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Note: I undertook year 4C in 2020, during the COVID-19 pandemic. Significant disruptions and changes resulted during this year, which may or may not reflect the situation in the future.

Placement

Year 4C, like year 3B, is taught entirely from clinical sites. Unlike year 3B, which has a heavy focus on acute care general hospital medicine, year 4C has somewhat more of a focus on primary and subacute care.

Also unlike in year 3B, where students are allocated to a specific clinical school, students in 4C are allocated to one of 3 regions – metropolitan, rural, or Mornington Peninsula (including Frankston Hospital) – and rotate between different services within that area. In 2020, I was placed within the metropolitan program, and that's what I discuss in this post.

The metropolitan Year 4C program is divided into 4 9-week rotations1,2 in each of the following disciplines:

  • General Practice
  • Psychiatry
  • Women's Health (Obstetrics and Gynaecology)
  • Children's Health (Paediatrics)

As in year 3B, teaching does not follow the standard university semester dates, with the year 4C year beginning one week earlier than year 3B, with no mid-semester breaks.

Curriculum

Prior to 2020, most disciplines did not produce a curriculum matrix comparable to the year 3B matrix, and the scope of examinable content for each discipline was therefore considered very large. However, for 2020, due to COVID-19, a more manageable matrix was produced for every discipline.

Women's Health

Women's Health was my first rotation in 2020 – and was largely undisrupted by COVID-19. Women's Health typically begins with a week of lectures and tutorials at Monash Medical Centre.3

Metropolitan placement sites for Women's Health include Monash Medical Centre, Casey Hospital and Dandenong Hospital. I undertook 4 weeks at Monash Medical Centre, and 4 weeks at Casey Hospital.

For obstetrics, rostered activities include attending birth suite (including overnight shifts), elective Caesarean section theatre lists, antenatal clinics and postnatal care. For gynaecology, rostered activities include gynaecology clinics (e.g. early pregnancy bleeding, abnormal uterine/menstrual bleeding), contraception clinic, gynaecology–oncology clinics (e.g. cervical colposcopy), gynaecological surgery (e.g. hysterectomy).

As in year 3B, there is a 4C logbook with mandatory procedural skills to perform over the course of the rotation.4 In Women's Health, this includes performing speculum and vaginal exams, antenatal abdominal examinations, and observing births and surgeries. The Women's Health logbook is generally considered the most difficult to complete.

In addition to practical requirements, there is one regular weekly tutorial, at which a small amount of oral presentations and written assignments are organised.

General Practice

General Practice was my second rotation in 2020. In the metropolitan program, each week there are 2 days of placement at general practice clinics (usually different clinics) and 2 days of lectures and tutorials at the Monash University Department of General Practice in Notting Hill.5

General practice clinics are entirely separate to the university and hospital services, affording supervisors wide discretion in structuring placement for students. Typically, placement involves a combination of observing consultations with the GP, and seeing patients on your own in a different room before reviewing with the GP. There is often ample opportunity to observe procedures or perform simple ones, such as giving injections and taking blood. 50 clinical encounters are required to be logged by the student for the General Practice logbook.6

I found GP placement to be a valuable opportunity to get a taste of independent practice, taking histories, performing examinations, writing notes and considering differential diagnoses away from the direct input of the GP. I am also very grateful that I developed good relations with both my supervisors; the frank discussions we were able to have provided valuable insight for my development as a future doctor. (Thank you Drs VH and JP!)

Lectures and small group tutorials are also conducted by GPs, each day focusing on a different area of medicine. Over the course of the rotation, during placement or tutorials, some Observed Clinical Encounters (OCEs) in clinical reasoning, prescribing and writing a referral letter must be passed, as well as some written assignments.6

Children's Health

Children's Health was my third rotation in 2020. As with Women's Health, Children's Health typically begins with a week of lectures and tutorials at Monash Children's Hospital.3 All metropolitan students then undertake 4 weeks' placement at Monash Children's Hospital, and a further 4 weeks at another hospital. My external rotation was conducted at the Angliss Hospital.

At Angliss, I and the other students at Angliss alternated attending ward rounds with the paediatric team. This involved rounding in the special care nursery, reviewing neonates when required on the postnatal ward, and seeing new patients and reviews in the emergency department and short stay unit. This was combined with bedside tutorials and other teaching from consultant paediatricians on-site.

At Monash Children's Hospital, I spent one week attached to the paediatric gastroenterology team, attending ward rounds in the morning and typically staying until the team clocked off in the afternoon, reviewing day procedure patients and attending endoscopies; as well as a few other bedside tutorials and activities scattered throughout the rotation. Students typically also complete a week of placement in the Monash Medical Centre emergency department, focusing on paediatric patients.7

As with other disciplines, the Children's Health rotation involves logbook requirements, procedural skills assessment and some oral presentations.4

My Children's Health placement was significantly impacted by COVID-19 compared with usual years – usually, students gain extensive experience in common conditions in childhood, such as gastroenteritis and asthma exacerbations, but this is difficult when all the febrile patients are in isolation!

Psychiatry

Psychiatry was my fourth rotation in 2020. In the metropolitan program, Psychiatry is taught either out of Monash Health or Alfred Health – I completed my placement at Alfred Health.

As with Children's Health, my own Psychiatry placement was significantly impacted by COVID-19. Students completed a week of placement with one of the Alfred Health psychiatry teams – my own was with the Mobile Support and Treatment Service. This was combined with a large number of lectures and tutorials throughout the rotation from Alfred psychiatrists, and some procedural skills, oral presentations and written assessments.

Assessment

Year 4C is again composed of 2 year-long units, MED4100 (pass-fail) and MED4200 (graded).

MED4100 holds the in-semester assessment tasks described above for each discipline.

MED4200 holds the summative assessment for year 4C, composed of a 16-station OSCE held over 2 days, and 2 written papers.8

At present, year 4C contributes a weighting of two-thirds to the academic indicator used in selection for intern jobs after graduation.9

Studying/tips for year 4C

As with year 3B, a considerable amount of self-directed study will be required in year 4C. In addition to the general resources for year 3B, useful discipline-specific resources include:

Footnotes

  1. In 2020, rotation 2 was significantly disrupted due to COVID-19, so a 5th 6-week ‘catch up’ rotation was added, and rotations 3 and 4 shortened to 6 weeks accordingly. 

  2. Rural students instead undertake 18 weeks (1 semester) of General Practice, and 6 weeks each of the other 3 disciplines. 

  3. Due to COVID-19-related disruptions, lecture week was discontinued later in 2020, with pre-recorded lectures provided to students for self-directed study over the course of the rotation.  2

  4. However, due to COVID-19, logbooks were made optional in 2020.  2

  5. Due to COVID-19, there was no placement in rotation 2, and placement in rotation 5 tended to be at the same clinic. Tutorials were conducted exclusively online. 

  6. Due to COVID-19, the 50-encounter logbook and written assignments were removed for 2020.  2

  7. Due to COVID-19, my emergency department experience was limited to one half day :( 

  8. Prior to 2020, a second Vertically Integrated Assessment (VIA) examining all material from years 1–4 was included, but this was removed for 2020. 

  9. However, this indicator (the InternZ score) was discontinued for the my year, the class of 2021. It is unknown what will replace it, or whether it will return for future years.