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How to succeed at exams for medics

Practice joined-up thinking

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Medical knowledge is not a series of isolated facts that have no bearing on each other. It's important that you're aware of how one piece of knowledge is linked to another piece.

 

Applying the knowledge from pre-clinical training to a clinical setting is not always straightforward. Students who have done problem based learning will have a clearer idea of how knowledge from one area can be linked to knowledge from a seemingly unrelated area. Students are notorious for compartmentalising their knowledge, but this is not helpful when you are trying to offer a diagnosis to a patient.

As you revise, try revising by condition instead of, or as well as, by subject. For example, instead of trying to revise gastroenterology, choose a common condition such as inflammatory bowel disease. As you read around this condition, you will cover the bowel associations, but also the systemic complications that affect the musculoskeletal system and the skin. When you come to revise rheumatological conditions, you will cover the musculoskeletal complications of ulcerative colitis and Crohn's disease again. This will reinforce your knowledge and help you to see the big picture.

This structural approach will also help you recall information when you're in a clinical environment. When you're confronted with a patient in the long case clinical exam, their history and presenting symptoms may suggest a diagnosis. Your physical examination to determine clinical signs may also help to activate prior knowledge, and help you recall more about the condition you're faced with.

Examiners in oral exams often use laboratory investigations or management of a condition as the basis for their questions. The revision strategy in the activity below can enhance your ability to store and recall information in a form that will be useful in your exams - and your clinical career.

Activity: a structured revision strategy - 30 minutes

1. Find a blank sheet of paper - A4 or larger is best.

2. Decide on a condition to revise and write the name of this condition across the top of your paper.

3. Split your sheet of paper into 4 equal sections under the headings.

  • symptoms
  • signs
  • investigations
  • management

4. Read through your notes or textbooks and make notes under each heading. For each section consider the following things...

  • symptoms - what symptoms might the patient complain of when presenting this conditions? Will there be any differences if the condition is acute or chronic? Are there any other considerations that may be found in the history, such as foreign travel, occupation, previous medication etc.?
  • signs - what physical signs can be found when examining a patient with this condition? Are there any other conditions associated with the same signs? What significance is associated with each sign, and can prognosis be determined by careful physical examination?
  • investigation - what bedside or laboratory investigations can be used to determine the extent of the disease, or confirm the diagnosis? What margins of error are associated with these investigations? Can the clinical data be misinterpreted to suggest any other conditions?
  • management - how can this patient be managed? Does management differ for mild, moderate or severely affected patients? Are there any complications of the management or drugs used for treatment?

5. File your notes safely to use as a revision aid.

Activity: joined-up thinking - 30 minutes

1. If your notes are organised by subject, try revising by condition instead. Choose a topic (gasteroenterology for example).

2. Choose a common condition within this subject (inflammatory bowel disease). As you read around your condition, you will also cover systemic complications; helping you to link to see how your knowledge of other areas can be linked.

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