Final exams of medical school – 4th year OSCEs

November 22-23, 2014

As you may recall from my last post, we had our Surgical Specialties (orthopaedics and ophthalmology) exam on Nov 13. Following that, we had a week to prepare for our final exams of medical school – the dreaded OSCEs!

These are a set of clinical exams that test all the skills we’ve learned and honed throughout medical school. A variety of skills may be tested, including history taking and examination, clinical reasoning, basic/advanced life saving, investigation interpretation and response, procedural skills (venepuncture, blood gases, etc) and more.

We were told ahead of time that we would be rotation through 8 stations, each with 2 minutes perusal (to read your stem and collect your thoughts). 6 of the stations were 8 minutes long and the other 2 stations were broken down to 2×4 minute stations with related tasks.

Needless to say, we were stressed. We were incredibly stressed! The entirety of our medical school could be tested in 1.5 hours. Not only was there so much to know, but 2 of the most important rotations (paediatrics and obstetrics & gynaecology) we had completed first in the year, which seemed like so long ago.

My OSCEs took place on the morning of Saturday, November 22nd. The group of us sat in nervous anticipation waiting to start, trying to pass the time by chatting with our colleagues or doing some last minute reading.

I was allocated to the green team with 7 other students and we were soon escorted to our first stations. Facing away from the wall, the buzzers soon went off, signaling the start of our OSCEs. Everyone turned to the walls to read the stem (taped to the wall) of our first station.

Once the OSCEs started, they passed by in a whirl. Time flew and you were in and out of each station in what felt to be a blink of an eye. There was no time to rehash or even think about how you did in the last station because you were too busy giving it your all in the next. In less than 1.5 hours, it was over. The wonderful ladies coordinating the exam for my green team gave us big smiles and congratulated us before ushering us out to join up with the rest of the group.

The room was a buzz with students discussing the stations and their performance. Lots of happy smiles to have one last hurdle behind our backs, however, not without some caution that our performance in one or more stations may have been lacking. The director of the MBBS program shook our hands on the way out and asked everyone how the OSCEs went for them, a nice comforting gesture!

And since I might forget what my stations were in a few months time, I am going to record them here.

In no particular order unless specified.

1) This was my first station, which was a 2×4 minutes. Was given an ECG to report, which was SVT. Then also given some bloods to interpret (hypochromic microcytic anemia, likely due to iron deficiency). After interpreting the bloods, we were given pathology forms to request the blood tests we thought appropriate. This was almost a ‘gimme’ station as it was very similar to previous years, however, I was so nervous it definitely took away from my performance!

2) My second station was an 8 minute one. A few weeks prior to our OSCEs, we were asked to submit a clinical & procedural skills log – a report of the things we accomplished and to what level. At this station, the examiner looked through my log and asked me questions seemingly to verify our stated level of competency. I was asked a number of questions, including, “Talk me through how to do an IV cannulation. What complications could arise? How do you do an ECG? What gets printed out on the tracing? What are leads V1-V6 called? If you walked into a room and someone was unconscious, what would you do? And how do you do chest compressions? How do you perform ophthalmoscopy?” Nothing the examiner asked was out of my comfort zone and I just continued to answer his questions until the bell rang.

3) A young male fainted while gardening. Tasks are to take a history, examine and manage. Was greeted by the examiner as I came into the room playing the role of a nurse, with an unwell patient on the bed. Turned out he was in anaphylactic shock and required acute resus and further management once he was stable.

4) An expected death in a patient with advanced bowel cancer. Had to do a death certification, talk to the spouse and write up the paperwork.

5) Preadmission talk to a patient for an anaesthestic assessment. The main finding in his history is a mechanical valve on warfarin therapy. Would need heparin bridging and antibiotics.

6) Giving a distraught lady the results of her hysteroscopy D&C, which was thankfully not cancerous but endometrial hyperplasia. Talk to her about the risks of endometrial cancer and treatment options for endometrial hyperplasia.

7) Taking a history and presenting a mental state exam of a patient experiencing acute psychosis, likely schizophrenia.

8) My last station, another 2×4 minutes. First task was to interpret a chest x-ray which demonstrated lobar pneumonia and then to write up the medication chart.

Overall, the OSCEs went well. At every station, I can still to this day, think about things I forgot to say, things I should’ve done and things I could’ve done better. I just hoped that the examiners felt I performed well enough to pass overall!

Last 4 weeks of medical school – Orthopaedic Surgery

October 20 – November 13, 2014

Ending medical school with a specialty I had been dreading… Orthopaedic surgery. Crazy hours, macho surgeons, and an intense knowledge of anatomy required were only some of the things I had been warned about.

Needless to say, I found none of the above true and in fact, extremely enjoyed my ortho term. There were 5 other students in my group and we were based at a smaller hospital especially known for elective hip and knee replacements. We were split into smaller groups of 1-2 students and assigned to an ortho surgery team. There were 3 doctors on my team, a consultant, a senior registrar and an intern – and I was very appreciative of each person, in particular, our consultant.

He started every face to face encounter throughout the day (even after coming back from lunch) with a smile on his face and the words, “So, did you do any reading? What did you learn? Why don’t you tell me all about it?” In response to our answers, he would ask us questions and provide us with more teaching. He was always kind and non judgmental, even if you didn’t know the easiest answers. His continuous interest and support in our learning was the push students (like myself) sometimes needed to really become interested in what we learning. Although the registrar had a different style of teaching, he was the same. There was never any time we spent with our team, whether that be in clinic, in theatre, or even on coffee break, that we didn’t gain more knowledge.

Even though I am not interested in pursuing surgery, for the first time in a long time, I felt useful and wanted in theatre. The team would encourage us to come to theatre and rather than leave us to watch silently and awkwardly in a corner (the bane of medical students’ existence sometimes), we were always asked to scrub in and assist. Even if we weren’t assisting, the team would continuously ask questions and teach during the surgeries, which was great.

I really thought Orthopaedic surgery would be my least favourite rotation, especially with less interest in surgery and my subpar anatomy – but I have to say, these last 4 weeks of medical school have only bettered the two. I’m looking forward to my surgical terms next year when I’m finally working and I have to say my anatomy is heaps better now!

My last rotation ended with 2 MCQ exams on Nov 13 (a day earlier due to the G20 public holiday) – one 50 question ophthalmology exam and another 50 question Orthopaedic exam. Despite walking out of the exam with the trembling thought of, “Oh my god, that was so much harder than I anticipated,” I’m happy to say that our results have seen been released and I got an excellent mark – so stoked!

We didn’t have time to lament awaiting our surg exam results though, as we had OSCEs to study for, which I will talk about in my next post 🙂

2 weeks on Opthalmology

October 6 – 17, 2014

My two weeks on ENT was immediately followed by two weeks on Ophthalmology. Without very little prior exposure to this specialty, you could say I was certainly a little stressed! However, my concerns were proven to be completely unwarranted. We were rostered to work in a variety of environments, each welcoming with its own learning objective.

The majority of my time was spent in the Eye Casualty Clinic seeing patients with acute illnesses like infections, foreign bodies in the eye, pain, etc. We also reviewed quite a number of follow up patients. Being in Eye Casualty allowed us to learn and hone some critical skills including how to take and document an opthalmology specific history, how to measure intraocular pressures, more practice using a slit lamp (with lenses) for indirect ophthalmoscopy and using a fundoscope for direct ophthalmoscopy. In addition, we also had the chance to see more specialised tests using machines such as optical coherence tomography and wide-field retinal imaging using Optos. Many thanks to the doctor in Eye Casualty for giving us much of your time teaching us!

We also had the opportunity to spend time in theatre, where I had the chance to see procedures such as an orbital decompression for Graves disease, ocular biopsy suspicious for cancer, and of course, cataract surgery. Although it may seem mundane after watching it more than 5 times, intravitreal injections are an important component for treatment of diseases that affect the retina, such as macular degeneration and diabetic retinopathy. As someone who is interested in General Practice, I especially appreciated learning how to identify and refer ocular emergencies.

And to end my brief blurb about my time on ophthalmology, here’s a photo of my (currently) healthy looking retina!

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2 weeks on ENT

Sept 22 – Oct 3, 2014

My two weeks with the Ears, Nose & Throat (ENT) team flew by very quickly. As part of my Surgical Specialties rotation, I chose to do my 2 weeks surgical elective in ENT for more exposure to a field that comprises a significant proportion of GP consults – particularly because I am interested in General Practice.

It wasn’t, however, exactly the experience I had anticipated. Fully expecting to see a lot of ‘bread and butter’ stuff (ear infections, sinus infections, etc), I had forgotten that as a tertiary hospital, we also saw all the rare and serious presentations. During the two weeks, I was lucky to have had the opportunity to meet and learn from many patients. From being on ward rounds, participating in clinics and attending theatre, I saw simple conditions from sinusitis, Meniere’s disease and ear infections to inverted papillomas, cholesteatomas, and serious cancers of different types and stages.

I worked alongside a great team who were keen to have students and willing to teach – so I learned a lot, and quickly! In addition, our team made it clear that they remembered what it was like to be a student. They were happy for us come and go as we please, to use our time as we saw fit. Thanks ENT team!

Back in Brisbane for the start of last rotation

We landed in Gold Coast at 8am on September 21st, Mike’s birthday!

Happy 35th birthday to Michael! We had a lot of fun celebrating in Canada and during our trip back in Hong Kong and Singapore so we didn’t have any special plans for once we were back in Brisbane.

No special plans didn’t mean we wouldn’t have appreciated not being held up at the airport for nearly 2 hours after landing though.

Let me tell you the story of how we almost ended up on Border Security. Actually, I’m lying, the show is never filmed out of Gold Coast Airport, but if we had been in Sydney or Melbourne, cameras might’ve been rolling. We got through immigration without any difficulties, picked up our luggage and headed to the customs declaration and exit line. While in line, a lady customs officer went up to Michael and asked him to see his incoming passenger card. He had nothing to declare (only me with homemade kimchi) and was given back the card with a simple thank you. I thought it was odd that she had solely singled him out of a big line and watched her go… straight to the customs officer at the front of the line and whisper something in his ear while pointing to Mike.

Great. Here comes trouble.

In the past, we have cleared customs through one of 3 lines:

  1. Straight out the door.
  2. Dog sniff. You lay all your bags on the ground and stand beside them while a cute beagle sniffs through all your stuff. If you’re clear, you’re free to go. This usually takes less then 10 minutes.
  3. Bag search and/or x-ray. We often end up in this line when we have things to declare and while slightly more tedious, still goes pretty quickly. The officer normally asks you to clarify what exactly it is you’ve declared, and if they deem necessary, they can ask you to open up your bags and show them the items or put your bags through a scanner. We have been in this line when we’ve declared bringing back wooden souvenirs from Vietnam and bringing back Frentel butter from Canada. Both times, we’ve simply opened our bags, showed them the items, which they were happy to let through and we were on our way.

This time, without any obvious reason or being told specifically why, both Michael and I were directed to a fourth line. One we didn’t know existed but immediately referred to it as the Border Security line. We were told to sit down on the benches and that an officer would be with us ‘shortly’. This area is completely blocked off from public view and actually depicts some scenes very similar to Border Security. Ie. An Asian man getting every nook of his baggage searched while he sits in a chair looking weary and worried. In another line, a ‘tough’ guy looks annoyed as his bags are being searched and he’s being questioned.

After letting us sit and stew for what seemed to be forever. The initial lady customs officer came over and said to Mike she wanted to talk about his “travel patterns.” Funny, because we both have the exact same travel pattern. We immediately figured it was because Mike was a guy and traveled too often and looked suspicious, especially when we frequented SE Asian countries. We explained to her that we were both medical students, have a 1 week break after every 2 month rotation and took the opportunity to travel cheap.

You could see her realise it… she was barking up the wrong tree. But that wasn’t enough and we had to sit there and answer more questions, including how we were even able to afford studying in Australia and travel at the same time. She was getting nothing and decided to let us go, after scanning our bags. One last jab from her as my bag was going through the scanner, “Are those cigarettes?” No, those are KitKat bars (and they look nothing like cigarettes, but nice try).

Anyway, we finally made our way out the airport. And miraculously, we were able to lug home 3 large pieces of luggage and 2 wheeled carry-ons back to Brisbane – via the bus, then the train. Pros or what?

Jet lag hit us pretty quickly but no time to diddle daddle as we had school the next day! The start of our last rotation – Surgical Specialties!

I was starting with 2 weeks of ENT, then 2 weeks of Opthalmology and finally finishing my medical degree with 4 weeks of orthopaedics. So close! Have to keep pushing to the end!

My Cardiology Elective experience in Halifax, NS

August 18 to September 12, 2014

After my Geriatric Medicine experience in Nanaimo, BC, I continued my medical elective adventure with 4 weeks of Cardiology in Halifax, Nova Scotia.

I will be forever grateful to Matt (Mike’s best friend) and his wife Laura for allowing me to stay with them and their daughter Isabelle during my 4 weeks in Halifax – thank you so much again guys!

I chose to do Cardiology because I wanted to become more confident as it has never been my forte and is so important within any medical specialty. I was lucky to be allocated to the Inpatient Cardiology Consult Service for my elective, which is a team who oversees all cardiology referrals for inpatients at the QEII and a number of other sites including Victoria General, Rehab, Veteran’s Memorial, and Abbie J Lane. It was a great opportunity to see lots of patient presentations, visit different hospital sites, and interact with numerous staff.

The consult service team consisted of a staff member (cardiology consultant) who rotated every 2 weeks and a resident (registrar). As you can imagine, it’s a pretty small team to take care of all inpatient cardiology referrals across numerous sites. There were some rare slow days, but most were extremely busy with continuous consults and follow ups.

I thoroughly enjoyed my experience on consult service! My responsibilities included: seeing new consults (full history and exam) and presenting them to the team including an impression and appropriate plans, communicating with treating teams and multidisciplinary team members, administrative work (writing notes, filling forms and orders), following up with investigations and plans, etc.

