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So uh welcome to answers. Uh talk on year three, if you're not from Imperial or one c within imperial. Um I try and keep it relatively short since I'm sure everyone wants to enjoy that evening. Um Essentially the things I'm gonna cover um include the rough structure of year three at Imperial. If you're not from imperial, then maybe you could ignore like the the small intricacies that are only relevant to Imperial's year three course. But the overall things I'm gonna talk about in terms of revision methods and especially larking history taking and also Aussies will apply uh because generically year three is everyone's first clinical year. So I'll just get started, feel free to ask any questions um throughout in the chat. So at Imperial, this is your structure of one seat. Um You essentially have three main placement box GP, medicine and surgery. The order in which you'd get is random. I'm not gonna talk about too much about that since you would have already started. Um So into the bulk of things you're, you're given around 232 UK MLA conditions to learn and it is really quite useful. Now, that they've introduced UK MLA because when you do finals, you'll be basically tested on the exact same conditions in total. There's about 2000 odd, including all your specialities. I am pay. You have a platform called Sophia. What they've done here is they've organized all the conditions they want you to learn this year into specialities or into groupings. It's not exactly identical or alphabetical. So it is a little bit complicated. So my first suggestion would be to essentially find out what conditions are listed on Sophia and organize them into your own list, whether that's on, on word on notion on anything. And personally, I like to do that into specialties. So you have your or your cardiology, then your respiratory, then your endocrinology, et cetera. And I do it alphabetically, you can do it by um other ways of sorting it. It, it's just a bit easier to use when you have your own list that you can check off or that you can look at rather than using Sophia. If you don't attend Imperial, then I would suggest something similar. Just find out all the conditions on the UK MLA website and then make sure you have a nice clear uh list. Essentially, it's quite difficult to gauge how much you'll need to know how much you'll need to learn. Um As I've said here, some conditions presentations that aren't explicitly mentioned on Sophia will come up and they have come up in the past. This is because presentations might be things like back pain and back pain can encompass many, many, many different conditions. But for some reason, they don't list all of the conditions in the conditions list. So my general rule um that I tend to follow is that common things are common if you see a condition, for example, related to back pain, but it's not in your conditions list, but it is still a relatively common condition that you see in questions a lot or that you see at placement, I would still include it. It's it's always better to overlearn than under learn. Um And how much information you need to learn. How relevant some information is you will gauge over time at the beginning of the year. I think it's very difficult to, to know what you need to know off by heart, what you need to learn. Um And that is something that would develop as you go through the year. Um I think going from preclinical years, you're kind of in the mindset that you need to know everything like everything slides, everything mentioned by lecturers, et cetera. But that's not so much the case for clinical. You really need to take some personal decision making into how much you decide to learn. For example, is it really useful learning fourth line antibiotics uh for strep throat. Uh II would say no, it it's not exactly very useful. Whereas 1st and 2nd line is always a bare minimum because first line is, is what you would give normally. And second line is usually what you would give if someone's allergic, for example. So it is um something you will acquire simply as you go through the year. Um I would say another big thing is to always double check the latest guidelines. The the thing with um year three and clinical years is that the way they test you is based off national guidelines. So guidelines by nice et cetera. So you must always check because some guidelines change year to year. Um I think they always like to change a lot in gastro for things like imaging. And um I would say treatment changes less often. It's always um imaging or investigations that change quite a lot in terms of what you do first, what you do, second. So always double check official guidelines, especially if you're using all the year's notes. And a personal thing for me that I really think is very valuable is understand pathophysiology because I feel a lot of people just to memorize and they limit their scope. And if you if you are just really good at memorization, then that's fine. But II found for myself, if I understand the reasons behind why certain diseases act, the way they do, why they progress the way they do and then understand how the treatment works. It allows me to simply retain this information better without having so much brute force memorization. And for me, I really like the U Assembly textbooks. I think the American medical textbooks are really good on pathophysiology. So even if you aren't doing step one, step two, if you take a look at step one's textbooks, it has some really good basic pathophysiology without