LOTS (Block 2): Life on the - wait, this is the title of a block?!

Life on the Street (LOTS). The content of the block is pretty much as random as the title. There is no real flow to the block, like there is in the Cardiovascular block; however, the content is super important. I'd advise you know each week before entering the next. Seeing as science has yet again failed us and we still don't have a machine that can stop time, that means working from day one.

LOTS consists of five weeks after which you'll write a couple of exams. I'll chat about exams in another post. PBL's will now be the order of the day. The first week starts with Little Anna. What a depressing topic to kick off with - Protein energy malnutrition (previously known as kwashiorkor and marasmus). This is such an important topic - it's basically what most of your Paediatrics block in GEMP III will be about. Wish someone had told me that... The lectures were very useful, so were the theme sessions.

Week two deals with genes. Levi's, Polo and Guess. (Okay, wow, that was lame even by my unusually low standards...) So the topic of the week is genetics. Although the PBL of the week is on Albinism, that's not the focus. The lectures will cover other genetic disorders, too. And for those who wanted to know: the opposite (so to speak) of Albinism is Melanism.

Week three is perhaps the most important week of LOTS, for our setting at least. The great imitator of our times - HIV. HIV can change the presentation of any disease, it can mimic many diseases and affects every single organ in the body, either directly by virological damage or indirectly via autoimmune manifestations. There simply is no way of getting around it - we all must know HIV. Although not a huge part of the week, treatment guidelines can be accessed readily and should be known. (Just Google the SA guidelines)

Week four... a difficult one. Perhaps not in terms of content, but certainly emotionally. Rape and sexual assault. This week is the only opportunity, most likely until Internship, that you will have to learn how to fill in a J88 form. This is the form we as doctors fill in when patients present after assault. I clearly remember the lecture on abnormal genito-anal findings. It's difficult to look at, but this is the reality of what happens in our world. Remember to treat every patient that has been assaulted, sexually or otherwise, with the utmost sensitivity and respect!

Ahhh... week five. For those who have not yet had the privilege to meet Prof Duse, will do so here. What a legend. This week is about infections - and a little on old folks. The PBL is about an Afrikaans farmer who hurts his hand on a gate. I got excited here, because I am Afrikaans. I don't sound it when I speak English (apparently) so don't read the posts in an accent from now on.

Apart from the above, you will get to learn some basic clinical skills this block. If you see me in the wards (just look for the really tall guy, I'm just under two meters tall) you can ask me to help you out with any skills you might be struggling with. Also make use of friends and parents to practise skills on. Not all skills though - avoid prostate exams, people don't like them...

Stethoscope, sphygmomanometer, Wikipedia - check

Welcome to the hospital! This is your first taste of real medicine. You will have what is called "Hospital Practice Day" (HPD) once a week in your GEMP I and II years. It's pretty exciting. You get to walk around with your stethocope and look all fancy!

You will be allocated to Charlotte Maxeke Johannesburg Academic Hospital (the Gen), Chris Hani Baragwanath Academic Hospital (Bara), Rahima Moosa Mother and Child Hospital (Coro), Helen Joseph Hospital, Edenvale Hospital or Tambo Memorial Hospital. You will be with your clinical partner (a friend you choose) and will wander the wards, lost and confused, at least until GEMP II...

In GEMP I block 2 you will spend time with the nursing staff and get used to how the hospital runs. Please make sure that you do stuff. When there's a drip to be put in, say "Hey! I'll do that!". If you haven't done a drip yet, ask to be taught. If you don't ask, you won't learn.

The rule of "See one, Do one, Teach one" applies. In my internal medicine rotation in GEMP III I saw how to do a Bone Marrow Aspirate and Trephine, I did one, and then I taught one. Same thing with Lumbar Punctures (LP's). We are very blessed to be studying medicine at Wits. I watched an Australian medical programme a few weeks ago and a patient needed an LP. They called the Neurology consultant at three in the morning, he scrubbed in and did it in theatre! And there I was, a GEMP III student doing LP's left, right and centre. Okay, only centre. You can damage organs if you go left and right.

In subsequent blocks you will join different departments, Internal Medicine, Surgery, Ortho, Obs, etc. In the morning you will have an opportunity to join the ward round (like in Scrubs - the TV show, not the clothing). Ask questions, be involved. Don't just stand in the back all quiet, otherwise the whole day will be meaningless. After that you will have to clerk a patient for your tutorial. You will get to use your clinical skills.

This is a good time to mention clinical skills (CS). You will have a CS session every HPD in the afternoon. Here doctors will teach you how to take a history, do a general examination, take blood pressure, how to use your lightsaber, etc. Lightsaber? Okay, no, but come on science - it's 2014 and no lightsaber?? 

In the CS sessions if a doctor asks for a volunteer, let it always be you. If you make a mistake, the doctor will see it and help you. Rather make a mistake here than in your exam...

