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.

What a day

I think people were kind of looking at me oddly on the train today. Thanks to the hot sun and my forgetfulness, a melted chocolate in my right pocket spelled disaster for the earphones, ipod shuffle, mobile phone and parker pen (No, my pockets are not abnormally large) nearby. Thanks to my amazing foresight and provision, I also did not carry tissues or a bottle of water with me that day. So lets see. Brilliant genius medical student is confronted with messy electronic goods, and *almost* nothing to clean it with. What to do? Well, use the closest replacement to tissues - good old-fashioned paper from a notepad! How I managed to clean my earphones with pieces of paper, you can figure out for yourself, heh.
Anywho. Today was also a notable day because it was the last day of ICM. This means that I will not be seeing Blacktown Hospital for the next 4 months (until February at least), but more importantly (of course, what could possibly be worse than not seeing a hospital for months?) a new ICM group and tutor. My group and tutor are...LEGEN (wait for it, wait for it, wait for it - and I hope you're not lactose intolerant, because the next word is)DARY. I can't really rate one over the other - I think the group is so important in terms of your experience in ICM; whilst our tutor is a brilliant physician who has such a great love for people and for teaching us young whipper-snappers. I will miss them. Of course, the aforementioned chocolate was the result of a farewell gift thoughtfully thought of by one of us in the group (the rest of us all forgot, or didn't even know that this was the last week of ICM).
Anyway, the reason why I was on the train was not because I was going home, but because I was doing part of another PPD assignment (talking to a health professional). I went to Hornsby where I met my cousin (a registrar), and we and my friend who's also in first-year had a nice long chat about what we should expect in the future, and tips to manage stress and adverse situations. That was cool - I've just finished typing up my notes taken during the session; we'll have to present it at a time and date I'm not sure of. Thus, one would assume I am quite free for the rest of tonight - not so, too much work to catch up. Should get cracking, then.

So Tired...

I thought I'd name some of my posts in honour of several of our PBL cases. So this one's an appropriate one to start off with. PPD today - a 3rd party recollection and informal presentation based on our patient barriers to care interview - was alright. It kind of killed the mood for the day though - 2 hours listening to person after person speak; it was HSC English speeches all over again, except a little bit more interesting, haha. I did concentrate though, which may or may not have been the right thing to do, as I was phased out for the rest of the day (it was first thing in the morning). I think our PPD tutor is getting better (obviously, no names); he genuinely does care, although presenting with a few rather conflicting ideas. Our next two sessions are all going to be about talking about ourselves. And our life experiences. YAY...
I've found that taking a few lectures off and a friday PBL session really knocks you back hard in terms of keeping up with what's happening. Everyone is talking about the cardiac cycle this week, and I feel that I don't really understand them. I'm not exactly a model student, but I do make a serious effort (this is medicine after all) - this kind of thing worries me; not because of whether I'll do good in an exam or not, but rather just the feeling of inadequacy. I guess one gets used to it as the entire field is littered with over-achievers; but still, it is nice to feel like you know something.
ICM though was once again as interesting as always. We had a patient with an arteriovenous (i.e. arteries and veins) fistula (a bulge or protrusion) in his wrist; the turbulence in the vessels was so noticeable, both via a stethoscope and by simply resting one's fingers on the area. We started the cardiovascular system exam; I do feel like we're making serious progress in ICM, with the abdominal exam out of the way in just a few weeks, cardiovascular for these few weeks, and probably respiratory in the weeks to come before our big OSCE (clinical examinations). ARGGGH SCARY
It's before our theoretical exams, in October. So close. Yikes.

ISAN09! Rawwwrrrrrr

I'm pumped for Sept 5&6, because UWS' School of Medicine is hosting a satellite meeting for ISAN09! ISAN is short for the International Society for the Autonomic Nervous system, which has it's biennial congress in various cities - this time around it's in Sydney. If you have no idea what the Autonomic Nervous System is (which is in the second week of our PBL), it's the part of the nervous system that controls all the non-voluntary, or autonomous actions; such as regulating blood pressure, sweating, etc - essentially keeping our body's internal environment constant (a concept which is also introduced at about the same time as the ANS). So, being a first year med student with little idea on the ANS, I jumped at the opportunity to attend this meeting, as well some 20-odd students from our course, which our school provided complimentary registrations for. Happy happy happy :)

