Seniors Advice for M4 from the Class of 2014

Contributions by:
Tan Hwee Leong, Kwek Lee Koon, Liu Xuandao, Vivian Lee, Deborah Khoo, Chue Koy Min, Michael Lim, Sophia Tan, Bryan Buan,
Joel Arun
Note: Format of assessment may be different this year (AY2013/14), please check during your respective postings
Do also take this advice with a pinch of salt experiences and study methods differ greatly :)
General
Time to explore sub-specs that you may be interested in
M4 is a lot more about learning investigations, practical skills and management. The scope is narrower in terms of
approaches, but you are expected to learn certain practical skills in each posting - it would be wise to make learning
them the top priority. It is possible to learn subjects completely in terms of medical student level (unlike IM), so with
the right books things should go well."
Topics covered are real REAL ones that will be encountered with patients next time
No real fixed textbooks for a lot of topics depends on preference
Time for you to revise for final MBBS
Reflect on priorities in life or simply relax
EOPT not as difficult to study for
Doctors treat you like tourists rather than their future HOs
Eat good food and send your friends postcards
In decreasing order of free time: Psych > Anaes > Patho > Eye > ENT > Emed = O&G
Recommended readings: Toronto for all specialties, See individual postings for specific books.
Anaesthesia 2 weeks
What comprises

the posting?

How much free

time?

How should I
study for EOPT?

Lectures, simulations, OT attachments

Basics of intubation and resus in OT/ critical care setting
Mini-CEX
TTSH posting: Being inside OT with a tutor who will hold theoretical discussions with you, allow you
to intubate, let you insert laryngeal mask airway (LMA)(tutor dependant), practice bag and mask
(VERY IMPORTANT). Bring you around to see regional anaesthesia mainly for exposure.
CGH posting: All OT time, no clinics
SGH posting: Attached to anesthetist and basically follower/shadowed them the entire day, for their
scheduled operations
Depending on how long you stay for OT attachment days
there are usually 1-2 hour breaks during which the consultant takes breaks. So i recommend you
bring your reading materials with you to theatre.
TTSH posting: OT usually ends at 5, dont have to stay late unless you want to impress your tutor.
Must sign attendance so try not to pon.
CGH posting: I was usually let off after lunch. Free lah. 8-3?

Format of assessment:
1) MCQs & OSSEs combined with EMED
- May be quite factual (eg. interpreting capnographs)
2) OSCEs
- Tend to be repeated
Note: They tend to shuffle the sequence of questions for different test papers so people cant memorise it
How to study:
Department lectures notes
Recommended books
Read broadly (because only comprises MCQs)
Past year EOPTs
It is vital to revise your cardiovascular and respiratory physiology from year 1. I personally like
costanzo, its short and sweet. Most of the mcqs and questions you'll be pimped on have a
physiological basis.
Memorise your ASA scoring, different types of ETTs, and face masks.

What should I

Be consistent

take note of
during the
posting?

Random questions tested by cons during OT

Pre-reading will be helpful, so you can use OT time to ask questions
Posting is graded based on a logbook. It may be helpful to let tutor know in advance what you need
to cover so they can give you more opportunities
Theory & knowledge mainly from student anaes survival guide.
You might be asked lots of physio
How to read bispectral index, capnograph, ABG, usual monitors
Assesment will be CEX style you assess a patient for op then probably intubate/insert LMA
During simulation, practice bag & mask, intubation, inserting laryngeal mask because it will come out
- Pay attention to technical and practical details
- Eg. Prep, assembly, correct technique, how much air to inflate ETT, larnygeal mask, etc
- They have a model to practise intubation on, do practise because it will probably come out
again for pros
Practical skills to pick up definitely bag and mask

Emergency Medicine 4 weeks

What comprises
Fulfill at least 10 shifts
the posting?
o If you are suay enough to kena shift on saturday night, then you can enjoy the
alcoholic admissions as well
Tutorials are dependant on department
Prof Sureshs legendary ECG lectures on Saturdays optional but EXTREMELY useful (4-6hours x 6/7
sessions)
1 day ambulance attachment
Principles of acute care for undifferentiated cases
Quick focused histories and examination to rule out life-threatening causes
Lots of procedures

How much free

time?

