"The dim light of the O.R... Intense silence, apart from the soft beeping of the ECG monitor. Gwen, the hospital CEO's daughter and junior surgeon's love is on the table after a tragic skiing accident on Mount Doom. Enter Dr. McSomething, her first love. As he flawlessly glides across the spotless room toward the operating table, he looks down at the once beautiful Gwen. She is hardly recognisable. He sheds a tear and confidently, without hesitation, and in an assured voice, says 'Scalpel,'..."
Sound familiar? This is how we have been made to believe what medicine is like. It's not. Perhaps a more realistic account would be this...
"The O.R is dimmed for a few seconds as load shedding is initiated, until the generator kicks in. Lights flood the theatre. The monitors beep and ring loudly, with intense noise as the nursing staff, doctors and students struggle to hear one another. Patient number 458952 lies on the table. She was hit by a car while crossing the road. Enter Dr So-and-so. He traverses the treacherous obstacles - the power cable of the wall radio, the diathermy machine, three students, the nursing staff and the overhead lights. He looks down at patient number 458952 - hardly recognisable, because he is tired and this is his fifth operation today. He doesn't shed a tear, only sweat, because the air conditioner has been out of order for the last three months. As he waits for the nurses to find equipment from the adjacent theatre, he says, with a deep sigh, 'Not this again,'..."
I suppose that if this was what was shown on television it would be canned and fewer people would want to become doctors. This post is going to be a difficult one to read, whether you're doing medicine, or contemplating it. I urge you, however, to read it all the way to the end because there is light at the end of the tunnel...
The romance that we are made to believe about medicine doesn't exist. To illustrate this, I will take you through a scenario...
You're a final year medical student. It's Monday, the start of your new rotation: Paediatrics. You wait for someone to orientate you but, alas, the department wasn't expecting you. After a few hours, a senior doctor comes to chat to you. You are told that you will join the various units within the department, which typically consists of a head of unit (the consultant), a registrar and an intern. You are also told that you have to be a part of the unit, fully, as if you were an intern. That means that you are to partake in every activity, every meeting, every clinic, every ward round and all the calls. Oh, and don't forget, if you want to do well in the exams you'll have to read at least four hours a day. Great.
It's been a long morning already and you can't wait to go home and just relax. You can't, sorry. It just so happens that your unit is on call today. You didn't bring food, a change of clothes or a will to be there. None of which is a suitable excuse and you are to stay. (One of the worst feelings for me in medicine is having to walk to the ward as everyone else is leaving and the sun is setting...)
The call starts. The patient files start piling up. The registrar has disappeared because she is writing exams in a few weeks, the intern has gone for lunch (three hours ago) and you and your partner are left in the ward. Alone. On the first day. A mother brings her child, she's angry as she has been waiting for four hours and she shouts at you. Oh, and she doesn't speak any English, only Portuguese, she's from Mozambique. You take a history as best you can and examine the child, who urinates on you. Now you have to take blood from the child, but there are no needles to use. Luckily there are nurses that would love to help you find needles - yes, and no. Sure, there are nurses, and no to everything else. So you leave the patient to search for equipment from other wards and just as you leave, the registrar comes back and finds you M.I.A. Of course...
What happens when you return need not be spelled out. Luckily it's almost 20h00 and that means you can go home, right? Wrong. The intern has come back from "lunch" and wants you to "quickly help out" before you go. This means doing all the bloods, running to the blood bank, putting up some drips and filling out some forms. It's 21h30 now and you're eventually leaving. Getting home is really nice, except that you haven't had anything to eat, you smell of urine and you have to prepare for the tutorial tomorrow.
The next day you're up early, to make sure you don't miss the post intake ward round where you are expected to present the patients that were admitted under your care. You get ridiculed if you don't know much when a consultant asks you questions. "But it's only day two!", sure but you were supposed to read up on the topics already, somehow...
After the round you have to do the follow up bloods, book some X-rays, and go to a tutorial. Eventually you get home and you can take a nap, except you can't because now you have to study, and you probably smell of urine again. This happens every four days, and is not fun. At all. To add insult to injury, you don't get paid a single cent. Instead, you (or your family) are paying thousands per year for you to work. Either that or you have, seemingly, forever signed your life away to the bank or government.
"That means that things get better when internship starts, right?" Unfortunately not. As an intern you get left alone with students, because the registrar is studying. You have to run around wards when all you want to do is have some lunch, but everybody keeps calling you and now the students probably hate you because they think you're slacking off. To add to that, you have to ask the students to help you before they go, as you will be all alone, all night, once they leave.
"Ahh, okay, so when you're a registrar life is easier!" Again, no. You are now responsible for teaching students, helping interns and studying for your very difficult (and very expensive!) exams that are looming.
"Okay, but surely being a consultant is better?" I suppose it could be, I don't really know. Granted, you're 40 and you've missed almost every school play and sports game that your children have been in, because you've been a registrar for so long. You are also responsible for looking after an entire unit and should anything go wrong, you will be to blame. You might also be working in private. Money, yay! That is, of course, if the medical aid is willing to pay or whether you're willing to send debt collectors after your patients when they don't. And no weekends in private, either, I'm afraid. So yeah... "better"...
