The end of a road... to merge onto the motorway?

Well, it's been more than a year since my last post, and the impetus for revisiting this blog actually came from a source outside medicine altogether but perhaps more pertinent now for me - an article on an entrepreneurial magazine about tracking your life's satisfaction by way of a happiness diary. I'll go into that perhaps later as I'm currently blogging from my mobile, determined not to let anything get in the way of updating this (not to mention its 1am and I have an early start tomorrow!).

So what's happened? Well to put it bluntly, my life has at once been chugging along as it has realised many new facets. Briefly, I went overseas to Singapore for my medical elective, stressed over and subsequently passed final barrier exams, applied for and now have an internship next year, and on the cusp of finishing my final hospital based rotation as a student ever! On the other non medical side, I wrapped up active duties with student representation at university, did a south east Asia tour, met lots of new people and did a lot of personal introspection.

I don't have much time or energy to write a huge catchup post (though I'll cover those topics hopefully later) but at present I feel like I'm on the edge of an enormous change in my life. Next year will be my first full time job, and along with this the newly found responsibility and financial freedom that this entails. In addition to this are many simultaneously running matters that demand my attention, some of which I'm hoping to finish before I start working and some of which I might not. Some things I want to answer myself include - what do I feel my purpose in life is? Is medicine going to help me achieve this? Will practicing medicine make me happy and satisfied? And how much would I be willing to sacrifice if another door opens? A doctor I recently met joked to me that it wasn't too late to get out. There's a very real chance that for me this may not have been in jest.

Just finished exams; now thinking of exams again

This seems to be rather pervasive among many groups of students, but perhaps only the most nerdy ones... however, this time around, I was not in my nerd mindset - rather, I was in a pretty good place! I just finished my Paediatric OSCEs, and with it, the end of my paediatrics term - which is a bit sad, as the patients were oh so cute and lovely, especially the last one who volunteered (or her mother did?) to be part of our OSCEs. However, my mind was now set on fixing up my elective (hopefully in Singapore), which until now had not been sorted out yet. Setting upon this task with great diligence, a spanner was thrown in the works and I was notified that one of my elective rotations may have to be delayed until the middle of December (meaning that I would be in the hospital during the Christmas/New Years break! Oh how novel! How exciting! How nerdy!). This lead me to consult my academic calendar for 2013 of which I could not find evidence of existing, and then to the Year 5 (i.e. the last year) unit outline.

And there it was, in bold, nicely formatted at the end of a long table of deadlines... the BARRIER EXAMS. 3 and a half years after I had started my degree, I was now exactly 52 weeks - that is, 1 year - away from my final exams of medical school ever! This of course is not withstanding accidental freaks of nature, angry examiners, unfair marking criteria, or simply not studying hard enough this year. So, if all is smooth sailing and the next 52 weeks progresses as the past 170-odd weeks have done in the past, I will be sitting my final barrier exams. Sorry for repeating myself, but I could not get over this fact. One year may be a long time for some, but I find that one year goes by extremely quickly, and before I know it, the year has gone. Much like these last 3 and a half years - apparently, according to my parents, I've barely aged! Of course I am still 1.5 years away from graduation itself, but nonetheless, barriers feel like...well, barriers, and once they're done, graduation is pretty much guaranteed.

There seem to be two peaks of knowledge reached by a doctor - or at least the sane ones who only go into one specialty - the first I feel is right at the end of medical school at the barrier exams, where an enormous amount of studying goes into achieving that final hurdle and making it out. The second is right after successfully finishing the fellowship exams, and it astounded me just how much registrars at that stage knew - many could talk for a good 15 minutes without pause about any particular condition. Whilst less of a demonstrated challenge may be required for medical school final barrier exams, I still feel that this is an expectation I have of myself. Perhaps not many trials and studies, but at least every common disease, and every uncommon disease, and some rare diseases as well. Then surrounding and supporting the pathology would be the anatomy and physiology of which I most likely will have to revise by that stage, the clinical processes, and the treatments that may be recommended. I feel this is most likely a surmountable task which can be achieved with adequate preparation; I just wonder how many of my friends and fellow cohort will be thinking of the same thing.

More than anything though, there is real motivation to study in these clinical years as the finish line draws closer. Exams, sure, are motivation, but for many, they are only motivation for cramming. What really gets the gears moving is the clinical immersion, and the fact that soon enough, you will be on the payroll of whatever state or country's health system you are employed by, and then as an PGY1 (post-graduate 1st year) or intern, you're now in it. Unlike the medical students who you are now swamped by, you cannot choose to do one discharge summary and then head to the "library" to "study". You cannot accompany half the ward round in a dozed state and then leave for a "tutorial". You now have a pager, so now people can contact you if need be. Finally, your actions, and your written record, can be pulled up years from the time and presented in formal proceedings of a court, Medical Board or coroner.

All of this brings about with it a special kind of motivation - though unfortunately the last one does play in many people's minds, for myself it's more about the fact that, yes being paid means you get a relative windfall of money as an ex-student, but also means you're responsible. Combined with the fact that most doctors don't want to hurt any patient more than is required to eventually help them, this motivation is the motivation to become the very best you can be.

And I'm not sure whether some of my fellows, or even myself, fully grasp this. Sure, as I am blogging away about this, contemplating this within the gyri of my brain, I am aware of this motivation and want to eagerly pursue it. However, I am still wont to procrastination and all sorts of fun ways to waste time, though admittedly I have cut right back down on the amount of gaming time. I also wonder about whether I have some priorities right - my heavy involvement with the student representation at university is most likely to end by the close of this year, but for the present, what effect is it having on my overall motivation and efforts in medicine?

My solution to this is simple, and for those who are reading and are medical students, consider: the first principle of medical practice is Do No Harm. This means that, when all is said and done, the most important thing for a medical school is that their graduates are first and foremost safe doctors. No amount of amazing trivia on von Recklinghausen disease is going to outweigh the lack of preparedness in an emergency situation.  Hence, the concerns listed above largely disappear if one were to be considered a safe doctor. At the same time, there are only so many things that need to be done well to be considered safe doctors, and many of them are actually not related to what is taught in lectures and tutorials. Things like being responsible with allocated tasks, always being honest, making sure to document important events and happenings, communicating with and informing patients as much as possible, not going Rambo when there is help available - they are all things that medical schools try to include in their curriculum but never seem fully teach, mainly because it is so difficult. Then of course there are the things that are taught in medical school, but primarily it steers away from book knowledge - how to recognise subtle and not-so-subtle emergencies, how to handle them, how to competently take histories, perform exams and interpret investigations, how to assess whether a patient is fit to send home - these are critical elements to being a safe doctor as well.

By and large though, these things don't require enormous amounts of knowledge, and in particular enormous amounts of book knowledge - but they do require a significant amount of clinical exposure, and the dedication to attempt to gain this clinical exposure, learn from it and then retain it through study. This element is what frustrates me when I know that people are missing on this clinical exposure in the belief that they can compensate for this by simply studying from a book. No matter how 'clinical' the book is, the clinical exposure and bedside teaching simply cannot be replaced, and those who are skipping out on these to go to the "library" to "study" are missing out - but more concerning than that, they're losing opportunities to learn to be safe doctors. I know this happens everywhere, and in other courses as well; I have friends in Engineering who mention how the majority of graduates have a piece of paper that only really serves one purpose, to get them into an entry-level job; and on day 1 most are largely clueless, and continue to be so for the first year or even first few years of their job, relying on various aids available to them. However, this element is more critical for junior doctors, and I can't recall exactly where I heard it, but a man once said: the most dangerous time to be in a hospital is at the start of the year.

So my justification for anyone who does a significant amount of extracurricular or have other priorities, perhaps having children themselves or other life priorities - is that as long as the clinical exposure is there, and the learning from the clinical exposure is present, and you're fulfilling the criteria of learning to be a safe doctor, don't stress about it so much. It's my justification, and I feel that it's important to know that there really is a point at which one must study and put more effort into their academics, but there is also a ceiling in regards to the 'safe doctor' concept, where beyond the proficient grasp of things that make you safe, there is little else to be gained. This is not so easy to learn though - as one eventually finds out, there are many many things that can go wrong with the human body!

This post was way too long and I'm sorry for subjecting your minds to this; so I think a summary is somewhat useful.
- Extracurricular and life priorities should not stress you out as long as you graduate as a safe doctor
- Clinical exposure and bedside teaching is one of the primary ways of learning to be a safe doctor
- Therefore treasure them; skipping on clinical opportunities to study or bludge is not the way forward.
- All this said, the clinical needs to be consolidated with relevant study, so there needs to be a balance.

And as a postscript, I am now heading to another Conference Week and then a Mental Health rotation - this may certainly be an interesting rotation!

The easiest rotation in the year...?

A good three months have elapsed since the last post, and I absolutely forgive every single one of you for thinking that I will run off into the night and never return to post on this blog anymore. A couple of things have to fall in place to create the wonderful occurrence that is a blog update - the first, of course, being bothered to write a blog update - given that, unlike some reflective journals in the course with a similar style to a blog, there is really no tangible reward for the blog update. Contrary to beliefs, neither are bloggers necessarily self-centred persons and so would garner their reward from simply spouting about themselves and the little intricacies of their lives - otherwise I would be posting daily - and wouldn't you love that! Heh. The second is that one needs to have time to write a blog update, and often, both the desire and the time don't necessarily correlate - in my case, this magical occurrence only happened three months after the last post. So, without further ado, should get into the meat-and-potatoes of the blog; the medicine.

