they provide you with. Your diagnosis is the least important part of the exam. I assure you. Do well on the history and physical exam parts and that is a big chunk of your grade. What they want you to learn during clerkship is how to be a good historian and examiner. The rest (management, diagnosis) comes with experience and reading.

OSCE: unlike the pre-clerkship phase, there are no longer merely 2-3 stations in the OSCE with 15-20 minutes each. That was the honeymoon phase dearest. Now it’s reality time. 10-12 stations with 5-6minutes each and 2-3 break stations between. 6-8 stations are a focused task that can definitely be completed in time. You will either be asked to do a focused abdominal exam, or peripheral vascular exam….etc. They do not teach you in previous years how to be focused in history or physical exams. I cannot predict all the scenarios you will get, so I can’t post any help here (I will try). Therefore what you need to do is to make sure you inform your hospital doctors of this at the start of your rotation. Let them know, you want to “learn how to take focused histories and do focused exams in 6 minutes tops”.

Along with history taking and physical examinations, you may have stations with:

•        Breaking bad news
•        Counseling on:

o   How to use a device

o   Major/minor operation

o   Contraceptives (for OBG)

3-4 stations will be computerized unmanned stations. 

FOR THE LOVE OF GOD WHAT DOES THAT MEAN?! You will go inside the room but instead of a doctor testing you, there is a computer with a picture and a paper in front of you with questions you have to answer about the picture on the computer. It could be a disease case, imaging, devices…etc. Sort of like OSPE.

Written: need I say anything? >70 questions: MCQs + EMQs.