I promised at the beginning of this post that there would be light at the end of the tunnel, so here it is...
The moment that you realise you want to become a doctor is the point of no return. We all have different reasons why we want to become doctors and some make more sense than others. For example, it was the very first time I smelled the inside of an operating theatre that I knew I wanted to become a doctor. Strange, I know, considering the fact that I really don't like surgery, but every single time I walk past a theatre I am reminded of that exact point in my life.
Your reason might be that your parents are doctors, or that you had a family member who was very ill and you want to help others in that position, or because you're not fond of the title "Mr", "Miss" or "Mrs". Regardless of your reason, that will always be greater than the things I've said above.
Oh, and the above scenario is quite a hectic one, and life after internship could be very different, depending on what you choose to do (general surgery vs. dermatology) and what your priorities are (achieving the highest honours in your field vs. having a family in the countryside). Being a student or an intern is inherently tough, I'm afraid, but not all the time. Some rotations are worse than others.
If I knew what I would be going through at the beginning of my studies... The long hours, not being appreciated, the lack of pay, the workload, the smell of urine... I would still choose to become a doctor, over and over and over again. I know of people who chose to step away from clinical medicine after internship, and that too is okay.
For the most part though, at the risk of sounding terribly cliché, you don't get to choose Medicine, it chooses you. There will come a moment in your career when you will wish that it had just minded its own blooming business and ignored you. A moment where you will wish that Fine Arts, Accounting or the ability to photosynthesise had chosen you, whether you're trying to get into medicine, or studying medicine, or working as an intern. You'll see, it will pass, and in the long run you won't regret pushing on.
Saturday 12 September 2015
Thursday 14 May 2015
Life outside medicine. Wait, what?
As many of you may know, I'm getting married this year (2015). To a final year medical student. Yes, in my final year. Questions like "Where do you find time to organise stuff?!", "Wait, YOU are getting married to that beautiful woman? Does she know?" and "Will there be an open bar?" have arisen quite frequently. Although the latter two are valid questions, let's focus on the first one.
Contrary to popular belief, and to how you're feeling right now, there is a world outside of medicine. It's not just a fairytale written by J.R.R. Tolkien. And realising that is quite important if you're to stay sane, or at least something close. Medicine is an all-consuming lifestyle which won't change until you're a hotshot consultant doing video lectures from your yacht off the coast of your private island. And to think, we choose to do this to ourselves. Thankfully there is a but.
I've come to realise that I don't have much in common with people who don't study medicine. Also, I always get bombarded with questions about lumps and bumps that I really didn't want to hear about from someone I went to school with. Or from my mother. Plus it always gets awkward when I ask someone to pass me that glass lateral to the book. And it isn't just me.
So making friends in Medical School is really important. They will understand your struggles, your tiredness and your jargon and will laugh with you when you joke about polyps. Finding time to spend with these very important people outside of lecture theatres and wards is sometimes difficult, but is a must. Go to the movies, drink wine, go to festivals and have fun. Weekends aren't just for studying, and enjoying life is bound to make it easier to study the next day. Unless you have a hangover, which isn't what I'm getting at here, either.
I've also been asked by prospective students (especially graduates) whether it is possible to have a family and study medicine. The truth is, yeah, absolutely. Look, it won't always be easy and it will take a lot of understanding on the part of your spouse, but it certainly is possible. You also won't become "that strange person living in the room upstairs" to your children. My friend has a family and manages to go away for long weekends without having to stress about the reality that is exams. Granted, it takes a lot of prioritising and working hard the rest of the time, but it's possible and shouldn't be a deterrent.
What if you meet the one in medical school? Should you wait until after your studies or get married as soon as possible? It depends, really. If you have the financial means to get married in your final year (like you're getting married to a chartered accountant, or you've saved up, or that aunt you haven't spoken to in years has left you a pretty penny in her will), sure why not! Claudia (my future wife, for those who don't know) and I are doing a lot by ourselves. The invitations were handmade, the gifts were skillfully (of course) designed, the table decorations crafted, etc. The trick to it all is time management. We spent many nights doing all of these things, but studied really hard to make sure we can afford that time. It was fun and made for a good getaway from the books.
It's definitely worth having a life outside of medicine. The trick is to strike the right balance between fun and work. If you already do these things, or you really don't like people and prefer to spend time with only your books (which I totally get), good for you. Just make sure you do what makes you happy and become a doctor at the end of it all.
P.S To put this into context, I'm typing this a few days before my final year Internal Medicine exam. Let's hope that goes down well.
Contrary to popular belief, and to how you're feeling right now, there is a world outside of medicine. It's not just a fairytale written by J.R.R. Tolkien. And realising that is quite important if you're to stay sane, or at least something close. Medicine is an all-consuming lifestyle which won't change until you're a hotshot consultant doing video lectures from your yacht off the coast of your private island. And to think, we choose to do this to ourselves. Thankfully there is a but.
I've come to realise that I don't have much in common with people who don't study medicine. Also, I always get bombarded with questions about lumps and bumps that I really didn't want to hear about from someone I went to school with. Or from my mother. Plus it always gets awkward when I ask someone to pass me that glass lateral to the book. And it isn't just me.