going too much into the academic scientific level that may help you understand um different aspects. So for example, Crohn's um and ulcerative colitis, understand the patho pathophysiology of the inflammatory changes and things like that. They have really good explanations that you may not necessarily get. And obviously, this kind of information isn't, is it necessary? Um Sometimes you do need to know, for example, for IBD, you will need to know what the imaging will show. If you put, if you have a colonoscopy, what kind of mucosal change you'll have. But obviously for other things, you don't necessarily need to understand it. But ii would say it's quite important because obviously that's why they're teaching preclinical years is so you have a fundamental basis of understanding and that will help you go along. And it's also a really useful point point for whenever you have um whenever you have um sorry, just checking shot whenever you have um doctors on placement, some of them, I found particularly Oxbridge graduates tend to really like to test your pathophysiology if you have an understanding of health on placement as well. Um Now, for Imperial specifically, I can't speak for other unis but Imperial specifically, you have a three hour exam, they're all single best answer, 100 and 50 questions. So multiple choice they're split like so between this is kind of useless, to be honest. Um It's just done by how Imperial decide to collate the conditions by placement. Um But you know, it's just basically this many questions on your 232 conditions and 15 ethics and law questions. OK. So now on to study techniques, I think for clinical years, um it's funny because when everyone starts med school, their advice is always um Anky, Anky or, you know, space repetition and all of this and everyone's always against making notes and things like that. I personally like to make notes in, in preclinical years, but I would say they were less useful back then. I'd say notes are really quite useful for clinical. Um the amount of resources you're gonna find yourselves using, you know, um zero to finals so that the student made the student made um resource websites, but also the official websites. So things like B NF um Nice C Ks or the um the, the B MJ or the official sources of information you're gonna find. And what's gonna happen is that if you don't take or have some form of notes, you're gonna get closer to the exam and you're gonna have to double check investigations, treatment symptoms because it gets quite confusing when you start to learn more because a lot of the things overlap and you'll start mixing some of them. And unless you have some sort of system where you can look back, I know you can search and an you and things like II personally just don't find it very useful. Um then it, you will get, it will get difficult. And I think there is a strong sense of um disagreement with notes, I think is very up in the air. It's very 5050 from my experience for what people prefer. I would say you definitely you don't have to make your own notes starting off with note back notes or a years' notes and uh adding and editing those is really the most efficient way you can make your notes from scratch. I think I made mine from scratch. Uh but supplement with all the websites and I think that's really good. Um going onto flashcards. Um Yeah, use these if, if you find these useful. Um I think people really like to use these to um retain information. I personally just like reading notes um or using toggle features on notion things like that. But if you find that flash cards work really well for you, for example, questions could be uh what are the symptoms of Addison's and then you could do investigation of Addison's and making hp their own individual card. It may be very useful um to help your retention. Um And what is a must this for clinical years is question about, there's a big debate about a surrounding whether past medicine and ques medicine is better from my personal experience and opinion in for imperial specifically ques meed is ques Meed's question wording is similar to Imperials, but the level of difficulty is too easy. I'd say passed's level of difficulty is much more similar. However, I purchase both and I think if you can afford it financially, both is a, both are a fantastic investment because they, if obviously, if you're doing both, they will cover some overlap. I think in terms of difficulty, I would start off with the what? 1st and 2nd level. So the first hammer and, and then two hammers, um if you have time at the end, you can do the hardest difficulty questions, but really there's no need. Um the hardest difficulty often involved the most niche conditions and they're just really unlikely to come up. But these are the two main question banks that everyone uses. You can filter by specific conditions. There's a way to do it in both. Uh II just didn't bother with that. I just selected cardiology or whichever speciality I wanted to revise and I just skipped the questions which I knew were on conditions that or presentations that we, we weren't being tested on and for me that was faster. Um And I think fundamentally, it's the same as previous years. I mean, you're all quite experienced now in terms of taking university level exams. So don't, I'd say, I'd say, don't be a sheep, don't follow the crowd. You know what works for you. So stick by it. You will have to make adaptations because the content is different from preclinical. There's a lot less biochemistry, there's a lot less science. Um, but figure out