In the three months that I've not posted, I've finished an entire rotation, one out of four in the year, with this particular rotation being notable for actually containing TWO rotations. Half of it is the research project as I mentioned before, the other half being oncology - the study and practice of cancers and its management. Reportedly, this was considered the most laid-back rotation out of all four in the penultimate year of the course - reflected in my style of dress during the research rotation - the hoodie became my personal uniform. As an aside, I am particularly fond of hoodies; ever practical, ever versatile, unfortunately culturally perceived as significantly more casual than a normal jacket, and thus restricting its use in certain situations. I have bought two, which is two more items of clothing I've personally bought of any other type of clothing. This also demonstrates my love for clothes shopping. It's just below ironing, another clothes-related activity which brings me great joy to delegate to my sister.

So, the group research project was in fact fairly time-consuming; the process of data collection, analysis and writing was complicated by our decision to do a qualitative research paper over quantitative. For those who don't know the difference, quantitative research involves the use of numerical findings to draw conclusions, whilst qualitative research involves methods of communication to draw conclusions, such as interviews, forums and the like. Statistical significance is a phrase that applies to quantitative research, as opposed to qualitative research where the buzzword is probably 'thematic analysis' - unearthing themes that were elicited from the participant's collective voices. So for us, qualitative research meant full days of data analysis, and significant amounts of time writing and editing the final paper. Though our group was well organised in starting the project during the summer holidays (yes, we did coursework during the holidays, voluntarily), we still submitted it on the due date, using the entire time allocated to polish the paper. We were also considering publication; but in getting into the flow of the rest of the year, that may be a challenge for us to do, juggling the requirements for publication with the standard coursework of the other rotations. We'll see how we go for that, I guess.

After the research was oncology. The most pertinent experience from this was the dying patient - of course, in medicine, you will come across death fairly frequently, significantly more than your age-matched peers. In fact, the first patient I took a history from last year died less than 24 hours after I spoke to him. Palliative care was part of the oncology rotation, and was indeed a sobering portion of the rotation. Thinking back on it, I was struck by the care, determination and love demonstrated by the patients and families, and watching the patient and family together was a privileged insight into the beauty of human relationships. This happens in the normal wards as well, but at the hospital I was at, the palliative care unit was not even physically attached to the hospital, and the atmosphere was more homely and less clinical - which served to allow families and patients to have a small degree of separation from the 'hospital' setting. It also struck me as to how important small gestures were to people. The friendly touch of comfort on the shoulder or hands was so evidently, so visibly effective, as was the act of getting a box of tissues and offering it to them. They would continue to grieve as is normal, but in the space of a few minutes, after recollecting themselves, or even in the process of grieving, they would look at you with an expression of gratitude and thankfulness. In the context of imminent death, the value of human relationships, gestures and communication become enormously amplified, and the display of compassion and empathy were hallmarks of the palliative treatment of the patient.

Palliative care also included time in clinics - not all of the time was spent in the ward. Here, we saw a number of approaches by palliative care physicians in their mannerisms, from the overtly sympathetic, to the energetic and compassionate, to the blunt but good-hearted - the last always made it evident that the intentions were for the patient's benefit. Patients responded differently to each, but it was interesting to see that the blunt but good-hearted physician had very good rapport with patients; in fact, this had a tangible effect on management when a patient revealed information to the physician that had not been unearthed by any other; this, however, occurred over a period of months. It goes to show that it is not your personality that must become that of a compassionate mother-hen, but rather that, in your own unique way, you can connect with the patient, empathise and build the relationship. I think this was a perception that I had, where I believed that there was simply one way to act around palliative care patients, that I now don't have with the exposure of multiple, effective, clinician approaches.

Oncology also included medical and radiation oncology; both were fantastic, especially radiation oncology with the amount of teaching that everyone gave us. I will gloss over it however because though there may be much to say, I've not much time left anymore!

So, easiest rotation in the year? I wouldn't necessarily say so. The complexity of research and oncology can be limitless, especially the research component, which involved both an extended period of groupwork and thus co-ordination of the team, combined with a general inexperience of research, and especially inexperience with the type of research to do, qualitative vs quantitative. There was however a one-week break between the two sub-rotations though - which was mostly consumed in my case by various other extracurricular commitments.

Currently, I've already started my second term, that of paediatrics (kids medicine)! It's my first week and I am excited to really get into it; we had a relatively unrelated conference to attend on Monday, and currently it's the school holidays so this week is a little bit odd for the special schools attachment that paediatrics includes - and it is this schools attachment that I am currently on. By far the most difficult thing I've encountered so far is actually getting down to the level of a child, and I think this is something that might face many people who do not have much experience with children. When saying things, or playing with children, sometimes thoughts race around my head such as: "am I doing it right?" and "I don't know what to do/say now" and "This feels childish" - all of these thoughts are probably stemming from the adult-child dichotomy and levels of thinking, and most likely also my own stupid propensity to think and write using words like 'dichotomy' and 'propensity'. I don't even know what they mean, I'm just writing it to sound smarter. But seriously, it is challenging, and one of the teachers has called it 'daunting' - I absolutely agree, not just with children with special needs, but children in general. I had even gone so far as to see if there were any papers on building rapport with children (which there are by the way, there are papers on everything) and asking parents what they do with children. Anyway, I'm fairly sure this will fade with experience with children, and I've hoped that my exposure with my nieces/nephews (ranging from 2-8yo) will help somewhat. But in no way do I feel ready to be a parent, haha - I personally think that's one of the hardest jobs in the world, full respect to parents juggling parenthood with everything else going on at the same time.

Seniority

Well, the 4th years at UWS have just started and we're on our second day of Conference Week 4 (continuing on from the three conference weeks in year 3). It's been a pretty hectic couple of days, and...

...oh, yeah, by the way sorry for not posting for 4 months, haha... I've been pretty busy during the holidays with all sorts of extracurricular as well as a family holiday, and now that I'm back it's going to be even busier than ever. 4th Year sounds deceptively easy because everyone makes a big deal of the fact that there are no end of year exams this year - but, thankfully, there's our massive barrier exam in the middle of 5th year, OSCEs at the end of each term, miscellaneous internet-based projects to complete, the end of year elective to plan, and the hefty schedules during some of the most intense terms during the course (paediatrics and obstetrics&gynaecology).

I therefore don't have much time to post, but nonetheless will try to post as regularly as I have in the past (admittedly not that regularly) - so once every month or so. I'm still astounded that this is around and will do my best to see this through the years.

Anyway, congratulations once again to the new UWS meddies! I hope you enjoy your first year and take advantage of all there is at UWS, not just academically but extracurricular as well. I feel that the university experience, especially in first year, is about developing academic curiosity, learning how to learn the university style, and making the most of your time with a group of fantastic like-minded people who are all smart and driven. First year is a relative cakewalk if you can adjust well to university-style studying, but also is a good opportunity to get some solid foundations down and explore avenues you may not have otherwise considered. Also, you may see me pop up at one of your first lectures!

I'll be back with more substantial stuff later on, I'm starting off with a group research project which we're quite excited to be working on (and hopefully publishing), which has been going quite well and is in an area I didn't really quite expect to be interested in - and also a research-void area of interest as well! So until later,

Its the end of the year, 'fore we know it

And just like that another year has gone, HSC kiddies have mostly finished exams, some University students have... and we're about to start our StuVac. Firstly, to those who have been keeping track of this blog, you may be scratching your heads as to how a post (the one just before this one) supposedly posted on August, somehow was not there in August...or in September, or in October.

Did you time travel?

Did the blog time travel?

Did the internet time travel?

Is time travel even possible?

All important questions, yes (and perhaps not, apparently there was a paper published regarding a theoretical proof against the possibility of time travel). But then how did it get there? Simply put, I was busy. So I actually wrote half of it in August, left it as a draft, and forgot about it until today, when I was brushing my teeth, getting ready to go to sleep.

Yeah, I'm a bit random like that.

Neither my toothbrush, toothpaste, nor bathroom are in any way reminiscent of this blog, medicine, or even an indication of something I've forgotten to do.

So it's the end of my rotations and the end of my first clinical year. Towards the end of my last surgical rotation, it was pretty cruise-y as we were placed in a different hospital, but needed to go to our base hospital for tutorials and such (which happened quite frequently) - and I had multiple meetings for various councils and committees which took up an annoying amount of time. The rotation was general/maxillofacial, but as it was all elective surgery that we had seen at our base hospital, and maxillofacial essentially consisted of pulling out teeth (and only one day a week at that), the surgery itself was rather uninteresting. I may have shot my own foot when I said that surgery was interesting in my last post - yes it is, but only if you're doing it. It's like the game of cricket.

Oops. May have offended a few people there.

Moving on...

So it's come up to exams, and just a month prior we had our third-year OSCEs. The biggest change from OSCEs of previous years was that there were patients with real symptoms and signs... something that shook things up a little! People found that they were running out of time with exams as their polished routine for the examination of a normal person was suddenly routed with the presence of a sign that needed further investigation. Of course, we all encounter that on the wards, but those are usually never timed, and fall in place with a nice, long, detailed 20 minute history. Personally I didn't run out of time, but fudged a few things, which probably reflected in my OSCE mark, which whilst was a pass was hardly anything inspiring. Probably a reason why I've forgotten about this and wanted to focus on studies...