So making friends in Medical School is really important. They will understand your struggles, your tiredness and your jargon and will laugh with you when you joke about polyps. Finding time to spend with these very important people outside of lecture theatres and wards is sometimes difficult, but is a must. Go to the movies, drink wine, go to festivals and have fun. Weekends aren't just for studying, and enjoying life is bound to make it easier to study the next day. Unless you have a hangover, which isn't what I'm getting at here, either.
I've also been asked by prospective students (especially graduates) whether it is possible to have a family and study medicine. The truth is, yeah, absolutely. Look, it won't always be easy and it will take a lot of understanding on the part of your spouse, but it certainly is possible. You also won't become "that strange person living in the room upstairs" to your children. My friend has a family and manages to go away for long weekends without having to stress about the reality that is exams. Granted, it takes a lot of prioritising and working hard the rest of the time, but it's possible and shouldn't be a deterrent.
What if you meet the one in medical school? Should you wait until after your studies or get married as soon as possible? It depends, really. If you have the financial means to get married in your final year (like you're getting married to a chartered accountant, or you've saved up, or that aunt you haven't spoken to in years has left you a pretty penny in her will), sure why not! Claudia (my future wife, for those who don't know) and I are doing a lot by ourselves. The invitations were handmade, the gifts were skillfully (of course) designed, the table decorations crafted, etc. The trick to it all is time management. We spent many nights doing all of these things, but studied really hard to make sure we can afford that time. It was fun and made for a good getaway from the books.
It's definitely worth having a life outside of medicine. The trick is to strike the right balance between fun and work. If you already do these things, or you really don't like people and prefer to spend time with only your books (which I totally get), good for you. Just make sure you do what makes you happy and become a doctor at the end of it all.
P.S To put this into context, I'm typing this a few days before my final year Internal Medicine exam. Let's hope that goes down well.
Sunday 19 April 2015
GIT and Nutrition (Block 3) - Guts and glory
The Gastrointestinal tract and Nutrition (GIT) block... I almost died
in this block. Not so much from the content, rather the encephalitis I
had. As a result of me being in ICU for a few days I missed quite a bit
of the block and I still managed to pass, so it's not such a bad block!
The GIT block is divided into seven weeks. It's quite a long block. I have mixed feelings about the block, for obvious reasons, but I'm sure you'll enjoy it. Although it might be difficult to stomach near the end.
The first week is the bread and butter of paediatrics in the clinical years. Malnutrition. In this week you'll learn that the terms marasmus and kwashiorkor is not used, because it is now seen as a spectrum of disorders, rather than separate entities. The preferred term is protein energy malnutrition. As random as it may seem, this week also deals with lactation. Food for thought (was that pun in bad taste...?).
Week two is all about gastro-oesophageal reflux disease (GORD). It will be repeated (get it?) again in surgery in your clinical years. It's super important. It also covers upper GI bleeds, which is devastating. I've seen a couple of patients succumb to this. The treatment of peptic ulcers will be covered as well. Try to embed the eradication therapy of Helicobacter pylori (the culprit that causes peptic ulcer disease) well. Surgeons love asking it, especially on ward rounds. The pharmacology is pretty much the same stuff from PCMS.
Week three is quite a mouth full. It covers a lot of important topics in very little time. Inflammatory bowel disease (Crohn's disease and Ulcerative colitis), disorders of the pancreas and obesity and its effects on the liver. The important thing here is to know the differences, both clinically and pathologically, between Crohn's and Ulcerative colitis. Both for MCQ and SACS papers. This is probably the week with the most content. It's a tough one.
So week four isn't great, either. Here infections of the GIT are discussed. It has a huge amount of pharmacology in the course pack. Don't panic. Have a general approach to the mechanisms of action, but don't get too bogged down in the detail. I found it simply too much. Read through it a couple of times and be able to recognise it in MCQs. Personally, I don't think this is a great way to study pharmacology, but anyway... The lectures were really useful in this week, so know them well.
The fifth week deals with cancers. GIT malignancies are devastating. In an elderly patient with anaemia, you MUST rule out malignancy first and foremost. Remember that for clinical practice. The course pack is great. Recognise the importance of certain genetic disorders and their propensity to cause neoplastic change in the gut. The course pack also covers oesophageal cancer. What a terrible disease. It has a dismal prognosis. The molecular basis of neoplastic change is discussed. They love asking this as well, so know it! The lectures are pretty meh...
Ahhh the liver. The organ that endures a lot of abuse from students. This is what weeks six and seven cover. It's quite difficult and, again, a lot of information to cram. So try to have the first five weeks covered by the weekend before this starts. It will just make your life easier. Week six handles alcohol and the liver. You'll find out that binge drinking is perhaps more detrimental to the liver than chronic alcohol abuse. (I'm pretty sure PubCrawl counts.) It also gives information about the hepatitidies. Remember, Hep A = Acute, Hep B and C are chronic. Hep C = Cirrhosis. Unfortunately only Hep A and B have vaccines. Hep C is often a co morbidity with HIV infection.
