What to Know

Introduction

The medical school must know that you will be safe before they let you work as a junior doctor and letting you prove this is the basis of medical finals. Therefore you should base your learning around things that you must know to be a competent junior doctor. This can be divided in to:

1. Knowledge
• Core knowledge that you must know back to front: i.e. questions that you might get asked in a viva, OSCE, or long case. An example of this kind of knowledge is red flag symptoms, common investigations, and the management of common emergencies
• General knowledge of disease: that will help you get through your written exams.
2. Clinical skills
• History, Examination
• Procedures, such as blood taking
• Data interpretation: such as ECGs and XRs

Knowledge

Here is a quote from Surgical Talk:

In finals the examiners are looking for a minimum standard across the breadth of medicine and surgery. Effectively, they wish to assess whether you will be safe as a house officer subsequently. They will not be impressed by superb knowledge in one area if there is ignorance about basic facts in another... It is in your best interest to make sure that you know the essential basics about all relevant topics before attempting to learn some topics in greater detail.

Goldberg, Stansby. Surgical Talk.

In general you can determine whether something is important to learn in detail if it is dangerous or common. Another problem with revision is, to quote Surgical Talk again, that: "it is a basic fact of human psychology that, when revising, students tend to revise more often the areas they feel comfortable about. To avoid leaving gaps in your revision take the chapter headings of your surgical textbook and make sure that you feel you could give a short summary of the basic points in each chapter."

Many people take the option of picking a textbook and learning all of it. This strategy can work very well. Common textbooks for this purpose include Saunders Pocket Guide to Clinical Medicine, or Medicine at a Glance. These kind of condensed textbooks are the right standard for finals. Other unbiased opinion on the books to buy are recommended on the Things To Buy page.

Your medical school should release a syllabus, however sometimes it is difficult to interpret. The given below is a summary of the topics you should cover. Note that all these do not have to be known in the same level of detail, there is a heavy emphasis towards medicine. Schools will differ, but a suggested division of your time might be medicine 60%, surgery 20%, and all the rest of the specialities 20%.

Clinical skills

Although the questions may be hard in the written section of exam the pass standard is often set quite low. It is the clinical parts of finals that students repeatedly fail on. In the heat of the exam it is easy to get nervous and look inexperienced. This can be combatted by practicing these skills until they are second nature.

There was an influential paper published in the Journal of Medicsl Education (1997, 31:347-351) investigating core skills that doctors should know before they start working, involving 63 consultants, 238 junior doctors, and 110 students. Core skills were identified as those that over 50% of consultants thought you should know how to perform. Those identified were:

• History
  
• Examination
  
• Investigation selection
  
• Performing an ECG
  
• Inserting cannula in to peripheral vein
  
• Rectal Examination
  
• IV injection
  
• IM injection
  
• Subcutaneous injection
  
• IV infusion administering
  
• Interpreting a CXR
  
• Using an auroscope
  
• Suturing a superficial wound
  
• Bladder catheterisation
  
• Talking with patients relatives

Less important skills were:

• Performing respiratory function tests
  
• Inserting an NG tube
  
• Mixing and injecting drugs into IV bag
  
• Using pump to give drug treatemnt
  
• Head injury monitoring
  
• Talking with patient's relatives

This should be helpful in identifying OSCE stations that might come up.