MED3051: Medicine and Surgery 1

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) .

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, 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

It is completely randomised as to which hospital/site you get (other than the choice of rural vs metro sites), no more preferences!

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, 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.

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 led by a registrar (think Angliss, Casey, etc). Med students can write the ward notes, they may be asked questions by the consultant or registrar, 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, etc.) because they'll like 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!
• Your tasks can span the whole day depending on the urgency, usually try and get your cannulas and bloods done ASAP. Throughout the day you may have tutes (more details later) and have the opportunity to clerk patients (basically take a history, perform an examination and report back to a senior on the ward) and go into surgeries (obviously only in surgical rotations, you may get to scrub up and assist with suturing and whatnot depending on the surgery).
• 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 basis 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!

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. Other tutes include PBLs, specialty tutes, practical skills tutes, clinical skills tutes, epidemiology tutes, law and ethics tutes, etc etc. Some sites have an attendance that includes these tutes, others do not.

Another thing I want to touch on are a few of the assessments:

• MCRs: These are basically mini-OSCEs. 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.

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 Med Students Online, copied here for convenience:

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

No, the Faculty has now 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.

5/5

No.

• At a Glance - Medicine - Davey*
• 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 2012 - Klostranec and Kolin*
• 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 as much as possible.

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.

Semester 1, 2014