Student-to-Student

Gui de
-2014-15

IC2 / IC3

WRITTEN BY STUDENTS FOR STUDENTS










This guide is for student use and is not copyrighted. It can be adjusted, reproduced, photocopied,
updated and distributed as needed.

Many of your peers as well as alumni members have put a great deal of effort into ensuring that the
data and information in this text is up to date and relevant to the 2014 curriculum at RCSI. However,
the authors and RCSI are not responsible for any errors or omissions or for any consequences from
application of the information provided in this text. We do not claim that this text will guarantee a
student a passing grade or honors in their respective courses. This text is simply a way for students
to get a better understanding of what to expect in their respective courses, as well as being provided
with information and tips on how students who managed an honors grade were able to achieve this
grade.
Everybody is different. Some require 1 read through of information to understand and some take 20.
Use the information provided in this text to help guide your studying but keep in mind and
understand your strengths and limitations. There is no easy way to success, however the information
in this guide should help limit or eliminate the time many students waste in gathering information
and tips about courses from senior students, as well as the time they spend trying to figure out what
each course is about and what content is heavily tested.
There will always be changes on courses from year to year, so please continue to review your
courses administration page as well as the Marks and Standards for changes and updates to your
respective courses. However this guide still provides tips and information which is relevant to IC.
Best of luck in your studies, we hope that this guide provides you with a useful blueprint to your
courses and helps you achieve the grade that you seek! Please email any suggestions or complaints
to stsguide@gmail.com, we welcome any compliments, suggestions or criticism!

Sincerely,
STS guide members.






















INTRODUCTION TO INTERMEDIATE CYCLE 2 (IC2):
IC2 and IC3 will be addressed separately as they are two very different formats in terms of what and
how to study.

Outline of the semester:
IC2 is very similar in format as IC1. There are four modules:
Renal, genitourinary, endocrine and breast (REGUB)
CNS, Locomotor, Forensics (CNSLMF)
Tropical Medicine (TM)
Gastrointestinal / Hepatobillary (GI HEP) This used to be in IC1 and has now been
transferred to IC2

Teaching:
1) Lectures
2) Therapeutics interactive sessions in which you work through a case and decide on
particular management of hot topics. These sessions may seem daunting because you get
questioned in front of your peers but they are extremely helpful, and questions from the
lectures provided always show up on exams.
3) Patient Cases a patient is brought into the class; you will have the opportunity to practice
history taking as a group. A tutor will be there to guide you as well as provide extra teaching
on the pathology and clinical management of the case. These sessions are good to relate
your pathology to clinical scenarios. There are given power points and these topics have
been frequently chosen as hot topics that tend to show up as long cases on exams as they
include all aspects of microbiology, pathology and clinical medicine.
4) Microbiology tutorials take place in the Smurfit building. These sessions are good to focus
on the E learning, which covers all the topics, provided in lectures. They are especially
helpful for the OSCE worth exam worth a total of 15%.
5) CPC sessions very good practice to prepare for CPC questions on the exam. The CPC on the
exam is heavily weighted so this is worth interacting and learning from. It is important to
study the topic ahead of time to get the most out of these sessions and re-enforce what you
have learned.
6) Multidisciplinary teaching (MDT) 2-hour sessions excellent in identifying the hot topics for
exams. Doctors from different disciplines come together and present you with a case and
help you work though it from a pathology, micro, surgery, medicine, radiology, etc
perspective. It helps to be interactive in these sessions, to maximize your learning.




General advice:
As far as studying goes, the lecture notes given on moodle should be your first resource. Your exam
will be centered on these topics. Textbooks and online resources will be helpful to enforce and
expand on what you are taught in lectures.
When revising for the exam we urge you not to miss out or skip any lectures because questions on
the exam are drawn from all the lectures, however the main focus of your studying should be on
pathology, micro, and clinical medicine; these should be your first priority.
Additionally, your exams are before Christmas, leaving you with less time for revision than the
previous years. We want to emphasize that this semester is all about managing your time efficiently,
and starting to review much earlier than you had to in IC1.


Resources you may find useful:
Books
Pathoma by Hussain Satar (www.pathoma.com) the videos that accompany the book are a great
resource for pathology. It is very easy to understand, well organized and covers most of the IC2
material. It is also good for USMLE study.

BRS Pathology by Arthur S. Schneider bullet point format containing very concise, important
pathology knowledge. Very easy to understand and a higher level of detail than what is covered in
this book is not necessary for your IC exams.

