Year 3B is the first clinical year of the Monash medicine course, and is based entirely within hospital sites, not the main university campus. If the transition from year 12 to medical school is a significant change, the transition from preclinical to clinical medicine is even greater.
Year 3B is also where the undergraduate and graduate-entry streams join, with students from year 2 (undergraduate) and year A (graduate) proceeding into a unified year 3B together.
Around the middle of year 2 semester 2, students enter their preferences for placement in year 3B – whether they would like to be placed at a metropolitan site, or a rural site.
In late year 2 semester 2, students are allocated to a clinical school. The clinical schools are:
- School of Clinical Sciences at Monash Health (SCS)1
- Central Clinical School (CCS)
- Eastern Health Clinical School (EHCS)
- School of Rural Health (SRH)
In December, the clinical school then allocates students to a particular hospital site. Clinical schools operate largely independent of each other and independent of the university, and different clinical schools have different procedures. I was placed at CCS, which allowed students to preference hospitals, but not all clinical schools allowed this.
The hospitals at each site are:
- SCS: Monash Medical Centre (Clayton), Casey Hospital (Berwick) and Dandenong Hospital
- CCS: Alfred Hospital (Melbourne City), Cabrini Malvern and, bizarrely, Frankston Hospital2
- EHCS: Box Hill Hospital, Angliss Hospital (Upper Ferntree Gully) and Maroondah Hospital (Ringwood East)
- SRH: Bairnsdale, Bendigo, Churchill, Leongatha, Mildura, Sale, Traralgon and Warragul
Like the clinical schools, the hospitals operate largely independently of each other, and experiences can vary substantially depending on the hospital you are placed at.
As year 3B is based out of hospitals rather than the university, the semester dates no longer follow the standard university semester. Rather, semester 1 begins about 1 month before the rest of the university and there is no mid-semester break. Semester 2 is similarly lengthened, so that everyone still finishes at the same time in time for exams.
Each semester is divided into 3 rotations (since COVID-19, 2 rotations). Over the course of the year, there will be 1 rotation in General Medicine, 1 rotation in General Surgery, and 4 rotations in arbitrary specialties, depending on hospital availability.
In 2019, my rotations were:
- R#1: General Medicine – Epworth Richmond2
- R#2: General Surgery – Epworth Richmond
- R#3: Cardiology and Respiratory Medicine – Epworth Richmond
- R#4: Endocrinology, Rheumatology, Medical Oncology, Radiation Oncology and Infectious Diseases – Alfred Hospital
- R#5: Neurology, Orthopaedic Surgery and Plastic Surgery – Frankston Hospital
- R#6: Gastroenterology, Nephrology and Urology – Epworth Richmond
At most public teaching hospitals, students are attached to a clinical team – generally for either the whole rotation, or 2 weeks at a time. For example, at the Alfred Hospital in rotation 4, I was attached to Endocrinology as my ‘home team’ for the whole rotation. Teams usually consist of a registrar (senior doctor-in-training in that specialty) and resident (junior doctor-in-training). There will additionally be a consultant (senior doctor completed their training) on duty for the day, who may or may not be at the ward round. There may also be other staff involved, such as other doctors or allied health staff.
The day begins with ward rounds – typically at 8 am for medical teams and 7 am for surgical teams.3 You would meet the day team in their office at 8 am, where the team would receive a handover from the previous night's staff explaining anything that has happened overnight. If the team is nice, they would print you a patient list for you to follow along.
The team would then go and see all of the current inpatients on the list under the care of that team. While attached to Neurology at Frankston, there would generally be many patients with complex medical needs, and ward rounds would usually stretch into the afternoon. In contrast, Orthopaedic Surgery ward rounds at Frankston would be done within the hour, as doctors would need to prepare for surgeries beginning at 8 am.
When ward rounds are not blazing through the hospital at breakneck pace, medical students can be of help. Traditionally, this was in the form of looking for and carrying around patient files. Now that most metropolitan hospitals (and increasingly many rural hospitals) have gone digital, the role is instead to go hunting for a spare computer and swap out dead batteries.