I had the opportunity to work alongside the same resident (4th yr anaesthesia) during the entirety of my 4 weeks, which was great. He was smart, friendly, and always willing to teach and provide guidance. I don’t think I would’ve enjoyed the experience nearly as much if not for him. I also had the chance to meet and work with 3 wonderful cardiology consultants – each with their own style and method of teaching and all of whom provided really positive feedback on my performance. They also offered to help me out in any way I needed (including being a reference), without me asking, thank you so much! 🙂 I worked as hard as I could, which was appreciated and validated, yay! Not to mention all the wonderful patients and other staff members I met and learned from throughout the 4 weeks. Heart failure, arrhythmias, myocardial infarctions, endocarditis, pericardial effusion/tamponade, etc.

Thank you to all the people I met and worked with, who were so patient with me and taught me so much! I hope to have the opportunity to see and work alongside you again. 🙂

My Geriatric Medicine Elective experience in Nanaimo

In summary, it was a wonderful experience for many reasons but primarily because I had a great preceptor. I may have previously mentioned, he is a one-man-geriatric-team who previously trained and worked for years as a GP. He does all the hospital geriatric medicine consults as well as see patients in his own clinic, so I had the opportunity to work alongside him and in both environments.

He was an excellent teacher, he was never impatient with me or colleagues or patients, and always provided good learning opportunities. I especially appreciated that he trusted me with his patients. He believed in my skills, and where they were lacking he helped me develop them. I saw many patients on my own and he always listened to my assessments and trusted my findings and judgement. Due to this, I felt I had the opportunity to thrive and become more confident.

Many of his long term patients said I was very lucky to have him as my supervisor and I do not disagree! His patients loved him as a doctor because he was always comprehensive, understanding, and willing to give as much time as needed.

Through this elective, I also had the opportunity to experience many ‘firsts’ in medicine. Here are a few I would like to share:

  • My first unexpected death. I was sent to see a patient who we were asked to consult for query MI (heart attack). He also had leukemia (terminal, not being treated) and hyperviscosity syndrome. When I came in to see him, he was sweaty, complaining of hard-to-explain discomfort, and extremely restless. He kept changing positions from laying to sitting up in bed. He was a little breathless (oxygen saturations in the high 80s to low 90s) but alert and speaking in full sentences. With his history and symptoms, I immediately wondered if he had a pulmonary embolism (clot in the blood vessels of the lung) instead. On physical examination, my main finding was bilateral costovertebral angle tenderness (often a sign of kidney inflammation/infection) which could also explain why he was in such restless pain. After a few short minutes, he began to quiet down. He laid still in his bed and appeared quite comfortable. I asked him how he was feeling and he said he was feeling better. He think told me to come closer and said, “You know, I have leukemia. And I know, I’m going to die. But it’s okay, I’ve accepted it.” Right after he told me that, he began to have difficulties speaking, opening and closing his mouth but no words would come out. Then, within a span of 3-5 minutes, his blood pressure dropped, he became completely unresponsive, and his GCS (Glascow Come Scale – neurological scale that measures a person’s state of consciousness) went from 15 (max score) to 3 (lowest score possible). His pupils became dilated and asymmetrical. It was just myself and a nurse with him at the time and he was DNR (do not resuscitate). The nurse asked, “What would you like me to do?” I felt so utterly useless because there wasn’t much I could do. I suggested pushing fluids to hopefully get his blood pressure up and agreed when she asked if we should send for blood gases. On previous imaging, he had progressive, chronic subdural haemorrhages (bleeding under the skull, pressing onto the brain) and from his acute deterioration, he must’ve had a massive bleed or other cerebral event. I called my preceptor who arrived within a few minutes and agreed there was nothing more to be done. He died within the hour. The shock of having someone unexpectedly crash on me and feeling so powerless to help was a very new experience to me, and the patient passed away. I had to sit in silence and digest afterwards for at least 15 minutes before moving on with my next task. My preceptor was quite understanding. “You get used to it,” he said, “but it never gets easier.
  • Haemoptysis. The coughing up of blood from your lower respiratory tract. A term I’ve read many times in books. A question I ask all patients with a cough, however, aside from some blood tinged sputum, I have never really seen. We were on call and asked to come see a lady who had a 2 week history of coughing up blood. She was also a First Nations woman and had a previous exposure to Tuberculosis (TB). In addition, she had Takayasu’s Arteritis – an inflammation of the large blood vessels that particularly affects the aorta and its major branches (to the brain, arms, etc). This vasculitis had affected her so much and she had had such extensive previous surgeries to her blood vessels that she now only had very limited blood flow to her brain. If anything were to happen and her heart didn’t pump blood effectively, it would affect oxygen delivery to her brain and she likely wouldn’t make it through without severe brain damage. A lot of interesting factors in this lady’s presentation. While getting a history from her, she started to develop a gurgle in her chest and started to cough, and cough and cough. She brought up bright red blood, even big blood clots. It was the first time I had ever seen true haemoptysis. Not a sight I will soon forget. Throughout her hospital stay, her cough and bleeding eventually settled down, her cultures never came back TB positive and she was eventually freed from isolation. She had a bronchoscopy (a scope to look down the lungs and take samples) which didn’t come back with any sinister findings, like cancer. Whatever caused the bleeding remained a mystery but she left hospital happy and symptom free and promised to return for follow up!
  • Met a man in emergency who had a STEMI (heart attack with characteristic ECG changes) that completely resolved after thrombolysis treatment on ECG. Then it came back! Definitely had to quickly transfer him to the closest facility for PCI treatment!
  • Encountered a pulsus paradoxus (abnormally large decrease (>10mmHg) in systolic blood pressure and pulse wave amplitude during inspiration). This lovely 90yo lady had presented with 2 weeks of increasing shortness of breath and 2 syncopal (fainting) episodes. The doctors who saw her thought she was having heart failure and was fluid overloaded so gave her diuretics and sent her for an ECHO (ultrasound of the heart). Over the course of the day, she became delirious and her ECHO came back with unexpected findings. She had a large pericardial effusion (blood in the sac space around the heart) which was causing a tamponade effect on her heart. Needless to say, once the effusion was drained, she immediately felt a million bucks better. Apparently, I probably won’t come across such a significant pulsus paradoxus again anytime soon in my career.
  • Had a lovely patient who had come in with severe sepsis but also had an ongoing history (years) of hallucinations. They always occurred around the time he fell asleep. They were never threatening but he described them with such amusement and laughter that of course, I joined in. “Oh yes, I see animals all the time. Today, I had a baby goat on my pillow” and “I see birds fly around chandeliers when I look up at the empty ceiling” and “I’m always reaching for coffees and food that are not actually there” and “When I watch TV, I will see another TV screen beside mine playing something else.” Incidentally, he was also found to have liver cirrhosis, splenomegaly, and abnormal blood results (significant of a developing haematologic malignancy) so there was that interesting aspect of treatment and management as well.
  • Had a 90yo lady with such severe aortic stenosis that she was no longer able to get out of the bed without being breathless. She didn’t want invasive intervention but what really stood out for me was her passion in life. She was an avid hunter, baseball player, and loved fly fishing.
  • Did my first trochanteric bursitis local anaesthetic/steroid injection. Probably one of the most easiest procedures I’ll ever do in my career but it was exciting and provided immediate relief for the patient.

Those are just a few of my experiences on my Geriatric Medicine term, I’m sure I’ll remember other ones I’ll want to share! One of the things I enjoyed most about this elective was the complexity surrounding each elderly patient, very rarely are they simple cases. Patients had cardiovascular disease, lung disease, dementia, mobility limitations, falls, frailty, diabetes, incontinence, no social support, etc. Their medication list hadn’t been reviewed and they were on too many or not enough medications. Physical examinations had to be comprehensive – I often did a cardiovascular, respiratory, GI and neuro exam on every patient – and often found incidental but important findings! Some findings include: postural hypotension or gait disturbances that could’ve accounted for falls, heart murmurs not previously mentioned, enlarged liver/spleen, etc. Even though at times it can be overwhelming, it was very rewarding to tease out all the pertinent information and use it to create an all encompassing plan of management.

The best surprise of my elective? My preceptor telling me that he would be on vacation during my last (4th) week on elective and offering me a ‘self-guided learning week’ if I wanted it. The opportunity to go home and spend an extra week with family in Ottawa? I told him that it would be a cherished opportunity, as long as he felt I had worked hard enough and was functioning at a level to deserve it. Yep! And backed up by a good assessment and an agreement to be a reference for me. So happy!

Even though it cost me an additional $400 (I know, it’s ridiculous) to change my flight, it was worth it. My sister was also back in Ottawa from Vancouver, so we had a complete family and quality time together. I was very grateful for this extra time with family as I really don’t know when my next opportunity to visit Canada will be.

Thank you to my preceptor, the hospital staff, and the patients I met for making my geriatric medicine elective such a great learning experience!

DHAL: July 29, 2014 – Best news ever!

(Note: Sorry, this is going to be a long post because I want to document this part of our journey)

As some family and friends may know, the last few weeks have been incredible stressful for Michael and I as we held our breath and waited for potential job offers for next year.

Since some of you may be unfamiliar with how the Australian system works, let me try to summarize it:

In Australia, the medical degree is called an MBBS (Bachelor of Medicine/Bachelor of Surgery), not an MD like North America. They are, however, equivalent. Both countries have a 4 year program with the first 2 years being course based and the last 2 years being clinically based in hospitals.

Once you graduate, however, it’s quite different.

In North America, you apply to the residency program (specialty training) of your choice in your last year of school, in order to start shortly after graduation. These training programs range from 2 years (Family Practice) to 4-6 years for other specialties. Once you are done your residency, you might chose to do a fellowship(s) to become even more specialized.

In Australia, once you graduate, you must complete an internship year before you receive your full registration. This year consists of 5 rotations: general medicine, surgery, emergency medicine and 2 electives. Following intern year, many doctors do a Junior House Officer (JHO) followed by a Senior House Officer (SHO) year in order to gain experience and get to know seniors in their field of interest before applying to a Registrar Training Program (equivalent to the North American Residency program). The length of the Australian training programs are about 2 years longer, with General Practice being 4 years. Overall, the training takes a few years longer in Australia vs North America.

Now that you know more, here is our story. Both Michael and I want to stay in Australia after graduation and complete at least our internship year. For that reason, we have not completed all the required exams in order to apply for residency back in Canada this year. Depending on how internship goes, we would be more than happy to stay in Australia to complete our training. The problem was, however, where we stood when it came to applying for an internship position.

The state of Queensland has 6 priority groups (you can see them HERE), and jobs are allocated in order of your priority. According to the list, as Canadians studying in QLD, we are Priority 4 (P4). Unfortunately, there are not enough jobs for the number of applicants. Not only did both Michael and I want jobs, we wanted jobs in the same city in order to be together… what were the odds?

In order to apply, you had to preference 16 hospitals in Queensland from 1 to 16, #1 being the hospital you want a job offer from the most. Therefore, jobs are allocated first in order of priority, and second in order of preference. All Priority Groups submit their preferences by the same date. However, P1s get allocated their positions first. Once they have accepted or denied their offers, the remaining spots are finalized and published. At this time, P2-6s have the opportunity to submit a new list of preferences if they wish.

For example, if a P4 listed Hospital A as their first preference, but after P1s have been allocated their jobs, there are no spots left at Hospital A. He or she may choose to submit a new preference list topped with other hospitals that still have spots.

After a lot of thought and talking to our senior colleagues and friends, both Michael and I decided to chose Rockhampton Base Hospital as our first preference. We had read and heard first hand from many people that Rockhampton had many new and continuously expanding facilities, numerous educational opportunities, consistent workplace support, great teaching from senior physicians, and attractive intern to consultant ratios.

This was this year’s Position Status Report after P1s had accepted their offers and P2-P6 had submitted their second preference list. Note the number of intern spots remaining vs the number of P2-P6 who applied.

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There were 20 spots total available at Rockhampton. Luckily, it turned out not to be a popular hospital with the Australian students, with only 3 people who preferenced it high enough to get a spot. That left 17 spots leftover for the 63 (P2-P6) applicants who had listed Rockhampton first, slightly less than a 1 in 3 chance.

We had been told that unlike P1s, job offers for P2-P6s were not random. We would be specifically selected based on the (unknown) criteria/interest of each respective hospital.

What could we possibly do to increase our chances of getting an offer from Rockhampton? There were lots of rumours, but here’s what we decided to do:

  • We listed Rockhampton as our first choice during the first round of preferencing and didn’t change it. This showed that we were initially dedicated to them, and didn’t chose them first in the 2nd round simply because they had spots left over.
  • We made contact after submitting our application. If we hadn’t been in Canada, we probably would’ve flown up to Rockhampton to meet the recruitment team in person. Since we couldn’t, we emailed them instead – as a couple, which was different. We also didn’t just email them to express our interest. We spent a lot of time and thought putting together a package for their perusal. This PDF package consisted of:
    • A letter of interest. We expressed the reasons why we wanted to be together and work in Rockhampton, and that we would be fully committed if lucky enough to be offered a position. Canadians have been notorious in the past for accepting internship positions (that start in January), then abandoning their jobs in July when they receive acceptances into residency programs back in Canada. We knew it was a black mark against Canadians and wanted to make it clear that we had no plans of ditching our contracts and responsibilities.
    • Photos of us. If we couldn’t meet them, at least we could help them put faces to our names. We also didn’t send traditional headshots, we sent in photos of us as a couple, another difference.
    • Our CVs. We both had our own weaknesses when it came to our CVs, but it gave them a picture of who we were and what we’ve accomplished.
    • Our transcripts. Neither of us had the best transcript in the class, but we worked hard for what’s on it.
    • And lastly, our personal statements. In our application, we had to submit 2 statements: Tell us briefly why you would like to undertake your internship in Queensland or at a specific facility(s) and What are the critical career related experiences you want to pursue in your intern year? We put them in the package so they could view everything together at once, rather than having to look at our application, as well as this document.

