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...

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.

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!

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.