If the team fancies, the student might practise writing notes for the ward round on the computer, or might be tasked with clerking a patient and presenting that patient on later ward rounds.
After the ward round, the most senior doctor may or may not buy the team coffee,4 and the students may or may not claim (truthfully or not) that they have a scheduled tutorial and bid the team adieu.
If, instead, the students stay on the ward, there may be opportunity to practise taking histories from and examining patients, practising procedural skills on willing volunteers when required, helping make telephone calls or faxes, or receiving informal teaching from doctors.
A dreaded feature of year 3B is the so-called ‘logbook’. The logbook is a hurdle requirement, mandatory for passing the year. Throughout the year, the clinical school/hospital will organise tutorials on various clinical skills. The most notable are venepuncture (taking blood) and IV cannulation (inserting an intravenous cannula), as well as others like recording an ECG, performing a digital rectal exam5 or male urinary catheterisation.
Students must then perform a prescribed number of each of these procedures on (in most cases) real patients in the hospital, with their consent, under supervision and when medically indicated and appropriate.
In addition to ward-based clinical experience, clinical schools also organise formal lectures and tutorials, albeit based at the hospital rather than the university. For example, at Central Clinical School sites (except Frankston), students attend the Alfred Hospital every Wednesday for a day of lectures and tutorials. Hospitals also organise other formal tutorials, such as regular radiology tutorials, pathology tutorials and clinical skills tutorials, and within each rotation the timetable may allow for doctors to give tutorials to students on that rotation.
The knowledge-based expectations of students by the end of the year are set out in the so-called ‘matrix’, a 6-page-long list of some 170-odd conditions students should learn. The conditions are classified from R1 (most important) to R3 (least important), so not all conditions are expected to be known in the same level of detail, but this is nevertheless a significant amount of content, and only some will be covered by formal teaching. The rest is up to students' own initiative.
Formative assessment comprises ‘observed clinical encounters’ (OCEs) assessing real patients in the hospital, marked by clinical skills tutors during the year, as well as a small number of written assignments and formative written exams.
Summative assessment comprises an OSCE, like year 2 but longer, and 2 written examination papers at the end of the year.
Until 2021, selection for intern jobs after graduation was based largely on academic results. While the use of academic results for this purpose has now been substantially reduced, a Weighted Average Mark (WAM) is still generated for students, and Year 3B is the first year that counts towards this mark, contributing a weighting of one-half.6
Studying/tips for year 3B
Unlike preclinical years, the material provided by the faculty, clinical schools and hospitals is not sufficient to meet the requirements of the matrix, and self-study will be required.
Useful websites for self-study include:
- eTG (the Therapeutic Guidelines) – access available through the Monash University library
- BMJ Best Practice – access available through the Monash University library
- UpToDate – although the depth of information in UpToDate far exceeds that required in year 3B – access available through the Monash University library
However, I continued to find that textbooks (other than Talley and O'Connor) were not generally of great benefit in year 3B, although may be useful in some situations as a reference.
At the same time, it is vital not to neglect clinical skills – history-taking and examination, and in year 3B, investigations and management. Remember that the OSCE contributes 50% of the year 3B grade! I performed poorly in the year 3B OSCE, and it significantly impacted my grade for the year.
Many years ago when Monash Health was called Southern Health, SCS stood for Southern Clinical School. Despite never having been around at that time, ‘Southern Clinical School’ is still my brain's instinctive reaction when reading ‘SCS’… ↩
For example, orthopaedic surgery ward rounds at Frankston Hospital which began at 7 am. As I did not own a car, I needed to catch literally the first bus of the day to make it there in time. I did not attend very many of those ward rounds. ↩
If you thought, like me, you weren't a coffee person, year 3B will prove you wrong. ↩
Digital here meaning ‘with the fingers’. ↩
Prior to the class of 2021, all year levels contributed in part to intern selection, as did most assessment items now regarded as formative, and a standardised metric known as the InternZ score was in use as an academic indicator for internship selection. ↩