In other news, I'm always constantly surprised at how med students manage to keep the drinking culture alive, whilst learning about the very unpleasant side effects of binge drinking (defined as 6 or more standard drinks, which, ironically, seems to be about standard for a regular meddie's night out). We were introduced in ICM today to the alcohol screening test - a quiz with some quite heavy-hitting and personal questions (such as: how often do you drink 6 or more standard drinks, has anyone been injured due to your drinking), which may be a non-issue for non-drinkers (like me! yay!) but a significant issue for those who've relied on that 'liquid gold', as we discovered during patient rounds...
It's not like alcoholics don't know what they're doing; its just our culture; our 'mates' positive perception of alcohol, it's place in common culture as a synonym for a good time. Unlike the smokers who get really bad rep, the alkis are getting none. And, sadly, its always 'I am going to stop' and meaning it, but much of the time, being unable to stop the cycle until they meet a doctor, or the pearly white gates.

Anyway, anatomy practical tomorrow! Yippee! Nothing like a quick (2 hours?) squizz at cadavers to brighten a week up :)

Time passed so quickly...

I've always known that talking with a few of your best friends can take up hours of your time, and you don't realise it. It was a surprise to me though, that our patient interview for our PPD assignment went by so quickly. We (me and my partner for the interview) interviewed a really nice couple who lived in a self-contained villa in a retirement village; time just flew by as we listened to them talk. There were a few interesting things of note; they seemed quite satisfied with the public health system; the husband was in hospital many times and was really happy with how he was treated. So that was a really good thing to hear :) They were also happy with the retirement village and the social activities provided; something I will be mentioning to my parents in the years to come, as an option in the future (for some reason, my dad is very pro-retirement village, whilst my mum is very anti... I wonder why). The last thing I thought was notable was how positive they both were, how happy they were to have us over, and were in high spirits; this despite the significant medical conditions they had (over a dozen between the two of them) and their relatively moderate socioeconomic position.

That was pretty much the highlight of the day. Our 2-hour liver practical was a pretty hard slog (not an anatomy prac, just going through a program in our computer labs), and the PPD tutorial before that (discussing death and how it impacts patients and us) was quite intense as well. Follow that with two more lectures in the afternoon, and so it was with delight that, upon reaching home, I took a nice long nap. Ahhhh....

ICM this week was unremarkable, save for one spectacular patient who let us (all five of us) do an abdominal examination on him. I felt pretty bad once we said our goodbyes though, when we saw another group waiting outside, inevitably about to ask him for permission to examine him...eek. There seems to be a lack of patients willing to allow us to do physical examinations; I'm guessing part of the reason is the invasiveness of the procedure, compared to history taking. So for the patients who have allowed us to practice our clinical skills, and who will allow us in the future, I am really grateful. Our ICM tutor is awesome, she's learnt all our names by heart already! I wish we could just keep her for the rest of clinical teaching; it appears that ICM tutors can be a mixed bag, which is a shame.

On that (sad? disappointed?) note, PBL seems to have lost it's lustre. The excitement of diagnosis has, much like House MD episodes (at least, to me), vanished. Then again, interest in medicine shouldn't be propped up by styles of teaching; but yep, PBL seems to be more about learning issues related to that case (which is what it's meant to be) versus the case itself. If that makes sense. Which I'm sure it doesn't. Anyway, speaking of PBL, I should be working on the first learning issue for this week...

A Small Update

Thought I might write a bit more, since some time has passed. I got my stethoscope, but my books haven't arrived yet. It came with soft ear-tips, a back-up pair of soft ear-tips, a pair of hard ear-tips (haven't used them, and hopefully never will), a name tag, and two paediatric attachments - the bell and diaphragm. I quite liked the smaller diaphragm, and am yet to see why a larger diaphragm is more useful than the smaller one - the adult-sized diaphragm is not changeable though, probably because of my engraving. Speaking of which, I thought the engraving was done well, quite happy with it :)
One thing the Medshop description fails to include of the C&R Trikoph, is that the rims are non-chill. I was pretty worried about this actually, since every stethoscope except this one had "non-chill rims" in its description, but yep, rest assured.
I'm yet to have any other stethoscopes to compare the steth directly with, so I don't think I'm quite qualified to make a recommendation for this based on acoustics. From what I can hear, the acoustics seem pretty good; nice differentiation between parts of the sound, and it seems quite loud. I'll comment about this once I get another yardstick to compare it with. Also, if you ever come around to purchasing your first stethoscope (like I was), don't worry if the ends of the steth seem to put a lot of pressure on your ears, and even if it hurts to use it at first. After about an hour (cumulative) of usage, my ears seem to be getting used to it, and it's not really painful now, but merely slightly uncomfortable (which I hope will subside very soon as well).