TTSH posting: shift work and procedure based learning

- Shifts practice blood taking, plug setting, casting, simple suturing, ECG reading and to do CPR if
you have cases in P1
- Tutors will teach if you ask questions
- Do participate in resus and experience doing CPR

Freedom to decide which shift you want to do, fair bit of time to play around with

How should I
study for EOPT?

TTSH posting: Schedule your shifts properly and you may potentially have a few free days in the
second week!
Format of assessment
1) MCQ
- Tend to test esoteric facts
- Another senior said: Almost 100% repeated from past years
2) OSSE
- TTSH had practice slides which were useful
- Theres an OSSE book by Dr Phua Dong Haur (she thinks)
3) OSCE
- Like a condensed internal medicine station
- History, PE, diagnosis, investigations, read ECG
How to study:
Learn the important life threatening causes that must be ruled out (e.g. abdo pain in old man AAA,
6 life threatening causes of hest pain), how to read ABG and CXR/AXR
Black Book
o Not everything there is important though, so it is best to find out on shifts what is
important.
o Although a lot of people take issue with the way they organise chapters (by
alphabetical order) and some of the management algorithms are out of date.
Practice past year EOPT, usually repeated
Study by approaches, questions are quite clinical based
you should find slides resources on your class dropbox or passed down from seniors, cos theres a
very large slides component in the EOPT.

What should I
take note of
during the
posting?

Recommended reading: Black book

Do your shifts
P1: resuscitation; P2: critical care; P3: everything else
o P1 is usually the most exciting and fast paced setting. You will be expected to help
actively in setting plugs (green, usually), CPR and whatever else there is to do in ATLS /
ACLS.
o P2 is where you can practise your history taking and physical examinations. Take the
initiative to start clerking patients that have just been wheeled in, you can then present
to the MO. You can also start setting the plugs and drawing the bloods, check with your
hospital what are the standard bloods to take, or you just take all 4 tubes to be safe
(+/- blood c/s if theyre febrile).
Follow the cons that let you do stuff (most will but some let you be VERY independent)
Try to clerk cases and present to tutors.
EMed physicians value summarising as a very vital skill
really helpful for overall clinical acumen if you practice the whole process from hx taking to
management, and the more you do it and present to your tutor, the better you'll get.
actually mentally calculate GCS, and ramp up your neuro examinations at twice the speed.
Take the opportunity to do procedures and practice clerking undifferentiated patients
Some opportunities to do some suturing/ help with manipulation and reduction
Serves as revision for GS and IM
No better time to practice blood taking and plug setting, intubation, catheter
Known how to identify what is an emergency and how to handle them
Study from black book, do lots of past year questions
Use your time well

Psychiatry 6 weeks
What comprises
the posting?

Lectures
IMH posting
- Focus: Psychotic disorders and addiction
- Ward rounds were not very useful but eye-opening in terms of severity of disease
- No attendance taking
- Difficult to clerk patients on your own for write up but you can try to experience confusion.
Clarify using case notes.
- Addiction ward rounds are good
- The 2/52 posting at IMH is pretty chill, ward rounds are conducted like interviews, where the
team doctors wait in an interview room as the nurses bring the patients in one by one. The type
of patients youll see depends on the type of ward youre in, though, so you might be limited in
that aspect. After the morning rounds, theres usually not much else to be done. If you want to
clerk patients that your tutor has identified during the rounds, youll have to ask the nurses for
help in taking them out of the ward and into a separate interview room (much like rounds
themselves). If you were thinking of leaving early, though, the school has pre-empted that by
scheduling tutorials in the afternoons, and attendance will be marked.
-

Restructured hospital posting

- Focus: All other major conditions
Ward rounds, teaching, didactic sessions
- Some tutorials are good, some time wasting. Ask seniors for names

SGH posting: Very exam oriented, get to do a lot of MCQs, sit in a lot of interesting clinics. Dr Ng BY is
a dedicated tutor who will monitor your attendance in a non-threatening manner

Will have to submit writeup and CEX, can do in either hospitals but IMH is relatively more chill, quite
good to get it done there
Recognise psych conditions and their behaviour, develop skills to deal with difficult patients, learn
about the drugs and their side effects as these are important when you are the HO on call

How much free

time?