It's much the same this year as the last - a short-answer question (SAQ) paper, an MEQ/SAQ paper, and two multiple choice papers. The content I'd expect would be significantly more clinical in orientation, but I still expect a good amount of pathophysiology and mechanisms, as opposed to definitive treatments. We had a formative exam which wasn't terribly difficult, so I think it should be good, as long as everyone studies. Did I mention that no-one has failed third year yet? No-one in the past two cohorts. So we're really crossing our fingers that our grade isn't the first to sport a third-year casualty. Given that fourth year does not have barrier exams (however I've heard of people failing individual rotations), passing the third-year exams essentially means a ticket to the final fifth year exams.

And then shortly after that, we'd graduate, become interns, and then be responsible for patient lives. Phew.

Back to now - study caps on, and I'll hope to do another post from the other side. To others doing exams or having completed them, good luck and hope your preparation pays off :)

Blood

I've seen a lot of it these past couple of weeks, as I've started my first surgical rotation. I remember I was fairly opposed to the idea of going down the path of doing surgery, for a variety of reasons - including rather pragmatic and practical reasons, down to the more medically related and life-path incompatibility that doesn't mesh well with a surgical career. However, I've vowed to myself to always remain open-minded and liberal to all persuasion relating to my medical career, so in I went.

So, what can I say? Well, for all you budding surgeons out there, I can tell you that surgery is what you imagine it to be - and more. My friends have said that surgery is really a "see it once, you know it all" thing - but I don't know if they are the owner of laser-sharp eyesight and a photographic memory, because I certainly can't see how I would know the procedure based on one scrub-in alone. I'll take the example of a laparoscopic cholecystectomy (aka the "lap chole", chole pronounced coh-li - you can Google what this procedure is), the bread and butter of general surgery, which by the way is not really general so much as abdominal. In one week, I saw two standard lap choles, two complicated lap choles with abnormal anatomy, and what amounted to removing an acute gallbladder - a massively inflamed gallbladder filled with stones and what appeared to be lots of gunk (a non-medical term, by the way). Each one was different, and each one was a learning experience for everyone involved - or those who were watching, anyway.

Amongst other operations I witnessed included hernia repairs (one of which was complicated and turned into open surgery), an abdominal defect repair (technically a hernia, once again, you can Google the type of hernias), and a laparotomy combined with a hemicolonectomy (open abdominal surgery, with the removal of half of the colon). The variety of operations combined with the sharp learning curve, the number of complications and variations, and even the organisational side (anaesthetics and operating theatre nurses) really broke the image I had of surgery being a rather repetitive job. When you then take into account the invariable changes in technology (laparascopic technology being quite a recent advance in general surgery, requiring surgeons to re-learn the procedure of gallbladder removal again), I think it's fair enough to say that the operating side of surgery will remain fascinating and challenging for at least as long, if not more, than the tasks of being a physician, radiologist or pathologist.

The other side to surgery was the pre and post-operation care of the patient. The ward rounds for our surgical team inevitably clocked in at under an hour, with many patients being seen for five minutes or less. When thinking about the ward rounds of the medical teams (generally lasting anywhere from 2-4 hours, but in some unfortunately busy teams, up to 6-7 hours), the difference was really quite stark. I found myself knowing little about the patients under our team unless I took the time outside of ward rounds and attending surgery to see them, besides what they came in for - and this disappointed me. I was somewhat pacified when one of my friends who is on our team (our team composes of the surgeons, a surgical registrar, a resident/intern and three medical students) sat in on one of our surgeon's clinics, held once a fortnight - there, the personal side of pre and post-operative care apparently flourished, so I am looking forward to attending later on in the rotation.

I also got the impression that surgeons knew pretty much everything about the medical side of their specialty. I don't know if it's just my registrar, who is brilliant and keen on teaching us, but he seems to know everything in the domain of the gastrointestinal physician, in addition to the detailed anatomy and procedural skills necessary - it overwhelms me when I think of how many hours they study...and then I think about how much I study right now, haha...

So I'll be back after my surgical rotations for another update, and then it's exam time! More fun and games for all, yay...

Another rotation flies by

Back after a month, and this time I've finished my Endocrinology/Geriatrics rotation, with the exception of a one week stint doing rehabilitation medicine in a linked hospital. The term was extremely busy compared to Cardiology - we had about three times the patient load of my old cardiology team; but somehow, we managed to have more coffee breaks! I never really quite got my head around that one. The rotation was essentially a geriatric one, with endocrinology clinics featuring some interesting cases of thyroid problems, acromegaly and carcinoid syndrome (!) which are quite rare cases indeed, and it was wonderful to meet these patients first-hand, who had a real can-do, positive attitude about managing their disease. Strangely enough, the team was also burdened with a rheumatology aside, which was all but inconspicuous to me until the very last day when I saw my first case of scleroderma.

This term was punctuated by AMSA Convention!!

AMSA Convention was at Sydney this year, and seeing as I really don't expect to have the time, energy or money to bother flying out to any conference/convention in the future, I thought it best that I attend it whilst it was at least here in my own harbour. I must say, it was brilliant - inspiring and engaging speakers from all sorts of backgrounds - working with the UN, Discovery Channel, media personalities, and authors from around the world. It is interesting to see where some doctors go after they finish their training, and thought-provoking (at least, for me) in considering the path we could choose when we would be done with ours. The afternoon workshops were also excellent, including the renowned Talley and O'Connor duo (who I fear must have been sick of medical students lining up to take their photo, impeding a quick exit from the lectern hall) and controversial neurosurgeon Dr Charlie Teo. The topics of discussion were at once filled with humour, reflection and practices within medicine, and it was certainly well worth the attendance. Finally, the inter-uni debating series organised at Convention were a great source of amusement, in particular the UNSW vs USyd match, which I felt fitting to have in the lectern hall given the sizeable rivalry displayed at the debate. Unfortunately, I only attended two days (no nights - wasn't feeling up to the night-time mischief that goes on whilst knowing I had to be back at hospital the next day), and so was not able to attend the Emergency Medicine Challenge or the other talks - but from what I heard, they were excellent as well. So, definitely a worthwhile experience - if you can, make a point to attend AMSA at least once during your course - and if you've been to AMSA Con before, I'm sure you'll back me up :)

Going back to the rotation business, I thought it pertinent to bring up an issue very commonly seen in geriatrics - the Advance Care Directive (ACD) and Not-For-Resuscitation documentation. For those who are unaware, this is essentially the decision of the capable patient, or if not possible, the next of kin, in regards to how much the hospital should intervene in the event of an arrest or decline in function. The two forms are not identical, as the ACD is more general and comprehensive, but both deal with making sure that what happens to the patient is what the patient wants.

The cynical observer may put forward the idea that ACDs save hospitals money and time, as sustain life artificially is an expensive and arduous task, as well as occupying a bed in Intensive Care Unit. However, as one may have realised already, ACDs are a way of ensuring that we deliver the best possible care to patients. At what point does intervention so reduce the quality of life that it is, in fact, causing the patient harm? There is no set-in-stone regulation answer to this question, and it depends on the patient's mentality and wishes. Thus, there is no better way to make sure that the patient and family are satisfied than to arrange plans for the time when there is no time to plan. The ACD also gives a good idea as to what is offered by the hospital, as most patients, upon entering the hospital system, have very little idea as to what happens within the system and what can be done in their case. Finally, I believe that bringing up the ACD and NFR status of the patient stimulates discussion of death and dying, good and bad ways of dying, and how this may affect the family. Since mortality in this life is 100%, we can only really control how we die - and medical treatment can help determine when we die, but not whether we die (at least, not at the moment or in the foreseeable future). Through observing the process of resuscitation, intubation, insertion of various lines and admission into Intensive Care Unit, it makes sense to me why many doctors in geriatric medicine tend to recommend NFR status and withholding of various invasive treatments, and the majority of patients and their families come to understand this as the most humane treatment of the patient.

It's the opposite of what many imagine a doctor to be - a life saver, a guardian standing between life and death, etc etc. The heroics are newsworthy, but the genuine compassion and care that occurs every day within the hospital and outside is far more important in affecting the population that come through the doors of hospitals. It's triggered an internal conflict, as I had found myself leaning towards Emergency Medicine for the patient variety, all-encompassing nature, and opportunity to impact the patient's initial management the most - but the most impressive work seems to be hidden away from that hustle and bustle, and I am definitely most impressed.

One down, three more to go

Just decided to pop back in, as I've just finished my cardiology rotation. The past six weeks have, in general, been pretty awesome, but it is interesting to see how people progress throughout the rotation.

As somewhat expected, towards the end of the rotation, people started doing things less. The number of students attending the morning 8am handover meetings steadily decreased. The number of students going home at 1pm (or earlier) steadily increased. And yet I soldier on. Woo, go me.

Cannulations are still tricky, my histories and examinations still aren't perfect, and sure, I don't think I'm ace at cardio now - but I've been encouraged by my supervising doctors, who have been brilliant in doing what they do and trying to accommodate us at the same time. Although we are exhorted to be part of the team and thus help the team, we're still a hindrance in terms of time - except when we do discharge summaries, which I actually haven't done since the fourth week, thanks to a very efficient resident that joined our team.

Whilst I'm here, for those who haven't got a clue as to who's who, here's a brief glossary of people you see in the hospital:

Intern - Post-graduate year 1 (PGY1) - they know the practicalities of being a doctor but definitely still need to be supervised. We actually didn't have an intern during our rotation.