what works for you and just stick with that. I think a big issue in early years is people. Well, it's not, it's, it gets an issue when people decide to live, but it's really good to experiment on in early years and I always encourage it. But what happens is that people get really close to the exam and still haven't settled on one. So I'd say try different methods if you still haven't figured out what works for you for clinical stuff and stick with that, I would say by early next year. Um But those, those are a couple of tips that I would give in terms of how I would do it. Um So now it's a place I'd say the biggest thing is just try and complete yours as soon as possible. Uh What, what you'll find is will happen is that a lot of people who don't complete their sign offs will end up, I don't know in March April so close to exams um with very limited time at placement left with still 10 sign offs and they're panicking and they're having to find different ways to get it. And really, I think I completed all my sign off by, by Christmas. I think, you know, I did basically all of mine at GPM and, and the ones that you could only do at, at hospital I did it within the first week. Like, it, it's just such a relief if you can get them done as soon as possible. And I guess it's, it depends, uh, if you go to, er, it depends on the order of which you are placed. I had GP first. So it was really useful for me because it was quite easy cos GPS, obviously the most intimate, it's really easy to get the GP to watch you perform one of your sign offs and get you to sign a and, and get them to sign it for you. The best thing to do is make a checklist of all your sign offs and establish which ones are suited to, to your different placements. Obviously, some things are extremely suited to GP, like urine sample, throat, swab these kind of things and other, other ones are, are only possible. A hospital, like, I don't know many GPS at all that offer E CG services. Um, and the ones that do are very limited. So that is gonna be a hospital placement, most likely medicine. And so try and figure them out and try and get them done as fast as possible. Really. Um, many of my classmates had to, had to either go into extra placement days to get them done close to exams and it was just something you don't want to be wasting your time, time off and make sure you take them off as you go along. Because it's often there's so many, there's probably like 35 or 40 it's so easy to get lost in which ones you've completed and which ones you haven't. And it happens where people have thought, think they've done one but they haven't. And so make sure you're careful with it. And for Imperial we use now, I think we, when we used it, it was called for Skype, I think they changed it now to spark forms. Uh be really careful uh with interconnect, internet connection many times, especially in hospital or GP connection isn't always the best. And if you're not using the app, the app and you're using the web browser, it, if you don't submit it properly or there's an error, it won't go through. So sometimes I'd recommend using the app or most of the time because it does save it locally without internet. Um And so just make sure, you know, you've got the email confirmations and things as you go along with that. Um in terms of attending placement, I think GP, obviously, you're gonna have to attend as often as they want you in because it's such a small group of people and it's often quite intimate. But for medicine and surgery I'd say attend where is necessary and useful. I definitely didn't attend all the time. Often, some placement sites have, um, sign in sheets or QR S and you're gonna have to find a way to adhere to that otherwise you obviously wanna avoid trouble. Um, but I'd say know your consultant's timetable, especially surgery. Most of my consultants only had one or two list days. There's no point going in when your consultant isn't performing surgery. Um, and there's no point going in when your consultant I isn't, you know, isn't there unless obviously you're finding it useful and, and that's uh your own personal decision. You need to know when placement is being useful and when your time is better spent elsewhere, for example, doing passed or revising conditions, making notes, et cetera. Often I'd go to placement sites, but I find myself in the library most of the time because wards aren't too useful but there are times where placement, teaching is extremely useful or consultants are in and they're giving you really good advice or uh content. And F ones are F ones, F twos are always really good and, and they'll always sign you off for, for things like ECG S and stuff because they've just completed med school. So, um, yeah, I'd say use your own personal uh judgment for when, when and where to attend. Ok. So now to oy, if you don't go to, er, it might be called something else. But I think ay in peril, you have 12 stations, uh four core three clinical com one P VB and for other skills at Imperial, the rule is that you need to pass a minimum of half of them. So six out of 12, but the caveat is you need a minimum percentage score. So that'll calculate that by taking your average score essentially. And that has to be above whatever the average passmark score they've set. It is quite rare to fail. Osk you're unlikely to fail but people have failed and people do need to resit. Um So I it isn't something I would neglect now for Aussies, I use if you go to imperial use simple osk. It's really good. It was written by Imperial medical students. Well, imperial