Rapid Review Goljan by Edward Goljan bullet point format containing very detailed and very
helpful information for pathology. Contains high yield knowledge for some microbiology and clinical
medicine topics also.

Microbiology Made Ridiculously Simple by Mark Gladwin exactly as the title implies. This book uses
illustrations, tables, and anectodes to make microbiology easier to understand, and perhaps even
fun!

Robbins Basic Pathology by Vinay Kumar, Abul K. Abbas, Nelson Fausto, Richard Mitchell paragraph
format containing many illustrative diagrams that are very useful to deeply understand the
mechanisms of diseases. However, it focuses more on Histopathology which is not a significant part
of the exam.

Other
Goljan Audio lectures: It is a great source for developing great fundamentals and a good review of
some key physiology and the tie-ins to pathology. It is an excellent resource for USMLE studying as
well.

Calpath RCSIs histology, pathology and microbiology online resource. Has important pictures and
knowledge that is necessary to learn for exams. They have restructured this to be an extremely
valuable resource for the MCQs.

E learning for micro lectures


Renal, Endocrine, Genitourinary and Breast (REGUB) Module
REGUB is the largest and most extensive module in Intermediate Cycle 2. It is important to break it
down into its 4 components, to make it more manageable.
It covers pathology, microbiology, and clinical medicine in the respective systems. REGUB is usually
the first module in the year, and due to the volume in this module you need to make sure you keep
up with the lectures before the other modules begin. Finally, as with all other modules, look at the
Marks and Standards to understand how marks will be allocated.

How to do well:
Pathology and Clinical Medicine:
Renal Pathology: Very difficult and other sources will probably be needed for further explanations. It
is quite easy to get caught up in the terminology in renal pathology, so be clear on your core
physiological principles/ histological makeup of the kidney. Make sure you can distinguish between
the different clinical and lab findings for all the different nephrotic and nephritic syndromes. The
renal component of Goljan Audio and Pathoma are excellent for renal pathology, especially
nephrotic vs. nephritic syndrome. The Microsoft Word document, which accompanies the lectures
posted on moodle, is an excellent guide to the important topics and some students found those to
be more helpful than the PowerPoint lectures.

Genitourinary Lectures: These lectures are difficult and a bit confusing to understand. These topics
are discussed very well in Calpath and Goljan. In addition, Pathoma is an excellent source for these.

Breast Lectures: Do not miss these lectures given by Prof Hill. This will make life a lot easier when
reviewing the different breast pathologies.

Endocrine Lectures: Remember to spend time on the endocrine lectures. Some students may find
them tougher than renal pathology due to the sheer amount of information they have, however
they tie in a lot of the physiology. Students found Goljan Audio to be excellent additional resource
for this.

Clinical Medicine Lectures: These are best done in conjunction with the pathology lectures, as they
tend to repeat some pathology facts. The Renal Failure lectures are very extensive, so make sure you
understand the general principles before dwelling into the specific details.

Microbiology:
Urinary Tract Infections vs. Pyelonephritis: It is very important you are able to distinguish between
these two and recall common organisms that cause this.

Antibiotics: Make sure to know the main ones for each condition. However, do not spend too much
time trying to remember every single antibiotic treatment for every condition. Students have found
the charts at the end of Microbiology Made Ridiculously Simple to be a very good review.

Know the antibiotic resistant pathogens and the treatments for them as they tend to come on
exams often.

Central nervous system and locomotor and Forensics (CNSLMF):
This module will include pathology, microbiology and clinical medicine, as all other modules.
However, it also includes forensics. Forensics should not be the focus of your studying, however, this
section should not be underestimated; they are always included in the exams as part of MCQ and
SNQ, and again, we advise you not to skip any lectures when revising.

How to do well:
Clinical Medicine and Pathology:
Lectures for CML may be a little abstract and hard to understand if you did not attend the
presentation in Beaumont.
Reading from the rapid review textbook by Goljan is very helpful for the main topics.
You may need to combine your studying with neuroanatomy from JC3, and this will help understand
the specific pathologies and why they have the effects they have.
All lectures in the CML and pathology sections are hot topics for exams.
Try to study the same concept in pathology then move onto the equivalent lecture in CML. This will
help solidify the concepts and give you a review while studying.

Microbiology:
There are only 6 micro lectures to cover, and not as many organisms as the other modules.
There is more than enough information provided in the lectures,
however Microbiology Made Ridiculously Simple is a good resource if you are struggling with a
concept. This book also had good illustrations to help you remember some of the organisms.

