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...