Something that will become very clear to you in GEMP I and II is, what I like to call, 'The Hospital Hierarchy". Yeah, we're riiight at the bottom. See that drip stand in the corner of the ward? That's higher up than we are. At least for now. That's why if you don't ask questions, volunteer to do bloods and drips, etc., you won't progress upwards. 

Perhaps I'm being a little dramatic, but it really is important to be proactive. Passivity should be left for ion channels in your cells. You will find yourself standing around, doing nothing because there aren't any doctors around, or a tut has been cancelled. Go and practice your history taking with a patient, go and take blood pressures, go and practice your 4 times table (trust me, you'll need this!)...

And now the role of Wikipedia. It's not to be used as a reference, in the sense that you shouldn't reference it in your portfolio entries, research project, and so forth. It is, however, a fantastic resource for the wards and even in PBL's. You'll hear doctors talk about Takayasu's Arteritis and have no idea what it is - so Google it. Use Wikipedia, or eMedicine to give you a nice idea of what it is. I used it pretty much every day in GEMP I and II and still use it fairly often.

That's all for now. Hope this was useful! If you have any questions, feel free to comment below, or visit the Facebook page and we can interact there.

General structure of the blocks after Death by Studying

Now that PCMS (oy vey) is done and dusted, the subsequent blocks all follow a similar pattern. In block 2, Life on the Street, you will be introduced to some new concepts. PBL, HPD, Quantum Physics and course packs. Okay, so maybe not quantum physics, but it would have been cool though... No? Okay, maybe that's just me.

Let's start with Problem Based Learning (PBL). The term PBL, from what I could find after extensive research (i.e. Googling the words...), is a student-centered pedagogy (which means science and art, thanks again Google) in which students learn about a subject through the experience of problem solving. It's been adopted all over the world and the trend seems to be towards this kind of teaching as opposed to the old ways (whatever those may be). 

Each week you have three PBL's. The PBL's take place in PBL rooms (which make for amazing sleeping areas!). The first PBL (cleverly named PBL 1) introduces you to the case. You get the "trigger text" from the GEMP website/ SAKAI (both websites which will be introduced to you early in GEMP I). The trigger text will give you a scenario that you and your group members (your PBL group, another cleverly named entity) will have to decipher. You will have the help of a doctor called "The Facilitator" (kinda sounds like the title of Arnold Schwarzernegger's next movie). 

He or she will guide you through the process of approaching the problem in a biopsychosocial manner, taking into account all three spheres of a patient - the disease, the psychological effect and the social situation your patient lives. 

So I'll be very honest with you. I thought the whole biopsychosocial thing was pointless. I argued that I would rather have a doctor who is rude and doesn't care if I have running water at home than a sweet doctor who has no clue what the difference is between a haemorrhagic stroke and a stroke of lightning. On paper, this is a reasonable argument. But in real life? A patient would rather have a doctor holding their hand as they die than a doctor who knows exactly what's wrong with her, and she still dies, but alone... The trick is to find a perfect balance.

By the end of PBL 1 you should have an idea of what the week is all about. (Each block is divided into weekly topics)

PBL 2 you meet with your group, without the doctor, and receive test results you would have ordered for your patient. This includes urine dipstix, the full blood count, X-rays, CT scans, etc. You interpret it and answer questions around it.

PBL 3 is where you find out if your diagnosis was correct. The facilitator (am I the only one reading that with Arnie's accent?) goes through the case with you again and then you focus on the management of the patient. 

PBL is a really cool process, and can be done rather swiftly. It is meant to teach us how to approach a clinical problem. And, if done correctly, it does. The cases are really well thought out! A possible pitfall is tunnel vision. The PBL topic is Protein Energy Malnutrition, or Stroke, for example - so people focus on that and don't think laterally.

During PBL 1 you will receive what is known as the course pack (CP). The CP consists of different Learning Topics (LT's) which you need to know really, really well. TIP: I would suggest that you cover the LT's by the Wednesday of every week. If you can, read through all of them (even just briefly) on the Monday and study them in depth on the Tuesday and Wednesday. It will make the lectures way more meaningful. The CP essentially takes the place of textbooks. Some are well written, others... not so much and will require Googling (or Yahoo-ing for the hipsters) on your part.

Before this entry becomes the length of a CP, I'll stop there. In the next blog entry, I'll chat about the HPD's and the role of Wikipedia...

PCMS (Block 1): Welcome to Medicine!

Congratulations!! You've either survived second year anatomy (and can now watch Grey's Anatomy and be like "Hey, that's not right!") or you've passed the WAPT (like a boss!) and are now going into in GEMP I. You're going to love it.

"What should I expect in GEMP I?" I hear you saying? (Auditory hallucinations on my part?)... So GEMP I is divided into several different "blocks" lasting a couple of weeks. Sounds like a long time, but it goes by so fast!

You start off with what is known as (enter dramatic Stars Wars music here) PCMS. PCMS officially stands for Preliminary Concepts in Medical Science, but I think it's some Latin acronym that loosely translates into Death by Studying. This will be your greatest challenge in GEMP (at least, I thought so).