Forensics:
Some of the major topics include the coroner and their duties, changes after death and drug abuse
however be prepared to write a short note on any of the topics mentioned in the lectures.



Tropical Medicine (TM)
This module focuses on the major illnesses and diseases occurring in the tropics. Your priorities
should always be based on the main topics in this module and the module objectives.. This module
has been recalibrated to only include the tropical medicine component in comparison to previous
years, which also contained the pathology and clinical medicine for hematology. Due to this change
it is extremely important to focus on all life cycles and clinical manifestations of the microbiology
given within this module with further emphasis on the hot topics and infectious diseases.

Microbiology:
It is even more important in this module as infectious diseases form an important part of it.
In microbiology the first resource to look at after the lecture notes is the E-Learning. However, some
students find that it goes into too much detail. Although the lectures provided have more than
enough information than is needed for your final, using Clinical Microbiology Made Ridiculously
Simple has been helpful for students in previous years to distinguish the different life cycles and
clinical manifestations / treatments for the organisms.
Antifungals and antiviral are very common exam questions and could show up either on MCQs or
SNQs.

Tropical Medicine:
Do not be scared by the amount of lectures under this component of the course!!
Important topics should be your priority: HIV and Malaria need to be thoroughly studied. Other
major diseases occurring in the tropics such as viral hepatitis should also be your focus.
Again, many students find the book Clinical Microbiology Made Ridiculously Simple very useful and a
good summery of the important topics.
The lectures may seem daunting, however if you can summarize each lecture into
1. The main life cycles and
2. The major diseases the organisms cause, you will find it much easier than studying all the details.
It is helpful to divide the lectures into the following sub-topics:

A. Viral illnesses:
- HIV
- Hepatitis
- Yellow fever
- Dengue virus
- Sandfly fever virus
- Rabies virus
B. Protozoan illnesses:
- Malaria
- Leishmaniasis
- Intestinal Protozoa
- Sexually Transmitted Protozoa
C.Helminths:
- Nematodes
- Trematodes
- Cestodes
D. Others

Finally, students should always keep an eye on the Mark and Standards document on module and
manage their time and effort accordingly



Gastrointestinal Hepatobillary (GI HEP)
GIHEP is a module that many people underestimate Dont leave it till the end because it is quite
dense. How to do well:
As mentioned previously, it is important to attend all lectures and get a thorough
understanding of the pathology within this module
The physiology in GI/Hep is fairly straight forward, therefore it is essential to get a deep
understanding of the pathology and study the associated clinical medicine at the same time
The hepatobilary lecture powerpoints contain notes within the powerpoints which are
extremely helpful to gain a general understanding, these points do not need to be
memorized
Hepatitis in the microbiology section is emphasized tremendously along with the various
Antigen testing / vaccinations, and commonly shows up in multiple MCQs
It is important to understand the clinical relevance and pathology of Jaundice and the
implications of hyperbilirubinemia

Due to the shift of GI/HEP into IC2, components of the module may have changed therefore
it is extremely important to follow the lectures / outline given on moodle and check the
marks and standards for updates throughout the semester for exam duration / format























INTERMEDIATE CYCLE THREE


INTRODUCTION TO IC3
IC3 is an exciting time as it allows you to escape from the lecture theatre for the first time to become
part of several clinical teams throughout the semester. IC3 differs significantly from all of the
previous semesters and this needs to be reflected in your study methods. There is a great deal of
self-directed learning, so a proactive attitude, self-discipline and independence are expected of you.

To do well, you need to find a good balance between studying for the exams by talking to and
examining patients on the wards, and by expanding your knowledge of clinical medicine, especially
differential diagnosis and basic investigations. Consult some of the resources outlined at the end of
this section to enhance your knowledge on clinical medicine, differential diagnoses and basic
investigations.

There are few official clinical tutorials or lectures during IC3, apart from during your time in
Cappagh, Pre-Clinical Skills and in some hospitals. This effectively means you need to manage a lot of
your own time.

Be warned, it is usually very obvious to an examiner if you have not taken many histories from real
patients or performed many physical exams! Therefore, we highly recommend that you attend your
clinical rotation every day with the aim of practicing your clinical skills as much as possible. Late
morning or the afternoon is usually the best time to take histories off a patient as the nurses and
healthcare assistants are usually attending to the patients around breakfast time (after rounds).
Therefore, if there is no clinic in the morning, this is a good opportunity to go to the library for a
couple of hours and come back to the patient mid-morning. Some students will be assigned to A&E
for their rotation. However, often students leave by mid-afternoon and if you are short of patients, it
is usually worth going to ask the A&E registrars if there is any patients that you can talk to.