I had my first abdomen physical examination for ICM this week, on a patient who could barely speak English (thankfully, our tutor spoke whatever language he was able to speak), which hindered communication somewhat. He was really nice though, very compliant and happy to sit through whatever I was doing. Other than that, nothing really remarkable occurred this week... except for today, when 2(!) lectures were suddenly cancelled. That was a bit of an eyebrow-raiser. Oh, and only one more week till UMATo9! The tension is palpable (get it? get it? naww yeh k that was lame) Signing out,

What a day.

Today, I managed to miss Macarthur (which was one stop from Campbelltown). Let me explain - there's no direct train from where I catch the train to get to Macarthur - our uni's unofficial train station. So today I would catch a train to Campbelltown, the station everyone thinks is the end of the southern train line, and catch a train from Campbelltown to the 'real' end of the southern train line - Macarthur. This train doesn't stop at Macarthur though, it heads all the way to Moss Vale, which is approximately 40 kilometres away. Me being me, I managed to miss that one stop, and ended up at Menangle Park, the next stop. Herewith, upon finding the next train was an hour away, and thinking that one stop would be approximately 2km or so, I hatched the brilliant idea to walk back to Macarthur. Boy, was I wrong. The road that appeared to follow the train station turned left...and then turned left again...and there was no end in sight. So after 20 minutes I arrived back at the station, caught the train back to Macarthur, and was on my way.

Our first real anatomy practical was pretty super (abdomen/groin region) - having surgeons/surgical registrars were pretty cool, they were really knowledgeable and knew how to teach (very important, one would think), so yeh pretty awesome. Only bugger was that whenever they'd ask some questions about stuff, they'd draw a blank look from us and in general, we felt very stupid. We also did some surface anatomy, though only for a half hour or so.

We also got exam results back - I passed with a 60 average, but as a result, was in the bottom 3rd of the cohort. Still satisfied though, gave it a fair amount of effort and will be looking forward to improving that result. I felt that my mark was quite equivalent to my effort in the HSC, maybe a little more (so, ATAR of about 98 as a guesstimation) - obviously theres not really any comparison, since there are so many other factors that come into play, but that could give an idea as to what to expect. Looking for a 70+ in the finals so I can even up with a Credit average for the year, so I've got a big task ahead of me... *nods*

Our first physical examination for ICM was also pretty interesting...pity our patient though, who persevered with us (well, only one of us was performing the examination, but I digress) for an hour as we learnt how to percuss (tapping the abdomen, listening for the resonance of sounds to indicate hollowness and the presence of liquid and solid) and to palpate (fancy word for using our fingers to search for organs), and were assured (or amazed?) at our tutor's statement that the entire examination should take, at most, 5 minutes. Which reminds me, I should be writing up some notes so I can recollect what she said about signs and symptoms...

I also got email notifications that my stethoscope had been sent via Aus Post today, and my order for textbooks from India (about $50/textbook inc shipping) got processed. Also got my Talley and O'Connor clinical examination book yesterday, and found out that I really did not have any book-contacting skill anymore :\ Lots of bubbles and even a few jagged edges. Bleh. So yeh, exciting couple of days :)

2nd Last Week of ICM for the Semester...

Today our ICM, and next week's ICM, was a review session. In essence, we didn't watch the videos of actors portraying medical students doing interviews, but instead went straight to the wards for some friendly non-assessable assessment of our History taking skills and bedside manner. We managed to fit three histories into one session, and I just so happened to be the last, which caught me unaware - nonetheless I did my history without any real fuss, but wasn't really thinking quite as optimally as I would have liked. Today was also special because:

1) We introduced our tutor, Dr Zelas (a middle-aged male surgeon) to Twilight via a patient who was reading New Moon (one of the novels in the Twilight series), and;
2) We spent a good fifteen minutes after the session planning what to get for Dr Zelas as a thank-you present for this semester's ICM; apparently we will be switching ICM tutors next semester(but not our group, yay), and may be thinking of including said novel in the present package. Hah! It would be amusing if he finds he quite likes Edward and Bella; perhaps he's an old-faashioned romantic, in which case he should take quite a liking to this novel aimed at the teenage female demographic! I have male friends who enjoyed the series; and I certainly enjoyed it (stayed up to 4am reading Twilight, and yes I'm quite straight) so the scenario of Dr Zelas sitting on a sofa reading Twilight until...twilight, might perhaps be not very farfetched at all, haha...