Week seven is a mean week. Seriously, you'll see. It's so much information, and it's all covered in the last week. I have no idea why it's done this way. Jaundice is the main topic and it's important to understand the differences between pre-, intra- and posthepatic jaundice and the causes thereof. Also remember the specific biochemical differences. Oh, porphyria is also covered here. It's in the course pack and it is a serious amount of detail. I tried really hard to study it all, but don't waste time. Get a general idea of what it is and some key differences. Don't aim to become an expert in porphyria just yet.
As always, I hope this helps. All the best!
The GIT block is divided into seven weeks. It's quite a long block. I have mixed feelings about the block, for obvious reasons, but I'm sure you'll enjoy it. Although it might be difficult to stomach near the end.
The first week is the bread and butter of paediatrics in the clinical years. Malnutrition. In this week you'll learn that the terms marasmus and kwashiorkor is not used, because it is now seen as a spectrum of disorders, rather than separate entities. The preferred term is protein energy malnutrition. As random as it may seem, this week also deals with lactation. Food for thought (was that pun in bad taste...?).
Week two is all about gastro-oesophageal reflux disease (GORD). It will be repeated (get it?) again in surgery in your clinical years. It's super important. It also covers upper GI bleeds, which is devastating. I've seen a couple of patients succumb to this. The treatment of peptic ulcers will be covered as well. Try to embed the eradication therapy of Helicobacter pylori (the culprit that causes peptic ulcer disease) well. Surgeons love asking it, especially on ward rounds. The pharmacology is pretty much the same stuff from PCMS.
Week three is quite a mouth full. It covers a lot of important topics in very little time. Inflammatory bowel disease (Crohn's disease and Ulcerative colitis), disorders of the pancreas and obesity and its effects on the liver. The important thing here is to know the differences, both clinically and pathologically, between Crohn's and Ulcerative colitis. Both for MCQ and SACS papers. This is probably the week with the most content. It's a tough one.
So week four isn't great, either. Here infections of the GIT are discussed. It has a huge amount of pharmacology in the course pack. Don't panic. Have a general approach to the mechanisms of action, but don't get too bogged down in the detail. I found it simply too much. Read through it a couple of times and be able to recognise it in MCQs. Personally, I don't think this is a great way to study pharmacology, but anyway... The lectures were really useful in this week, so know them well.
The fifth week deals with cancers. GIT malignancies are devastating. In an elderly patient with anaemia, you MUST rule out malignancy first and foremost. Remember that for clinical practice. The course pack is great. Recognise the importance of certain genetic disorders and their propensity to cause neoplastic change in the gut. The course pack also covers oesophageal cancer. What a terrible disease. It has a dismal prognosis. The molecular basis of neoplastic change is discussed. They love asking this as well, so know it! The lectures are pretty meh...
Ahhh the liver. The organ that endures a lot of abuse from students. This is what weeks six and seven cover. It's quite difficult and, again, a lot of information to cram. So try to have the first five weeks covered by the weekend before this starts. It will just make your life easier. Week six handles alcohol and the liver. You'll find out that binge drinking is perhaps more detrimental to the liver than chronic alcohol abuse. (I'm pretty sure PubCrawl counts.) It also gives information about the hepatitidies. Remember, Hep A = Acute, Hep B and C are chronic. Hep C = Cirrhosis. Unfortunately only Hep A and B have vaccines. Hep C is often a co morbidity with HIV infection.
Week seven is a mean week. Seriously, you'll see. It's so much information, and it's all covered in the last week. I have no idea why it's done this way. Jaundice is the main topic and it's important to understand the differences between pre-, intra- and posthepatic jaundice and the causes thereof. Also remember the specific biochemical differences. Oh, porphyria is also covered here. It's in the course pack and it is a serious amount of detail. I tried really hard to study it all, but don't waste time. Get a general idea of what it is and some key differences. Don't aim to become an expert in porphyria just yet.
As always, I hope this helps. All the best!
Muskuloskeletal (Block 2) - Do you even lift?
The musculoskeletal block has changed quite a bit from when I did it. I want to make sure the blog is current, so I'll find out what has changed and update this entry.
Monday 16 February 2015
Obstetrics: Home of the brave and land of the bodily fluids
Ahh Obstetrics. If there is a kind of bodily fluid that you haven't seen yet, you're in luck! Everything from urine to meconium. So. Much. Fun.
Apart from that, it's a great block. Unlike many curricula around the world, Obstetrics and Gynaecology will form two separate blocks in fifth and final year. The block is, like the other blocks, six weeks long and it will go pretty quickly.
You will be expected to do a few deliveries yourself, which is great (the first time). You will also hear that you must get all your deliveries in the first week and unless you're at Bara that simply isn't possible. The Gen is notoriously quiet, so make sure you use every opportunity. Rahima Moosa (the old Coronation) is where I was situated. It was loads of fun and the on call rooms are great. Only real issue is that there are very often student nurses who also have to deliver kiddies and, no matter who says what, they get preference and they are EVERYWHERE! If you're lucky enough and they're not there, getting your deliveries shouldn't be a problem.
