What I wish I had known starting my final year

by Leo Mansell

Wellbeing, learning and career planning – how to make the most of your time

Location: Northern Ireland
Published: Tuesday 27 October 2020
leo mansell

Looking after yourself

Your final year at medical school will get very busy very quickly, with the sole focus of the first six months being your final exams. This in turn means that revision will become your (and everyone else’s) primary occupation. Here are some pointers on looking after yourself during this intense period:

  • The only thing more important than studying during exams in not studying
  • You absolutely have to factor in breaks and sleep into any work schedule (a break is one that should ideally get you away from a screen or computer)
  • For the vast majority, all-nighters in the library are completely non-conducive to content retention or concept intake. Those ‘extra couple of hours’ you devote to revision instead of sleep are detrimental to the next day’s work
  • An extra hour of sleep is worth an extra three hours of revision through the night
  • There’s a horrifically flawed culture amongst some medics that an all-consuming furnace of work must be kept burning otherwise you won’t succeed. This is wrong
  • The smartest are those who work smart
  • Both tomorrow’s you and exam day you will be grateful for the sleep!

Learning in final year

As I’ve mentioned above, your sole focus in the first six months of final year is your finals, and rightly so. Here are some key revision tips that I often gave to many students:

  • Before going any further, you absolutely must remember one thing - you cannot learn it all. Medicine is huge in both depth and breadth; therefore you need to revise tactically.
  • Although there are many advertised and popular revision ‘shortcuts’, they require the same fuel - hours at the desk. How you spend those hours is the second most important concept.
  • Allocate these hours tactically and efficiently to maximise your marks by: 1) Learning the content you are good at/comes naturally to you very well. This includes reading around the subjects to pick up those top marks that often get allocated to ‘extra reading’. 2) Not wasting time on areas you struggle with. The key here is to pick up the basic marks and sacrifice the top tier marks because obtaining those would eat up lots of your revision time that could be spent more efficiently elsewhere. In order to do this effectively, you need to acquire a breakdown of marks per topic e.g. 20 marks allocated to Surgery whilst only three marks might be allocated to Radiology.
  • Final tip is topic prioritisation, especially for the big specialties such as paediatrics and O&G. For example, you don’t need to learn all the different types paeds inborn errors of metabolism, but you do need to know everything about meningitis.
  • Aim to cover topics in a cyclical or spiral manner if possible, using multiple sources. For example: Firstly, see the lecture, then read the corresponding page in oxford handbook (of medicine and clinical specialties) and then (for some topics) use a textbook or other source.

Here are some further points on written exam technique:

  • Stem analysis – not a wasted word is present in an MCQ stem. Everything is included for a reason, be it valid info or a red hearing/distractor. Experience and subject knowledge allows you to differentiate most of these. Pattern recognition plays a large part in this, consciously or otherwise, and so MCQ practice is key
  • Time management (again) – total exam time is published knowledge so use it and divide it wisely as follows: Allocate two minutes to quickly scan through the paper and let key words (gall stones, pancreatitis, neonate, renal etc), images, figures, graphs etc register in your subconscious. Work out time per-question and move on from that question if it is eating up time. There is a recognised phenomenon that your confidence increases as a paper progresses (the beginning often seems the hardest). This is more reason to leave earlier questions you are struggling with to the end as your cognitive wheels are well greased by then.

Career planning – ThinkAheadMed in final year

Final year is really the start of your career. It’s where you’ll likely learn the most medicine out of the whole five years! Here’s a couple of generic tips to prime you before starting F1 as well as general career tips:

  • After finals, spend some high-quality time on the wards. Don’t just stand on the ward round if it’s endless and/or useless.
  • See some sick patients. Nothing prepares you for when you are suddenly confronted with a very sick patient and everyone’s looking at you for answers. As a final year you aren’t expected to be involved in the care of these patients but observing how others do it (especially those first few minutes of recognition and management initiation) will prove invaluable.
  • Begin tailoring your placement activity to your interests. If you are surgically minded, go to theatre! Download the logbook and start gaining experience. If you are medically minded, go to clinic, A&E or the post-take etc. Find what interests you, experience it first-hand and network.
  • Ask seniors candid questions. Do they enjoy their job? Best and worst parts of the job? Advice for a junior wanting to enter that specialty? Where will it be in 10 years’ time?
  • Download CT/IMT/ST3 portfolio requirements and see if you’ve already got some points. If you don’t, can you get any before the end of the year? Remember the key requirements: Quality improvement – audits can be large, small and are always available. Teaching – teaching other medical students and getting feedback is invaluable experience that has real longevity. Leadership – can you join a committee or lead a project?

Leo Mansell is a foundation year 1 doctor and former chair of the BMA Northern Ireland medical students committee