These were the photos we sent in:

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  • We received a response thanking us for confirming our interest and were encouraged to ask any questions. We replied to voice our concern of missing a possible important phone call from them because we were overseas. We reiterated that we were very interested and asked if there was anything we could do on our end to ensure we wouldn’t miss out.
  • There was! We were told that the initial phone call is often made to clarify a few things. The problem with Canadians abandoning their jobs was mentioned and we were given the opportunity to answer the questions we would’ve been asked during this phone call via email, in advance. The questions were:
    • Are you still on track to graduate December 2014?
    • Have you completed the necessary requirements to be considered for an internship position in Canada?
    • Your intentions to commit to Rockhampton Hospital for the full year (at least) if offered a position?
  • We were polite and enthusiastic in all our correspondence, and replied to each email in a very timely manner. The officer asked for our replies to the above questions at our earliest convenience/ASAP and we replied within hours – despite time differences.

Soon Monday, July 28th came around, and I heard from my friend Amanda (who had also applied to Rockhampton) that they were starting to make phone calls. Not with job offers though, they were just asking for answers to the questions mentioned above. Michael and I didn’t receive a phone call that day, presumably because we had already given our answers via email, but we were still nervous.

Then came afternoon/evening of our July 29th, business hours of Wednesday July 29th in Brisbane. This was the day that Rockhampton offers were scheduled to come out. We waited with bated breath. Nearly 7pm my time (11pm Michael’s time) Amanda messaged me to say Rockhampton was starting their phone calls because she just received a phone call from them with a job offer. Congratulations to her, how freakin’ exciting!

But then my heart started pounding. I was FaceTiming with Michael and we were incredibly nervous and stressed. Would we get a phone call? Would it be just one of us? Would luck be on our side and we both get job offers? It was really agonizing.

Nearly an hour later, Michael couldn’t stay awake any longer and he had an early day ahead of him. We said our good byes and he went to bed with his cell phone beside him and volume on maximum in case he gets the phone call.

I was beginning to stress. There are only 17 positions to give away. Surely the phone calls do not take very long. It had been over an hour since Amanda got her offer, did we miss out?

I decided to log onto Skype and try calling my cell phone, just to make sure calls were going through. Yep, it was ringing (as 0000123456) through fine, I quickly hung up.

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Now I kid you not, literally 2 minutes later, my phone rings, from an Unknown caller. I picked up, “Hello, Sandra speaking.”

I don’t even know how to describe exactly how I felt in those next few minutes. Relief and happiness flooded through me as the officer told me she had great news and wanted to offer me an internship position at Rockhampton Hospital for 2015. I really almost cried. I immediately thanked her and told her how incredibly happy I would be to accept her offer. She explained to me that the official offer will be arriving by email in the next few hours and to make sure I respond to it by the deadline.

Before I could ask her if Michael had received an offer too, she said, “Now, I’m about to call Michael next. I have no idea what time it is for you guys over there right now.” I laughed and told her it was after midnight for Michael and he had just gone to bed but don’t worry, his cell phone was right beside him. She was so lovely, she even asked if it would be okay to call to call him at this hour. I said most definitely and that he would be thrilled to hear from her. I thanked her again and we hung up.

Less than 5 minutes later, my FaceTime rang and I knew exactly who it was. I answered to Michael’s beaming face (the officer had told him I received an offer too), we couldn’t believe it! We had beaten the odds, both of us had been offered a position at Rockhampton Base Hospital – our first preference. We were now a statistic – 2 out of the 17 available positions!

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We were so ecstatic and relieved. We both had a job, and therefore a career and our feet in the door towards our future! Michael said, “Now that we have jobs, we can finally start planning our wedding!” And how true!

The excitement kept Michael awake for a couple of hours talking to me before he could go back to sleep. The sleep deprivation no longer mattered once we found out we had jobs for next year! 😛

And that, is the story of the best news I’ve received since the start of my medical degree. Best belated birthday present too 🙂 I have since emailed my referees to let them know the good news and thank them again for playing a part in my future – they were super pleased for us as well.

By now, we have also heard from a number of our Canadian friends who didn’t receive a job offer in Queensland 😦 Emphasized for us again how lucky we are and fingers crossed for them that they will soon receive an offer from out of state or from the private sector (Commonwealth Medical Internships – CMI).

If you’re still here reading, then thank you for your interest and sharing this happy moment with me!

DHAL: July 19-25, 2014 – Week 1 in Nanaimo

July 19. After saying farewell to my sister in downtown Vancouver, I hopped on the bus to head to Horseshoe Bay Ferry Terminal. The bus ride took less than an hour and a one way ferry ticket to Nanaimo cost $16.25.

Beautiful views from the ferry terminal!

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I was on the Coastal Renaissance… never have I been on such a humongous ferry! I admit, I did get lost but I was impressed. Ended up making it to the top deck and… fell asleep for most of the ride over to Nanaimo 😛 I was exhausted with only 3 hours of sleep, I tried!

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Once we arrived in Nanaimo and with my luggage, I decided to grab a taxi instead of the bus. I don’t think I mentioned this in a previous post, but the hospital I’m doing my elective at has a 3 bedroom house that they rent out to medical elective students for FREE. I felt quite lucky to be able to save some money! I was dropped off at the hospital to pick up my house keys and then walked approximately 700m to my accommodation.

The house is spacious, with everything provided, including linen and household products. Even has a desktop computer and printer for tenants to use.

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There is a housekeeper who comes by every Tuesday to clean the house as well.

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I had a moderate sized room with a desk and closet, didn’t take long to settle in! There’s also a lock on every bedroom door, allowing more security when you’re in and out of the house.

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Pretty great internet provided!

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I ordered some groceries online the day I arrived and was too lazy to go exploring so I even ordered some Chinese take out for dinner. Lowlight: It was THE WORST food I’ve ever eaten, I don’t even want to explain it. Those in Nanaimo, never order from Sun’s Noodle Bar. Needless to say, not much got eaten and a lot was thrown out.

I spent Sunday at home, reading and relaxing. There wasn’t much to do around my neighbourhood and I didn’t care to go into the city. Sunday night my housemate came home, a really sweet medical student from Ireland doing an elective in Paediatrics.

Otherwise, I was just nervous for the start of my elective! Was hoping for a nice preceptor! Have never worked in the Canadian medical system before so didn’t know what was expected of me yet. Monday came quickly. I started my week with some PowerChart training – the online medical record system they use here. I then met the course coordinator and eventually my preceptor. I was expecting to be a part of a hospital team for my geriatrics elective. Turns out my preceptor is a one man team!

He’s great though. Extremely patient and never discouraging towards me. He lets me do as much as I want within my limits of comfort and learn what I want to learn. Always takes his time to answer my questions and teaches whenever the opportunity arises.

As you can imagine, elderly patients most often have a plethora of issues that landed them in hospital. These can include: dementia, delirium, instability, falls, cardiac disease, stroke, incontinence, infection, etc. I love geriatric medicine because it is so general that you always see a variety of presentations. History taking needs to be thorough and examinations need to be all encompassing in order to not miss anything in an elderly patient, especially when there can be so many causes to their issues.

On Mondays, Tuesdays, and Thursdays, we are in the hospital in the morning and at his clinic (about 5min drive away) in the afternoon. We spend Wednesdays and Fridays in hospital.

My first week passed very quickly. My days start later than I’m accustomed to. My preceptor often tries to make it in by 9am but he has 3 young children to take care of and drop off at different activities in the morning, so we often don’t meet up until 10am. I get to start my day at a good pace and have time to review patients before he gets in. The days pass quickly because we are so busy, I often don’t get home until 7pm and we normally don’t have time to take a proper lunch. Usually we work until we need to rush to clinic and eat our lunch during the 5 minute drive there. A one man team is busy busy!

So far so good though, I’m quite enjoying my time working! Don’t know if I’ll see much of Vancouver Island while I’m here, we’ll see!

My sister is coming for my first weekend here, to celebrate my birthday early with me, which makes it less lonely!

DHAL: July 04-12, 2014

A huge gap of DHALs, how shameful! This is going to be a long one!

Friday, July 4th… meant one more week of Anaesthesia before the completion of my Critical Care rotation! It was getting harder to see the end now because although it was so close, it felt so far! Since there was no final exam (aside from an online multiple choice exam I had already completed in week 2 of 8), I did not have to spend my weekends immersed in studying, I was able to enjoy going out and seeing my friends.

So on Friday after my shift, I met up with Amanda for dinner. There is a vegetarian restaurant in Fortitude Valley called Kuan Yin Tea House that Michael and I have been meaning to visit because we have heard good things and it is highly rated on Urbanspoon (96%). I was a fun night out with Amanda but the food was subpar, I’ll be writing a separate blog post for this later on!

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Next day on July 5, I finally had the opportunity to see and catch up with Josiah and Danya! They are living in Bundaberg this year, so we have not had a chance to hang out since coming back from Canada, but it finally happened! Weekends in Brisbane for them are always hectic but they had some time to pop over for a visit! And I was finally able to pass on a small wedding gift that Mike and I brought back for them from Canada, which only had to wait 7 months 😉 They even gifted us a nice bottle of wine as a belated engagement present, unexpected but thanks so much guys! It was so good to catch up and hear that they are enjoying living in a new city and being well looked after by the small Bundaberg community. They are liking it so much that they have decided to stay for Josiah to pursue his internship training… that’s saying heaps!

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Lowlight: My cousin, Hoang, from Vietnam who now lives in Brisbane with his wife, was supposed to come over for dinner on July 5th. Unfortunately, something came up and they had to cancel!

The following day on July 6, I had a photo shoot session with the Gibson family!

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This was the first ‘photo shoot’ of any kind I’ve ever done. Pretty much had no idea what I was doing, didn’t have any special equipment, and worked with kit lenses. Had a good time with Kristen, Matt & Abigail but too bad Abigail wasn’t her usual smiling bubbly self! I imagine having a big black camera covering my face might be a little intimidating for a 6 month old! Was able to get a few photos, even some smiling ones. I’ll have to make a separate post but here’s a teaser photo!

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Because my cousins never made it on Saturday for dinner, I invited Sarah and Amanda over for some studying and dinner on Monday, July 7! Had bought a bunch of ingredients to make dinner and didn’t want them to go to waste, what better way to use them up than to have friends help you? Made some Thai green curry chicken to have with rice, yum!

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Had also made lots of peanut butter chocolate chip cookies so sent the girls home with a bunch as well. What made the night fun was meeting Sarah’s boyfriend, Jay. After years of poking fun at her for having an imaginary partner (he has always been too busy to attend any of our events or get togethers), we met him when he came to pick her up. Mind you, it was completely dark outside so I have yet to see what he looks like in person 😛

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The weekend passed too quickly and soon I was completing my last week of the critical core rotation. I feel quite lucky to have had most, if not all, preceptors be very kind and willing to teach. It made for a very good learning environment and I never felt intimidated with any procedural skills, even when I failed them. There was always room to improve and my supervisors were always willing to make things work better for me.

It is also nice when your effort and hard work doesn’t go unnoticed. I was rostered for 2 days (July 09-10) on the APMS (Acute Pain Management Services) team, who are responsible for hospital wide consults for patients who require more specialised care for the managment of their pain. These patients can include those who have epidurals, regional blocks, or patient controlled analgesia (PCA). With only 2 days on the service, I made the most of it including being proactive in taking notes, chatting with patients, and handing over plans to nurses in charge. I’m not sure what the other medical students did during their time on APMS, but when I received the note (not required and squeezed beside the signature box) “Above and beyond the call of duty” on my last day and a number of verbal thank yous and compliments, I knew I had done well 🙂

Lowlight: I was told this last week of the rotation by the course administrator that she wanted me to make up time for 2 sick days I took earlier in the rotation. My last week, where I’m fully rostered, and she wanted me to make up 2 extra shifts last minute. I was not happy as we were never made aware of having to make up for sick time, isn’t that why you have sick days to begin with? After having a chat with her and explaining to her that the request was unreasonable in the amount of time I had left, she told me to have a chat with the respective professors of the Emergency and Anaesthesia departments. Bring them my work books and evaluation forms so they can assess if I have done work to their satisfaction and maybe they will let me pass the rotation without making up the time. Lucky for me, both professors were more than happy to let me off after having a chat and leafing through my documents. It was annoying and stressful before I was given approval because of the potential to fail the rotation, but I’m glad things worked out!

Soon, Friday (July 11) rolled around and I was super eager to finish my last day of work! I had been packing up and cleaning the house bit by bit throughout the last 2 weeks so I didn’t have much left to do before flying out Saturday morning. And to end the rotation on a good note, the anaesthetist of my last shift was awesome. He spent the first few hours of my shift grilling me and asking me questions non stop, explaining things along the way as required. When that was exhausted, we just chatted about life in general where he also shared some good advice for my internship year. By 2:30pm, he was showing me his wedding videos and because the same surgery had been going on since 8:30am, he asked me if I just wanted to head home. Early day on my last day? Heck yes! I could definitely use some extra time.

I went home, where I met up with Yoni. He’ll be renting out one of our bedrooms (Christine’s in the other one) so I just wanted to give him the keys and a verbal handover, including what food he should help us finish, which he’s always happy about.

I then headed back into the city to meet up with Mabel, Amanda, Sarah, and Xuan for a post-rotation hang out! We had a coffee catch up at Bonsai Botanika before heading to Maru for a yummy Korean dinner and finished the night with some delicious bubble tea at Gong Cha. I will be writing blogs for the respective restaurants soon! Lovely evening with good company to end my time in Brisbane!

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It was around 9pm by the time I got home, plenty of time to finish up my packing and cleaning. I tried to stay up as late as I could in order to sleep easier on the plane but by 3am, I had to lay down for a 3 hour nap.

Thanks to Christine for giving me a ride to the airport at 7 in the morning! and soon I was boarding Qantas flight 15 to Los Angeles. Boy oh boy was it not the best journey home, will tell you more in the next DHAL!

DHAL: July 02-03, 2014

Lowlights:

  • Yesterday I experienced the worst lowlight since starting DHAL. I was feeling quite down and sad regarding the anniversary of my dad’s passing and being alone at home made it even worse, I’ve never been alone on this day before. I cried many tears. But writing yesterday’s blog definitely helped me deal with my emotions, even if it brought back many many memories. Thank you to all my friends who sent me their love, it was very much appreciated!

