How to Revise for Clinical Exams

Once you have entered your clinical years studying medicine, it ceases to focus on how the human body works, but becomes more about how it doesn't work and what you can do about it. These years are about transforming you from a lay individual to a doctor. As such, revising for exams becomes a little different - you need to have clinical knowledge (for written exams) and you also need clinical skills (for your "OSCEs").

On the one hand, you will need to revise a wide range of clinical diseases for which you will need to know the key components - pathology, epidemiology, aetiology, clinical features, investigations and management. On the other hand, you will also need to ensure you are comfortable and 'slick' at performing the clinical skills (taking a history, performing clinical examinations and performing the core procedures).

In this article, I'll help you make the most of your examination revision period by taking you through tried and tested revision techniques.

Clinical Knowledge

The more active you can make this revision process, the better your chances of being able to recall the details of the wide range of clinical conditions that you need to know. This starts on the hospital wards - experience here gives you clinical exposures to 'hang' clinical information on much more readily than paragraphs in a textbook. For example, remembering the clinical signs of alcoholic liver disease is much easier if you have taken a history and examined such a patient, compared to reading it passively in a textbook. It is very tempting to sacrifice the time you have available to spend in the hospital for time at your desk, but you must try to resist this for as long as possible.

Of course, time will also need to be spent at a desk, simply studying. An effective method for revising clinical knowledge goes as follows:

Read - Test - Reread & Retest

Read: You will first need to acquire or revise the information. Do this by reading your textbooks, or searching online - nowadays there are plentiful resources for written summaries about clinical topics that often render textbooks rather superfluous! For example - Geekymedics (www.geekymedics.com) and Almostadoctor (www.almostadoctor.com) have great revision notes to give you key information.

However, you may feel more engaged with more dynamic content, such as podcasts and video tutorials that have the added advantage of varying the modality to explain complex concepts. Afterall, I believe that you're more likely to remember something if you understand it and more engaged with what is being presented to you. A good animation or diagram may be easier to remember than a paragraph of black text.

For example - Boxmedicine has 20 high quality video tutorials that contain a variety of media modalities to help you understand and remember a variety of surgical conditions. You can then test yourself using the tailored MCQs following each tutorial. Alternative ways to maintain engagement and ensure a more active revision process includes writing notes and diagrams to which you can refer later and use to test yourself and your friends.

Test: Indeed, next you need to practice recalling the information that you have revised. The purpose here is to become familiar with exam-style questions and to identify persistent gaps in your knowledge. There are literally thousands of free multiple choice and extended matching questions online from which you can choose. Alternatively, team up with a revision partner and use your revision notes to test each other out loud. This can actually be very enjoyable and can bring about some great fun in and amongst the dark and lonely hours spent at the desk! Highly recommended with cups of tea and biscuits...

Working in this way, you will also learn a few extra things from your friends that you never picked up during your reading. And there's nothing like motivation after realising your friends know more than you!

Reread & Retest: The benefits of this stage are simple - you concentrate on persistent gaps in your knowledge rather than wasting valuable time going over things you already know.

Clinical Skills

In your OSCE, you will need to appear as if you can do the various skills in your sleep. 'Slick' is the key word, and if you don't need to keep pausing to remember things then you should not have a problem with time-keeping in the exam. The key process for this is:

Learn - Consolidate - Practice - More Practice

Learn: Time spent on the ward before your exams is time to learn the 'tricks of the trade' from actual doctors, rather than relying on textbooks and clinical skills teachers. It is an opportunity to receive feedback on your technique, and also to pick up real clinical signs. You may find it frustrating to learn a technique for examining a particular system, only to find that another doctor does it differently - this is normal, and is why you need to consolidate.

Consolidate: Indeed, there is more than one way to skin a cat. But time on the ward will help you identify the key steps to examining a particular system, or performing a particular clinical skill. Type a list for each clinical skill and systems examination and go over each one until you think you have everything. Then rearrange the order of each step - this is where you will gain some extra points - for example, make sure you auscultate the lung bases during a cardiac examination while the patient is already sat up as you auscultate over the aortic valve.

Do the same thing with history-taking - write a list of the key questions you need to ask. With practice, you will find that your history-taking becomes much more concise as you focus on these key questions.

Practice: Now you have your consolidated 'recipe' for each clinical skill, you need to practice. You ought to practice on real patients - taking histories and examining - teaming up with a friend to give each other feedback, and ideally finding a doctor to do the same, particularly for clinical examinations. Put time in your schedule for the clinical skills laboratory. If there are no real patients (i.e. at home) then examine and take histories from each other.

And then when your friends have abandoned you back at home, find a teddy bear! If you don't have one, dress up your chair with a shirt and trousers, or lay them out on your bed. Your non-medic friends will think you are very strange indeed, but at least you will have a great opportunity to repetitively run-through the motions of an examination so that the steps are remembered, while you perfect the technique on friends and real patients. Similarly, use your pretend patient to run through the steps of clinical skills. You may not be able to cannulate a shirt, but you can practice explaining what you are going to do, and mimic the actions.

More Practice: This is to emphasise the importance of repetition - just as your cerebellum enables you to walk without thinking about it, you need to be able to go through the steps of each clinical skill without pausing for thought. Save your thoughts for interpreting what you find.

Final Thoughts

The most important part of exam revision that many medical students fail to realise is that preparation begins at the start of the year, on your first clinical rotation. The more time you spend in the clinical environment, the easier those clinical exams are going to be.

Another benefit is this - many of the clinical gems of knowledge that us clinicians have today are the result of clinical experiences had as a medical students, and not random passages of text. Time on the ward now will make you a better doctor later. Good luck!

If you have any great revision tips, share them by writing in the comments area below!