Apparently, we also switch PBL tutors this semester too. So we'll be looking to get something for our PBL tutor as well; although my absolutely shocking PBL assessment mark of 14/20 doesn't quite encourage me (though on second thoughts I was a bit quiet...) I will look forward to writing the cards. I get the impression that Dr Zelas has no clue what our names are, and that we might be quite forgotten in a few years time, but I hope the gifts might help jog his memory when we become colleagues, hah.

So it appears that each semester, we switch PBL and ICM tutors, have no idea in regards to switching PBL groups (although that may be quite possible), stay in our ICM groups, and stay at our chosen hospital (Blacktown, woo!) but also stay on the same day. It's unfortunate abotu switching PBL groups but I guess I look forward to working with other people and see what dynamics will appear in the new group :)

Expectations and Deep Breathing

We received our Formative exam result back yesterday.
To recap, we didn't have mid-semester exams, unlike other courses at other universities. So to replace it, we had an exam that did not count - i.e. meant to be used as a measuring tool to see how large your knowledge base was.
I got back my exam results, and, on counting, I scored 54%. Which was a pass. It's about this stage that I see that there is no comparison with high school results; with the kind of work I was doing, I could easily expect 80% or more (I didn't do any revision for the exam, but did do continuous work during the mid-semester), but I'm wondering how to broach this result to my over-expecting parents. I can envision the scenario:
"Mum, dad, I passed my first medical exam!"
"How did you go?"
"Umm 54 percent. I beat heaps of people though..."
"What was the top mark?"
"Oh it was horrible. Really hard test. I think it was 65% or something"
"You must study harder. Your grade is not smart. You should have got much better."
"But it was a really hard test."
"Nothing is impossible. I told you those games are a distraction. Maybe you should stop tutoring as well."
"But........."
I was pretty content with my result, relative to our cohort, because marks are fairly meaningless when you don't have comparison results. Looking at the bigger picture though, this mark doesn't make me feel like I'd be a competent doctor in the future, and that really worries me. So study I shall, now. Or tomorrow. Maybe next week.

On another note, we had ICMs today, and this week we focused on respiratory problems, mainly coughing/shortness of breath. For ICM tutorials, we usually get a booklet for the specific tutorial on vUWS (virtual uws, or our online resources/lecture notes hub) to print out - however my group fell out of practice of printing those booklets due to lack of usage. Next week, however, we might change, since we never touched on respiratory symptoms before. I came to realise that most symptoms had many basic questions overlapping, such as when did it start, describe the symptom, and things that made it worse and/or better. Our patient today was a picture of many elderly people in the Greater Western Sydney region; a frail old lady living on a pension with barely any savings. We seem to encounter many smokers in Blacktown hospital (my allocated hospital for clinicals) and she was another one, who suffered from emphysema, most likely due to smoking but also a pre-existing tendency towards it. It was sad to see that although she stopped smoking more than a decade ago due to her parents suffering from the same problem she has now, her daughter hasn't. Whether that is a case of young people feeling invincible or that the addictive nature of smoking is such that it can defeat something as powerful as your mother suffering from emphysema, I'm not sure; but I do know that smoking is a massive plague on health resources, and especially in the GWS area, for some reason. At any rate, tomorrow I'll be facing another interview of a different sort - a John Flynn Placement Program (JFPP) interview, to be precise. So I'm off for the day, to just do a little bit of preparation for that and try to do some study.

Hospitals are not cheery places.