Quite a lot of things scheduled but days dont end too late
Good amount of time to study
Ends by latest 4 pm everyday. There are good days where you end much earlier

How should I
study for EOPT?

Format of assessment: (Accurate for 2013/14)

1) 50 MCQs + 10 Extended Matching Items (EMI)
- Practice! SGH people will have Ng BY MCQs which are much tougher than EOPT MCQs but no
harm practicing. Do past year papers.
2) 4 Short Answer Questions
3) 4 OSCE stations (2 live stations, 1 video station, 1 interpretation station)
- OSCE: Quite straight forward, use Roger Hos OSCE
- Essentially either: Counselling, Diagnostic Hx, Explaining certain things (medication indication,
SEs, ECT etc)
o basically if its a diagnostic case for psych certain formats can be used like...
- establish the dsm-iv (or if ure imba icd-10 diagnosis)
- tro other possible differentials
- risk assessment (suciide, homicide, infanticide, for dementia wandering, fires, floods
etc.; for schiz need to ask for command hallucinations and how far they've obeyed the
commands) --> this is usually the pass/fail criteria in psych
- insight, current/ previous management, complications, substance abuse/ alcohol etc.
blahblahblah
4) 1 Case writeup

What should I
take note of
during the
posting?

Most intense EOPT

Read extensively
Do prior OSCE practice
Recommended reading: First Aid, Mastering Psychiatry, Toronto Notes most used Mastering
Psychiatry +/- First Aid
- First Aid easy to finish reading, broad coverage of conditions, good to prime one to read
Mastering Psych
o Invaluable book for last minute cramming
- Mastering Psychiatry gives good exam orientated coverage of various topics
o downside is that its the thickest text out of the options to read through.
Additional resource: Trick Cyclist (http://www.trickcyclists.co.uk) for OSCE practice
Make good use of time with SPs to practice for OSCE
Go for Roger Ho's revision sessions
Memorise DSM early during your posting sounds excessive but really much easier if you know it
Steep learning curve
May take a little getting used to. Doesn't work the same way as a normal clinical posting, a lot of it is
using gut feeling to put the presenting complaint into a particular category (anxiety, mood etc), and
then asking all the relevant questions for that category.
What and How you say things during exams matters a great deal
Be empathic, tactful and appropriate when clerking patient may make a difference between
passing and failing
Learn how to deal with patients and be a nice person
Fair bit of counseling stations not enough to just have knowledge, need to know how to relay
appropriately in lay man terms
Practice, practice, practice
DSM, DSM, DSM
theres 999 diagnostic criteria to familiarise with (note. familiarise. NOT memorise) and 999 drugs
(with their corresponding 999 side effects) to memorise (note. memorise. NOT familiarise).
Do not neglect seemingly unimportant topics like alcohol addiction, drug abuse (which may pale in
comparison to Depression, Bipolar Disorder etc.) as they did come out as questions for my EOPT
Roger Ho!
Not much practical stuff
Pros OSCEs are SPs who are really nice

Ophthalmology 2 weeks
What comprises
Lectures, Clinics, OT
the posting?
Predominantly in the clinic, take this as an in depth study of the eye component of cranial nerves
examination
Make sure to clarify confusing parts of neuro ophthalmo before you leave

How much free

time?
How should I
study for EOPT?

Quite a bit depending on how you spend clinics and OT

TTSH posting: Clinics from 9-5, lectures may end earlier
SNEC posting: 8/9-5/6
Format of assessment:
1) 6 OSSE slides with questions for EOPT which cover important conditions and approaches
How to study:
Lecture notes for broad coverage of important conditions
Toronto notes to supplement lecture notes
Ophthalmo Atlas by Arthur lim good pictures and short notes on variety of conditions
Recommended reading: Ophthalmo At A Glance
Past year questions, fundoscopy pictures, approaches
Learn approaches to eye pain, red eye, BOV, treatment. Learn how to read fundoscopy photos
(there will be slides). Learn how to deal with different problems picked up during eye PE
(egstrabismus, abnormalpupilary reflexes)

What should I
take note of
during the
posting?

