3rd Year Medical School Advice: Year in Review

Last July I finished wrapping up my third year in medical school. As an international student, studying abroad, it’s been a tough year. The first semester went smooth enough. The second, as I’m sure we all know, was massively disrupted.

The purpose of this article, that I’m putting together on the eve of starting my 4th year, is to reflect on lessons learned over the last 12 months. Identify things I think i did well. Figure out things I might have done better.

Hopefully? I might even impart some advice for other future medics in the process.

Note: This is a personal update in-line with previous posts like Studying Medicine in Your 30’s: An Honest Perspective.

What Courses Did I Take in Year 3 of Med School?

The curriculum at Medical University Varna, Bulgaria, is available for public access for anyone who’s interested. This is usually the case for most universities.

Winter Semester

Here you can see the classes I took in the winter semester. This started in September of 2019 and ended around February of 2020.

You’ll see here that Medical Ethics, General Pathology and Medical Psychology were only one semester (15-weeks) long in course duration. The exams here were completed in February. Meaning the winter semester break is a pretty nice one in terms of work load (only three study topics!)

Here’s how I rank each of these courses in terms of personal difficulty (hardest to easiest):

• General Pathology
• Medical Psychology
• Medical Ethics

General Pathology: This was a fairly difficult course in terms of the examination protocol; MCQ’s, essays and orals. You’re expected to know the organ specimens inside-out and make sensible commentary on the gross and micro anatomy of each. Lab sessions were really great for this course; we got to visit the morgue a couple of times and observe the clinical signs of death.

Related: A Rough Guide to European Med School Exams

Recommended Resource: The first few chapters of Pathoma is fantastic for getting a general overview of the course. Dr Sattar, the course author, explains things very precisely, using plenty of images and mnemonics to aid recall. Couple this with Zanki (Anki flashcard deck) and the Pathoma sections included and you’ll be fine. Just be sure to pay close attention to the specimens presented in class. My school based a lot of the final exam off this material.

Medical Psychology: Saw some interesting things in the psychiatry wards. Got to personally evaluate patients with addiction problems, schizophrenia and depression. The course was very easy to pass and required a topical essay and a short oral exam.

Medical Ethics: Probably the easiest class to pass in all of medical school. Just involves some critical analysis on the cases presented. Some interesting talking points; specifically discussions involving social and private access to healthcare and medical interventions in-line with patients’ wishes.

Resource-wise I didn’t use anything external to the lecture/seminar materials to successfully pass these last two classes.

Summer Semester

Here’s how the summer semester looked in 3rd year medicine. This ran from late February to July.

You’ll see the summer examination period had higher volume than the winter semester, with six total course finals included here.

Pharmacology, you may observe, is a course that actually runs across three semesters at my med school. Meaning I won’t actually conclude that until the winter semester of 4th year. You’ll also see that Radiology and Clinical Pathology began (but didn’t finish) in this semester too.

Course Rundown: Pros & Cons

Wrapping up all the courses that finished in the 3rd year then, here’s a rundown of them in perceived order of difficulty (again from hardest to easiest).

• Introduction to Internal Diseases
• Microbiology
• Pathophysiology
• Hygiene and Ecology
• General and Operative Surgery

The main thing to take away here is that although the curriculum of each medical school is broadly similar, their timings can be very different. I understand that in the US, for example, most of these courses would be completed at the end of second year. Ahead of study for the USMLE Step 1.

Here’s a brief analysis of each of these subjects:

Introduction to Internal Diseases

Pros:

• Fascinating course; your first proper introduction to hospital wards and patient evaluation
• Hands-on experience; learning how to auscultate, palpate, percuss, take an effective patient history and more
• Pairs well with both general and clinical pathology (studying here will help both of those classes)

Cons:

• My classes took place on the oncology ward, can be a shock to the system
• Very fast paced. A recap of physiology and anatomy helps here.

I got very lucky in this course in that I had an excellent teacher who really went and above and beyond to explain all the clinical signs, symptoms and common pathology in great detail. The final exam, given her preparation, was fairly straightforward as a result.

Again, Pathoma and Zanki were my two go-to resources here. Although I did get some value from skimming through Macleod’s Clinical Examination book. As well as the great vids over at Geeky Medics.