Obs probably has the worst calls of fifth year. You are expected to call until one in the morning, after which you can go and sleep for a small number of hours before the ward round starts at seven. Calls are great, because you get to learn a lot. Labour is a long drawn-out process (just ask your mum) and you will have lots of time to get well acquainted with the different dilatory measures of the cervix. In addition, your call will provide the opportunity to assist in theater. What an experience.
Just be careful on your calls. After a long day of tutorials and then many hours of doing the intern's work you will be tired and wish that contraception was more widely utilised. I had my first post-exposure prophylaxis experience in Obs. Be careful guys! ARVs suck and give some people night terrors, and you wake up screaming for no apparent reason other than the toxins floating in your body. There's also a slight possibility that your liver could fail and you'll need a transplant... but that's neither here nor there.
What textbooks will you need? Clinical Obstetrics is amazing. It describes things very well. Obstetrics was probably the only block in which I found the objectives to be really useful. Use that in conjunction with this textbook and you will be very comfortable. The tutorials we had were also amazing. Make sure you ask a lot of questions and write down everything the consultants say. They will more often than not describe things way better than the textbook.
The most important book of the block is the Wits Obstetrics - Guidelines (little yellow book) that you must get from the department. You simply need to start reading it from day one and know everything verbatim. This is especially important for your OSPE in which it's possible to get 95%. You must know the drugs and their doses too. For example - you might get a case in the OSPE (which is a paper based theoretical patient) in which there is preterm labour. On page 86 are the exact guidelines as to what you need to do. I can't stress enough how well you need to know this. It may seem like a daunting task, but six weeks is enough time. I promise. Repetition is key.
This brings me to the assessment. Everything counts 20% to your final mark. Firstly there is the marks for jam - block assessment. This is seriously free marks. Half of the block mark is for your attendance, attitude, etc. Ask a lot of questions, be active in tuts and impress your ward consultant and you're set. The other half is for your case report. Make sure to clarify with the person marking it what they want. If in doubt, write your case report early and give it to another consultant for them to read it and give you some feedback.
The clinical case is fairly stressful. Here you are given 20 minutes to clerk a patient (history and examination) and to formulate and assessment. Then a consultant will grill you for like 20 minutes. Know your theory, but more importantly, know how to do the examination properly! They will often ask you to show them the maneuvers on the patient. Stay calm, and use the experience that the calls gave you.
The OSPE (which Dr Bera from Coro usually sets up, so listen to his hints!!) is a different kind of exam. You get 18 minutes to read the scenario and write down what you will do with this patient. Always start with history, exam, investigations. They will give you the values and ask you questions around it. KNOW THE YELLOW BOOK!!
The OSCE is basic. You go from one station to the next answering questions based on a picture, scenario, etc. It can be rather difficult and random. Make sure you know the names of the forceps and how to use them. Ask someone to show you during the block. Oh, and there will be a CTG to interpret.
There isn't much to say about the MCQ exam. It's random and it's difficult. Like every MCQ ever!
A few useful tips: stand clear from projectile fluids (that includes the ladies in lithotomy with membranes about to rupture); treat every patient with the utmost respect! It's not a nice thing they're going through and they really deserve respect; always get consent before you perform a per vaginal exam; for the guys - ask the patient if they would prefer if a female doctor does it or if a female doctor is in the room with you. Other than that, you'll be fine!
All the best!
Apart from that, it's a great block. Unlike many curricula around the world, Obstetrics and Gynaecology will form two separate blocks in fifth and final year. The block is, like the other blocks, six weeks long and it will go pretty quickly.
You will be expected to do a few deliveries yourself, which is great (the first time). You will also hear that you must get all your deliveries in the first week and unless you're at Bara that simply isn't possible. The Gen is notoriously quiet, so make sure you use every opportunity. Rahima Moosa (the old Coronation) is where I was situated. It was loads of fun and the on call rooms are great. Only real issue is that there are very often student nurses who also have to deliver kiddies and, no matter who says what, they get preference and they are EVERYWHERE! If you're lucky enough and they're not there, getting your deliveries shouldn't be a problem.
Obs probably has the worst calls of fifth year. You are expected to call until one in the morning, after which you can go and sleep for a small number of hours before the ward round starts at seven. Calls are great, because you get to learn a lot. Labour is a long drawn-out process (just ask your mum) and you will have lots of time to get well acquainted with the different dilatory measures of the cervix. In addition, your call will provide the opportunity to assist in theater. What an experience.
Just be careful on your calls. After a long day of tutorials and then many hours of doing the intern's work you will be tired and wish that contraception was more widely utilised. I had my first post-exposure prophylaxis experience in Obs. Be careful guys! ARVs suck and give some people night terrors, and you wake up screaming for no apparent reason other than the toxins floating in your body. There's also a slight possibility that your liver could fail and you'll need a transplant... but that's neither here nor there.
What textbooks will you need? Clinical Obstetrics is amazing. It describes things very well. Obstetrics was probably the only block in which I found the objectives to be really useful. Use that in conjunction with this textbook and you will be very comfortable. The tutorials we had were also amazing. Make sure you ask a lot of questions and write down everything the consultants say. They will more often than not describe things way better than the textbook.