You will be required to pick up a logbook at the beginning of IC3 from the SARA office. This logbook
will contain areas for you to write up histories that you have taken from patients throughout your
IC3 rotations. Additionally, there will be sections for you to fill in demonstrating that you have
actively involved yourself in your rotations by familiarizing yourself with common hospital
equipment and procedures (i.e. ECGs, blood pressure cuffs, colonoscopies and angiograms).
Furthermore, you will be required to attend surgeries in the OR and document them in your logbook
as a part of your surgical rotation. Although surgery can be very interesting to many students, we do
recommend that when you have attended enough surgeries to fully complete your log book that you
return your focus to histories and physical examination in preparation for your OSCEs.

You should try to see as many of the procedures listed in your logbook as your individual rotations
permit. Your logbook is aimed at helping you direct your learning in IC3 so be sure to use it as a
guide for what to learn from your rotations. You will be required to hand it in at the time of your
OSCE at the end of the year.




Clinical Rotations
The goals of these 8 weeks of clinical attachments are to
1. Improve your history taking skills
2. Improve your examination skills
3. Improve your communication skills
4. Expand your clinical knowledge of differential diagnosis, investigations and management

You can be assigned to peripheral hospitals for part or all of this time. Rotations may take place in a
range of hospitals including: Beaumont Hospital, Connolly Hospital, Our Lady of Lourdes Hospital
Drogheda, Enniskillen and Waterford Regional Hospital. The full list of hospitals and your assigned
rotations is available on Moodle. Below you will find a brief introduction to each peripheral rotation
(outside of Dublin) and some tips on how to get settled in.
You will have one four week clinical attachment and two clinical attachments that are two weeks in
duration. At the end of the four week clinical attachment, you will have your physical exam OCSE. At
the end of the year, you will have your history taking OSCE. Do not forget to still take plenty of
histories during your four week rotation, in addition to practicing physical exams, as the history
taking OSCE is 45%.

When taking a history, do not look at the patients chart in advance. Instead, take the history first
and then check their chart. Following each history, take a few moments to write down the
differential diagnosis, investigations you would perform, as well as any questions you feel that you
forgot to ask the patient.

The Exams (End Of Year-EOY):
At the end of this semester your clinical skills will be examined in one 15-minute history
taking station. This is likely to be changed into a 30 minute history and examination
assessment in 2015 so watch this space.
Note that these OSCEs differ from the type of OSCEs you may have experienced in previous
years. You will be asked to present your findings and answer questions on differential
diagnoses and investigations. A list of commonly examined cases can be found at the end of
this section.
These OSCEs carry most of the marks for IC3 (45%). Your success depends largely on how
you perform in these exams so practice as much as possible all throughout the semester!
You have to pass the OSCE, so even if you get over 50% overall in the semester, but you fail
the OSCE, you will have to re-sit it before being allowed to progress to senior cycle.
There will be two examiners per station. From the time you enter the station you have 10
minutes to take a history. Afterwards you will have 5 minutes to present the history to your
examiners, followed by questions focused primarily on differential diagnosis and
investigations. Occasionally, you may be asked some basic questions on patient
management. With regards to management, always state the most immediate management
first, for example, what bloods you would take as opposed to what imaging you would like to
do.
While you should aim to take a full history, the history of presenting complaint is usually the
most important part of the history. Make sure you ask appropriate questions (incl. risk factor
and family history as necessary) early on to form a differential diagnosis (this is what you will
be asked about!)
Have a system for answering questions e.g. break differential diagnoses down by body
system (cardiac causes, respiratory causes etc.)This can take considerable practice so
actively seek out a wide variety of patients on clinical rotations to practice each system on.
Be confident, clear and systematic both when taking the history and when answering
questions. Do not forget to express genuine sympathy for the patient where appropriate
during the history.
It is especially important to be as systematic as possible when answering questions. We
suggest that you develop a basic system which divides your answers into
subcategories/subheadings e.g. Immediate, early and late side effects of surgery; cardiac,
respiratory, musculoskeletal or CNS causes of dyspnoea etc.
It does not suffice to simply regurgitate the information, you need to present it in a
systematic manner to your examiner in order to do well. In order to become succinct at
presenting histories, you need to present daily to a member of your team and ask for
feedback with regards to your format/content and differential diagnosis.