doctors uh who were once imperial medical students is quite good. GS of course, is the go to um the check that provided by in imperial on incity do not cover all the marketing points. I think a big misconception at the beginning of the year is that this is the market scheme is not um it's essentially a bare minimum and I personally feel that they don't include everything you need to do. And if you, if you follow that and only follow that and only do what's stated, you'll not score above 70% I don't think on each station. So there is essentially a bare minimum, a rough template, a rough framework. Um So make sure you cover all the points, but make sure you're adding whatever you're being taught, um, different clinicians will teach differently. Uh Don't get too caught up in this. Doctor said that, that doctor said this G me says this at the end of the day, everyone has their own personal technique. There's obviously a roughly general, widely accepted way of doing things and you'll figure that out. But if you have slight nuances, it's OK. And if there's a particular method which you like and suits you well, then stick with it. Um And obviously there are some things which you don't need for year three sys um that geeky medics teach. So, so no, and, and again, it's just something that will come in time. But if you attend teaching, um and, and things like that tutorials, you'll find out what is useful, what is co what is not necessarily co and uh and leading on from that, I'd say attend all your teaching at placement pla uh placement sites that goes for clinical skills and your osk sessions, um they are really useful. And if you don't go, I think you're missing out on a lot. You'll get mock osk in March next year. So make sure you go to those cos they are basically a copy paste of the, of the real thing. And it's such a good experience. And if you do have an older years uh session or, or like group from CPA or something like that or some sort of teaching group, try and organize sessions because older years have done it and, and they'll know what to do. And for me personally, I like learning a script. Um So I don't want to sound like a robot, but it is good having a script for each bit. It, it gets really confusing when you have so many different exams and you're trying to instruct patients on what to do. And if you've ever tried it on placement yet, you'll see that patients get really confused if you don't explain things clearly. I think actors are slightly better. But when you get to later years and they start using real patients, especially in finals, if you don't explain things clearly, they won't do what the action you're trying to get them to do very easily and it's gonna lose you time um for P VB and history taking. Uh the example of PVV that I had was um someone with asthma who also use recreational drugs and dealing with that in a sensitive manner. You could get breaking bad news. Um These kind of things, they are quite challenging and I would say it is the lowest scoring station overall. Um But make sure you practice, especially if you're weak at empathy or communications. History taking is quite um standard but also needs a good level of com skills. But I'll cover that in a minute when I go through larking. Um So these are your OS stationss are imperial. Um You should have, please do check this because this might have changed. Um But those are your core examinations. They will all definitely come up for neurological. You could either get upper, lower or cranial. I would say last year they locked in fundoscopy with cranial nerves. Um You will never be asked really to do all the cranial nerves. It will be very harsh if they do because there's simply not enough time in II in the time that they give you. Um but they will select three or four or two or three out of the uh 12. And yeah, you had, you just have to learn all of these exams because essentially any who come up, they will lump some in with some of the skills. Er So as I was saying, fundoscopy or ophthalmoscopy that they call it now was lumped in with uh cranial last year. Um and talk to your clinical skills tutors at your placement size because often they have insight, they're part of the assessment team, they will give hints as what will come up. Um You know, I think things like peak flow is a big one inhaler technique. Inhaler technique was kind of lumped into P VB last year. So they like to mix things up, things like catheterization isn't really gonna come up because it just takes too long, the turnaround between each student. So bear that in mind scrubbing up as well, not every facility, not every placement site or where they hold the Aussies is gonna have the facilities to allow everyone to scrub up and things like that. So there are definitely ways you can gauge what's more likely, what's less likely, but obviously still learn everything. Um, but this is for when you get closer to the exams, you can kind of gauge and guess what's more likely to come up, what's less likely to come up and, and go off of that. Um But still make sure you have a good understanding of everything. So no answer, clerking and history taking, they're kind of one of the same. Um clerking just refers to kind of the note taking aspect when you talk to a patient. There are three main systems that we use in NHS. Uh Sirna is this one here is what you'll see basically at all hospitals EIS and system one is what GPS are using. Uh This is EIS and this is system one you'll learn as you go along and as you start using them, it's the only way they give