The most important book of the block is the Wits Obstetrics - Guidelines (little yellow book) that you must get from the department. You simply need to start reading it from day one and know everything verbatim. This is especially important for your OSPE in which it's possible to get 95%. You must know the drugs and their doses too. For example - you might get a case in the OSPE (which is a paper based theoretical patient) in which there is preterm labour. On page 86 are the exact guidelines as to what you need to do. I can't stress enough how well you need to know this. It may seem like a daunting task, but six weeks is enough time. I promise. Repetition is key.
This brings me to the assessment. Everything counts 20% to your final mark. Firstly there is the marks for jam - block assessment. This is seriously free marks. Half of the block mark is for your attendance, attitude, etc. Ask a lot of questions, be active in tuts and impress your ward consultant and you're set. The other half is for your case report. Make sure to clarify with the person marking it what they want. If in doubt, write your case report early and give it to another consultant for them to read it and give you some feedback.
The clinical case is fairly stressful. Here you are given 20 minutes to clerk a patient (history and examination) and to formulate and assessment. Then a consultant will grill you for like 20 minutes. Know your theory, but more importantly, know how to do the examination properly! They will often ask you to show them the maneuvers on the patient. Stay calm, and use the experience that the calls gave you.
The OSPE (which Dr Bera from Coro usually sets up, so listen to his hints!!) is a different kind of exam. You get 18 minutes to read the scenario and write down what you will do with this patient. Always start with history, exam, investigations. They will give you the values and ask you questions around it. KNOW THE YELLOW BOOK!!
The OSCE is basic. You go from one station to the next answering questions based on a picture, scenario, etc. It can be rather difficult and random. Make sure you know the names of the forceps and how to use them. Ask someone to show you during the block. Oh, and there will be a CTG to interpret.
There isn't much to say about the MCQ exam. It's random and it's difficult. Like every MCQ ever!
A few useful tips: stand clear from projectile fluids (that includes the ladies in lithotomy with membranes about to rupture); treat every patient with the utmost respect! It's not a nice thing they're going through and they really deserve respect; always get consent before you perform a per vaginal exam; for the guys - ask the patient if they would prefer if a female doctor does it or if a female doctor is in the room with you. Other than that, you'll be fine!
All the best!
Monday 12 January 2015
Check yourself before you wreck yourself
In and around the hospital one has to be very careful with what one says... I've learnt this the hard way quite a few times, much to my embarrassment.
The first instance happened while we were on call during our Internal Medicine block. It was a very long day filled with tutorials and seeing many, many patients (it was Bara after all). I was walking around looking for one of my colleagues but it seemed that everyone was with a patient. I very politely pulled back the curtain and, in a very nice way, said "Excuse me, sir, I just need to speak with my colleague for a second". At that moment the patient, their family and my colleague gave me very strange looks. I ignored this and asked my colleague what I needed to know and, again, politely said to the patient "Thank you very much, sir".
It was then that the patient looked me in the eyes and very calmly stated "I am a woman". I was standing there in extreme embarrassment and put my foot in my mouth (even more so) by saying "I'm so terribly sorry, sir"! Seriously? Sigh... So just remember, don't always assume a beard means that the patient is a man... (Google hirsutism...)
I have a very tight-knit group of friends and we, as many others, have some inside jokes. Another interesting factoid is that I am not ghetto in the least. I'm sure you just gasped at that fact, but alas, it is true. So to up my street cred (did I use that phrase correctly?) I often, albeit sarcastically, add some ghettoness to my day (much to the dismay of my friends). This brings us to the second incident. It again happened during Internal Medicine at Bara. In GEMP I you will be taught how to examine the Respiratory system. When palpating the chest wall you can elicit a change in tactile fremitus (that simply means that you can feel a change in vibration over areas of the lung in which there is pathology like, say, pneumonia) by asking the patient to say "99" while feeling over different areas of the chest wall.
There was a patient with great signs of pneumonia and we all had a shot at eliciting these. After I examined the patient I, without really thinking, said (loud enough for the professor to hear me, sigh...) that the patient has 99 problems - and pneumonia is one. Why... Why oh why could I not just have kept my mouth shut. Everyone laughed, including the professor and the patient.
Oh, and when you do a procedure on a patient, don't ever say "Wow, not too bad for my first time!"... The patient will look at you in horror, and the intern will probably just walk away very quickly.
I share my embarrassing stories with you so that you don't make the same mistakes. And if you are going to make them, just smile, wave and swiftly walk away never to return to the scene again. The above mentioned didn't do any harm, but please do be careful with what you say in front of patients.
When you hear your very first pan systolic murmur don't show your excitement there and then. Yes, it's a great sign for you to learn from, but it's scary for the patient sitting there. Be tactful and respectful towards all your patients, always. Watch what you say and how you say it. Being in hospital is terrifying without the need for medical students discussing the poor prognosis of a disease...
The first instance happened while we were on call during our Internal Medicine block. It was a very long day filled with tutorials and seeing many, many patients (it was Bara after all). I was walking around looking for one of my colleagues but it seemed that everyone was with a patient. I very politely pulled back the curtain and, in a very nice way, said "Excuse me, sir, I just need to speak with my colleague for a second". At that moment the patient, their family and my colleague gave me very strange looks. I ignored this and asked my colleague what I needed to know and, again, politely said to the patient "Thank you very much, sir".