I keep hearing that ICM (Introduction to Clinical Medicine, or hospital visits) are the best part of *insert students name here*'s Medicine experience. While I think it certainly is necessary and is useful to build up communication and clinical skills (later on), I don't always agree that ICMs are the best part. Today was a rather shell-shocking day; an elderly man was gaunt and straining to exhale due to progressed emphysema, hard of hearing and generally in a poor state. In the next few minutes of our interview we were introduced to his life as a result of decades of smoking. It's not like we aren't aware of the dangers of smoking, or the possible consequences and risks; but more the fact that it confronted us here, right then and now when we were just expecting to practice our history-taking and interview skills. His condition was such that he could not work, mow the lawn, do most housework, and look after his wife; confined to sedentary activity and struggling with every breath, he remarked that he felt suicidal. When he said that, we were all stunned; 6 first year medical students meeting a man in whom hope did not exist and despair reigned. And this reminded me of what we were here to do, but also, it reminded me of what we couldn't do; when all we can do is really give painkillers and pretty much pray for a painless death. In PBLs and other ICM interviews we have encountered a few chronic diseases, and its nice to be a doctor and be able to make someone get better, but with specialities like Pallative Care I wonder how they get through every day intact. Our patient re-iterated "don't smoke" and its a fair warning, considering his personal testimony, and all I can think of is how he hopes to stop others from going through what he is right now. Whilst cases generally make me motivated to study harder (in light of an application for that knowledge later on), this one just hit me and hasn't had any positive effect so far, except for this reflection. Much food for thought.

A review of the first half of Semester 1, Year 1

This should actually be a much larger post, since the beginning is pretty memorable, but I'll condense it since I'm posting this at the end of Week 1 of the second half of semester 1 (wow what a mouthful).

So our first week begins with a whizbang (or perhaps not) introductory lecture by UWS Medical School's Dean, Neville Yeomans, to which our parents were invited. Made new friends, found some old ones, and the rest of that. We then had an introduction into the PBL style of teaching, which I had much forewarning about and so wasn't really that revolutionary; and then a series of lectures on what it means to be a doctor, ethics, morals, and all the rest of it.

The rest of the first half of Sem 1 was pretty much an introduction to all things medicine. Our lectures were mostly named 'Introduction to MRI', 'Introduction to Pharmacology', 'Introduction to Communication Systems in the body', etc. The UWS Course has two main components; Foundations of Medicine, which you could call the science side, and Personal and Professional Development (PPD), which you could call the humanities side.

Those components are covered by a week-long Problem Based Learning (PBL) case study (Monday being the introduction to the new case of the week, and Friday being the debriefing of that case), as well as lectures, practical sessions which were all in the computer lab for this first half, our ICMs (Introduction to Clinical Medicine - one 1.5hr session per week at a hospital as part of our clinical experience) and later on, dedicated PPD sessions.

So the PBL style of learning is essentially studying a fictional case of a patient who presents (or comes in with) a certain symptom, upon which we would hypothesise over reasons for the symptom (i.e. diagnose), note down anything we didn't know about the case that we should need to know (Learning Issues, or Objectives), and going away for the week to research by ourselves on the case. Lectures were generally related to the case of that week, which provided a little oddity in that we could predict what the problem with the patient was by deducing information from lecture names, hah! Then on Friday we would gather back and report on what we've learnt, and find out (a) what the actual diagnosis was (which is usually not a surprise by Friday), (b) what the official Learning Issues that UWS wants us to know are. PBL Groups are groups of around 10 people, with 1 tutor who is not a 'content expert' - i.e. we aren't meant to ask him/her about details of the information in the case (such as: "Is this really a myocardial infarction?") because he/she will reply with "I don't know, maybe you should put that up as a Learning Issue", heh..

Over the cases we had in that 1st term, we covered a host of things such as epilepsy, spinal injury, myasthenia gravis, anaemia, heat stroke, and sunburn, along with many others due to the broad hypothesising that we were meant to do as part of the PBL process. So it's been an interesting first half of the semester :)

We also had a Formative Test (read: a test used exclusively for your own standards to see how well you would do, andd it does not count towards final year marks) which we haven't received the results of back yet; I'm not too sure we were taking it seriously, but I certainly saw that there was much that I had not covered or had forgot due to lack of revision. Which brings me to...

...how much effort I put into this first half of Sem 1, Year 1 of Medicine, versus the HSC. I must say that I've done exceedingly more than I ever did in the HSC, and I probably would have done much better, were I to have put that same amount into last year. I didn't though, and it's a regret but I've learnt from it, so I've decided to just do as well as I possibly can, in the knowledge that this is part of my career, and not working towards a certain number. So yep, that about wraps it up :)

Oh, and I spent my holidays semi-productively, revising most lectures, but also visiting old school friends and things. So I thought that was a very good start to a non-procrastination filled life ;)