you some tutorials to watch, but it's just so confusing and useless. You'll literally just learn on the job and, and doctors will help you. Um I'd say quite rarely, you would need to make notes on Sirna. Depends on who your consultant is, who, what your, what the doctors on your, on your firm want you to do. Uh But you'll definitely use sir to read patient notes and to look at patients charts, et cetera. Uh E in system one you'll be using at GP when you're running your own uh clinics to take patient notes individually. Um So it's quite important. So this is my personal way of how I would take a history or, or, or do class. Um I would first go through presenting complaint and a history of presenting complaint. II lump these together because I think they're very well related. Some people like to separate them. But to me, it doesn't make sense. So really here you're asking why the patients come to GP or why they're in hospital. Um This is not the time to ask, you know, what medication you're taking, what's your medical history that's later as you can see here, this is simply the, the current period in time while they're here. And then after you've established why they're here. For example, I've ca I've come to the GP with a cough, then you establish what you're gonna ask next. And you do that I II always use a flow diagram in your head. You know, it's always really useful. So if there's pain, for example, I've come in with chest pain, then you would do your Socrates and you would ask about all these different questions. If not example, well, even if it is chest pain, you could, you could do um this. But if it's things like cough, um you can do a modified Socrates. People get very cough something Socrates, it's only for pain, but it's not, um, things you would take aspects of Socrates to ask even when things aren't pain and there are other things to ask. So things like if someone comes in with a rash, you can still ask, when did it start? How long it's been going on? Character? You know, there's still character of rashes. Um, is it itchy? Does it, does it w pus things like that? Um So there are ways to adapt it and what people really miss out and I think is a real um differentiator between top level students is the focus system review. You need to fit that in and you're presenting in and history presenting a pain when you're asking all these questions about, you know, where's the pain? Uh does it radiate et cetera? Um And this is, this is a place to ask aspects of your system review, but at the beginning, um because you, you need to relate it and I think if you're early on in clinical years, you'll probably not be very good at this. And it's something that you'll get better as you go along and system review isn't something they teach you too much in preclinical. So it's probably the biggest addition in your first clinical year. So if I just jump to system review, essentially what you're doing here is you're asking questions not directly related to the system of the presenting complaint. So chest pain is cardiology, shortness of breath is respiratory. If a patient is coming in or presenting, or that's the reason why they've come into hospital or come to see you at the GP, then you will ask specific questions related to that physiological system in your presenting complaint. So for example, here, if there's chest pain, you can ask these cardio questions here because they're directly relevant to what the patient has come in to see you about right here right now. Same for shortness of breath. If they come in with that, you would ask the respiratory questions. But it's really important to ask associated symptoms because patients are often not very good explainers and they will answer what you ask and they're not very good at just giving you all the information you need off the bat. So the point of the systems review is to ask any other really important symptoms and what you're looking for here are red flag symptoms and red flag symptoms. Obviously, you're thinking anything that's a medical emergency or obviously cancer and that could really change your your plan of action or treatment. And it's really important to ask these questions because if you miss it, that is almost when you can get to the realms of medical negligence Ansu, that's something that I would come to. At the end systems review, I would do it at the end of asking all the main questions but bear in mind, make sure to include this focus system review because these are ss the focus system review includes questions directly relevant to the system that they're complaining about. Just need some more time. Excuse me. So after you've done presenting complaint, a history of presenting complaint, I would move on to past medical history. Find out what other medical problems they have. Do they have diabetes? Um, any other conditions that they're not coming to see you about today? Also any medication they take any regular medication dot Doesn't really matter if they occasionally take paracetamol, the headache. That's not what you're trying to find out. You're trying to find out regular medications, something I haven't included here. Allergies. Um, on the drug history, I would ask about allergies. Are you allergic to any drugs or anything at all? And that's something you had better then on to family history, any family history of medical conditions, if there's a family history of diabetes, you know, type two, you know, there's strong associations, family history of cancer. Very important. So the way I, um, ask is I say anything and everything