Physical Examination Station
This exam is worth 40 marks or 20% of your semester.
There will be one examiner per station
Each station is 7 minutes long and that time will pass by quickly! As soon as youre done
with your examination you will be asked questions.
Again, use a system for answering questions
Youll be instructed to perform specific examinations as part of one system (e.g. respiratory;
Examine this ladys hands and posterior chest from a respiratory point of view)
Make sure you do exactly what you have been asked to do at the beginning of the station
but never forget the basics ie: always ask for pain!!
Wash your hands, introduce yourself and get consent from the patient, offer to start with
general inspection
Be confident (even if you feel nervous).

How to do well:
Engage in your teams activities. Show interest and enthusiasm on the wards and in the OR! This is
key to making the most of your rotations. Ask your team nicely for explanations and tutorials. Note
that often everyone in the hospital is very busy. Instead of distracting your team from their work, ask
when would be a good/less busy time for them to teach you or give you a tutorial. Be persistent but
not intrusive.

It is a good idea to give your mobile number to your interns/SHOs. Ask them to call you when they
have an interesting patient for you to examine or take a history from. Ask junior members of your
team if you can present the history to them. Presenting a history in an organised and fluent manner
requires practice! So practice, practice, practice!
If your interns/SHOs offer to give you a tutorial on a topic of your choice, we suggest the following
- Stomas, Surgical wound infections and care, Hernias
- Ulcers (arterial vs. venous vs. neuropathic), Peripheral vascular exam
- Exam techniques, especially how to present your findings, How to present and summarise a history

Make the most of morning rounds
Rounds can be very useful. Often consultants take their time during morning rounds to teach you
and explain details of patient management.
We advise you to find out when rounds start on the first day of a new clinical rotation. Make sure to
be there on time and find a member of your team (typically an intern or SHO) to get an updated
patient list.
It is a good idea to take notes on each patient during rounds. Go back to examine patients with
common clinical findings e.g. heart murmurs, pleural effusion, peripheral neuropathy, ulcers.
Rounds also offer you the opportunity to familiarise yourself with the various medical equipment
and bedside paraphernalia. Occasionally, equipment may be present at an OSCE station so it is a
good idea to be able to identify common items such as incentive spirometers and nebulisers. This is
also great for your logbook!

Take Histories
Take as many patient histories as possible, ideally covering a wide range of presenting complaints.
We advise you to take histories in pairs so that you can mark each others performance and practice
presenting the cases

Examine Patients
There will be real patients in the OSCE. You should familiarise yourself with pathologies that are
commonly tested. It is best to examine patients in pairs. Compare your findings and comment on
each others examination techniques. It is advisable to have a checklist so that fellow students can
mark your performance and make sure you did not miss anything.

Attend Clinics
We recommend that if presented with the opportunity to attend the weekly outpatient clinics, do
take this opportunity. These offer good learning opportunities. Frequently, you will either be asked
to see and examine patients by yourself before presenting their case to your consultant or SpR, or
accompany the consultant. Therefore, clinics often allow the opportunity to practice history taking
and clinical examination skills as well as the opportunity to see a wide variety of common pathology
which may not require in-patient admission.

Beside Manner and Etiquette
Always get the patients consent before any examination of history-taking. Most patients are happy
for you to practice your skills on them. However, some patients do not want to talk to medical
students, so respect their wishes. Interns and SHOs usually know which patients are good to talk to
and examine, so ask them! Do not attend patients with more than one other student.
Always close the curtains around the bed when examining a patient, unless a patients asks you not
to do so.

Group study
Meet up with friends to go through physical exams and history taking together, particularly in the
run up to exams. You should be confident and fluent.
The standard expected of you may exceed what has previously been taught in Clinical Competence
and Skills session in JC and IC1-2. We strongly recommend that you consult the resources listed
below to enhance your knowledge
Note that you need to draw on your knowledge of pathology and clinical medicine in order to
answer the OSCE questions well.

Recommended Resources:
Moodle
Study the surgical and physical exam notes on Moodle. There is a reason why these documents have
been posted (they are important!)
You can also access Senior Cycle notes which are likely to be too detailed but provide you with more
comprehensive information of important topics. These documents are very clear and well-structured
but beyond the scope of what is expected during IC3.



Books
Essential Examination by Ruthven concise book which is great for physical exams; covers all
systems as well as important surgical cases such as hernias
Clinical Examination by Talley and OConnor excellent book but very detailed; good for differentials
Macleods Clinical Examination similar to Talley and OConnor but more concise with more images
and short textboxes for differentials and common presenting complaints
Oxford Handbook of Clinical Medicine and the Oxford Handbook of Clinical Examination and
Practical Skills great for reviewing core clinical knowledge, pathology as well as examination and
history techniques, and good to carry around with you in your white coat when you have free time
on the wards.