It was then that the patient looked me in the eyes and very calmly stated "I am a woman". I was standing there in extreme embarrassment and put my foot in my mouth (even more so) by saying "I'm so terribly sorry, sir"! Seriously? Sigh... So just remember, don't always assume a beard means that the patient is a man... (Google hirsutism...)
I have a very tight-knit group of friends and we, as many others, have some inside jokes. Another interesting factoid is that I am not ghetto in the least. I'm sure you just gasped at that fact, but alas, it is true. So to up my street cred (did I use that phrase correctly?) I often, albeit sarcastically, add some ghettoness to my day (much to the dismay of my friends). This brings us to the second incident. It again happened during Internal Medicine at Bara. In GEMP I you will be taught how to examine the Respiratory system. When palpating the chest wall you can elicit a change in tactile fremitus (that simply means that you can feel a change in vibration over areas of the lung in which there is pathology like, say, pneumonia) by asking the patient to say "99" while feeling over different areas of the chest wall.
There was a patient with great signs of pneumonia and we all had a shot at eliciting these. After I examined the patient I, without really thinking, said (loud enough for the professor to hear me, sigh...) that the patient has 99 problems - and pneumonia is one. Why... Why oh why could I not just have kept my mouth shut. Everyone laughed, including the professor and the patient.
Oh, and when you do a procedure on a patient, don't ever say "Wow, not too bad for my first time!"... The patient will look at you in horror, and the intern will probably just walk away very quickly.
I share my embarrassing stories with you so that you don't make the same mistakes. And if you are going to make them, just smile, wave and swiftly walk away never to return to the scene again. The above mentioned didn't do any harm, but please do be careful with what you say in front of patients.
When you hear your very first pan systolic murmur don't show your excitement there and then. Yes, it's a great sign for you to learn from, but it's scary for the patient sitting there. Be tactful and respectful towards all your patients, always. Watch what you say and how you say it. Being in hospital is terrifying without the need for medical students discussing the poor prognosis of a disease...
Friday 9 January 2015
A doctor, a teacher and a lawyer walk into a bar...
The title is slightly misleading, because it brings forward the assumption that there's going to be a punchline. There isn't. Sorry...
I think I was in GEMP I when I just so happened to overhear a conversation amongst some people in my class. I have no idea who they were. The conversation went a little something like this...
"I can't believe she's studying to be a teacher."
"Yeah, that's so lame. What a waste of time."
"Totes (okay, maybe they didn't say totes, but I just wanted to convey the tone of the conversation...). She's clearly not as clever as we all are."
"Yeah, we're so much better than people who aren't becoming doctors."
I know it was a little rude of me to have interjected their highly intelligent conversation, but I felt I had to. I simply turned to them and reminded them, politely, that were it not for teachers they would not be in medical school in the first place.
This brings me to the point I want to make. See, not everyone can become doctors, or lawyers, or teachers for that matter. It's easy to forget that we all have our separate roles to play in the big screenplay that is life (deep, hey?). It is in no way our place to judge.
I think that the important thing is passion. Whether it be for science, for medicine, for law, for cake, for teaching or for sweeping streets - passion is what people need to look out for, not the profession itself.
This is a short post, but one of the most important pieces I will ever type. Never look down on any other profession, no matter what profession it is.
I think I was in GEMP I when I just so happened to overhear a conversation amongst some people in my class. I have no idea who they were. The conversation went a little something like this...
"I can't believe she's studying to be a teacher."
"Yeah, that's so lame. What a waste of time."
"Totes (okay, maybe they didn't say totes, but I just wanted to convey the tone of the conversation...). She's clearly not as clever as we all are."
"Yeah, we're so much better than people who aren't becoming doctors."
I know it was a little rude of me to have interjected their highly intelligent conversation, but I felt I had to. I simply turned to them and reminded them, politely, that were it not for teachers they would not be in medical school in the first place.
This brings me to the point I want to make. See, not everyone can become doctors, or lawyers, or teachers for that matter. It's easy to forget that we all have our separate roles to play in the big screenplay that is life (deep, hey?). It is in no way our place to judge.
I think that the important thing is passion. Whether it be for science, for medicine, for law, for cake, for teaching or for sweeping streets - passion is what people need to look out for, not the profession itself.
This is a short post, but one of the most important pieces I will ever type. Never look down on any other profession, no matter what profession it is.
Tuesday 6 January 2015
Internal Medicine Block I: Gregory House and friends
Ahhh Internal Medicine. My passion. So much so my fiancée and I started the world's very first student internal medicine society at Wits! (The Physician Society, check it out!) This block will certainly teach a lot, especially that Lupus is, sometimes, the answer. I was at Bara, but I'm sure the following will apply everywhere.
As all other clinical blocks in GEMP III the focus is on your clinical skills. How you engage with a patient, how you examine the patient, how you think. In this block you will only require one textbook - Clinical examination: A systematic guide to physical diagnosis by NJ Talley & S O’Connor (or as everyone calls it - Talley's). Everything you need to know is here.