Microbiology

Pros:

• Easy to pass with Sketchy Micro as a resource

Cons:

• Very difficult final exam MCQ
• Lots of irrelevant detail on agar mediums, testing etc that’s beyond clinical scope

Microbiology was a bit of a beast at my school. The lectures were dense, the seminars were heavy, there was a lot of what I felt was irrelevant information. Stuff that went beyond the clinical and ran far into epidemiology.

The final exam, a monster 120 multiple choice question test, was pretty rough too. And focused on a lot of one-line or one-sentence minutiae that was embedded heavily in specific lectures.

Thank god for Sketchy here. Going through the whole Sketchy Micro series, and pairing it up in Anki, meant I had a solid background to fall back on. Getting me the pass at the first time of asking.

Sketchy was fun too, and I actively looked forward to chilling out with their vids.

Pathophysiology

Pros

• Builds on physio very nicely (so if you had a good grounding there you shouldn’t have any problems here)

Cons

• Repetitive in certain areas

It’s hard to complain about pathophysiology as a course. Personally I felt it rounded off my knowledge of physiology really well. And now I feel a lot more confident applying what I learned here when it comes to working towards possible diagnosis on the wards.

Particularly areas of the course I enjoyed were its focus on the renal system and endocrinology. I was still a bit fuzzy on these sections after the second year. So going more in-depth really helped round-out my understanding. The course probably spent too much time rehashing the cardio and respiratory systems though – I think most of us already had those down pretty well.

Pathoma and Zanki, again, are my go-to recommended resources here. Coupled with Constanzo’s Physiology if you need to recap things.

Hygiene and Ecology

A surprisingly dense and detailed course given the subject matter. My school had us jumping through a lot of hoops here with weekly quizzes, presentations and everything else. But the department did a good job of delivering the content – even if they did seem to take it seriously than most!

The ecology part, learning the relative humidity thresholds of rooms etc, seemed a little unnecessary. But the nutrition part, although brief, was a personal highlight. Focusing on reliable data rather than whatever current dietary fad the internet has us believing is beneficial.

I just used the staple University materials to pass this one.

General and Operative Surgery

Not much to say about this course as, due to Covid complications and Bulgarian operating rooms, it was a write-off. The final still went ahead though, which was a very easy to pass short MCQ test.

For students that really want to learn practical techniques in the subject? I’d advise doing it in your own time. See my article How Do Medical Students Practice Surgery for more.

Highlights of the Year

Obviously the best thing about the last academic year was that it was actually, given Covid, still able to happen. Given my age and my desire to get my medical degree done as quickly as possible, I couldn’t afford a delay.

In this regard I think Medical University Varna did very well to avoid disruptions to their International Medicine course. They made full use of the school’s technology to deliver the courses online and to our regular timetabled schedule.

The way they adjusted the formats of final exams – one’s that couldn’t afford us being physically present in hospital – appropriately, also deserves respect.

Personal highlights involve passing everything first time despite having to leave Bulgaria, come back to the UK and spend the quarantine studying. I’ve got my family and friends to thank there.

I also finally started this site after years of deliberation!

Lowlights of the Year

The lack of clinical experience, thanks to hospital regulations surrounding the pandemic, does worry me. I also missed out on my summer internship, a program I had lined up at Cheltenham General Hospital in the UK, too.

As well as the one at the University Hospital due to Bulgaria’s travel restrictions also.

Compared to the world’s general 2020 experience however, I can’t really complain. I’m still on track to graduate on time. And can make up that clinical time later in the year hopefully.

Things to Work On in the 4th Year

4th year medicine is going to be intense by all accounts. My personal goals are basically more of the same. Keep my head down, keep studying and keep working toward that end goal of finally becoming a doctor.

Getting back into a solid study routine, after the distractions of the summer, will be my first plan of action. So I expect to live by my own advice and get that habit and discipline back in full order.

I also plan on experimenting with things a little more this year. See if I can’t shave a couple of hours off my study time to work on some gigs outside of my medical studies. Particularly when it comes to this blog and other writing opportunities.

Oh and I’d like to keep my health and wellness up too! Meaning plenty of calisthenics and the odd bit of running.

Final Thoughts

By no means was this a typical 3rd year in medicine. The global pandemic saw to that.

But hopefully it does give a run down of the things I studied in the past two semesters, as well as some of the tools I used to get past them all first time.

If you want to see more of my recommended resources for all years of med school check out this page.

Image Credit; Denislav Popov at Unsplash. Lovely photo of the Port of Varna.