Clinical cases and OSCEs in Surgery by Ramachandran concise book which covers surgical cases
such as scars, thyroid, hernias and stomas; topics are arranged in order of importance (most to least
commonly tested); it also offers sample questions and answers similar to those which you may
encounter in your surgical OSCE station
History Taking in Medicine and Surgery by Fishman this book tells you what questions to ask for
each symptom. It also teach you how to introduce yourself in a better way and how to professionally
present the patients history. The good thing about it is that it approaches topics by symptoms not
by system and then it gives you investigations and differential diagnosis for that symptom

Videos
There are videos on Moodle and plenty available on YouTube, particularly useful for listening to
heart murmurs and lung pathology.
In addition, there are YouTube videos of senior cycle tutorials given by Dr. Spooner. These may be
very useful to further enhance your knowledge and exam techniques. Links to these videos are
usually sent around in class.

Websites
www.fastbleep.com/medical-notes/ offers a good set of revision notes for many topics (both
medicine and surgery)
www.geekymedics.com/ provides you with many useful links and videos. It is done by medical
students and makes you familiar in how to talk to the examiner while performing physical exams.
Commonly Examined Cases System- History & Physical Exam
Respiratory: Dyspnoea, Haemoptysis, Cough, Asthma, COPD, PE, Cystic Fibrosis
Cardiac: MI/Angina, Arrhythmias (palpitations), AAA, Oedema/Dyspnoea (heart failure), Murmurs/
artificial valves, Heart failure
GI: Jaundice, Haematemesis, Pain (Pancreatitis, gallstone disease, peptic ulcer disease, IBD) Change
of bowel habits, Small/large bowl obstruction, PR bleed, Dysphagia, GERD, Abdominal masses,
Hepatomegaly, Hernias
Neuro: TIA/Stroke Headache (migraines, subarachnoid haemorrhage), Peripheral neuropathy, Post-
stroke, Dizziness/ vertigo, Multiple Sclerosis/ vision problems Parkinson's Seizures, Foot drop, Ataxia,
Nerve palsies
Endocrine: Diabetes, Hypo/Hyperthyroidism, Diabetic neuropathy, Thyroid lump
Rheumatology/ musculoskeletal: RA,OA, Back pain, Rheumatoid hands, Orthopaedic hip/knee exam
Nephrology: Haematuria, Pain (Cystitis, Renal stones), Oedema (nephrotic syndrome), Post-
transplant
Surgery: Hernias, Stomas, Scars
PVD exam (ulcers)



Peripheral rotations
Galway Clinic
Clinic is kept in extremely good shape it was clean throughout (patient rooms, OR, cafeteria, etc.)
The rotation is considered very beneficial by students as they were really integrated into their
teams
Consultants are keen on giving students tutorials on history taking and concepts of various disease
processes and teach how to insert central and peripheral lines if in an ICU situation be sure to avail
of these opportunities!
Consultants allow students to scrub into surgeries, which provides a great opportunity for all the
students and not just the ones interested in surgery.
Consultants focus on allowing students to do physical exams on patients and they were keen to
give appropriate feedback

Kilkenny Hospital
Students are assigned to a team and are individually tasked to take histories and present them to
the team
The teams give constructive feedback on the history presentation, which is very helpful in
preparation for exams.
Students get a lot of practical exposure as some are allowed to insert IV cannulas and some are
allowed to put in urinary catheters as well.
Consultants give students tutorials on OSCE preparation as well as disease process tutorials, which
helps tie in things very well be sure to attend these to help guide your studying!
Overall students find this rotation to be very beneficial