Resident - PGY2 and above, aka RMO/MO (for Medical Officer) - good people to hang around, as they teach you many things.

Registrar - PGY3+, in a training program to become a specialist. These can actually be really great resources as well - the registrars I've come across have inspired and taught me a great deal. They're also quite up to date with details, seeing as they have to study for exams.

Consultant - completed fellowship of a post-graduate college; if they're not a staff specialist (i.e. employed by the hospital on a full-time basis) then you see them quite sporadically.

Nurses - come in a multitude of flavours; you'll mostly come across enrolled nurses (EN) and registered nurses (RN), as well as some clinical nurse specialists (CNC) and some nurse educators. They run the wards, love to let you try your hand at cannulas.

Allied Health - physios, OT (occupational therapists), speech therapists, social workers, pharmacists, dietitians - they're the main allied health professions on the ward and you see them very frequently. Important people, especially when aiming to discharge patients - which seems to be the main goal of the hospital.

Others - there's a number of other people, such as the ward clerks, jan itors, and of course the support staff at Blacktown Clinical School. Love those people ;)

So I'm heading off to my second rotation in Endocrinology/Geriatrics, they seem to be a lot busier than Cardiology, so I may not post back until the end of that. Meanwhile, apparently everyone has exams around this period - I would like to take this opportunity to say "SUCK IT!" - it's a rare occasion when medicine is able to trump other courses on workload, so I savour every opportunity that comes along.

On that note, I would like to reflect on something that's popped up quite a lot. There's obviously a great number of med hopefuls around Australia and even abroad, looking to study in Australia as a medical student. Over the last month or so, I've noticed a couple of situations where doctors begin to stress and agitate over the workload, physically and mentally, placed upon them. These are invariably the junior doctors (interns and MOs); we don't see enough of the consultants to observe anything like that (and anyhow, they've reached the end of the tunnel and are out the other side), and the registrars seem to be somehow dealing with it okay. However, to see the junior doctors with a vacated expression during a half hour lunch break, or to break down during ward rounds, or become frustrated with a difficult patient - I mean, we know it's not an easy profession to go into, but it still hits me hard. The overwhelming sense of everything crashing down upon you is something I've personally only experienced very rarely, and I don't wish it upon anyone, yet in the short space of a month I've already witnessed this. Support services for junior doctors are certainly an important aspect in this, but I don't expect that even brilliant support and continuous lobbying will stop these incidents from happening, it appears to be a part of the workforce - a 'just live with it' attitude. This is happening in a country where our health system is comparatively tame and standards, thanks to bodies such as the AMA, have been established to prevent burnout and, worse, mistakes being made - what about doctors in countries that aren't in these situations? The overseas-trained doctors that I've talked to all mention how Australia has beyond world-class standards for working hours and conditions of junior doctors - which makes me think what world-class actually means.

I'm no specialist in these kind of issues, so I don't really want to say anything more about this, but just thought I'd share this with people. A number of med hopefuls may also be members of forums or have talked to doctors, and have wondered, maybe, if the negativism that sometimes exudes from others stems from trying to prevent people from trying out to get into medicine and basically being self-serving by making out doctors to be messiahs and self-sacrificing members of society, of which no other profession comes close. I believe that it's not - it's out of a wish to open the eyes of those who have not had experience, and not to dissuade them, but, in some way, to encourage those who enter medicine to strive and work for what they believe in. To walk into medicine, knowing that these things exist, makes for a better student and a better doctor, and a better person, as objectiveness allows people to prepare for situations and make the best hand out of the cards they're dealt. I also want to say that this is not unique to medicine - I met recent law graduates who are undergoing the same thing; and in fact, worse - the attitude and culture is exactly the same; live with it. I've heard the same for business and finance as well - and especially important is the difficulty in hunting and securing that first job, which we thankfully do not have to worry about much.

So, we who are not working - enjoy, savour, treasure the time we have as students. For those who are living with parents, enjoy the fact that you only contribute partly (or, even not at all, as I did for the last couple of decades, I will admit) to the running of the household. Procrastination is fine, but use this time to grow in other aspects, find out where you want to go and what you plan to do, and be hungry to learn, not just the contents of your course, but skills and abilities that you want to pursue - because there is no better place or time to do it, than now.

And with that, I shall head off to bed - off to another rotation, and looking forward to it, the experiences and relationships with patients and staff I will soon acquire, whatever it may bring :)

P.S: The experiences I've mentioned do not happen every single day. Nor to every single doctor. In addition, everyone else is not immune - although I've yet to see anyone else besides the doctors in emotionally charged situations, possibly because I'm following the doctors around. And yes, they're true, I'm not exaggerating.

Keen as keen can be

I just finished my first week of my clinical rotation in cardiology.

It was the most freaking awesome week I've ever had.

The first couple of weeks in the first clinical year are where you find all the super-keen students; everyone itching to learn the mundane tasks of writing in notes in ward rounds, learning how to do discharge summaries and *gasp* cannulating patients! Except they are far from mundane right now; everything is new, and everything is exciting. Write in the next patient's notes? What a privilege! Asked to interpret the patient's ECG? Wouldn't miss it for the world! Want to hold the patient's charts? I could hold it all day and night!

Okay, so I'm probably just a little bit abnormal. But the buzz of starting the hospital rotations has not really left, and I sure hope it continues for a good few weeks. This honeymoon period is what I need to catch up on my laziness in the last couple of years, making it up by focusing all my efforts on learning what I need to understand to best understand the patients now under my team's care.

There are of course a few things that I've garnered from this first week. The most important thing was that I realised I would've benefited an enormous amount if I had exerted as much effort studying in the pre-clinical years as I am sure to do this year. This is, in hindsight, quite a difficult thing for me to have done because there was not really as much stimulus to study (i.e. no patient list to care for), but nonetheless, I keep thinking about all those hours gaming away and feel it's just a little bit lost. Oh well. This is one of the reasons why I don't like super notes (which are like condensed study notes produced by students in the years above) for PBL cases (and subsequently never used them); it takes away the (imaginary) patient's role in stimulating learning, and I think that is one of the key advantages to a PBL-centred course. It doesn't last very long, true, but I think that part of the reason is because classmates begin to use supernotes, so discussion begins to be a little bit hampered by the fact that, in essence, the PBL tutorials are rendered accessory and auxiliary. The second thing I realised was that it would be difficult to then revise all that pre-clinical stuff if it was never really absorbed well, since the clinical side has now taken over and many questions to registrars are along the lines of why or how questions, as opposed to the what. The third thing I've realised is that, paradoxically, I'm now playing more piano than I ever was. Random, yes. Applicable, well... I consider piano-playing to be a form of productive procrastination, like wikipedia (as opposed to, say, eBay, or watching toddlers pinch each other). So my procrastination (if any) seems to now take a more productive form. Which is a nice thing to happen. It's a phenomenon that many may experience throughout their periods as a student; the more pressure there is to complete a task in a limited amount of time, the more likely it is that the amount of time devoted to that task is increased. A rather curious phenomenon indeed - but something I'm going to take advantage of; 50-hour weeks are shrinking my potential study time by a good amount.

Oh, and I've still got extracurricular roles back at Campbelltown campus and UWS in general. Well, at least I don't have to cook.

The tension is palpable

Holidays have arrived, yay! And, for the first time in quite a long time, our break is actually longer than everyone else - since we started more than a month earlier, whilst everyone enjoys their mid-sem break, for us it's actually our end-of-sem break.

The last couple of weeks of MiC have crawled by rather slowly, as the promise of our hospital attachments drew nearer. The last weeks of an MiC attachment are a bit dreary - the excitement of change between the last attachment and the current one has dissipated, many of the tasks you set out to do may have already been accomplished, and generally there's a sense of staleness that you want to be rid of. It's not really dependent on the quality of the attachment either - it's just the nature of community attachments. One of our professors commented: "the things you do in MiC - it's not until 10,15 years down the track where you go 'oh...so that's what it was all about'". That's exactly the sentiment you get when you do MiC, especially if you come out from hospital attachments when MiC is second or last; the amount you learn in practical skills at hospital seems to dwarf what you absorb in MiC; learning about service provision is just not as exciting as doing a cannula, no matter how badly our School wants it to be.

To wrap up the term, we had a Reflection-week, which consisted of a couple of lectures and tutorials about MiC - most of it, naturally, regarding reflection.

As I write this, I'm reviewing this draft post that I was meant to publish at the start of the holidays, but it's now the end. The holidays flew by quickly, in part because of my various commitments outside medicine such as the clubs and societies at UWS, and personal ones dealing with family and things I hadn't done much in a long time (piano, poker, learning Mandarin). And now I need to fulfill my role as the family's chauffeur. Sigh... anyway, till another time!

Born This Way

The catchy dance-pop song by Lady Gaga has been stuck in my head for quite a while now. It's got a good verse, great bridge and and an awesome chorus - well, in my opinion anyway - my tastes are pretty broad but sometimes don't agree with many, heh.

I just want to reflect on the title of this song. The song is actually about being bold about not being born 'perfect' - specifically, in regards to homosexuality. I don't want to bring any discussion about religion and homosexuality, because I am Christian, but I don't believe in discrimination based on any reason outside of pure competence, and I don't support homophobia. But I digress; the main reason why I brought this up was actually about disability.

