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.

Hip hip hooray

You could treat this title both literally and sarcastically.
In a literal sense (always good to break the good news first, right?), my summer holidays have just been planned out for me! UWS sent out letters for acceptance into their SSRS (Student Summer Research Scholarship - 6-8 weeks full-time on a research project) and I received one in the mail a few days ago. So it looks like I'll at least be doing something constructive this summer. I also turned 18 recently (kind of hard to perpetuate the med-students-are-drinkers culture if you can't legally drink) but I haven't exploited any of my newly-found (for me) privileges yet. Might see whether I can get a credit card (I am a very, very responsible spender) or my personal Paypal account (Once again, very responsible). I think 18 seems quite young to be given all these privileges though - but meh, who am I to complain, hehe. I've also managed to resurrect my PDA from the dead, thanks to a factory settings hard reset (basically an entire wipe-down of the PDA) - so I'm hopefully going to be using that as a learning(read: procrastination) device for times when a netbook is inappropriate (whipping out a netbook during ward rounds? hmmm....)
PPD today, our last session for this year, was pretty good; we did our health professionals informal speech presentation thing, and had some really interesting insights; for example, the differing viewpoints of consultants, trainee doctors, and patients.
Sarcastically, it is drawing ever so closer to the final exams - only two and a bit weeks left. We received our practice anatomy test results back, and suffice to say, my mark was hardly amazing. We also have our formative OSCEs tomorrow (clinical examinations), for which the majority of our grade are panicking about (including yours truly). So.... in essence, HSC students, do not worry about nearing the end of exams and stress; there's plenty more awaiting you!

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.

It's Never Happened Before

What hasn't happened before? Well, me winning in Minesweeper on Expert was what hasn't happened before. Minesweeper Expert was a constant source of rage and bereavement for me - I have this print screen titled "THISISWHYIDONTPLAYMINESWEEPEREXPERT.png" which highlights how I had nearly finished the entire board, and it all came down to one coin flip, which, by Murphy's Law, meant that I lost. This happened a multitude of times, and even today, until finally, I outwitted the probability table and finished in 542 seconds. Granted, I'm not going to break any records anytime soon, but the satisfaction is really keeping me on a high right now :)
Another thing that hasn't happened before was me speaking for 15 minutes straight. I've never, ever been able to do that. Ever. But the opportunity presented itself in the form of PPD's Reflections statement sessions; 2 hour sessions with your PBL group, talking about your life story. Multiplied by 11. Heh. It's actually quite fun, learning about where people come from; I quite liked it, and I think most of us did as well; the saying "I don't want to hear your life story" definitely didn't apply here.
Yet another first was me not sleeping through a particular (though excellent) lecturer for the first time. He is absolutely brilliant, but his voice...is...rather.....calm...and....mellow..........zzzzzzzzzzzzzzZZZZZ
BUT. Not today. Hah.

On top of all of this, ISAN09 is coming up in just 2 days time! Whoopee! This must be the greatest week ever. Winning Minesweeper, interesting PPD and ISAN. Oh, except on Friday it's PBL again. Akk. I would look forward to it if I did work this week, but alas. Various priorities popped up ahead of PBL (such as learning a song - Superchic[k]''s "Stand in the Rain"). Just goes to show how you can have a life outside of Medicine. :)

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.

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...

The leg bone's connected to the thigh bone...

A 2-hour anatomy practical really doesn't get you into the mood for a 2-hour statistics lesson (Yes, Statistics, you may be thinking wtf? in Medicine, but believe me it has it's purposes) straight afterwards. Add to that a lecture in the afternoon (which half the grade dozed off in) and I think Wednesday was a pretty long day...

I actually enjoy anatomy, to be honest; it's wonderful to know where everything's connected (actually we were looking at the abdomen this week, not the leg as the title so subtly implied), and wonderful to have some really great teachers of anatomy (we have this fairly old surgeon who's awesome at teaching, I think everything he taught went right into my head and displaced something else), and the cadavers themselves were (today, at least) far from obese, which was nice. It's just that learning anatomy, for me at least, requires intense concentration, somewhat alike to playing chess. Although I've played a four-hour chess game, a 2-hour anatomy prac seems just that much more tiring and satisfactory. So all that intense concentration took me right out of the zone when we started on database analysis in Statistics. *zzzz*

And oh dear, my computer just restarted after Automatic Updates. Thank heavens for Blogger's autosaving of drafts ^^

We were also meant to do our 'Interviewing of a Patient' (not official name) assignment, our first one so far (Yes, come to UWS if you don't like assignments!) yesterday. This is part of our PPD segment in the course, and the aim of this particular assignment is to interview a patient and give a recount of his/her experience, and empathise with the patient via means of a written response and a presentation. Our patient had his son come over to visit him, so he was busy, and as such we decided to reschedule the meeting, probably to next Wednesday. It's quite nice to have friends that can drive; Camden isn't exactly the most accessible place via public transport.
We were about to skip our last lecture so we could interview our patient, but since that didn't go to plan, we had the enormous privilege of dozing off through our lecture; I think I should go and look at the lecture notes/synopsis now. And probably revise anatomy... and probably write up my clinical ICM notes...and probably revise the statistics stuff as well... arggh.

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 ;)