In PCMS you are expected to learn a LOT of new things in a very short period of time. You'll be covering Pathology (Dr King is great, just sit close to the front in his lectures, you'll see why...), Pharmacology, Microbiology, Ethics, Immunology, some Stats and other random, but important, stuff.

The trick to tackling this overwhelming block is to remember one fundamental principle - you are always behind. Even before you've registered, you're behind. I don't say this to scare you, instead, to motivate you to start studying from day one. As clichè as that might sound, it's honestly the biggest tip I can give you.

The importance of PCMS is that it forms a base for the blocks to follow. You will notice that in all the other blocks the same Path, Pharm, etc. comes up in addition to the new material covered. So if you work hard in PCMS it will make subsequent blocks easier. In fact, I used my PCMS notes to study for a 5th year exam just the other day. Oh how I wish I studied Pharm harder... Sigh...

One last tip: I believe in goal directed living. I apply this to my studies as well. Set short, medium and long term goals for yourself and write them down. Short term goal - study pages 1 to 35 in Rippey's (you'll get to know Rippey's well) before 18h00 tomorrow. Medium term goal - Revise the first three weeks' work next Saturday. Long term goal - become ruler of the world by the year 2035.

Your goals will change day to day, but it's important to have them. Take it one day at a time.

Okay, last tip (I promise): remember to laugh and have fun (a synonym for cake). Life is short and isn't all about your studies, or medicine. My fiancée was in my GEMP I class for 6 months before we met. Don't be that blind.

Anyway... the next entry will be about the Life on the Streets (LOTS) block. Hope this was useful!

How to become a doctor - or at least something resembling one?

They say there are many ways to skin a cat. I think that's disturbing and wrong. I love cats. But there really are many ways to become a doctor. At Wits, that is.

In matric you apply to study MBBCh (at Wits or MBChB at the other medical schools in the country). Now one of two things happen - you get accepted (yay!) or you don't (ahh...); either way, if you want to become a doctor, you'll be one! If you got accepted from matric, you enter medicine in first year (basic sciences), go on to second year (anatomy and dead people and stuff) and the years three (GEMP I) to six (GEMP IV).

Didn't get accepted? Then you go on to doing a Bachelor of Science (BSc), or Bachelor of Health Sciences (BHSc) or, quite frankly, any degree with some biological subtext. You finish your degree and then apply for the GEMP. What's the GEMP? It's a fancy side door into medicine. See this site for a way better explanation than I could give. Should you get accepted you enter GEMP I (the equivalent of MBBCh III) with all the peeps who got in from matric. Pretty cool.

You can enter the GEMP after you've done your honours, masters or PhD. Any age, too. Just a warning - it's a pretty tightly contested entry point. You need to work super hard in your first degree and try to be the best!

I, inadvertently, went for the third option. I received my rejection letter from Wits in December 2009. It sucked so badly. I then got an SMS from Wits saying I got accepted to do a BSc. I didn't even know what that was, but hey, I was now a university student. At the end of my first year I went to chat to a prof at the medical school and asked him if I could do anatomy in my second year of BSc. He suggested I apply to do BHSc and do anatomy with the guys who got into second year medicine. So I did that. At the beginning of second year the Dean spoke to us and said that there are 20 spots available for the top performing students. At the end, 7 of us made the cut!

I'm not too sure whether Wits offers that anymore. It might have been a once off thing.

Anyway, that's it for now. If you have any questions, comment below.

What's this blog all about?

The Unofficial GEMP Guide. Sounds pretty official? Well, it really isn't. This blog-site is in no way affiliated with the University of the Witwatersrand. I'm Juan. A (now) final year medical student at Wits.

The reason for this blog-site? When I entered GEMP (Graduate Entry Medical Programme, but you probably already know what the acronym stands for, why else would you be on this site?) I was lost, overwhelmed and was questioning what "sleep" meant. I wished there was some sort of guide to this whole new world of Medicine. A map, if you will.

So here it is. The map that will, hopefully, make your life in GEMP a little easier. I'm writing it from my personal experiences, and it might differ from yours. I'll only be able to make comments on what I've seen, heard, smelled (Trauma) and tasted (Obstetrics). Only kidding about the tasting thing, but a jet of amniotic fluid did come very close to my pie-hole. I'll also put some tips where I can, to help the intrigued reader (that's hopefully you).

My posts will be aimed at students going into GEMP I (the great unknown), GEMP II (the lesser, but still mostly unknown) and GEMP III (the 'Hey! I'm actually doing doctory stuff!' year) and also GEMP IV, as I go through my blocks.

The post after this one will be about the different ways you can get into Medicine at Wits, and then the way I got in.

I hope you'll enjoy my posts! Please feel free to comment. If I can, I'll be more than happy to help out. And if I can't help, hopefully I can point you in the right direction.

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