Over the past five weeks I had been attached to a disability service that caters primarily for school leavers (over 18 years old), providing them with a variety of programs that are mainly recreational in nature (such as team sports and reading) but also give an opportunity for these people to develop some important life skills. As far as is possible, the service's aim is to promote independence of it's users, through the development of a person-centred goals plan and the constant follow-up of the progress made in these goals. Goals could include learning how to make a cup of coffee, using the internet and learning financial skills.

For the majority, it is realistically unlikely that they will achieve full independence - but the progress they make is remarkable, and in some cases, independence is a reality.

What is interesting is that these users have profiles on them, with data and information about them collected through the years at the service, or if they are new, supplied through their parents or carers, as well as their previous school. These profiles begin with the user's name and date of birth, followed by their medical condition, then other details.

The medical condition means next to nothing.

Each individual is so different, and these 'labels' box them, in the common mind, into a stereotyped behaviour expected of them. An example is a young woman who has Prader-Willi Syndrome; they are known for their inability to resist eating anything and everything, but this woman displayed none of this behaviour, and through five weeks of observation, I saw no efforts whatsoever to obtain more food other than what was already prepared for her. Another is a young man with intellectual disability who nonetheless has a gift for drawing comics and loves Japanese anime - we had quite a lengthy discussion over several days about Naruto, which eventually tired me out as my suspension of belief and immersion was not as deep as his.

What is wonderful to see is that every single user at this service is happy and satisfied. Their quality of life is greater than what many 'normal' people experience. The day begins with everyone streaming into the centre, greeting fellow users and staff alike - and in the case of one young man, doing so with quite intricate handshake combinations - and heading into their programs, which are group activities of 3-10 other users. The rest of the day is spent in the above mentioned recreational activities and working towards their goals; and at the end, the day is over, people leave to go to their group homes or are picked up by parents, and everyone looks forward to coming back the next day. The goals plan helps to ensure that the users are not being stagnant and just 'going through the days' like many people may.

Kudos has to be given to the staff as well; it is an enjoyable job but it is tiring and at times difficult. I'm not one to romanticise everything, and this place has it's ups-and-downs - unpredictable behaviour leading to assault and abuse, as well as anger and absconding (leaving the program without letting staff know), and other unpredictable events - these are not common experiences but are nonetheless present, and strategies exist to deal with these because they happen. The staff there deal with this marvelously and are, like many sectors of the health sector, often understaffed in their programs, and do the best they can for the users.

For sure, this attachment has certainly broadened my horizons significantly. I've not really been in contact with people with a disability, so by the end of the five weeks I felt a lot more comfortable with those with a disability, as well as having obtained a wonderful learning experience about disability, the people it affects, the service and how it is accessed. It can be a bit intimidating at first - we had an orientation day when we started and were joined with several volunteers; by the end of our fifth week, I noticed that one of the volunteers was waiting outside, and so struck up a conversation; it turned out that he felt too overwhelmed with dealing with so many people with a disability, so instead of being on the programs he raised this with the staff and felt more comfortable in helping in an administrative capacity - and so was contributing to the service through this way. I think this is quite valid (well, perhaps not for us as we were there primarily to learn) and important to realise - that volunteer efforts in a service based around a single focus (such as Doctors Without Borders) often can work wonders in supportive areas of the organisation requiring just as much help as the frontline.

So it was with a sad note that my partner and I (two of us were at the centre) had our last day, bade our farewells and promised we'd do what we can to visit again. And so in our sixth week of the Medicine in Context rotation, we split up, get new partners, and spend another five weeks in another attachment - for me, a mental health service. I guess once I've finished up with that, I'll report back - but hey, it's pretty hard to top this :)

And off we go!

I've got to say, the standard of teaching seemed to have increased dramatically from second to third year. That, or my attention span increased as well, because there were few times when I actually caught myself not paying attention - which was just as well, given the important details that we covered over our first Conference Week.

Conference Week was not as crazy as I first imagined; we did get breaks for lunch and there was a good balance of workshops (small group and practical learning) and lectures. The workshops were overall a fantastic experience - we covered lots of practical things from reading ECGs and X-rays to revisiting resuscitation, physical examinations and oxygen marks, and definitely were the highlight of the week. The lectures were overall pretty great as well - interesting and important stuff on managing fluid levels, suturing, communicating with Aboriginals, and shock, and filled with case studies to increase clinical relevance - the only ones which I thought could be improved were the cardiac lectures, in which a lecturer was droning on and on, reading off slides. Which brings me to another good aspect of the conference week - the last half-hour where our Year Co-ordinator hosted a feedback session on everything done in the conference week; great to hear the whole grade (in one of the rare times we're together) chip in on what could be improved and what should be included, and an excellent demonstration that the School held our feedback in high regard.

In contrast to the brilliance of Conference Week, O-Week for the Medicine in Context (MiC) students (i.e. me) wasn't so flash. Maybe it was because we had, in effect, two days off (one day, as you know, was Australia Day; the other was a 'call-your-MiC-supervisors-day'), or maybe because the E-learning lab that we were in was freezing (I brought a jacket with me the next day, people that saw me on the train probably thought I was crazy because it was so hot, even at 9am). Whatever it was, it wasn't as inspiring as the Conference Week. Nonetheless, there were some key highlights - a seminar on Child Abuse which was very well delivered and gave us a lot of new information, presentations by a fourth-year student on MiC, and a rather amusing session on grammar and the use of apostrophe to indicate possession (in amongst how to write academically, of course - grammar was not a lecture by itself). These were the only real gems I could remember from the week, however, as the remainder was about library resources (an important thing to know about, but rather droll and not as informative as we would've hoped - there was also another session on this in Conference Week), and why MiC was so great. The consensus opinion seemed to be that they could've packed a lot more into this week for us, as the students starting Medicine and Surgery rotations were going right into their teams from mid-day of the Monday of O-Week.

These couple of weeks, I was also hard at work co-ordinating O-Week efforts for Campbelltown campus. The student society at Ctown, Engage, finished technical details with setting up a web presence (at engageuws.com.au) and so I was busy updating that and working out details in our forums on Australia Day. We also had a couple of meetings to determine activities for O-Week, and I also had the UWS Chess Club (which I also run) to concern myself with. Both of these (and the Chair position I have with the student union) will be dropping off in the next couple of months, as I cannot see how this is very sustainable; but it's still an exciting thing to be part of, and if I could go back a year, I wouldn't have changed a thing. These efforts, though, conflict with me reading a 70-page document on guidelines to treating hypertension. Which is rather droll, I might add (and you might expect) - and which I should be finishing off now. These two weeks mark the end of the orientation, and so for the next ten weeks I'll be on my rotations for disability and mental health respectively - and am looking forward to learning a lot more about the services that cater for these tremendously important areas of health. So, until next time :)

The starting gun is loaded

I'm now only 6 days away from heading into third year, and am definitely excited about what's coming up ahead! Bought Oxford Handbook of Clinical Medicine (OHCM) after finding it at the cheapest place possible (on Abebooks.com for $33) and am voraciously reading it whilst waiting for mum to finish grocery shopping. The only downside of getting your P's (driving licence) for me was suddenly becoming my mum's chauffeur, and considering it's the holidays, she believes my main priority is to make up for the past 10 months of not contributing to the house - i.e. driving her around. So OHCM is my way to whittle away the wait... also got an ipod shuffle for Christmas, which I've loaded some New England Journal of Medicine (NEJM) audio summaries on for some bedtime listening (or alternatively whilst jogging).

Turns out that that was pretty much the extent of my study this holidays. I finished reading a book on clinical decision making, but only because it was interesting and only a couple of hundred pages; borrowed a few other books and haven't really made much headway. So I guess I've had a pretty relaxed holiday, which is good - considering how rare holidays are going to become. Took up some more exercising, as well as piano (after practicing for a month, I still can't quite get the Pirates of the Caribbean theme 100% correct yet), which I've neglected for a long time - presumably, due to studies (...not really).

I probably haven't discussed third year in much detail before, so I'll just give a little bit of a rundown as to what I'll be spending 90% of my waking hours on this year (psh, actually more like 50%, need to account for time spent doing very unrelated-to-med things). The year is essentially split into three 'semesters', which are each split furthermore into halves (hence, six 'terms'). The semesters are known as Medicine in Context, Medicine, and Surgery.

Medicine and Surgery are pretty self-explanatory; they are both hospital-based, and as you would expect, in Medicine you would be joining a medical team (e.g. gastroenterology, neurology, geriatrics, other fields of medicine besides surgery or general practice) and expected to both learn and pull your weight as part of the team; whilst in Surgery, you would be joining a surgical team (in third-year, this is mainly general surgery, but depending on what you were allocated, you may be joining a vascular, maxillofacial, orthopedics or other more specialised teams in addition to general surgery) and expected to be on time to scrub in (get ready for the surgery by taking surgical sterilisation precautions) and to learn.

Medicine in Context, which is the semester I'll be doing first (in order to spread out resources evenly, a third of students will be starting with MiC, a third with Med, a third with Surgery, and then rotate), the week is divided into a one-day-a-week General Practice (GP) attachment, a three-day-a-week Community Organisation attachment, and a "reflective/presentation" day (Fridays) which seems to be either a go-back-to-campus day or "free" (read: they want you to study) day. In regards to the Community Organisation, this is an organisation which deals with the related elective or subject that you have been allocated (although I say allocations, you are given a preferences list to fill out), which for me will be Disability and Mental Health, my first and second terms respectively. Each term is six weeks in length, and each semester begins with a conference week, which as mentioned before, is essentially a week filled with lectures.