Highlights:

  • Ran into Mabel after finishing my shift the past 2 days in a row! Nice to stop for a chat and a few laughs!
  • The flowers Michael sent me bloomed and are gorgeous! Thanks love!

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  • Even though I’m on afternoon and evening shifts this week, it’s nice being in emergency theatre when the rest of the operating rooms are empty and there are only a handful of staff on duty. Just nice and quiet… 🙂 Also, the tea room is always stocked with fresh bread (white and whole wheat!), butter, vegemite, and jams to make toast. A good pick me up when you’re feeling low on energy! Of course there is always coffee, tea, milk, juice and also a basket of cookies for some extra calories whenever you need it.

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  • Since coming to Australia, we have been buying the large tubs of yoghurt thinking that it was the cheapest option, especially when they’re on sale. Recently I learned that was a lie. And that regular priced yoghurt in individual servings is cheaper than large tubs on sale! Never again will I be buying tubs when I can be buying something cheaper, with more variety, and easy to pack for lunch!

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I know, my life is SO EXCITING! 😛

DHAL: June 19-26, 2014

Hello friends! How have you been?

What a long absence, but here’s what I’ve been up to this past week!

Highlights:

  • As I mentioned in my previous DHAL, I spent last week in ICU and glad to say I enjoyed my entire time there. Unfortunately, I do think a week is too short. Just as I was getting used to the very different medical environment and getting to know the team, it was time to move on. Alas!
  • On Friday, June 20th, I made soft cranberry white chocolate chips! I think they turned out good and not too sweet with a hint of cinnamon.

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  • The next day, I accompanied FangYing (and her younger sister FangZee) in the morning to help her look for wedding dresses. I couldn’t stay with her for all her appointments because I had lunch at Matt & Kristen’s – thank you so much for the delicious food! It was lovely to see their family – Abigail gets bigger, smarter and more gorgeous each time I see her. Not only was it really nice to see my friends (James, Kim and Smiles), it was also really nice to meet some of their friends and catch up with some of the ones I’ve met in the past. Annette, who I first met through Kristen during our first year elective in Vietnam is 6 months pregnant already, how time flies!
  • On Sunday, I went with FangYing and her sister again to another bridal shop in Indooroopilly, where she also convinced me to try on a few wedding dresses. Although I’m not seriously looking for one myself yet, it was a fun experience! I definitely do not want a mermaid wedding dress and after trying on some strapless ones, I like them a lot more than I think! That’s all I got so far 😛 Afterwards, we met up with YungHowe, her fiance, for dimsum lunch – yummy! I’ve been craving for a while so it was quite satisfying 🙂

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  • It was a fun weekend that continued even into Monday when I met up with Sarah and Amanda for a girl’s night catch up. We had dinner at New Shanghai, left stuffed with the promise of doing it again soon. It was also Amanda’s belated birthday so Sarah and I had the chance to treat her to dinner.
  • My gorgeous friend Ruixi married her love, Chris, on June 21! So sad I couldn’t be there with them and friends, but she was a beautiful bride and they both looked so happy!! I’m so happy for you two! Love seeing the photos!
  • Starting this week until the end of this rotation – July 11th, I will be on Anaesthesia. This entails me accompanying a different anaesthetic consultant everyday to theatre in order to learn and assist. So far, I have been blessed with very friendly seniors who are happy to have a medical student and eager to teach and give me hands on experience. I am getting better at ‘bag and masking,’ which is the most important skill to learn in these next few weeks. I still lack the upper body strength to hold the mask and bag at the same time, but I’m working on it! Another skill we try to master during this term is intubation – which I’ve met with variable success – I accidentally put the endotracheal tube in the oesophagus today. My last intubation was perfect though, hopefully I keep it up!
  • The other nice thing about anaesthesia is the chance to see surgeries I haven’t seen in the past. For example, a total hip replacement, maxillary advancement, bilateral breast reduction, etc.
  • This morning, I got confirmation that I will have free accommodation during my 4 week elective in Nanaimo, BC – yay! Saves me at least $500 🙂
  • I finished at the hospital quite late today. It was already very dark outside when I got home but I saw an outline of a bouquet waiting for me at the door. I couldn’t look at it until I was inside but what a beautiful surprise. A bouquet of our favourite flowers – lilies from Michael – I love you! They haven’t bloomed yet but are so fresh and I can’t wait to see what colour they are. Thank you dear!

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Lowlights:

  • I need to start packing! 2 weeks left until I go home! So much to do still. I have 2 pieces of baggage on my flight back so I will be bringing back goodies for my family 😉
  • Long days. I’m exhausted and falling asleep around 10pm these days. This rotation is draining! Can’t wait for it to be over and to be going home!

DHAL: June 11-18, 2014

Hello friends!

Look at that, I didn’t even get through one month of DHAL and I already failed at daily blogging, oops!

The reason I haven’t been blogging is because I have been on shift in the Emergency Department and in the Intensive Care Unit (ICU) for the past 7 days straight and I’m so tired when I get home – with laziness and studying distracting me. I still have a couple more days to go before I can finally have the weekend off. My days are averaging 10-11 hours, which is quite tiring for a number of reasons:

  • You’re not getting paid.
  • You need to be alert and learning at all time, so it can be very mentally exhausting.
  • It’s constantly a different environment with new staff, protocols, and procedures to become familiar with.
  • You still have to go home and study or read up every night to at least look slightly competent.

With that being said, there have been a number of highlights and lowlights this past week.

Highlights:

  • Enjoying and finishing my 4 week stint in the Emergency Department. I quite liked the variety of presentations – from mild to serious and seeing how they are assessed and managed. Had a good time working alongside the doctors (especially the interns), nurses, and physios. Felt appreciated for my work and had a good performance assessment by a senior doctor at the end.
  • I finally had suturing experience! An elder man had a large wooden post fall on his hand which gave him a number of lacerations that needed to be sutured. My only prior experience was in theatre while the patient was still asleep, not awake and watching me. I’m happy to say that unlike before, I sutured with a steady hand, with proper technique and approval by my seniors. Patient was also happy with my handiwork – yay! Confidence restored, I thought I was going to have to live with a hand tremor exacerbated under pressure for the rest of my life.
  • And related to previous post, where it used to be nerve wracking to have someone scrutinize me while doing procedures, either someone junior observing to learn or someone senior watching to make sure everything went well – I am now quite comfortable performing underneath someone’s gaze. Phew!
  • Did my own plaster casts, on real patients! I know, it’s silly that I’m halfway through the end of my last year of medical school and only getting this experience now. Unfortunately, as international students, we do not get the opportunity to go on a rural rotation, which is where you get a lot of hands on experience. With that being said, I’m trying to make the most of all opportunities I come across.
  • This week, I am the only student in ICU when normally there are 2-3. Initially, I was a little intimidated to be the only student, especially in such a different medical setting without a colleague, but now I definitely feel privileged. I now have scheduled one-on-one teaching time with great consultants, who never make you feel stupid for not knowing all the answers. I was invited to stick with one team throughout the week and follow the same patients so I get the opportunity to learn how patients are managed in ICU – as opposed to being with a different unit every day. I’m also getting opportunities to see and participate in procedures and tasks I haven’t in the past, like maxillary antral lavage, bedside bronchoscopy, and transport of critically ill patients. It’s cliche, but I really am finding everything interesting. My days in ICU pass by quickly as there are a number of scheduled activities every day including: morning handover rounds, one-on-one teaching, radiology meeting, afternoon teaching rounds, etc. I always feel welcomed to ask questions, which is a good facilitator to learning as well. Only 2 more days!

Lowlights:

  • I am SO tired! Would’ve been nice not working for 9 days straight, but I guess that’s what the real world will be like when I’m working.
  • Not eating well. I’ve been averaging 1-1.5 meals a day, which isn’t healthy but I’m trying to change that.
  • The sickest patients are in ICU… and it’s hard to see them not get better. For example, we are caring for a young woman who had pneumococcal meningitis and developed sepsis following a microvascular decompression surgery for trigeminal neuralgia. She now has partial locked in syndrome – paralyzed from the mouth down, intubated and ventilated and could only communicate by blinking her eyes. After a couple of weeks (when I first met her), she began to develop fevers with an unknown focus, despite adequate coverage with antibiotics. All possible tests and scans have been performed with no cause for her fevers found. In addition, she has a rash that was getting worse before our eyes and right before the end of my shift today, she took a turn for the worse and became completely unresponsive – GCS 3. It’s not easy dealing with an unwell patient, but even harder when we don’t know how to help a deteriorating patient.
  • June 15 was Father’s Day, always a difficult day when my dad is no longer with us in person…

DHAL: June 02, 2014

Highlights:

  • Having a filling breakfast before starting the day. Doesn’t often happen on a day when I’m working!
  • Video chatting with Michael who’s now in Vancouver and staying with my sister, so getting to see and talking to her too!

Lowlights:

Similar to May 30th, I was rostered to sit in on another 4 hr teaching session for the junior doctors (interns). Seeing that I was sitting away from the main table, the interns told me to join them and participate in order to “actively learn.” The module for this session was abdominal pain, which is a very common presentation with numerous causes from simple to complex. Unfortunately, I felt the consultant who ran the session was quite demeaning towards me and by the end of the session, I was infuriated. I remember 3 distinct moments:

  • Someone has come into the emergency department with severe abdominal pain. What kind of pain relief would you consider giving? You would want something strong and quick acting, a reasonable choice is intravenous morphine. The consultant pointed me out and said, “You… maybe others, are probably thinking of the WHO ladder.” I wasn’t, it would be nice to ask me rather than imply. The WHO ladder is more for the management of chronic pain, starting with simple analgesia like Tylenol/Panadol + Ibuprofen and working up to stronger pain killers like weak opioids and then strong opioids. Of course you would not use the WHO ladder in this acute setting, I know that.
  • We then talked about pelvic examinations. Which includes a speculum exam (like when you get a pap smear) and a bimanual exam – when you use your fingers to feel inside a woman’s vagina, trying to palpate their uterus and ovaries for any masses or tenderness. Again, he pointed me out saying, “You’ve probably done one or two? Like during the training session with the volunteers?” Then without giving me a chance to reply, continues speaking. I was dumbfounded. Yes, we were given a training session and had the opportunity to practice on volunteers… back in 2nd year. By now in 4th year, I’ve had the opportunity to do quite a number of exams, even felt pathology. But… thanks again.
  • The last and most upsetting. We were asked what bHCG levels are relevant when doing an ultrasound. After a few seconds of silence, I answered “1500 and 3500.” These numbers are relevant because they’re the cut offs for the sonographer to be able to see an intrauterine pregnancy via the vagina or abdomen, respectively. However, rather than simply saying, “Yes, why?” He responded with, “I can see you’ve done your reading.” No, I didn’t just do my reading, I have completed my OBGYN rotation, I know this because I’ve learned it and applied it clinically.

I work hard to learn because I want to be a good doctor next year. I want as much clinical experience and teaching as possible in order to help me to be the best doctor I can be. And if you want good doctors, then you need to treat final year medical students like the doctors you want them to be. You don’t treat them like first year medical students and/or assume they have no clinical experience or knowledge. Argh!

My rant of the day. Over.

 

DHAL: May 30, 2014

Highlights:

  • I passed my Obstetric & Gynaecology rotation! Woo hoo! Results came back last week, and if you didn’t know how I felt about the 3 consecutive days of exams, you can read about it HERE. I was genuinely worried about the possibility of failing and ended up doing much better than expected. Happy with my results and can now breathe and move on!
  • I was rostered to sit in on a 4hr teaching session for the junior doctors today. Couldn’t help myself from participating even though I think I was only supposed to be an observer but a great learning experience. Case based learning today on the topic of neurologic presentations to ED (syncope, delirium, altered mental state, overdose, etc) interspersed with clinical skills. I’m glad there will be teaching like this for me next year to help keep up with relevant knowledge and skills.

Lowlights:

  • Ending the day with a headache 😦

DHAL: May 29, 2014

Highlights:

  • Finding the motivation to finish all my assessments (ahead of time) for this current Critical Care rotation. Modules are completed online with respective quizzes followed by an online multiple choice exam. Passed everything, so that’s now done and out of the way!
  • Calling my great aunt and great uncle in Perth (grandma’s siblings) to catch up and invite them to Brisbane to visit and possibly attend my graduation. I felt guilty because I haven’t spoken to them in a loooong time, they didn’t even know of my engagement! My great uncle has Alzheimer’s but it was still great to have a conversation with him about what’s been going on in my life and my future plans… even if I ended up having the same conversation with him over and over at least 5 times.

Lowlights:

  • Ended up calling in sick today. Just haven’t been feeling well and low mood. 😦 Hard coping being alone and never been away from Michael before!

DHAL: May 27, 2014

Quite the uneventful day!

Highlights: 

  • A great teaching session alongside Lauren and Kee Ping given by the Medical Education Registrar at our hospital. Simple things that really drive home the point but exactly what we need to work as an intern next year.

Lowlights:

  • A pretty bad headache that knocked me out for a few hours.
  • It makes me sad to see family members not bother lifting a hand to help their loved ones in a health care setting. I don’t know if it’s because they don’t care or if they feel it is not their job/beneath them – but either way. I was assisting a staff member today (she was tiny) to change the sheets of a large elderly man. He had urinated on the bed and also had dementia, was delirious and agitated, and didn’t speak much English. Despite our struggle, his big burly son didn’t even try to assist, either physically or even speak to his dad to help calm him down. When we finally finished, he pointed to a clean urinal bottle, at his feet, that fell during the change of sheets and said, “Um, the urine bottle is on the floor.” Really, you couldn’t just pick it up? I know everyone is different and has their own reasons, I just couldn’t imagine being like that when my dad was very sick years ago and I was his care taker.

DHAL: May 26, 2014

Highlights:

  • Booked my (why so expensive) flight home! I will be arriving in Ottawa on July 12 at 6:55pm on flight United 3829 from Chicago! I will have a week in Ottawa before flying out to Nanaimo, BC for my first elective in Geriatric Medicine.
  • Completed most of my learning modules for this Critical Care rotation. Still a lot more studying to get done!