ENT 2 weeks
What comprises
the posting?

How much free

time?
How should I
study for EOPT?

Clinics useful to see a variety of cases and to practice fundoscopy (half of the batch will get it in
OSCE practise as much as you can during eye posting)
Fundoscopy!
Get tutors to go through OSSE with plenty of pictures

Lectures, clinics, OT
Clinics most of the time. Specialty spans: ear, nose, throat, oral cavity, upper esophagus, neck
Learn PEs and practice with CG mates early
Top 10 in batch will participate in prestigious ENT quiz at the end of the year!

NUH, CGH: Attachment to hearing test nursing stations, attendance everywhere you go. Try to
rotate around different clinics if you start to see repeat cases of one anatomic region.

Depends on how you spend clinics and OT

Generally 9-5

Format of assessment:
1) 6 OSSE slides with questions covering important conditions and approaches

What should I
take note of
during the
posting?

Lecture notes and blue book given by department supplemented by Toronto notes to organize
thoughts = sufficient
Other recommended reading: Essential ENT by Corbridge
Clinic is useful to see cases and examine patients
Practice otoscopy well half of batch will get in OSCE + you'll have to do it on own patients next
time
Learn to read hearing test results
Keep practising PEs in videos that NUH uploads for CEXes

Patho 2 weeks (does not = slack off)

What comprises
1 week lectures
the posting?
1 week forensic pathology
- Mortuary attachment
- Court attendance
- Tours of labs

How much free

time?

Pay special attention to lectures because half the class failed

Or pay no attention because theres a big chance youre gonna fail anyway

A LOT
Lectures end around 4, Forensic patho around 3+

How should I
study for EOPT?

What should I
take note of
during the
posting?

Format of assessment:
1) 3 OSSE slides with questions
- Impossible to predict what will come out
o Each batch rotating through postings will go through histo of different systems so no
real way to prepare for this part of EOPT
How to study:
Pay attention to lectures
Forensic patho will not appear but will feature in 1 MEQ for pros (study CTS notes)
o do double check with your coordinator whether its the same for you guys.
Recommended reading: posting notes
Just try your best with transcripts of the lectures, not just from your own cycle, but previous cycles

Quite useful if you stay awake

Important to take note of death certification because it will prob come out for pros
Covers topics you may never encounter again, useful for clinical practice
Includes haematology, blood transfusion, electolytes, biopsy, clinical microB, etc

Obstetrics & Gynaecology 6 weeks

What
Lectures + online assessment
comprises the
Wards, Labour wards, OT
posting?
Clinics
- KKH: Scheduled but may need to fight with DUKE, so turn up on time
Tutorials
Mini CEX
- May be theoretical discussion or observed clerking
Case writeups
- Choose simple cases but discuss management properly
Night call
- Most camp in labour ward but can find resident to bring you around to clerk new cases too
Major highlight: participating in a few deliveries
- NUH: no quota
- KKH: requires at least 2
- Whether you like it or not it is a litmus test for the suitability of the speciality for you
- The amount of teaching that youll get from the hospitals is usually inversely proportional to the
patient load they have.
How much free
time?

How should I
study for
EOPT?

Depending on how intense you are in wards, clinics and labour wards\
I cant really remember, PTSD does that to you.
KKH: Clinics may end around 5, otherwise should have time to study

Format of assessment:
1) MCQ
- Quite factual
2) 6 OSSE slides
How to study
Lecture notes are really useful to complement textbook, so be sure to cover them all
Textbook: Choice between Hacker and Moore and 10 teachers
- Hacker: More content, cheaper than 10 teachers
- 10 Teachers: Need to get 2 separate books
A lot of people use Chin yees notes, useful for introduction and revision, covers main points for
major conditions
Toronto notes are useful
A lot of management questions are asked which are SG-specific so need to know practice in
Singapore also. Most of the lecture notes will mention and Chinyee's will mention some
Practice OSSE very clinical based, focus on management and investigation
Learn important life-threatening differentials

What should I
take note of
during the
posting?