Waterford
This hospital provides an excellent learning environment and the doctors are all willing to teach and
you may even get to assist in procedures depending on your rotation and team. Besides the hospital,
Waterford is a very nice city, so do not miss this opportunity to explore the city!
Peripherals begin on Monday and everyone leaves on the Sunday night.
The bus is cheaper than the train. However, if you wish to leave later on Sunday, the trains departs
later. There is a student deal for trains to Waterford, but you have to go to the ticketing booth to get
it, not the automated machines.
It usually takes approximately 2 hours by train and 2.5-3 by bus.
Depending on when your rotation starts, you may either be put in the Ardkeen Woods Apartments
or the Woodlands Hotel.
The Ardkeen Woods apartments are right across from the hospital and there is a Tesco nearby the
apartments. The apartments have a kitchen so you can cook in there if you wish, as you are
responsible for your meals. They are usually very nice and well kept. If you are there for a long time
make sure you keep the place tidy.
Woodlands Hotel is about a 15-20 minute walk away and it is also an excellent accommodation.
Breakfast is included with your stay and you can always get groceries, but there are no refrigerators
in the room, so you may have to rely on take-out food or restaurants for the rest of the meals. The
internet connection in the rooms may vary so it is not a bad idea to bring your own internet mobile
stick
Hospital:
Waterford is a nice hospital and there is an RCSI area where tutorials may be run and the morning
grand rounds every Thursday. The RCSI building is an excellent place to study if you wish.
Surgical and medical rotations are heavily involved and provide you with an excellent learning
opportunity.
Every person is assigned to a surgical or medical team and every morning there are rounds with
the consultants, which are really good to see a variety of patients.
The surgical rotations usually begin early in the morning and you rotate through clinics, the
operating room and the wards. There are structured tutorials for the surgical rotations and do not
miss these because they are in small groups and you will learn a lot form them.
Orthopaedics and surgical tutorials can be scheduled anytime during the day, so make sure you are
at the hospital at all times.
The medical teams will give you patient lists and recommendations for good histories and physical
exams, make sure to do these and present your findings as many times as possible.
These rotations are very well organized and usually there will be two students at the most on a
team, so it provides you with ample opportunity to ask questions and learn.
The tutors keep tabs on everyone and they do ask questions if you are missing.

Drogheda
Travel:
The total journey time is approximately one hour
Accommodation:
Drogheda is a great posting with good accommodation.
Breakfast is provided to your specifications every morning in the main building.
Kitchen facilities are provided and there are good grocery stores and an M&S in town.
Downtown is approx. 25 min walk from the B&B.
Hospital:
The RCSI office at Our Lady of Loudres Hospital is very helpful.
The schedule is relatively relaxed, allowing for a lot of self-directed learning.
The best way to get into the OR is to talk to the scrub nurses directly first thing each morning.
Always attend rounds first thing in the morning as you will be provided with patient lists allowing
you to return to patients afterwards for practicing histories and physicals.
Tutorials will be scheduled at the last minute so don't plan to be elsewhere, attendance is taken
and followed up with.

Musculoskeletal Component
The 2 weeks at Cappagh Hospital or Waterford Hospital form the only lecture-based rotation. There
will be an MCQ at the end of this clinical attachment, which examines the lecture material. We
strongly encourage you to attend all of the lectures and study the material in class to do well in the
exam.
You will also have the opportunity to attend theatre one day during this rotation and you will be
required to prepare a case presentation as part of a team. Although the case presentation is not
worth any marks, you will be preparing case presentations for the rest of your career so it is a good
opportunity to learn the content and format.