Lowlights:

  • Still not done my internship application. Although I have until June 6, I really need to bang out some really well written personal statements. Not only is there the worry of not getting a job next year due to lack of positions and being lower on the priority list because we are international students, it is also likely that Michael and I will not be able to get a job in the same town 😦 Thinking of the distance saddens me.
  • Paying this (8 weeks long) rotation’s tuition of $10,560. My approximate $500 000 debt by the time I’m done medical school is quite nerve wracking. Not to mention with Michael, we will have a combined debt of $1million or more! Is there anybody wealthy reading this blog who would be interested in financially supporting 2 hard working, soon-to-be junior doctors with a massive debt and a wish to get married and start a family?

DHAL: May 25, 2014

Highlights:

  • Finally back on track with my blogging! I was finally able to upload my Bali video (using school’s internet because our upload speeds are so crappy) and I believe I am now mostly, if not fully, up to date with my blogging! I just need to stay on top of it and not fall months behind again 😉
  • I did clinical tutoring for first years today, and as always, really enjoyed it. This weekend was to help them learn their GI examination as well as to practice taking histories. Always makes me think of how far I’ve come as a student. I can still remember being nervous and trying so hard to remember the steps of each examination or all the questions I need to ask on a history taking (past medical history, medications, allergies, family history, etc). Now it is so second nature that I forgot how scared and new everything was back in first year. Growth and learning is good!
  • Lunch date with Mario! It’s been so long since we caught up over some good food – delicious ramen at Wagaya! Sent this photo to Michael to say hi and make him envy as Wagaya is on of his favourite restaurants as well.

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  • Skype date with my mom and brother, and then a phone call with my sister – both late last night. Good to catch up and we also discussed a number of future plans that I hope will work out… if it does, I’ll let you know!

Lowlights:

  • Discovering that hornets are making a nest on a large plant in our backyard. Ugh. And that I’m going to have to get rid of it before it gets rid of me. I’m scared!
  • You might have noticed how hideously burnt/dark I looked in photos at James & Kim’s wedding. My arms today… even good exfoliation can’t seem to help it resolve faster.

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DHAL: May 22, 2014

Highlights:

  • Seeing patients with such a variety of presentations: atypical chest pain, infective exacerbation of asthma in an 81, acute shortness of breath in an otherwise quite healthy 93yo man, superficial venous thrombosis, domestic violence, etc
  • Running into my supervisor from my Medicine Rotation last year. To this day I still remember rounding with him and the team when he suddenly stops in the hallway, points to an orchid and asks, “What flower is this?” When I answered, he questioned me back with, “How can you tell? How do you know for sure?” Completely stumped, he finally satisfied our curiosity with, “Because it’s the only flower with one plane of symmetry” and continued on down the hallway. Such a lovely old gentleman who is a great teacher and well respected by students and colleagues alike.
  • Being told to go home early! So nice, even if it was only 40 minutes early. And I even got a lunch break today! The blessings… haha
  • A glorious nap after dinner

Lowlights:

  • Just after piercing the skin and successfully getting flashback on my cannula insertion for a patient, it fell out! I don’t even know how it happened, but I hate having to prick someone more than once. It was even worse because the first one was successful and I most likely left the poor man with a bruise. The patient didn’t complain and it wasn’t painful, just completely unnecessary, bleh!
  • Knowing I had more highlights to share but now they’ve escaped me. I need to start taking notes throughout the day so I don’t forget!

Obstetrics & Gynaecology: The wrap up

It’s only been 2 weeks since my O&G rotation ended but it already feels like ages ago.

Overall, I really enjoyed my time on Obstetrics & Gynaecology. I have to say thank you to the other 4, lovely students on my team: Darice, Sam, Roger and Michael (not my partner) – for your support and for being so fun to work with. There was always a joke to share or something to laugh about. And more importantly, we shared knowledge and learned heaps from each other. Thank you especially to Darice for driving me all the way home so many times in the evening! You are such wonderful company and I hope you are enjoying your time back in Singapore!

So, final exams…

O&G had 3 consecutive days of exams, how did they go?

(Note: Sorry, this might turn out to be a little long. I’m trying to put everything down to look back on in the future!)

Wednesday, May 07

A written multiple choice question (MCQ) exam. 60 questions, 30 gynae and 30 obstetric. I think there was a collective ‘what the hell happened feeling’ after finishing that exam. So much so that the cohort got together and reproduced most, if not all, questions from memory in order to further discuss them. Very dissimilar to the example of a previous exam they provided us, I think many of us felt this MCQ exam did not test fundamental knowledge required for an O&G rotation. In addition, there was unequal weighting of topics tested. For example, out of 30 obstetric questions, 3 of them (10%) asked about oxytocin – a drug used in active management of third stage labour.

Thursday, May 08

3 Obstetric OSCE stations. Each 8 minutes long and without perusal time. Talk about anxiety!

Station 1: An older lady who is obese, with hypertension on an ACE inhibitor and a previous history of 2 large babies has come in to see you (the GP) because she’s 8 weeks pregnant. The point of this station is to not only address the standard steps of care (confirm pregnancy, blood tests for type + antibodies, Hb, syphilis, Hep B/C, Rubella status, etc, dating scan, folate, diet…) but also to address her specific risk factors (age, obese, previous large babies, all risk factors for gestational diabetes and pre eclampsia, take her off her ACE inhibitor as it is a category D drug, etc).

Station 2: A lady in her late 3rd trimester has come into see you in the Antenatal Clinic with vaginal bleeding and a diffusely tender abdomen/uterus. Morphology scan at 20 weeks showed a fundal placenta – effectively ruling out placenta previa and leaving the likely diagnosis of placental abruption. Important points of this station was to identify the likely cause of bleeding, to admit her for further testing and monitoring of baby, inform theatre and anesthesia of potential need for emergency c-section, etc.

Station 3: A lady has active post partum hemorrhaging. Important points included resuscitation if necessary, discussion of possible causes (atony, retained tissue, trauma, bleeding disorder) and their management options, consenting for theatre and the need to inform the patient of the possibility she might need a hysterectomy.

I found the content of each station to be very fair and expected. However, what really disappointed me, as well as every other student I spoke with, is the lack of standardisation across examiners. For myself, the examiner at Station 1 did not let me speak freely, he only wanted me to specifically answer his questions – some of which did not even relate to a first antenatal visit. As a result, with such time constraints, I did not get a chance to say most of what is expected at such an appointment. When I proceeded to Station 2, every time I paused to think or see if the examiner had any questions, she would loudly say to me, “Don’t let me prompt you! What else do you want to say? Keep going!” She never actually prompted me with anything and I felt her constant berating very distracting and disruptive. Finally at Station 3, the examiner sat in complete silence and let me talk through anything I wanted until I stopped, only then did he ask further questions.

Overall, I think it went okay. I never know how I’ve performed at these types of exams because you are always your biggest critic. I can still think of things I should’ve said or things I could’ve left out.

Friday, May 09

3 Gynaecology OSCE stations. Each 8 minutes long and without perusal.

Station 1: Young lady is referred by GP to you in ED with few weeks history of iliac fossa pain. Ultimately supposed to rule out an ectopic pregnancy and come to the conclusion that likely ruptured ovarian cyst and/or ovarian torsion through discussion of investigations you would order and being given the results.

Station 2: Young woman presents to ED with symptoms of PID, confirmed with investigations. Incidentally, she has acute Hepatitis B. Needed to discuss her medical management including the need for hospital admission, contact tracing, contraception counselling, medical consult for the hepatitis.

Station 3: Vaginal bleeding in an older woman post hysterectomy on the ward. Management including resuscitation, discussion of consent, likely source of bleeding, etc.

Again, similar to the Obstetric cases, the cases presented to us were very fair, however, different standards of examiners across the board again. My examiners at Station 1 and 3 carried a discussion with me, letting me speak but also asking questions and pushing my knowledge, which was very good. My examiner at Station 2 was completely silent and cold, making me even more nervous. We were told multiple times that if we were struggling, not to worry, the examiners will provide prompts or attempt to put you back on track, but that certainly did not happen for me with Station 2.

I felt this was my hardest set of exams so far, mainly because of the quantity of OSCEs we had to perform and the uncertainty of whether I passed or not. I think I excelled at some stations and got a little stumped at a couple others. Marking is also very subjective, so all I can do now is cross my fingers and hope that everything went okay!

After this O&G rotation and as someone who is interested in General Practice/Family Medicine, I definitely think I will love the aspect of women’s health and antenatal care within that career pathway, yay!

And if you’re still here, a toast! To the end of second rotation! With Yoni and Christine 🙂

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DHAL: May 21, 2014

A long day at the hospital (8am to 6pm) that luckily didn’t feel quite as long!

Highlights:

  • Finally knowing how to set up and use the neonatal resuscitation trolley properly! Attended daily morning teaching for junior doctors and was happy that I was still on top of neonatal resus principles. And now someone has taken the time to show me how all the equipment works
  • Getting to know a few more junior and senior doctors.
  • Picking up dinner at the hospital Subway on the way home. Haven’t had a sub in a while and no food preparation or cleaning!
  • Finally catching up with the show Once Upon A Time. I highly recommend this show, although it takes a few episodes to get into it. The sets and costumes are great. I think the most impressive aspect of this show is not only how they are able to blend reality with the fairy tale world so seamlessly but how the writers have been able to integrate all the fairy tale characters we’ve ever known into one world… Relating each character to another in such a creative way that keeps us on our toes.

Lowlights:

Being ‘gently’ reprimanded by my senior doctor. I was with her while she was removing 3 week old stubborn sutures (done by another Dr elsewhere and was now causing infection) from a patient’s neck. While she was tugging on a loose one trying to find its other end, I commented, “It’s not intuitive, the placement of the suture when you tug on it.” Although she completely understood the meaning behind my comment, she took me aside later to remind me that I should never make any comments that patients can take wrongly and in a negative way. While I completely agree, I guess I was just frustrated with myself for having someone senior, whom I’m trying to make a good impression on, remind me. She was lovely though!

MCCEE in Sydney

May 05, 2014

If you are a regular reader, you might remember that since the beginning of this year, I had been studying for the Medical Council of Canada Evaluating Exam, more commonly referred to as the MCCEE.

As a Canadian studying to be a doctor in Australia, writing the MCCEE is the first of a few steps if I ever want to complete a residency (training after graduating) back home.

I flew down from Brisbane to Sydney the day before to write my exam on May 5, 2014 from 9am to 1pm at ITIC PTY LTD LEVEL 3, 321 Pitt St. It is only a few minutes walk away from Museum train station and therefore easily accessible.

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Note: I’m going to be a little detailed with my experience, in case it can help anyone feel a little more comfortable going into their exam. 🙂

What did I bring?

I brought 2 pieces of ID, although they only looked at one, and my test confirmation email. Make sure that the name on your ID matches the name you registered with! I definitely wore a jacket in case it got cold and brought snacks and a bottled drink. There was water provided at my test centre. I also had other belongings with me like a purse, watch, study material, which was fine but must be locked up and access to them is not allowed during the duration of the test.

What was my experience like?

The test centre in Sydney, like all the others I assume, is very straight forward. You sign in and are given a key to store your belongings in a locker and taken to a separate testing area. You are not allowed to bring anything into the testing room except your ID and your key but you are allowed to have access to your locker during breaks. You will be seated at one of the cubicles where you have access to a computer, some paper and pencils to take note, and some headphones to drown out noise. The room I was in was small, approximately 5 cubicles, and got very warm – good thing there was a standing fan.

The computer is set up for you once you’re seated and you first have a 10 minute tutorial on how to navigate the exam (ie. moving through questions, how to highlight/strike out, how to mark questions for review, etc).

The exam is 4 hours long, which begins when you hit start and the first question is loaded. During these 4 hours, there are no scheduled breaks, however, you may take them whenever you want, for however long you want, it is up to you. The timer never stops, so your breaks are part of the allotted 4 hours. I have to say, 4 hours is plenty of time for this exam. After completing all the questions, I signed out for a break to go to the bathroom and to have a snack before going back in to review my questions, and still finished the exam with around half an hour to spare.

If you leave for breaks, you must sign in and out each time.

How was the actual exam?

The test consists of 180 questions total, however, only 150 of them are actually counted towards your score. The other 30 questions are used for quality control or even to test out newly developed questions. The questions revolve around the following 5 subjects: Child Health, Maternal Health, Adult Health, Mental Health, and Population Health and Ethics. Yes, I did find the distribution of questions equal amongst all topics. 

You don’t have to be concerned about knowing normal values or ranges. Any number given to you will be followed by the normal range in brackets, so you don’t even need to open a separate page. There were a few questions with images, which were displayed for you on the screen and the quality was completely fine to answer the question.

Unfortunately, I can’t give examples of questions but I did find all the questions to be fair, there were no impossible questions. The ones I struggled with, it was because I didn’t cover that topic enough during my studying, not because it was overly difficult.

The time passed quickly, although I never felt rushed and completed the questions at a steady pace. The relief and happiness after completing the exam is great, although I always find it hard to gauge how well I did on standardised exams. It takes about 2 months to receive your mark, so I have a long way to go!

What did I use to prepare for this exam?

I used mostly CanadaQBank questions and supplemented whatever question/topic not adequately explained with additional reading. I started ‘studying’ in January, however, with 2 busy rotations (Paediatrics and Obstetrics & Gynaecology), I simply did not have time to read additional textbooks. I found the CanadaQBank questions to be very representative of the MCCEE, both in terms of question style as well level of knowledge and difficulty – with even a few extremely similar questions on the actual exam.

CanadaQBank had a total of 3868 questions, of which I did approximately 80%. I didn’t have enough time to prepare for this exam as well as I would have wanted, but it is definitely possible to complete all questions multiple times if you have a good study schedule.

I also tried some USMLEWorld Step 2CK questions but stopped because the style was too different than the MCCEE. You will not have such long stems and style of question on the MCCEE.

Fees?