The GP I'm going to be attached to is very close to my house (about 3-4km) so I'll be looking to cycle there and back; my Disability organisation is also fairly close (about 8km) so that might be possible to cycle there as well. This is probably one of the big changes between pre-clinical (first and second years) and clinical years for me, as the return trip has literally dropped by >80% from 3 hours to 30 minutes - which is nothing to sneeze at. However, an equally big change is going to be the largely reduced amount of time with the rest of my cohort, as conference week is the only scheduled time for the whole cohort to meet; half of the cohort is in the south-west whilst the other is in the west/north-west; and a third of the cohort will be not in hospital the majority of the time (the third that will be doing the Medicine in Context rotation). Also, I don't get much time to get to know the Malaysian students, since they'll be at Campbelltown whilst I'll be an hour-and-a-half's commute away - which is kind of sad; in addition to the people from my cohort last year who won't be in my cohort this year (Medical Research degree, deferring, repeating). On the upside, I'll be spending a lot of time with a few people, which hopefully means I'll get to know them a lot better - my main partner for this year I barely know, so there'll be plenty to cover in the downtime.

So, it's time to ring up my allocated organisations, get ready those notebooks and prep my bag for what should be a very interesting year! As always, I'll try my best to keep posting during the year - still amazed that it's still here after two years, my longest blog effort ever haha...

The wonderful feeling

of passing second year. Let me describe the scene, blow-by-blow, as we take an instant replay on the event that unfolded. In the bottom-left corner with the blue gloves, weighing 52kg and raring to go, is Ruke. A scrawny, inexperienced and desperate fighter, needing to win this bout or hell ensues at home. In the top-right corner with the red gloves, are second year exam results. In their past matchup, the fight ended with a last-round TKO to give results the win, so this promises to be a tight one. The referee was nowhere to be found.

The bell rings, as the two fighters both approach each other in the centre; Ruke feels the nerves, as the clear underdog of the event, with much to lose and win this match. No matter, he is a determined fighter, and quickly takes the upper-hand with a left uppercut (OSCE) to the chin! The results stagger back, clearly maimed but hungry for blood, bouncing back and throwing a quick 1-2. Ruke dodges and fires off a right hook, only to be evaded and rewarded with a left hook (MEQ) from results! Stunned, Ruke takes a moment to recover, and quickly puts up his hands to defend from another onslaught. Taking his time, weaving and evading throws from the opponent, he waits, sees an opening and goes straight for an undefended chest (SAQ)! Brimming with confidence at the pure luck of the blow, he barrels in the punches, raining them on his helpless foe (MCQs one and two), and sends those results on the ground! He can't get up! It's all over! Ruke, stunned by this unlikely victory, passes through the next round (third year) - sure he's got a few grazes and a half-dozen broken ribs, but the grin he's got is showing no signs of the damage! Over and out!

So, yeah. I annoyed many a friend through my rather irritating commentary, complete with faux commercials and sponsors, and it's clear I probably don't have a future in writing. Nonetheless, nothing beats the feeling of getting through to next year - second year is in my opinion the worst year of the course, difficult yet not really in clinical stages, with comparatively little clinical contact compared to the years ahead. So third year, here I come!

Conference - Where kids can come to act smart

Only a couple of days out from finishing with the last of exams for this year, I was celebrating hard-stylez by attending the wonderful Victor Chang Cardiac Research Institute conference titled "Charting the depths of RNA". I must've been off my head or something, but I was really quite keen to attend this, listen to some awesome international speakers and generally learn something new. Once again, the experience of this conference was quite similar to the ISAN experience I blogged about more than a year ago; this time, without the good night's sleep, thanks to several friends (who don't do med) kindly playing Trivial Pursuit at my place till 1:30am - although I should be also to blame, I didn't have the heart to kick them out earlier...
At any rate, the conference was quite interesting, if you were a researcher in all the new and wonderful types of RNA around - microRNA, snRNA, and some other RNA's with small-letter prefixes that I couldn't remember. For the average medical student (and I didn't spot many, most seemed to be science students), it was next to useless, with perhaps the very interesting exception about novel therapies for Duchenne's Muscular Dystrophy (one to look up if you don't know what it is) and other clinical applications of microRNA. This was more focused on the variants of RNA rather than the old regular RNA that you read in the textbooks - it seems that, for the last few decades, we've getting it rather wrong and have not realised the importance of these microRNA things, which do not contain genetic code to translate into proteins, per se, but instead modify expression of regular DNA. A prime example of why this was important was given in the introductory speech by a Head of Science in UNSW, whereby it was noted that the number of DNA genes that coded for proteins (what we focus on in med school) did not necessarily correlate with complexity, but the number of genes not coding for proteins and instead doing something else, DID correlate with complexity - i.e. humans had more than, say, the fruit fly. This, I thought, was a rather succinct point which helped me concentrate through the first couple of talks, then fall asleep at some of the others and generally lose focus. The technical detail in the conference was enormous, and most of it went right over our heads (went with a friend, who was equally keen on this), but it was an interesting experience nonetheless.
The food was of average standard; to me, a rather undistinguished eater, the party meat pies were the most delectable, followed (by a long way) by this random ball of what tasted like cooked self-raising flour (with no eggs or milk), and then some rather unsavoury sandwiches. But hey, we didn't come for the food. Another aspect of the conference were the sponsors, which were very nice people - they handed me pens (they should upgrade to BIC promotional pens or something, pens aren't much good if they can't write), much needed Post-it notes, and even a thing that blocks out light from your eyes when you sleep - can't remember what it's called, unfortunately. That was a fun part of the conference.
In all fairness, as I stated above, I thought it was a great conference for those involved in the field. For us, the relevance is still there, but the clinical talks were few and far in between, it was very clearly pitched to scientists, as they were revising how the heart worked in one of the talks on Atrial Fibrillation. In contrast, they glossed over the basics of microRNA and did not mention the basics on the techniques used to extract RNA and assess it. Overall, I thought it was a good day out, a nice way to celebrate the end of exams, and a great way to give you a headache were you unfortunate enough to try to pay attention whilst not knowing what in the world microRNA was.

Summer times!

So, a couple of days ago, I finished with exams, hoorah! The actual exams were a kind of mixed bag...once again, an SAQ (Short answer questions - marks ranging anywhere from 1 through to 5), MEQ (Mini Essay Questions - generally short questions based on a scenario, in total worth 10-20 marks per scenario, 7 questions), and two MCQs (Multiple Choice Questions - yeah, I'm sure you're all more than familiar with them). Found the SAQ and the last MCQ difficult, MEQ and the first MCQ bearable but only slightly - which hardly raises my confidence levels, but what the heck - its OVER! Celebrate! *party poppers!* *streams of paper cover the room* *smiles all around*

Shame we had such a party pooper for our main supervisor in our last exam. Was really rather strict about no talking after the exam... I know, that's what is meant to happen, but it is nice to smile around, mouth "how did you go?", mouth back "omg that was so hard" and grin without being scolded for it.

At any rate, with the holidays now here, endless opportunity abounds. I could continue to learn guitar, start learning mandarin, maybe read some medical journals or finish summarising Boron... or continue dreaming, continuing procrastination methods, starting new games. Hmm. Endless opportunity... I would like to be optimistic these holidays, and believe I will at least moderate the two extremes and meet somewhere in the middle, like the good negotiator I am now supposed to be after intense training in student politics. I guess one can only simply start doing it rather than think about it, since thinking about it rarely leads to anything productive (for me, it leads to a game of minesweeper - reaching the 100 second mark on expert btw). Speaking of student politics stuff, these holidays will most likely represent my only significant chunk of time I can dedicate to it for this and next year; I'm getting the feeling that things like extracurricula are going to have to take second priority and be slotted in amongst the clinical attachments, which is probably a feeling amongst almost every full-time worker in the workforce; that everything seems to take second priority after work. Mulling on this, things like a family and religion may become difficult to maintain, and time management is really a rather critical thing to learn when young; when you hear statements like "your most precious asset is time", you think "hey, that makes sense, I agree!" but in real life I think that I, personally, forget about that, especially when procrastinating. Value your time, for it only comes around once...

On a more interesting note, I've just got wind recently of an exciting new project happening at UWS! A person that I'm working together with as part of the Campbelltown Campus Life Committee (mostly UWS Staff, and the sole student rep, me) is heading a new inter-professional project, whereby students of different professional pathways (Occupational Therapy, Physiotherapy, Nursing, and of course Medicine - with a few more maybe added in together) are mentored by professionals of their own chosen pathways, as well as of others. The goal of this project is to foster holistic, integrated and thus (hopefully) a better standard of healthcare in our future professionals. I'm not entirely sure as to how much I can reveal, but essentially, the sessions of the project would occur in an integrated clinic that already exists, whereby clinicians take up students and guide them to facilitate the treatment of real patients, rather than be a wallflower and observe passively. This is the most exciting thing of this development - more clinical exposure, to better prepare us for the future! A friend of mine commented on how this would have been great if it were introduced earlier, seeing as my cohort will be in full-time clinicals next year anyway; but nonetheless, it will most likely be a wonderful opportunity for the future students at UWS. Hopefully it goes to plan and produces some positive results!

Anyway, I hope you have an awesome break, especially those of you who've just completed the wonderful journey that is secondary school, and I'll see you around!