because patients often don't know what they, what you mean by. Is there any family history of medical stuff? I II just like to say anything and everything because patients, especially if they're not medically trained, they don't know what's relevant and that's for you to decide. So you really wanna get all the info. So after family history, I would cover social history. This includes your alcohol, smoking, recreational drugs. I'd also ask about their living situation. So, do they live at home? Like their own home? It doesn't matter if they own it or not. I'm not talking about like financial stuff. But do they live with their partner, et cetera? Um, do they work? And what do they do as the job? That's really important. People often miss that because especially in exams, you could get occupational related lung diseases, for example, or occupational related general diseases. And if you're, if it's someone who works in roofing and they've had a asbestos exposure and you didn't ask about it, you just missed a key diagnose diagno uh diagnosis there. So really important to ask about work, say it's more important than living situation, exercise and diet is always a good social one to ask um simply to know um general wellbeing and you can often give uh lifestyle advice on that. Um Exercise is always important as well to ask in chest pain because, you know, you're always trying to find out if it's, especially if it's angina, whether it's stable or unstable. Um But I will go into the details of, of, of, of each style of history taking. And then here you can see the, the kind of things I would ask in a, in a assistances review. And once you've selected your s your system to ask in your focus review the way I do it is head to toe. So I start with neuro and I work my way down all the way to, to general. Um That's the way I do it. Then I finish off with ideas, concerns expectations, really important. You always need to do this. Um It's a really big kind of movement right now to, to put patient care centered around them and let them be part of the, of your decision making. And, you know, it's a cohesive teamwork kind of thing. So you always need to note this down when you're talking patients um ideas, what did the patient think that could be causing it? You know, um often if they're coming in with a cough, they think they've got a bacterial infection very important because that's something you need to clarify when it often it's uh viral and they're demanding antibiotics and you're not gonna give it to them can cause a lot of issues, concerns any particular worries. Um This is often under the realm of cancer. Uh young women coming in or, or older women coming in with breast lumps, often concerned about breast cancer. So you really need to, to write that down and note that because any of your colleagues seeing your notes will need to see that because it's something that they can address or it's something you could address yourself. Um expectations as well is really important because it, it, it helps manage expectations. But also helps give you and the team an idea of, of what to plan. Um And at the end, I wouldn't include this in the notes. I would include, include a summary, but sometimes it is useful to summarize the key points back to the patient. I would say it depends on your own style. I I'm generally OK at um remembering what the patient had told me 10 minutes ago, some people find it very difficult to retain that much information. It's easier if you're taking notes as you go along because you've got the notes there, you're typing and then you can review it later. It's more difficult in the actual exam when you've got nothing, nothing to write down and everything's in your head. So in a actual history, taking what I like to do is that if I'm not writing notes, I will summarize everything back to the patient and ask them, I'd say, you know, um I'm just gonna summarize everything you've told me um today. And if I've missed anything out or if I recall anything correctly, please do correctly and feel free to interrupt me. And then often they, you know, um they all correct you because you've not remembered everything because they've given you such a long history. Um Really important thing for us. You try and remember their name and date of birth because when you present back, if you don't remember the name, it's not a very good thing. And it's quite common and it just a, it's just a nice touch if you say, you know, Miss Smith or Mr Webb and some of them do have hard names. So, um, sometimes what helps me is repeating it in my head three times before I start the history. Um There are different ways to do it but it is a nice touch and there's, it is ok in the exam. If, if you do say, you know, if you do forget the name, sometimes I would ask, you know, I'm, I'm so sorry, I've forgotten your name. Could you please remind me of it? And then when you're presenting to the examiner, you can just repeat what they've just told you and it is ok. Um But try not to be too awkward about it and just be quiet about it because it does give a good impression. Um In terms of what my notes would look like on the actual uh system, it would look like this. You would, you know, you'd get this information in the corner and this is how I would write it down. And at GP or before even at hospital before I see a patient, this is how I'm prep planning my notes in the notes section. I would say I would write this all out. I would underline it and then I would get everything ready out and then everything's nice and orderly and neat to