The cost of the exam is $1695 USD along with the expenses of flying down to Sydney, food and accommodation. It’s not a cheap exam and I suggest to be fully committed to passing it if you are going to write it. I had initially scheduled to write my MCCEE on February 28, 2014 with Michael in Melbourne. However, at the last minute I rescheduled it to May 5th ($50 USD fee) because I felt underprepared and uncomfortable with the possible notion of failing. Looking back now, with an extra 2 months, I did not get much additional studying done and probably would’ve performed similarly if I had written it earlier.

What next?

The next step is to complete the NAC OSCE… which I am not planning to complete anytime this year, so I will save that for a future post. 😉

Phew, long post! Thanks for reading if you are still here and of course, feel free to ask any questions! All the best if you are studying for your MCCEE!

April moments

During my Obstetrics & Gynaecology rotation, I was often leaving the house before 6am in order to be at the hospital in time for 8am. It was a drag, but some things made it worth it. The fact that I got a bit more exercise, since I was walking approximately 7km everyday to and from the train stations. Rediscovering all my favourite songs on my iPod. Since most of my travel is with Michael, I always preferred chatting in his company rather than listening to music. Walking by myself was actually quite a nice and relaxing change of scenery, something I used to know so well but had become unfamiliar to in the last few years.

And little moments with nature you experience. Like this possum carrying her young one across an electric wire:

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And beautiful skies like these over my head

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On April 11, we attended The Dashounds’ Kids Again EP launch at The Hideaway. The Dashounds consist of our two friends James Fielding and Pete Dixon, as well as Bas Pelly and Steve Ceccato.

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A Brisbane based, indie/pop/acoustic band, here is a quick blurb from their Facebook page:

The Dashounds have supported Josh Pyke,The Resin Dogs, and shared Festival stages with Regurgitator, Boy and Bear and many more. They played at the Caxton Seafood Fest and the Red Deer Music Fest in 2010, ’11 and ’12 to packed audiences of happy tail waggin’, raindropping fans. The ‘Hounds have recorded two EPs (available on iTunes). They are best known for their vibrant multi-layered vocal harmonies, dynamic acoustic pop anthems, and quirky lyrics about girls, dogs and their beloved home town of Brisbane.

A really fun and great night with amazing performances by the guys.

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CLICK HERE to visit triple j Unearthed and check out some of their tracks, even download! You are missing out though, because the recordings simply cannot capture the sound and energy of their live performances!

Bought a hardcopy, can you see the outfit similarities? 😉

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Despite a busy rotation, we did get out once in a while! About to head out for some yummy dim sum at New Shanghai with Yoni and Xuan in this photo.

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This was also the night we discovered a dish called “Deep fried calamari coated with salted egg yolk” Deliciously crunchy, rich and salty dish that was extremely well received by all of us!

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Girls day out with Christine, Fiona, Kristen and the cute Abigail on April 13th!

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Started with a lovely breakfast at Samson and Sophie Cafe in Teneriffe, followed by a walk along the river that ended with a drizzle and left us at the Old Museum enjoying tea and each other’s company for a little while longer… oh no! 😉

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As babies often command, and being as cute as Abbey is, she was definitely the centre of attention!

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Not often are the 4 of us in the same place at the same time, so it was lovely seeing them all and catching up!

And my sad attempt at photographing the Blood Moon night of April 15th. 😛

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Obstetrics & Gynaecology: The biggest privilege

Yesterday, I took part in, what I believe, is one the biggest privileges as a medical student: Delivering a baby.

One of the most intimate moments for a woman and her family, where inhibitions are lost and emotions quickly bubble to the surface – pain, excitement, fear and joy.

Thank you to all families who allow us medical students not only observe but even deliver your child as part of our training experience, especially to the two women whose babies I delivered yesterday. New life is such a miracle and the experience of being the person who catches a baby as he/she is born and hand him/her to mum is one that cannot be easily written into words.

I also cannot forget to mention the lovely midwives who I have been working alongside with. Without their expertise, patience, and teaching, I would not have been able to comfortably embrace such a special experience, thank you!

Obstetrics & Gynaecology: End of Week 4

Hello friends!

What an exciting, long and busy 4 weeks! Can’t believe so much time has past since my last joyful post! Thank you again to family and friends who have shared their congratulations with us! We certainly appreciate the love, friendship, and support very much.

I am completing this rotation at a different and smaller hospital outside the city, and it has taken a toll on me! Waking up at 5am in order to be at the hospital for 8am and not usually making it home until 6:30pm. As you can guess, there’s quite a bit of transportation time involved. With that being said, at least I have 3 hours of dedicated study time during my trips on the train? 😛

There are only 4 other O&G students at this small hospital, 3 of whom I already know, which is great. We have lots of opportunity for hands on learning and the teaching has been quite good as well. Our schedule revolves around clinics every day, as well as time in the operating theatre which isn’t so bad. However, all of us would really appreciate having dedicated studying time as well!

I will be rostered on Birth Suite for the entirety of this coming week. As a requirement of our O&G rotation, we must ‘catch’ 4 babies. This means following and caring for mothers while they’re in labour until delivering their child with your own hands. Unfortunately, the other 4 students have not been able to get all 4 of their catches during their Birth Suite week, hopefully I have some more luck!

So what do I have the privilege of seeing on my O&G rotation?

A lot of antenatal care (regular follow up and high risk pregancies), post-menopausal bleeding, heavy, irregular or painful periods, abnormal pap smears, contraception, urinary incontinence and more. In theatre, we often have the chance to see minor procedures like hysteroscopy with dilation and curettage, endometrial ablation and tubal ligation to more extensive surgeries like hysterectomies (removal of a uterus) and Caesarean sections.

Only 4 more weeks to go until the end of this rotation! How time flies!

Paediatric Medicine: End of Rotation 1

Hi friends 🙂

Today marked my last day of Rotation 1 – Paediatric Medicine, which I completed at a large tertiary hospital.

8 weeks on a variety of teams, soaking in as much as possible, in as little time as possible.

  • 2 weeks in General Paediatrics
  • 1.5 weeks in Emergency Department
  • 0.5 weeks in Neonatal Intensive Care Unit (NICU)
  • 1 week in General Surgery
  • 1 week in Gastroenterology
  • 1 week in Oncology
  • 1 week in Respirology

I definitely enjoyed some placements more than others, for a variety of reasons including: personal interest, consultants and senior staff more interested in teaching, and the learning opportunities provided.

For this rotation, we had a number of assessments, including 3 mini clinical examinations (mini-CEX, each worth 10%): neonatal (well-baby check), short case, and long case.

My well-baby check was performed an adorable newly born girl and her lovely parents. She was a little hungry and crying during my examination but was perfectly healthy.

My short case was a respiratory exam on a 1 year old girl who presented with noisy breathing. She was recovering from bronchiolitis and by chance also had a number of neurological findings with associated developmental delays.

And lastly, my long case was a young adolescent girl who presented with fevers on a background of complex mastoiditis leading to the severe complications of intracranial abscesses and venous sinus thrombosis. Incidentally, she had many features consistent with Cushing’s which led to additional discussion points.

The feedback I received from all 3 of my assessments were positive, so hopefully my grades will reflect that!

And today was the big day. A multiple choice exam of 75 questions worth 50% and 2 OSCE stations, each worth 10%.

The written exam was overall fair and very representative of our teachings this rotation.

The clinical exams each had 2 minutes perusal followed by 8 minutes of discussion:

  • Case #1: A 5 week old girl who came in with signs of sepsis.
  • Case #2: A 5 year old girl with acute exacerbation of asthma.

For each case, we had to discuss what additional information we would like on history and examination, what our differential diagnoses were, what investigations we wanted to perform, and how we’d like to manage the patient.

Those 10 minutes go by in the blink of an eye, and I always walk away thinking, “Should’ve said that, could’ve done that, forgot to ask about this, didn’t mention that.”

Only time will tell how I did this rotation! Hopefully hard work paid off.

In the meantime… I would love to catch up on my sleep. However, before I do that, I need to catch up on my blogging! Thanks for reading! 🙂

Year 4 Medical School: What’s going on!?

Hello friends!

It seems I’ve gotten into the habit of not regularly blogging – arg! I’ll try really hard to fix that, I promise. 🙂

As some of you may know, I’m now in my 2nd week of 4th (and final) year of medical school! My first rotation is Paediatric Medicine, which I’m absolutely loving. I feel quite lucky that all the doctors and staff we have come across have been kind and more than willing to share their time and teach us. More importantly, parents and their children have been very receptive of students, which makes all the difference in the world, because that’s the only way we learn – on real patients!

Also, babies are so freaking adorable, I can’t get over it. 

With that being said, I’ve also been quite busy and stressed out. 

During the day, I’m in the hospital on my rotation. When I get home, I have to put all my focus into studying for the Medical Council of Canada Evaluating Examination (MCCEE), which Mike and I will be writing on February 28th in Melbourne. That’s less than 6 weeks away! 😦 

The MCCEE is the first big step that we Canadians Studying Abroad (CSA) or International Medical Graduates (IMG) need to take in order to be eligible to apply for a training/residency program in Canada once we graduate. It is a daunting 180 multiple choice question exam that covers 5 broad topics: Child Health, Maternal Health, Adult Health, Mental Health, and Population Health and Ethics. 

Needless to say, we are freaking out. There’s so much to know, in so little time. The most challenging part is studying for Maternal Health when we won’t have actually started, let alone complete, our Obstetrics and Gynaecology rotation yet. 

The good news is, our leave from Feb 26-28 has been approved! That means we will be flying down to Melbourne on the 26th and have 2 dedicated days to study before our exam on the 28th. And then we will have a weekend to explore and see Melbourne, yay! 

Until then, study! 🙂 

Post-Medicine rotation gathering!

November 15, 2013

(I know, I’m now writing out of order too, sorry! :P)

In celebration of our time together throughout our Medicine rotation AND the fact that we finished our last exams of third year – we had to celebrate… with food, of course!

Very happy that most of us were able to meet for dinner Friday evening, hurray!

After some discussion, we decided on New Shanghai as they have many yummy and generous sized dishes to share. In particular, dumplings. Need I say more?

Credit to Sarah for the photos!

The ones who couldn’t make it: Clarence, Yung Howe, Tomas, Joseph, Mustak, Manisha, and Sunny

Adi, Kee Ping, Sarah & Daniel

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Me, Mike, Xuan & Christine

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Sarah & Daniel

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Mike & Xuan

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Daniel & I

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Love this picture 🙂

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For dessert, it didn’t take much convincing for everyone to join for some frozen yoghurt, yum!

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Thanks for the good times guys, have a great holiday!

The end of third year medical school!

Yes yes, that day has finally come!

Yesterday marked the end of my third year in medical school, woo hoo! I had two clinical exams for my final rotation (Medicine), both of which I left with mixed feelings…

The first exam was a long case – 1 hour with a patient during which we must get a full history and do a full examination. Followed by 20 minutes with two examiners where we present our case and get grilled with lots of questions. My patient’s presenting complaint was post-fall following possible syncope, with digoxin toxicity on a background of atrial fibrillation as well as chronic kidney disease, hypertension, and reflux disease.

The second exam was a short case – a focused examination completed within 8-10 minutes, also followed by a brief summary/presentation to the examiners and being questioned. Our short case was a cardiovascular examination on a patient who presented with shortness of breath. We later mostly agreed on the significant findings of murmurs and other signs of biventricular heart failure.

Hopefully I passed! But it’s so easy to look back and think, “I could’ve said this” or “I should’ve asked that.” Only time will tell now, our marks should be released in a few weeks!

Finished up packing this morning. Just need to pick up a couple last things but so ready to hop on a plane back home! Hopefully Mike and I can hit the beach tomorrow for some last minute relaxation (and tanning ;)) before heading back to Canada early Sunday morning.

Will be staying over in Vancouver for a couple of days to visit my sister. I’ve never been before so pretty excited! Here’s our flight itinerary:

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Random recent moments

As I mentioned in the last post, I haven’t done much in the last 3 weeks but there are a few things to share!

My dear friend Amanda gifted me with lovely chocolate covered sultanas by Melba’s and a bottle of Chenin Blanc (Coriole Vineyards), both presents from South Australia. The chocolates are rich, smooth and delicious and of the course, the wine was very tasty. She even wrote a really touching note… just because she’s an awesome friend and is always thinking of other people. 🙂

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Having some of the chocolates and salted cashews = winning snack.

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Craving for Korean food led us back to our usual spot – Madtongsan II for dinner on Oct 16!

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Oct 19 – Could not resist the great lunch specials at Wagaya. Went for my new favourite dish, tonkotsu ramen, so delicious! Even comes with dumplings and an amazing bowl of fried rice!

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For dessert, we chose to share the green tea cheese cake with green tea ice cream. Have been wanting to try this for a while but probably not worth getting again.

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Mike’s squishing me! Long but fun and extremely worthwhile days in hospital this rotation. But sooo tired when we finally get home, not much studying gets done.

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Yoni was in town from Nambour and staying with us Oct 19-20. We went to see Gravity which was good, although I was glad we didn’t see the 3D version because I think I would’ve gotten motion sickness. And we never go without food! My favourite wedges from Beastie Burgers and burritos from Guzman y Gomez, yummy picnic!

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I ordered a few BB Cream replacements recently, and look at all the amazing samples I received! All well known Korean brands too… can’t wait to try some of these out, especially the Ice Mask!

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Boiled quail eggs with some salt and pepper – delicious snack!

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How do you cut a pineapple? This is how I learned from my mom, least amount of pineapple wastage!

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Yummy! Honeydew melon with pineapple and lychee – can’t go wrong!

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Tried frozen yoghurt for the first time not too long ago – how delicious! Biscotti and coconut pandan flavour with fruits – yum!

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A new favourite in our house, basil & blueberry gin and tonic – try it! Very tasty 🙂

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Home made food update? Here are a few things!

Crispy oven baked sweet potato fries

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Creamy mushroom soup – delightful!

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More mango sticky rice with coconut cream, mmm

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Vegetarian pasta salad with Greek yoghurt based dressing

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Pear cupcakes with passionfruit icing for the students in my group

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Chocolate cupcakes with peanut butter icing and carrot cupcakes with cream cheese icing as thank you gifts for my med team.