Busy as a bee can be

As one may have noticed, my rate of posting has really, really slowed down. I guess it's inevitable thing that happens as priorities pile up, and I've noticed the same goes for computer games and watching TV series - all huge time-wasters that eventually have little to no place in my life anymore... for once, I'm seeing some truth in the stereotype that games are for kids, the adult's life seems too busy to regularly follow the games scene, especially since it is so fast-paced.

Anyway, third-year placements came out just a few days ago. I'm especially thrilled because not only do I have the closest hospitals to my home possible (Blacktown and Mt Druitt) but also because the rotations that I got happened to be amongst my top preferences! For those who don't know, UWS' medical degree from years 3-5 is essentially full-time clinical rotations, which involve you being attached with a medical or surgical team for the large bulk of the year, in the hospitals; with some time being given to other types of attachments such as Medicine In Context, which I'm still not quite crystal clear on. So yes, this means that second year already marks the end of our "university" university experience; I recently attended a friend's 20th, which was surprisingly lavish for a 20th - one of my other's friend's speeches remarked upon the idea that the party was so lavish because it was the last year our grade would be together as a combined cohort, and I suddenly felt quite moved. Yes, we will see each other during conference weeks (epically long days of lecture after lecture for a week) and in hospital, but not in the frequency as we do at the moment. I guess it was appropriate, then, that the party had quite a 'year 12 formal' feel to it.

So, I'm only two weeks away from our summative OSCE, one day away from an event I'm co-organising as part of the student union, and a few days away from a week-long sports event that a student collective at UWS Campbelltown is organising. Oh, and if you're curious, we made a promo video for the week: Inter-Society Sports Week on Youtube. Busy as a bee can be, you see.

A clinical focus...

So, over the last month or so, me and one of my good friends have decided to stay back after our compulsory ICM (Introduction to Clinical Medicine) tutorials with our awesome doctor, who kindly agreed to letting us tag along for the remainder of the afternoon. Over the weeks we've decided to make this permanent, since we've actually been learning a lot and getting significantly more patient contact than if we just sat on our bums and let all our clinical experience come from our ICM and PCS (Procedural Skills) - a total of 3 hours per week. In addition, the last few weeks have been difficult in terms of integrating the content of ICM tutes and patient contact, as we've been doing all the sensitive topics - the reproductive system and other things like illicit drug histories; so we've only had a couple of patients over the 7 weeks we've had of this semester. A few events that transpired today were quite noteworthy, and I will remember for as long as I live: (a) I was walking out from the hospital after ICM with my friend when I turned my head casually, just looking around, when I noticed a lady lying on the ground, spread out with a car stopped a few metres behind her. Fearing the worst, my friend and I rushed to the lady, who did not in fact get run over (and in this situation I was quite perplexed, for I was sure I didn't hear any screeching or noise generally accompanying a motor incident) but instead was lying down as a protest, determining not to budge as she didn't get the medication she wanted from the docs. I never really followed up on this, as another lady who she knew got her back up and convinced her that this was not the right way to go about it. (b) I was on ward rounds when, a few metres away, there broke an altercation between a patient and her doc, the patient demanding to know why her medication was reduced. The doc tried to explain but was probably a little bit tired or somewhat out of it, accounting for her snappy response and not as-friendly-as-demonstration-doctors-in-teaching-videos are, resulting most probably in.... (c) a MET call on the same ward; at the time we (my doc, a resident, my friend and myself) were attending to another patient in a different room; it turned it out that it was that same patient who probably did not receive a response she quite liked and decided to protest against it by trying to hang herself. From this, I saw first-hand the lessons of PPD (Personal and Professional Development) which included the fact that (a) docs can be snappy, and because of this, could lead to (b) an emotive, distraught patient doing things that are not good for themselves or anyone around them. Reflecting on this, amongst my friends and those who've met me, I'm often considered a very even-headed person who is slow to anger and is generally helpful; but I know that, especially in times when I'm exhausted, I become really apathetic to anything not concerning some shut-eye, and I don't know how or even if I can prevent that. Something to think about, perhaps.

In another related thought, I've started to see myself less of an annoying medical student and more as a part of a healthcare team. The ward rounds have somewhat impacted this shift in attitude, but in addition to that, one specific thing: me and my friend (yes, the same one; we're good buddies, hehe) were on our own, going to interview an elderly patient. Only a couple of minutes into the interview, the patient suddenly displayed signs of distress due to some chest pain. Whilst my friend went to get a nurse (as the patient said she thought she had heartburn), I went into autopilot, doing a pain history just to make sure it was really heartburn. A small and insignificant event, you say? I agree as well, but I think that helped me remember the whole point of being a medical student; in the midst of the studying, the shrieks of disgust when viewing rather horrendous skin diseases, the procrastination and the enthusiasm of discovering new differential diagnoses, I often forget the "medical" part, and I just feel like a uni student, studying to get good grades, to pass and hopefully do honours. Stuff like this makes me feel more relevant when talking or doing exams on patients, and less like a really useless accessory walking around the wards with nothing to contribute.

Die, Procrastination, Die

*swish* *slash* I stand valiantly as I parry and thrust my sword against a formidable, though familiar foe; one with whom many of us know well and share a decidedly love-hate relationship with. The foe's name is Procrastination; and my sword will be self-control. Unfortunately, this sword has been broken and splintered numerous times in the past, and when in one piece, has often proved to be a rather blunt object, bruising this thing that I face, whilst not entirely doing any real damage to it. So today, I've decided to sharpen this weapon with the promise that I shall only use the internet for recreational purposes on two selected days of the week, spaced out as Thursdays and Sundays. Why? Well, because they are optimal days in which less time goes by without me checking my inbox, which could be disastrous, if say, something was going to run next week and I had no knowledge of it. Sundays will cover any weekend communication in preparation for the week ahead, whilst Thursday will be the mid-week fix to make sure all is well and right in the outside world.

Shall this work, I will thus tame an animal which has hounded many before me who have been unable to rid it from their existence. This animal can never be vanquished completely; in fact, I think that a little Procrastination tends to make life more colourful and less monotonous. However, this wild beast tends to disrupt any long-term goals, and thus I think this endeavour is a worthy one which I will strive to succeed in.

This includes this blog, although I haven't been writing in this very often anyway, so this should be least affected. So, no real loss to you guys.

Well, I thought that this would be an interesting thing to document. I only wonder; will I in my later years, reflect upon this post with sadness and regret, or with fondness and appreciation (of my former self)? Only time will tell...

So, what did I learn...

Results for Semester 1 exams came out today, amid much anticipation, following the non-graded Y (which stands for 'Yes') grade I received previously, which meant that I would be continuing to next semester. This anticipation quickly turned into a more sombre emotion as I scrolled through my results and found that I failed half my exams - two out of four; one by less than half a percent, but a fail nonetheless. In UWS, you can only fail three exams in the entire year, even if your average score is over 50%, which I admit sounds fairly reasonable. But right now I think I'll need all of this leeway to get myself through this year and start clinicals.
I came into Year 2, Semester 1 with optimism; although previous years warned that this semester was difficult, I was, or so I thought, prepared for this difficulty; I saw it as simply a slightly larger obstacle to overcome. So naturally, I am sure I spent more time studying this semester than last year, and so expected a slightly better result than what faced me today. Thinking about this in a more rational manner, it is obvious that I must have underestimated the difficulty of the exams, overestimated my effort, and should have done a few things differently.

First, I can hardly blame the school for marking too hard, as the cohort statistics were published and, although, as an entire cohort, we slipped (a fair bit), my personal results slipped significantly further. This indicates that my result was personal and so must have reflected personal achievement.
Second, I didn't attend as many lectures as I did last year, and also paid less attention in labs and in PBLs. Anecdotes are given of hero students who cram in two weeks before exams and pull off Credits, but I'm of the opinion that these hero students could have been right at the top of their grade, had they bothered to put in the effort. And for a more average student like myself, not attending all the lectures really does make a difference. Something to correct for this semester. As an observation, overall attendance rates for lectures seemed to dip quite a bit this semester as well.
Third, I must find a more efficient way to study. I doubt this will come easily, but I think going back to handwriting may prove more effective, to reduce any distractions and to help retain memory.
Fourth, exam technique still applies in Medicine. I chalked my relative success in anatomy last year to online quizzes with photographic images and familiarisation with cavaders; yet for some reason, this semester I went back to learning straight off anatomy textbooks, which covers basics but isn't a good way to prepare for exams such as anatomy spot-tests; rapid-fire tests that you only succeed in when you are an expert in real-life anatomy. This probably traces back to studying earlier and more consistently, since I found myself still learning a couple of days before exams, which caused loss of quick recall of the anatomy learnt months ago, as well as inability to quickly recall the newly-crammed material due to a sense of overwhelming doom accompanying the names of hundreds of different structures.

This year, I'm still aiming for an overall Credit; which means I will most probably need to hit a Distinction average next semester. This nearly happened last year, but on reflection, I think I can do better without trying to suddenly become a hermit. Second semester starts in three days, and I'm actually quite excited to get back into it. Nothing beats crappy results better than a dose of optimism, a sprinkle of hindsight, a tablespoon of objectivity and a generous helping of get-back-into-it.