Good mix of surgical and medical

Guys have a tougher time getting vaginal examinations and deliveries
Be thick-skinned and nice to labour ward nurse who should be willing to help
Guys may have better luck following male doctors
Divide time equally for obs and gynae tutorials
Emergencies are the most important - eclampsia, shoulder dystocia etc.
First tutorial: ask tutor to go through Obs and Gynae examination very different from usual so just
get this right from the start!
Practical skills:
o Depnding on luck, have a go at delivering babies and episiotomy (apparently
episiotomy technique may come out for pros so practise on models!)
o Try to do swabs in clinics. Girls try to help your guys out in asking for permission
chaperone etc
o Borrow the model to practise your gynae exam on. This will almost definitely come out
for pros
o Learn how to examine a pregnant woman
Like most M3 postings, read consistently and prep for tutorials and you will do well
Management guidelines differ between hospitals Dont harp on small details, just learn principles
of management
Important to consider a wide range of differentials
Learn by approaches (Amenorrhea, Dysmenorrhea, Menorrhagia, infertility)

Professional Examinations
General tips:
Be consistent
Learn as much as you can during postings
Stuff that you leave out during EOPT might come back to haunt you during pros
Revise core content (except patho which wont feature except forensic patho)
Do past year papers!
Last years format:
120 MCQs, 9 MEQs, 9 OSCEs
MCQ, MEQ done on a computer
o MEQs: Computerized so you can only spend a certain amount of time on one part of each question and
cannot go back to previous qns to change your answers. Essentially you will find out if your answer is
wrong when you go to the next part of the same question
o MCQs: Heavily features O&G, Emed, Anaesthesia
OSCE: Notes complied by seniors with standard approaches. Pay attention to how clinicians approach their patients
including professional conduct, words and phrases to reassure patients or emphasize a point. These skills are useful
in real life.
Speciality specific OSCE stations
1. Obstetrics &
2 stations
Gynaecology
Require good understanding
Range from history to management
Try quizzing each other before hand
May be given pelvic model so know how to do a proper VE and papsmear
Pros will have a papsmear station and counseling station very important for O&G
A lot of counseling may want to come up with a script
Once again, the pelvic trainer is available during the study period for booking. They may even
ask you to perform an episiotomy repair, thats a separate trainer from the regular pelvic
trainer. So make sure you pay attention during the posting. Or just watch youtube videos to get
up to speed.
2. Psychiatry

2 stations
Usually history to establish diagnosis, counseling to communicate a diagnosis or treatment, or
task station (eg. simple relaxation exercises)
EOPT will help prepare you
Roger Ho OSCEs
Practice lots
Trick Cyclist is pretty useful

3. Emergency
Medicine

2 stations
Can test anything under the sun
Like IM
Usually history and PE and investigation and management
1 ECG usually (so attend Prof Sureshs lecture and learn ECG well)
o make sure your ECG reading skills are up to scratch, they tested ECG for both OSCE
days for our batch.

4. Eye & ENT

1 station (Eye on 1 day, ENT on the other day, so you will get either one depending on your luck)
o so if youre on day 2 of the OSCEs, youll know for sure which model youre getting.
Testing fundoscopy or otoscopy
Fundoscopy done on mannequin, this is also done during posting, may request from
department nearer pros to practice
o bad news is that the glass eye reflects light in the temporal retina, so its quite a lot
harder than an actual eye. The good news is that the glass eye doesnt blink.
Find slides of eye pathologies and learn what each thing looks like
Otoscopy mannequin was never revealed until pros which stunned half the batch, so google it
and make sure you know what it looks like
o even for ENT they managed to come up with a model of the ear with an LED display of
the middle ear that can change images
o better news is that the ENT ear canal is so huge you barely have to put an otoscope in
to see the image.
Otoscopy slides unexpected, hence they all died

5. Anaesthesia

6. Pathology

1 station
Usually pre-op assessment (commonly airway assessment) & task (bag and mask, intubation,
larngyneal mask insertion pay attention during simulation in posting, may also request for
practice sessions in simulation room nearing pros)
Bag and mask!
Make sure you know your ABCs very well, as well as NUMBERS. They like to test things like sizing
the various equipment, methods of O2 delivery etc. etc.
The best news is that patho isn't in the OSCEs