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3 weeks since I last posted!

Unbelievable how fast this rotation has gone by… tomorrow is already my last day in hospital… of the year. Then final exams next week!

I haven’t blogged in over three weeks, ashamed! No excuses! Although getting home late most days leaves me completely exhausted, especially after dinner when I still have to study 😦 That, and I have not done anything interesting during this rotation! Mostly focused on school, I haven’t even been taking photos regularly! Oopsies.

I’m very excited to be approaching the end of third year, which has been fantastic. I love being in the hospital, being part of a team, and the opportunity for hands on learning. Definitely excited to be finishing up this year, but a little apprehensive about next year as well, ah!

Here are a few updates:

  • So fortunate to have been a part of such an awesome medical team for this rotation. We are having a farewell lunch tomorrow… I’ll definitely be a little sad but it will be nice to see their faces next year as well 🙂
  • Final exams next Wednesday morning! It will consist of a long case and a short case. For the long case, we get 1 hour with a patient and during that hour, we must get a full history and do a full examination. This is followed by 20 minutes with two examiners where we present our case and get grilled. The short case will be a focused examination completed within 8-10 minutes, also followed by a brief summary/presentation to the examiners and being questioned. Sounds nerve wracking? It is!
  • Because real patients are used for our exams, we are banned from the hospital as of Friday. That way, newly admitted patients are kept secret 😉 And so, I’ve decided to go to the beach this weekend. Relax and do some reading under the sun… lots of reading to get through in preparation for my exams next week!
  • Will be going to my first baby shower! Mum-to-be is my lovely friend Kristen, who makes pregnancy look absolutely beautiful!
  • Then Mike and I are flying home on Sunday, November 17th at 7:45 am! We’ll be heading to the airport quite early, will we be up all night doing last minute packing? Mike will for sure. I’ll be doing my packing while procrastinating studying for exams.
  • We’ll be arriving in Vancouver on November 17th at 7:25 am and will spend a couple of days visiting my sister (studying OT at UBC) before going back to Ottawa, arriving at 11:40 pm on November 19th!
  • Yay, I’ll be home for my grandpa’s 80th birthday!
  • After many weeks of snail mail, I have finally completed my registration to write the Medical Council of Canada Evaluating Examination (MCCEE)! This will be the first of 4 Canadian exams I will have to complete should I wish to train in Canada. My exam will be on February 28th in Melbourne!
  • I have a lot of studying to do… for the rest of my life.
  • But yay, home soon! And for Christmas!

Mental Health: The End!

Yesterday marked the end of our fourth rotation, Mental Health – yay!

The past 8 weeks seemed to have gone by in the blink of an eye. We saw patients when they were admitted, learned their stories, followed their progress and said good bye when they left… a humbling and worthwhile learning opportunity.

Despite being laughed at by our registrar many times at our pathetic initial attempts of presenting a Mental Status Examination and formulation… in the end he said we did well and our evaluation backed that up.

Many thanks to our Registrar and the Consultants who took us under their wing and taught us throughout this past rotation. They are so knowledgeable and have so much experience to impart, couldn’t have done as well as we did without their guidance! And of course, to the wonderful staff at our hospital 🙂

On Thursday, we had our clinical exam where we were provided a vignette (clinical situation on paper) and 20 minutes perusal time. Then we had 20 minutes to present a summary, formulation, differential diagnoses and rationale, additional information needed and management plan to 2 consultants/examiners. I was SO nervous. But as soon as I sat down and started reading, I immediately calmed down – a case of an elderly patient in the hospital who developed delirium. Something I was familiar with and had prepared for, yes! I think that exam went well, but only time will tell what my 2 examiners thought!

Then we had our written exam yesterday, 50 multiple choice questions. As always, there were a handful of questions that left us thinking, “What was… what?” But in general, we left with a sense of security rather than panicked with the thought of, “Oh my god, I might’ve failed that,” racing through our minds.

So now, one week vacation!

Haven’t done anything… yet 😉 Hopefully it will be relaxing and full of nature! We have some plans but I’ll update as it happens!

Mental Health: What’s the deal?

Wow,

I am terribly behind with my regular blogging! 😦 There’s no excuse, but it’s been busy and blogging about our recent vacation took a lot longer than usual.

So what’s the deal with school now?

Well, I’m 5 weeks into my Mental Health rotation, and yes, I’m quite enjoying it! By random luck (or is it bad luck? Haha), both Mike and I got placed as the only 2 students at a private mental health hospital in Brisbane.

The experience so far has been very enlightening. We found it initially daunting and awkward learning to take a psychiatric history from patients and formulating our thoughts. The feeling is quite similar to being in first year again, learning how to take a medical history and talk to patients. Fortunately, we’ve gained a lot more confidence in the last few weeks. Taking a medical history is like second nature to us now, hopefully taking a psychiatric history will, in time, feel the same.

We are humbled and grateful every time a patient agrees to talk to us or allows us to sit in during a consultation. If you think about it, these people are sharing with us, complete (not yet qualified) strangers, the most personal aspects of their lives. Some people have been victims of sexual and/or physical abuse, others have gone through great losses, some struggle with their spouses having affairs, while others have thoughts of self harm and have even tried to kill themselves. Every single patient we’ve met has taught us something, in some way, that we could never learn from a textbook.

Every patient we’ve met has a different story and is fighting a different battle. One of the first and biggest challenges for us has been, “How do we talk to these patients? How do we approach sensitive topics in a way that will not be upsetting?” We quickly learned that despite all the differences, these patients are all still the same in one way: Like you and I, they are people too.

Talking to patients with mental illness or a difficult life/past can be hard. But it’s not necessary to over-think how to talk to them. As long as you are patient, empathic and a listener, most people will be more than happy to talk to you and share their stories with you.

We also get scheduled teaching time with 3-4 consultants every week, which has been great. They have all been great teachers and we’ve learned so much already! Not just in terms of knowledge aspect, but also plenty of real life stories and experiences – something you can never learn from reading a book.

Have I mentioned we have a great Registrar? Yes, thank goodness! Most of our day is spent with him and the patients. He’s pretty awesome with them and definitely a good role model to try and emulate. As one of our profs said, “Shamelessly steal!” Adapt the styles, sayings and techniques from your seniors and colleagues that can make you a better doctor!

The most scary aspect of Mental Health at this moment? The fact that we are approaching the end of Week 5… only 2 more weeks until final exams. Absolutely crazy. It’s insane how quickly time has gone by!

Post-Surgery… Vacation!

Surgery is officially over, woo hoo!

Our final written exam (worth 70%) was yesterday… 2.5 hours of looong testing-of-knowledge. The exam was certainly challenging, as many of my friends have agreed, but now we just have to sit and wait for our results!

More importantly – on to a one week vacation!

Mike and I were able to score really cheap plane tickets, so we are going overseas for the holiday!

Today, we are going down to Gold Coast.

Tomorrow morning, we are flying out to… Singapore!

Yep, again.

Our super basic itinerary:

  • July 12 – Gold Coast
  • July 13 – Singapore
  • July 14-17 – Bangkok
  • July 17-20 – Singapore

All our flights added up to less than $500, which we thought was a steal! We have already booked all our accommodation but haven’t really finalized our plans of where we want to go and what we want to do yet.

Like usual, I will try to blog whenever I can! If not, there will be tons of photos and posts after we come back 🙂

Have a great weekend everyone! And for those on a holiday like me, have a lovely vacation!

Surgery: You’re full Vietnamese?

During a chat with one of our patients, it was mentioned that both my parents are from Vietnam.

“Both your parents are Vietnamese?!” This pleasant gentleman asked.

Yep!

“So you were born in Canada?”

Yes I was!

“I wouldn’t have guessed you were Vietnamese!”

I’ve heard this many times before, so I responded with, “A lot of people have said I look Chinese or Japanese.”

He said, “Well… I thought you were a half case…”

A what?

“You know, a mixed race. Because you speak English perfectly!”

Why yes, that’s because I was born and raised in Canada!

Surgery: The uterus is pretty cute

Last week I had a chance to observe a 2-in-1 surgery.

There was an elderly lady with colorectal cancer who needed to have a high anterior resection. In this surgery, the sigmoid colon and part of the descending colon are removed. The remaining descending colon is then anastomosed (re-attached) to the rectum.

This woman also had a large lesion in her uterus and would need to have a hysterectomy (removal of her uterus) as well. It was decided that both surgeries would be done laparoscopically (minimally invasive surgery done through a number of small incisions, also known as keyhole surgery) and at the same time.

After the colorectal team finished mobilizing (freeing) the colon, the gynaecology team took over and removed her uterus, fallopian tubes and ovaries. The colorectal team then came back and finished the surgery, taking out the part of her colon with cancer and reattaching the remaining parts.

The other medical student observing the surgery with me told me to expect the uterus to be really cute. So tiny with its little fallopian tubes and ovaries. I have to say, she was right! How amazing that such a tiny thing can carry babies for 9 months. This woman had had 6 children!

I asked permission to take this picture. You can see the uterus with the fallopian tubes and ovaries (white oval structures). And if you look closely, you can even see some cysts, with clear fluid in them.

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My Ways of Being a Better Medical Student

I believe trying to observe the following makes me a better student doctor.

Here are My Ways of Being a Better Medical Student:

(Didn’t realize this post would be so long, so I added some pictures from the internet. Photos are linked to their sources!)

Always introduce yourself – to patients and to other staff members. You’ll be meeting people all the time, under a variety of circumstances, at all times of the day. It is only polite and respectful to let everyone know who you are – even just in case you’re not even wanted! It has happened to me a number of times, sometimes patients just want medical students to sit out from consults. It can definitely be awkward, even scary, to find the opportunity to introduce yourself but you just have to man up, find an opening, and do it! Trust me, I know first hand how awkward it feels, especially when it’s one of your registrars or consultants you’re finally seeing for the first time (maybe during rounds) but completely ignoring you. But, more often than not after introducing myself, people will treat me differently – I’m no longer invisible and even addressed by name, who would’ve thought! 😉

Say hello when passing others, and smile. It takes no effort from you and can brighten someone’s day. Win win.

Don’t gossip. And if you must, do it outside the professional environment and out of earshot from everyone else. It makes you look unprofessional and you never know who might be listening. The medical world is small and word can travel fast – don’t sink yourself! You never know who you will cross paths with again and that one person you bad-mouthed could end up being your preceptor, your examiner, etc. If there’s someone I particularly don’t like, I always try to find someone else more constructive to my learning and morale and spend my time with them instead.

Never be afraid to ask questions. It shows you are listening, processing information and are willing to learn. Some people are great teachers and love the opportunity to share their knowledge – they’re just waiting for you to take initiative. Of course, with that being said, there’s always a proper time and place for questions. If someone is having a heart attack, no one wants to hear, “Could you show me how to read the ECG?” And you should really have enough common sense not to ask “stupid” questions that will only make you look bad. If you’re a 3rd year medical student asking, “What’s aortic stenosis again?” you are going to be in big trouble and look ridiculous!

Never be afraid to say “I don’t know.” I have no problems saying, “I’m sorry I don’t know, could you show/tell me?” when I really don’t have a clue how to answer a question I’ve been asked. If I can give an educated guess, I do, but otherwise, there is also nothing wrong with, “I’m sorry, I’ve forgotten, could you remind me?” Sure it’s embarrassing for you, but you will learn on the spot and/or never forget that information again. I’ve lost count how many times I’ve heard, “That’s okay, this way you learn and won’t forget again!” For example, the other week, my surg team was commenting on the long half life of the drug Rutiximab (21 days). The registrar then says, “At least it’s not as bad as Amiodorone! Sandra, what’s the half life of Amiodorone?” I laughed (as if I would know this) and replied, “I know it’s more than 21 days!” Now I will never forget Amiodorone has an extremely long and varied half life of 25-100 days. However, not knowing the answer should happen much less than 50% of the time you are asked questions, otherwise, you don’t know enough and you should go study!

Learn as much as you can on the spot. At this point in our lives, we’re not going to have our hands held and be told what to study. Pay attention on the wards and learn as much as you can – that’s often the useful stuff that you can’t learn as easily from textbooks. Bring paper or a notebook and jot down all the things you learn throughout the day. Write down topics that come up which you need to go home and read up about – follow through with it. Interns are a wealth of knowledge, it wasn’t too long ago they were in the same position as you, ask them questions and listen to their suggestions.

Be keen and willing to learn. Someone who shows they want to learn will be taught more and given more responsibilities. Put in the time and effort you think is necessary for you to reach your learning goals. Ask to participate and ask for opportunities to practice your clinical skills or to broaden your knowledge. Try not to decline a learning opportunity that comes up.

Be that medical student you would want to be partnered with. It’s great when you’re paired with another student who’s friendly, encouraging and easy to get along with, who’s knowledgeable but not cocky, who helps you learn without stealing your thunder, who can shine without throwing you under the bus, who’s not the super keener but not a lazy bum, who’s respectful of patients and confidentiality, etc. But it’s even more important to try and be that person for others. You surround yourself with the people you deserve, so be deserving! 🙂

Bake. Everybody loves home baked goods. If you can bake, you should share that deliciousness. No one will fault you, people will love you.

Keep up with your studying. Cramming doesn’t work anymore. Unfortunately, you have to remember everything you learn and build upon it. It’s hard, I know, I’m continuously working on this point.

Eating is important. But don’t just eat, eat healthy – your body will thank you. Also keep snacks on you – granola bars, nuts, chocolate, etc. They will save your life when you are too busy to take a break.

Get enough sleep. If you function well with 5 hours of sleep, that’s great. If you need 7 hours – make sure you get it. That also means you need to time manage well. Don’t sacrifice your studying or your eating time to make more room for sleep. You really need a balance.

Do things that make you happy. Keep up with your hobbies, take up new ones, see your friends, have quality time with your partner, take time for yourself to rest and relax. Otherwise, you will be lonely, stressed, and crazy.

I’m sure there are lots more that I can’t think of at the moment! 🙂

What about you? Do you have any tips?

