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Major Adult Diseases


Major Adult Diseases consists of 4 weeks of cardiothoracic surgery at Papworth hospital, 2 weeks of infectious diseases and genitourinary medicine at Addie’s and 2 weeks of oncology at Addie’s.

How you will spend your time


Your time investment during the MAD placement can be as light or as heavy as you’d like.

At Papworth, you have a schedule of lectures, seminars, ward teaching and surgeries/procedures. In addition, you can arrange to go to clinics and spend as much time on the wards as you like. You can either live there or commute by car as it's not very far away.

During the infectious diseases/genitourinary diseases placement, you’ll be given a schedule of clinics and ward experience, and in addition will be asked to write up two of your patient clerkings. Of course you can put in additional time on the wards if you like. I found this placement very interesting and useful, as the ID doctor’s know a lot of microbiology and have a detective-like working style that it's worth taking on-board.

The oncology placement also consists of a schedule of clinics and some ward experience, as well as daily seminars that contain some excellent teaching. The clinics are very useful to reinforce some of the oncology-related pathology, and the teaching during clinics is quite good as well. However, right before exams, lots of clinics are probably not the most efficient way to spend your time - thankfully the organisers are aware of this. The seminars are really good and definitely worth attending, even if you will have to suppress any urge to yawn, sigh or have a sip of water during these hour ;-).

How to fit in path


MAD is a great placement to relate the clinical experience to the theoretical path revision to help you memorise it all:

Papworth is the perfect time to revise heart, vessel and lung histopathology, as well as related chemical pathology (ABGs, heart markers etc.).

Oncology is great to revise breast, prostate and colon cancer in detail (and haematological oncology if you haven't had a chance before), but is a bit short to work through all the other cancers mentioned in the handout. I’d try to have made a dent in the different cancer types before you start, if possible.

ID/GUM is great for immunology and medical microbiology, however it’s tough to work through the entire syllabus of these topics in those two weeks. Again it’s nice to have made some headway prior to this placement so you can use the placement for reinforcement.

Which books to use


For Papworth and Oncology, it’s enough to work with the Oxford Handbook of Clinical Medicine, as well as your Pathology textbooks (see here). For GUM, I found the Oxford Handbook of Genitourinary Medicine, HIV and Sexual Health very useful (also available from the library). In ID, I mainly used the Oxford Handbook of Clinical Medicine and the BNF to learn about antibiotics (chapter 5 is among the recommended reading for this placement and its introduction is definitely worth a look).

How to use the resources on Medportal


The online cases on Medportal are definitely worth working with. I'd also recommend looking at the medical microbiology podcasts, even though they are not the most pleasant, but give you an idea of what may be expected for pathology.


CLICK TO EXPAND In Papworth, you need to prepare a presentation on a topic of your choice and take a test on the first and last day.

In ID, you need to hand in two clerkings on the last day and while they are being corrected during the seminar, you will do a mini-test based on cases that you will discuss straight afterwards.

In oncology, there are daily cases to work through, and it's worth investing some time in these. On the final day, there may or may not be a test based on these cases.

There are also separate exams in GUM and ID during your R&I week.

What came up in the exams and how to prepare for them


The questions of the Papworth tests are evenly spread between heart and lung questions, asking about common conditions, investigations and management. They are different questions each time. I suggest not to prepare for the first one, so you are more likely to show some improvement at the end of the placement ;-). For the 2nd test, I worked through all the presentations taught during the attachment and did not manage to increase my score this way, so I am out of good advice for this one.

As stated above, the ID test on the final day is case based, asking about some common infections and interpretation of CSF analysis.

The oncology test is also case-based, no problem if you have worked through your daily case-load.

During R&I week, the ID exam consists of 10 short cases with a multiple choice answer (1 out of 5). You need to get 2 right to pass, which should be feasible. It deals with common infectious diseases such as TB, Strep. pneumonia meningitis, Legionella, GI infections etc.. The GUM exam is a bit more tricky, and you need to be familiar with some gross pathology and histopathology, which you'll learn about during clinics. Also familiarise yourselves with the symptoms, the diagnosis and the treatment of the most common genitourinary diseases. It's worth knowing some side-effects of drug treatments, e.g. for HIV and to know about Kaposi Sarcoma, even though you may not automatically include it in the first round of revision.

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