How to do well
Attend the lectures
o Each morning there will be a lecture, which covers some basic anatomy, orthopaedic pathology
and various treatment modalities. Material covered in these lectures is being tested at the end of
the 2 weeks in an MCQ format
o Lectures are interactive and students are usually asked a series of questions.
o Attendance is taken at all the lectures at accounts for 20% of this module (i.e. 2% of IC3)
o Performing a musculoskeletal examination on post-operative patients is not always easy to do so
do not forget to ask the lecturers to focus on teaching you how to take a musculoskeletal history and
the musculoskeletal examination.
o Performing a hip or knee exam is a common task in the OSCE, so learn this well in Cappagh!
Review the lecture material
o To do well in the MCQ, read through all the Cappagh documents posted on Moodle, even if some
of them may have not been covered in the lectures. You do not need to do additional reading as the
lectures are quite dense. However, you may feel that you need to briefly look over some anatomy
from JC.
The wards
While you should prioritise your time and learn the lecture material well, this rotation also affords
you the opportunity to practice taking a musculoskeletal history and perform a musculoskeletal
exam. Focus in particular on the knee, hip and shoulder examinations. Remember your bedside
etiquette, as many of these patients are post-op and are still drowsy or in pain from the surgery, so
please be careful when examining. Aim to take at least one history per day.
Pre-Clinical Skills (PCS)
The week prior to you beginning your four week rotation will be spent attending Pre-Clinical Skills
lectures in Beaumont. The week comprises of a diverse variety of lectures (radiology, ENT) as well as
revision of history taking and physical exams. In total, PCS counts for 5% of IC3. Attendance is
mandatory (goes towards marks for the module). You will also be required to take blood, perform
male catheterisation and do a breast exam on models on the Friday. No advance preparation is
required as all skills will be demonstrated in class prior to the assessment. Earlier in the week, you
will be video-taped taking a history from an actor. You will receive your video via email after the PCS
week and you will complete a reflective assignment on your history taking skills using a template on
moodle. It is important to note that the assignment is marked based on your reflection as opposed
to the quality of your history taking skills.
How to do well
Attendance, enthusiasm and a reasonable effort into your reflective assignment should ensure a
good grade in this module.
Student Selected Component (SSC)
In IC2 you will be instructed to choose a block of time for your next semester (IC3) in which you will
have 6 weeks to complete a 6-week research project. The research you do for your SSC can be
completed within Ireland or outside of Ireland. At the end of your SSC you will be asked to produce a
scientific paper based on your research outcomes and you will be required to make a presentation
on your research to some of your peers and two consultants.This module will account for 20% of
your final IC3 mark (10% is for your report, 5% is for your presentation, 5% for Intro to SSC).
Introduction to SSC is a one week long compulsory module that focuses on teaching molecular
therapeutics using both didactic and practical sessions. This module serves as an introduction to
your 6 week SSC project. At the end of the module there is an MCQ worth 7 marks and journal club
presentation/practical work worth 3 additional marks (Module worth 5% of semester in total). For
students completing an external SSC, the lectures and contents, including audio, will be uploaded to
Moodle. An alternative date near the end of the semester will be selected to sit the MCQ which will
be worth 10 marks for external students.
Intro to SSC was first introduced in 2014. The MCQ at the end of the week comprises of questions
directly from the lectures and no additional reading was necessary. As 2014 was the first year of this
course, it is advisable to check if any changes have been made for 2015 based on feedback from the
students of 2014.
Internal SSC
If you choose to do your SSC in Ireland, a list of doctors and their research projects will be listed on
Moodle for you to choose a project from after you pick your block. Most of these, if not all, will be
based in Dublin
Some projects can take only 1 student, while others can take 2-3. Decide what is best for you
Project allocation will be on a first come, first serve basis when the list for your block goes live on a
particular date.
If you have an interest in a particular area, you should approach a potential RCSI supervisor in IC2 or
early in IC3 and organise your own project. You will need to get the project approved,but it is quite
straight forward to do so.
External SSC
If you choose to do an external SSC (outside Ireland), you must start your planning early in IC2!
You will have to set up this research project yourself!
It takes work to find a research project in your external country of choice and to fill out the
appropriate forms in order for the college to approve this project for your SSC.
Additionally it takes time to set up accommodation, so ensure you have enough time to work out all
the details!
When looking for a research project, try to find a project that can produce achievable results
Look at hospital websites and university websites to see what research they offer and try to get in
contact with doctors involved in the research
Send them a polite email or call them and express your interest to work with them and to see if they
have any available projects for you
How to do well
Logbooks:
o To document your progress, you are required to keep a logbook with your daily research activities.
It does not need to be detailed (bullet points are fine).
o This will not be marked. However, you are required to bring the logbook together with your
midway feedback form to the meeting halfway through your SSC.
o If you are doing an external SSC, you need to send this logbook and midway feedback form by
email.
o The completed logbook needs to be uploaded to Moodle with your SSC paper at the end of the 6
weeks.
The paper
o Start your paper as early as you can! Dont leave the stress of writing a full scientific paper until the
last minute. It takes time and work to produce a good quality paper.
o You will have to submit a copy to RCSI and your research supervisor for feedback
The presentation
o Again, start early!
o This will be a 10 minute presentation (with only approx. 7 slides to outline your paper) followed by
a short question period. We advise making very concise slides and elaborating on your ideas
verbally. Practice and be confident! The questions are based on your research, so if you know your
research well you should be able to handle the questions
If possible and if you have an interest, talk to your supervisor about publishing a paper on the
research you conducted with them. Any involvement in research, and especially a publication, goes a
long way on your CV to making you a competitive candidate. Be very polite and enthusiastic and be
prepared to dedicate extra time to research with them if necessary
Keep in contact with your SSC supervisor for future opportunities and guidance!
USMLE
o If you have chosen to write the USMLE, your SSC is a great time to manage your studying on top
your research
o Use your 2 week vacation wisely enjoy your time off but we advise you to try and spend time
studying too!
o Note that if you have decided to write the USMLE you will be required to write a diagnostic test
before the college approves your USMLE registration
This is a tough test so we advise you to study for this well in advance
If you have booked a date to write the diagnostic after your SSC, again we strongly advice
you to use your 10 weeks to study for the diagnostic and your USMLE!