write your notes down. Clearly, people have different ways of writing notes. I like more of a, I wouldn't use bullet points. Exactly, because bullet points mess with the formatting. It's easier just to use plain text. But I would basically order it like bullet points. People who write in paragraphs. It really does bug me because it's really difficult to see all the information you're note taking. You know, there's no need to write essays and do line breaks. You know, it doesn't matter if it's long. Um So that's what I would recommend. Often there's a plan at the end. Um It depends how confident you are never submit notes without getting your lead clinician to check them over first because patients can see these notes and if you've submitted it and something's wrong, you can get in trouble and they can see when you've edited notes. So do be careful and always get permission before saving notes and plans should always be done with doctors. Um Sometimes GPS can predetermine plans with you and you're OK to deliver plans. Um Just know what's your within your competency level and know as long as you've got clear instructions and authorization from someone who can give you that authorization, then go with that. Um But this is how my structure would look when I'm actually parking patients onto presenting is something I find third year medical students not very good at. And in fifth year, sixth year, you'll need to get to the point where you can present a patient in one minute. You know, that's the whole thing of uh doing sbar at hospital presenting the whole story, but super precisely in one or two lines is really important, especially when there are time constraints. Um But if you have a bit more time in which you will do um in acies and things like that, this is how I would do it. I would do the, the background first. So uh the the example is Mr Smith, 44 year old male with background OC O PD. Uh I say background CPD is relevant chronic conditions. So for example, if a patient is presenting to A&E and they have a background, history of unstable angina and they're coming with crushing central chest pain, alarm bells are ringing for an acute M I. Um you know, so relevant history don't start listing that they have all these, you know, osteoarthritis when they're presenting with a headache, not necessarily relevant doctor at the moment doesn't really need to know if they want to know that detail, they can go read your notes later. Um and then just go through basically the whole structure that you've done uh and do it concisely. So here, the example is, you know, someone who he presents to A&E cough which started three days ago, productive moderate amount green sputum. And here is when you really do need to use medical jargon, you know, they always say when talking to patients don't use it, but here you do because it's, it's what makes that tacit understanding between you and the clinician better and faster. Um I'm not gonna read all of it. You can, you can have a read yourself um now, but this is how you present your history literally the same structure but presenting it in a really nice concise way. Uh And this is what I would call presenting a full history. If the doctor is just asking you to present, you know, really brief, you can cut some of this out. You know, this is always important, what, what's relevant background, uh what's he presenting with and then go from there. But in the osk you, you, you present most of this um something you won't do in OSC is present your examinations with your histories, you'd do that separately. Um There's I would go into more detail per exam. Um And I would add that to your notes, but this is a general overview. So, you know, you would always state whether their general state well or ill or, or orientated general inspection. Um And your examination findings, I will go into that in too much detail because this i it changes a lot um based on what system you're examining. And also for oss, you know, you need to have at the end your conclusion and your next steps. So uh in a cardio exam, you know, you'd always say to complete my examination I'd like to do E CG uh take bloods, et cetera, et cetera. So you need to go in a lot more detail than that, but that, that's quite a brief. Um So yeah. Um next is um yeah, summary. This is why I was talking about one line. This is something not really required of you at third years, more later years, but this is what you need to get good at giving a summary where it paints a picture clearly enough to your seniors um, without wasting too much time and then what you will need in your oscopies as well as you need to get three differential diagnoses for all of your examinations. So you'd say, um, you know, here the examples of the impression is infective exacerbation. However, different shows community acquired pneumonia and then you would need to get one more in your actual exams and then your next steps. So, investigations and plan. Um, that's basically everything I want to keep it relatively short. Um Does anyone have any questions, can put it in the chart? Any questions at all? No worries. No questions. Did I cover it that well? Yeah. No, no questions can be related to anything mad. Anything you want me to go back over in the slide? No. Ok. Well, thank you very much for attending guys. I hope that was somewhat useful. You can always email me. I'll put my email address there. Uh Let's chat, email me if you need anything or any questions that you can't think of now. And, um, thank you very much. I hope to see you at the next one.