Surgery: A New Experience

I think I was expecting to be in a perpetual state of fear and not knowing anything for my surgery rotation but I am quite enjoying it so far.

The rotation is mostly structured as we are placed in different units every 1-2 weeks, with additional scheduled tutorials and clinics. This is what my 8 weeks in surgery looks like:

  • Week 1 & 2 – Upper GI (General Surgery)
  • Week 3 & 4 – Colorectal (General Surgery)
  • Week 5 – Trauma
  • Week 6 – Acute Surgery
  • Week 7 – Burns Unit
  • Week 8 – Urology

There are other units I will unfortunately not have the opportunity to work in: Breast/Endocrine, Hepato/Pancreatic, Plastics and Vascular.

We also have scheduled sessions in multiple clinics that include: Breast Clinic, Breast Screening Clinic, Burns Outpatient Department, Colonoscopy Clinic, Endoscopy Clinic, and Minor-Ops Clinic.

Despite being more structured than in previous rotations, there are lots of opportunities to expand your knowledge and skills, depending on your willingness and your comfort level. Always take advantage of those opportunities! My partner and I have had the chance to see our own patients in the Gastroenterology Clinic and I finally got to put in my first IV canula – hurray!

And of course, being in surgery, we’ve gone in to the operating theatre (OT) to observe 2 surgeries so far. Both patients were from our surgical team. Patient 1 had a complete closure of an enormous abdominal hernia. He already had a surgery to repair the hernia months ago but suffered major complications with a wound that didn’t heal. Patient 2 had a distal gastrectomy (part of stomach removed) due to early stomach cancer.

Perhaps the most important thing in viewing operations: Know who your patients are, what operation they are having and why. Otherwise, not only do you look stupid if the doctors ask you any questions, but you will have no idea what’s going on and not be able to appreciate what you are observing.

If you have the chance to see patients in the ward or in the pre-admission clinic, take the opportunity to talk to them – get a history, do an examination, review their investigations, and read their file so you get the complete story. After surgery, follow the patient’s progress 🙂

We haven’t scrubbed in yet, which I think was a smart thing to do because it gave us the opportunity to walk around and get to know the staff (ie. nurses, anaesthesiologists, etc), and more importantly, stand back and observe how the team works and how the OT functions. Perhaps next time we will ask to scrub in!

[I wrote such a long post, but unfortunately half of it got deleted when I tried to publish and now I’m too lazy to rewrite it all… this is all for now]

Surgery: Groan

We are starting our 3rd rotation – Surgery, next week! I’m already scared just thinking about it.

Received the following email today:

Dear Rotation 3 Students,

Welcome to your Surgery rotation.

Your rotation commences on Monday 20th of May. You will be required to attend a 6.45am Scrub, Gown and Glove session at the RBWH before your orientation. Please report to Madonna Cameron and or Tina Boric on the 4th Floor Reception, Operating Theatres RBWH at 6.45am

6:45… in the am. My body is already crying. Thank goodness we live 5 minutes away by bus.

Oh well, have to start getting used to it! Surgery rounds (where the team will go around and see all their patients) start at 7am apparently.

On to a new adventure guys! Starting to set my alarm early (7:30am tomorrow) to lessen the shock when I will have to wake up and it’s still dark outside. 😛

Guess who got their N95 mask fitting?

We did!

Glad we got this done during the break because it would have been hard to get it done during business hours while on rotation again.

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What am I talking about?

From the FDA website: An N95 respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. In addition to blocking splashes, sprays and large droplets, the respirator is also designed to prevent the wearer from breathing in very small particles that may be in the air.

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Why did we have an N95 mask fitting done? Because it’s one of compulsory requirements for medical electives back in Canada. 🙂 As they come in different sizes, it is important to have a fitting done in order to know which one to use if they’re ever needed. If fitted properly, they can filter a minimum 95% of particles that are 0.3 microns or larger. We got to keep our 2 masks for reference/practice purposes. Let me tell you, it is not comfortable wearing a mask!

For any of our friends who need to get it done in Brisbane:

Contact Brian or Terry (Occupational Hygiene Advisers) at the Occupational Health & Safety office on St Lucia campus! You can get their contact information HERE.

The end of GP and 1 week holiday

GP Rotation is finally over after a multiple choice exam last Wednesday and 2 oral exams on Friday.

How did I do? Only time will tell. I always find it hard to gauge my performance, especially during oral exams because I can always think of things I could’ve said or things I could’ve managed better. All I can say is I hope I didn’t fail!

Ended my GP rotation performing a wedge resection of an ingrown toenail – sounds gross but I was pretty excited!

We have this week off before starting our Surgery Rotation next week. No plans to go anywhere or do anything in particular but time is flying. It’s already Monday!

I miss the GP Clinic already, it was such a wonderful place to learn. Thinking of starting a new rotation next week makes me nervous already…

GP: Coming to an end

Friday will be my very last session at the clinic for my GP rotation. How quickly 6 weeks have gone by!

We will having our final exams next week:

A multiple choice question exam on Wednesday and 2 oral exams on Friday. These are 13 minute stations (with an additional 5 minutes perusal) where we will have to perform a diagnostic case and a management case.

For the diagnostic case, we will have a patient come in with a presentation where we will have to take a history, talk through the physical examinations, provide our probability and differential diagnoses and lastly, provide a list of problems that should also be addressed.

For the management case, we will be giving a patient the diagnosis of their illness and will be working with the patient to manage their health. This will include assessing the patient’s knowledge, educating them on the diagnosis, coming up with short and long term management plans, taking the opportunity to discuss preventative health issues, providing resources, planning to follow up and safety netting.

Am I scared? Extremely!

There’s lots of time to study from now until then. I will definitely continue to practice cases and make sure I actually know how to manage diseases! I think the worst thing that could happen is to walk into a scenario where you have no idea what the disease is, let alone how to manage it!

And after next Friday – ONE WEEK HOLIDAY – YAY!

Note to self: Buy a stop watch for exams. Managing your allotted 13 minutes for oral exams is impossible if you have no idea how much time you have left.

Max Brenner, double rainbow and pretty skies

Our last treat out with Meaghan in Brisbane – Max Brenner (one of my favourite places) for dessert after our amazing dinner at Next Door Kitchen & Bar!

A very happy girl with her Toffee Choc-Nut Waffle – little pots of melted chocolate can bring such joy into people’s lives!

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Mike and I shared the Spectacular Choc-Fudge Brownie Sundae (with additional caramel sauce, haha). I don’t know how people finish this on their own – sugar coma!

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Silly face!

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Walked out of my house the other day and groaned aloud because it was raining and because it was so early in the morning. On the way to the train station, the rain stopped and this is what I saw – double rainbow all the way across the skyyyy!

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Some days, I make it out of the clinic and home before the sun goes down. When that happens, I get the chance to see pretty colours and bats flying across the sky.

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Other days, I have to walk home alone in the dark 😦 And by the time I get home, my brain and body are too tired to do anything but eat and sleep.

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GP: Way of Teaching

I’m happy to say I have a great preceptor at the clinic where I’m doing my GP Rotation. A teacher with lots of patience who provides many opportunities for learning and always answers my questions, no matter how many I ask.

He also goes by the motto of, “See one. Do one. Teach one.”

That means, for any procedure he feels comfortable allowing a 3rd year med student to perform, I am expected to watch him do it once, during which he talks me through the entire process, giving pointers where appropriate. The next case that comes in, I’m expected to be able to do it myself. Talk about my heart beating faster!

The next Implanon (contraceptive implant just under the skin) removal, punch biospy (sampling a suspicious skin lesion), sebaceous cyst popping (pretty excited for this one), etc – I get to do!

It is amazing how much medicine you don’t learn from textbooks but from a teacher and experience!

GP: “I can tell when my BP is high”

The last patient I saw the other day was, according to my preceptor, a “heart sink” patient. The kind of patient you see on your list that makes you sigh and hang your head in frustration.

This man had uncontrolled hypertension (high blood pressure – BP) simply because he is extremely non-compliant with his medication. He’s visited the clinic numerous times in the past but doesn’t agree on the importance of his medication, despite detailed explanations each time.

He came in with his wife, who said he still hasn’t been taking his medication and when we asked him why, he said, “Because I only take it when I feel my blood pressure is high.”

We asked, “Do you feel that your blood pressure is high at the moment?”

He responded, “No, because when my blood pressure is high, I can feel it in my ears.”

So we measured his BP, it was 190/80 – which was high, and we told him that. And for the umpteenth time, he was told about the importance of maintaining good BP and that he was at risk of having another stroke – apparently he’s had 3 already, one which took 3 years to recover. He’s also on Warfarin (blood thinning agent) so if he were to have a hemorrhagic stroke (burst blood vessel in the brain), it would be a big one that could potentially kill him or cause major complications.

He laughed and said, “I’ve already had 3, I will just have a big one then!”

His wife chirped in, “If you don’t control your BP, you might die tomorrow! You can’t leave me, I need you!” He replied with another laugh.

Needless to say, the consult ended up a waste of time because the patient refused to take the doctor’s advice. On the way out he apologized with a smile and said, “I’m sorry for my… indifference regarding my treatment.”

Perhaps one of the most difficult aspects of GP for me – knowing that your patients know their behaviours (smoking, not taking medications, etc) are putting them at risk of serious illness but despite your continued efforts, they simply don’t want to change.

Rotation 1 complete!

Today I completed my first exam, and thus my first rotation of Year 3 – hurray!

Our Medicine in Society – Geriatric Medicine exam was 1.5 hours with 40 multiple choice questions worth 80 marks, and 1 short answer radiology question worth 20 marks.

The exam was overall fair and representative of what I learned this rotation in geriatric wards. With that being said there were still a number of tricky questions, so hopefully I did well!

Now that that’s over, do I have vacation?

Why yes indeed!

I’m off until March 18, which will be our first week into Rotation 2 – General Practice.

Mike and I are actually at the international airport right now, 3 hours after exam! Heading to Vietnam until next Sunday and stopping over in Singapore tonight. My mom is currently in Vietnam, so we are meeting up with her to visit some family and do some quality relaxing on the beach! 🙂

Plans tonight in Singapore: Chocolate Buffet on the top level of the famous Marina Bay Sands! Mmm, is your mouth watering? Because mine is! We plan to try all 57 chocolate varieties they serve, wish us luck! And of course, we definitely have to check out Gardens by the Bay and photograph the supertree groves! So excited!

We are also flying with Singapore Airlines, so looking forward to a nice and relaxing flight, especially after the exam!

Plan to blog whenever I can during vacation, come back and visit!

Have a lovely day everyone! 😀

MIS: Coming to an End

After an amazing 6 weeks at Prince Charles Hospital learning so much about Geriatric Medicine, my Medicine in Society rotation is coming to an end.

You would not believe how worried and anxious I was to begin working in the hospital this year. The thought of constantly feeling stupid and not knowing enough was enough to get my heart racing. Luckily I was proven wrong. Every staff member I have met at The Prince Charles Hospital has been welcoming and kind. Not only have they taught me so much, but they trusted me and provided innumerable opportunities to apply and broaden my knowledge and skills – I couldn’t have asked for a better experience!

Here’s a review of what happened:

I spent my first 2 weeks in the Fractured Neck of Femur  (#NOF) Service (01/21 to 02/01). All patients in this ward had broken their hip and required surgery and rehabilitation.

Then I moved on to the Geriatric Evaluation and Management (GEM) Unit for 2 weeks (02/04 to 02/15). These patients can have any sort of health problem, and were in GEM for further rehabilitation or waiting for home services to be set up before going home.

Fifth week I spent in the Cognitive Assessment and Management (CAM) Unit (02/18 to 02/22). This ward is more long-term and all patients have some kind of dementia. CAM was an especially unique and enjoyable experience. I got to know all the patients on a personal level and it was admiring to see how the staff take care and handle patients when they are being difficult.

During my last week (02/18 to 02/22), I spent a few days with the Geriatric Referral and Liason Service (GRLS) and some days back in the CAM Unit. The GRLS team takes referrals from all different wards of the hospital to see if patients would be appropriate for transfer to the GEM unit or elsewhere. GRLS was especially beneficial because I was able to learn how referrals work and got to become more familiar with other wards in the hospital.

We now have this week off to study for our exam on Thursday! And also have to finish up our health projects. For mine, I’ve created a medical information brochure for the Fractured NOF Service. I’ve received patient/family feedback and it’s now in the final stages of editing before being submitted to the forms committee.

Overall, I’ve extremely enjoyed my Geriatric Medicine rotation. I have had so many encounters with patients, their families, and health professionals that have taught me more than any textbook could. Thank you TPCH for a wonderful experience! 🙂

MIS: Chart Writing

As silly as this may sound, one of the most exciting things I’ve done on the wards is writing in patient charts. It gives me a satisfying sense of responsibility and makes me feel like a trusted member of the team. But that could just be me!

10 things I’ve learned regarding patient charts:

  1. The whole world would be happier if charts were electronic.
  2. Everyone on a multidisciplinary team has better handwriting than doctors – MUCH better.
  3. Sometimes, doctors really do have nice penmanship and you are so so grateful.
  4. You spend a lot of time looking for charts because another person on the team is using it. Refer to #1.
  5. You need to put a patient sticker on every piece of paper in their chart. Things fall out of plastic sleeves and papers get ripped all the time. Refer to #1.
  6. You are happy to see that the file you’re holding is “Volume 1” and not “Volume 7” because that means: the patient has not had lengthy hospital stays and you don’t have a ton of catch up reading to do.
  7. Forget white coats, charts are the dirtiest things around. They get carted around the hospital everywhere the patient goes, are constantly manhandled by innumerable hands, and never get cleaned… ever. Refer again to #1.
  8. It is always better to be more detailed than brief in your charting.
  9. Describing patients as “pleasantly confused” is a lot more common than you think, especially in geriatric wards – thanks to dementia. It sure took me a second the first time I read that description in a patient file.
  10. Unlike my seniors, I am not even close to mastering the art of reading through an entire patient chart in less than 5 minutes, while retaining everything I read. Got a loooong way to go.