A well-deserved break

Well, my exams have finished, so I'm back. And what a better way to welcome me back to Blogger than the announcement that I have 4 spam comments to be moderated! Such a comforting thought, to know that these people are bothering to attempt to spam this blog with advertisements for chinese webcam sites and whatnot. But anyway...
My mid-year semester examinations were comprised of four papers; a MEQ (Multiple-Mini Essay paper), SAQ (Short-answer), MCQ (Multiple-choice) and an Anatomy Spot Test (the second one so far, we had one in semester two, last year). Suffice to say, I believe that this time around, my marks compared to last years will be lower, despite putting more effort into studying; the role with the student union has actually made me more inspired to study harder, paradoxically. The exams were quite a mixed bag in my opinion; the MEQ and Spot Test were filled with things I managed to only gloss over in my study (although entirely my fault, an example of this was not covering Chronic Renal Failure enough whilst covering every other pathology of renal disease possible; and knowing in great detail the structure of bones for the spot test which was never utilised), but to balance things out, the SAQ and MCQ had quite familiar questions which were answerable. The MCQ was a special test to note, since we had two sessions that were essentially filled with practice MCQs that could come up; once again, the number of MCQs repeated from previous years was a significant number; to the extent that I would confident in saying I would expect no more than single-digit numbers of people failing that exam. Essentially, if you were to memorise all the practice MCQs given out, and guessed the remainder, then assuming you have a 1 in 4 chance of getting those guessed questions right, you would be very, very, very close to passing.

I don't think that's necessarily a bad thing; in fact, I don't think failing future doctors on whether they can recall every detail of a cellular mechanism so they can find the answer that is INCORRECT, is essential, in this stage. Yes, doctors are responsible for people's lives, but at this stage, we're still medical students in pre-clinical years, and performances in OSCEs and the results of clinical years are more important. Regardless, it is one exam and shouldn't make much of a difference in the overall scheme of things.

Post-exam period mood: Nonchalant. Once again, the post-exam feeling of "I feel like I should be studying but I don't have to" has settled, and I'm inclined to start studying for next semester, although I feel like I may want to wrap up last semester with a nice concise book of notes. These holidays are going to be a bit different from the last ones though - now that there aren't any exams, it's full throttle to student union and general university affairs, as well as more personal ones like preparing to take my P's test (provisional driving license - i.e. license to drive unsupervised, for all those non-Australian/non-NSWers reading) and finishing Big Bang Theory. Also on the agenda is sleeping more, eating more, and exercising more; very important things that I didn't get as much of as I would've liked to during the exam period... speaking of which, a siesta sounds mighty alluring right now. Time to nod off..

This is shaping up to be an interesting year.

As an update on the UWS student union elections, I was voted in as the Campbelltown Chair for the 2010-11 period. I think this year will be very interesting; both on campus and personally, as I figure out how to balance studying for medicine and aiming for at least a Credit (I want to do Honours, not for the additional letters on the end of my degree, but rather the experience; I don't really mind not being awarded an Honours afterward if I don't meet the 5.5 GPA requirement), whilst doing my best involving myself with student life and organising activities on campus. I often wonder at how students like Ross Roberts-Thomson (AMSA president) manage to balance their own learning process and such a huge responsibility like that position; in a sense, I hope this chair position for me will teach me time management skills, as well as prioritisation and drifting away from procrastination.

Speaking of which, I've found recently that my interest in computer games has dropped, compared to last year. It's something about the countless hours essentially wasted on a game that really got to me, as I realise the importance of other activities. In my view, even movies seem more of a worthwhile time-waster than games, with an opportunity to discover something new, something hopefully thought-provoking. Issues like religion and politics are starting to take huge chunks of my dedicated 'wind back and relax' time (no, I'm not insane, for me these are genuinely relaxing topics), and I'm finding that it's helping me mould my views on the world, hopefully for the better.

I'm toying with the idea of moving on campus next year and going to Campbelltown Hospital; the idea of moving away for a while and learning essential life skills (I know the basics of ironing, but it still takes me 10 minutes to iron a shirt well) is attractive to me; unfortunately, the cost of obtaining said lessons is not so. Moving onto residence may help me continue to be involved in campus life next year as well, even if not as a chair. Oh, so many thoughts, so little time.

In the meantime, whilst my mind is rattling off somewhere in the great beyond of next year (my mind tends to do this at most inopportune times; I have an amusing navigating story that I shall unravel later), exams are only 3 weeks and 5 days away. This has been the busiest semester so far, and once again, it will be interesting for me to see how much I can learn, re-learn and summarise in this relatively short time. Since there are still PBLs going on, my study would most probably be hopping around between renal and neuro, in addition to completing my part of a group EBM (Evidence-Based Medicine) assignment and finishing my week's PBL notes for my group to use as study material.

Should get off Blogger and start studying, shouldn't I?

Life is moving at a fast pace...

As we reach the half-way point of the first semester of year two, I'm starting to feel a little overwhelmed by the amount of effort required to do well in Medicine. I know that the upcoming years will be tougher than this year, with a full-time 9-5, 5 days a week attachment and intense Conference weeks filled with lectures, I can't help but feel a bit apprehensive that if I'm lagging behind now, I will be lagging behind in future years. In the space of eight rather short weeks (in my opinion, they flew by pretty fast), we have covered both renal and musculoskeletal systems. At the moment, my knowledge on musculoskeletal is close to nil, and I'm brushing up on my renal block now; and to help things, we just started neurology. I guess it's just a tiny worry, but it's a worry nonetheless, and I guess I've just got to keep at it. Good thing I'm finding all of this interesting (well, maybe not the renal), but still, it's a heck of a lot to keep track of - indeed, I didn't expect musculoskeletal being only three weeks in length; there's so many tendons, muscles, parts of the bone and functions of the whole system to learn! I'm glad we have mid-sem breaks not combined with Easter (that gives us, effectively, an extra day), and we don't have any mid-sem exams (definitely felt good last week walking around the university and seeing everyone heads-down).

I think that me and my mates playing Starcraft at every break is hardly helping the issue either. Or that we now have a Starcraft club. Oh what have I got into...

The University Experience

I'm not quite sure whether this is the phenomenon in other universities, but for us at UWS, our cohort in medicine tends to be pretty friendly but also insular and exclusive to our own cohort. This may be due to various factors, such as different starting dates of our course versus other courses in the university; the geographical proximity of the rest of the university from our building; the self-sufficience of our totally awesome building; or simply that we can't really be bothered extending ourselves socially to the rest of the university when we seem to have no reason to (after all, having 400+ potential friends to meet and greet is quite enough). Thinking about how 'student life' is promoted so heavily as a strong point by my friends who attend other universities, I can't help but see that my own personal view of UWS as a university without much 'student life' could simply be due to my own indifferent attitude to involving myself in it, and thus, having no idea as to what could be either offered, or initiated. As a comparatively young university, with a comparatively young student union (after the last one went insolvent...), I see the 'lack' of student life as an opportunity to innovate, to be involved, and to improve this ourselves. The pre-clinical years of our course are hardly contact-hours heavy, so we do have some time to pursue this. Our own UWS Medicine Society is, in my opinion, brilliantly run, with a dedicated Executive and other involved students who are really keen on enriching the extracurricula experience of university; this does not line up with what is happening at the moment. This is why I think that the upcoming student union elections at the end of April will be an important turning point. I've joined a very keen and energetic team of students who call ourselves 'Action!' - an initiative to turn this around. Med students can exert an enormous effect on the university, simply by voting in the elections - getting the most enthusiastic and innovative students into the union, allowing them to change the blase attitude held by those in office now, and to think and act for the benefit of the students.

My friends that attend those other universities joined endless strings of clubs on O-Week. They did not bother to follow this up; and considering their circle of friends are still the same, I struggle to see how they could boast about student life. Taking action and being involved will do far more than sitting on the laurels of those coming before them.

SSRS from a good friend of mine...

So, here follows a report from one of my friends (yes, I did get their express permission!) for their involvement in the SSRS program.

"The aim of the study is to determine the impact of continuous positive airway pressure (CPAP) on chronic cough in patients with obstructive sleep apnoea (OSA). This is a single-blind, randomized, controlled and parallel group study of the effect of nasal CPAP on cough in patients with proven OSA and cough. Patients are recruited prior to their commencement of CPAP treatment and are allocated to either treatment group (CPAP with treatment pressure) or control group (CPAP with sham pressure). Cough data is collected 4 times during the study: at baseline, 1 week review, 1 month review and 2 month review respectively. This is achieved by using the 24 hours Ambulatory Cough Monitor and patients’ self assessment through completing the Leicester cough questionnaire. At the conclusion of the study cough results will be compared between the two groups to determine the effect of nasal CPAP on cough parameters including frequency, sensitivity, threshold and Quality of life in patients with proven OSA and chronic cough.

My main involvement and responsibility in this project was patient recruitment in the Concord and Liverpool hospital sleep lab. This involves presentation of the project, communication, negotiation with patient and answering patient queries. Relationship building and maintenance with Concord and Liverpool sleep lab staff was important, as frequent liaison with sleep lab scientific officers was required to follow up patient reports. My other responsibilities include data entry and maintenance of patient information in excel spreadsheet, as well as delivery and pick up of the cough monitor at the patient’s preferred time and location.

This project gave me an opportunity to gain a basic understanding of the clinical research process, the complexity in its set up and the difficulties that the researcher may encounter. A better understanding of sleep apnoea in the clinical setting was also attained. Patient recruitment was a challenge however it helped to improve my communication, presentation and negotiation skills in the process. Managing different aspect of this project helped me to further develop my organization skills."