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 😦

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!

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! 🙂 

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!

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: 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. 😛

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.

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!

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! 😀