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.

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.