The thing about Internal medicine is that if you don't practise, the physicians will see that. If you haven't clerked a Respiratory patient, Prof Wong at Bara will go to town on your proverbial behind. Don't just use tutorials as clerking opportunities. After a long day when it seems oh so tempting to go home, go and see a patient.
If you are "lucky" like I was, you will be on call on your very first day. Yeah,that's right, not knowing much, you will be expected to be on intake. It sucks at first, but then you get better at it. Some doctors will expect you to see, diagnose, and start management on patients. It's the best. You actually feel like a doctor. Oh, and might I remind you that there is no shame in Googling stuff... Other doctors will be more passive. So calls become what you make of them. On your first day be sure to take a pair of scrubs and enough food for supper, just in case you're the lucky unit on call that evening. Call at Bara was until 21h00.
The block is essentially only five weeks long, as in the sixth week you write exams. During the block you will spend time in the wards in the morning during post intake ward rounds if you were on call the night before. These are usually just business rounds, so don't expect to learn too much. Ask questions though. Remember, there is no such thing as a stupid question, just a stupid answer (as I once told a doctor at CHSE who didn't answer my question). After that you will have a lot of tutorials. For the tutorials I would suggest that you give the doctor giving the tutorial a call and ask if they have a patient, if they prefer a certain system (CVS, Resp, etc.) or if you can choose any patient. Before each tutorial make sure everyone has seen, felt, heard or smelled the signs. Everyone doesn't have to do a full clerk. Use the tutorial as a chance to sharpen your skills. Rather look like a fool here than in the exam.
The physicians want your clerked case presented in a very specific way. In internal medicine, you always start your presentation with an overall assessment of the patient. No one told us that, and boy did we pay for it. Below is an example which can be used in any patient, regardless of the system or diagnosis. In brackets I will put the importance. Then I will give you a template for cardiology tutorials, which will differ greatly.
Mrs Jones (the name is very important!), a 46 year old accountant from Sandton (a personal touch which some physicians regard very highly), a known diabetic patient, well controlled on medication for ten years, (here you mention their chronic ailments) presented with a three day history (time period is important) with signs and symptoms suggestive of meningitis (don't list positive Brudzinsky and Kernig, with a fever!), with a differential including encephalitis and neoplasm (only include a differential if you are not 99.99% sure of the diagnosis), complicated by focal neurological signs, specifically seizures and weakness of the left lower limb (mention the complications, and grade it if possible, including presence/absence of any prognostic factors).
In cardiology they want to know the following cardinal things : What is the NYHA class of the patient (is the patient in heart failure?); does the patient have infective endocarditis (splenomegaly, Roth spots, proximal splinter haemorrhages); does the patient have a history of Rheumatic Fever (Ducket Jones criteria...); is there pulmonary hypertension; and if there are any murmurs (and grade them). The thing about murmurs and heart failure - they are not diagnoses, just signs of an underlying diseases. For example: Mrs Jones (she's very ill this Jones lady), a 46 year old accountant from Sandton, a known well controlled diabetic for ten years, now presents with signs and symptoms of heart failure, most likely a dilated cardiomyopathy, secondary to chronic ethanol abuse (we don't say she drinks like a fish in front of the patient, or professor); NYHA functional class III; no signs of infective endocarditis; no history of Rheumatic Fever; no murmurs; no signs of pulmonary hypertension. (and that, ladies and gents, is how you make a cardiologist very happy!)
The logbooks are pretty important. Make sure you fill in every single patient you see. Whether it's on intake (calls) or for tutorials. When you present it to a consultant, registrar or intern (in order of preference, intern being least) you must have them sign you off in your log book. For procedures that you observe or carry out, make sure you write it all in! Just not things like popping in a drip or doing an arterial blood gas. If you see an intern doing something, watch them. The next time you can do it! Make use of your time. Putting a huge needle into someone's spine and catching whatever fluid comes out is scary. For both you and the patient. After your second or third LP, though, you'll be fine.
Some general tips. GEMP I and II hasn't taught us well. Every clinical examination starts with the hand (apart from Neuro, which starts with gait). When is comes to cardiology you must know what you are going to hear before you place your stethoscope on the chest of your patient. For example, say you feel a collapsing pulse, a positive Corrigan's sign and hippus pupils, you must expect to hear an early diastolic murmur, as you should already know that it is aortic regurgitation.
When it comes to the other systems, be thorough as well. Use Talley's to guide you in what order to go. From day one you must have an idea of what systems you want to study when and then practice the skills it teaches you the next day. Prepare well for tutorials as well. If you clerk a patient today, go and read up on that system and make sure you've picked up all the signs. If you haven't, just go and do it the next morning.
The exams are straight forward. An impossible MCQ and then the clinical exam. It's all very well explained in the handbook they provide.
I hope this was helpful. It probably doesn't answer all your questions, so if you have any other, please just send me a message and I will answer as best I can.
As all other clinical blocks in GEMP III the focus is on your clinical skills. How you engage with a patient, how you examine the patient, how you think. In this block you will only require one textbook - Clinical examination: A systematic guide to physical diagnosis by NJ Talley & S O’Connor (or as everyone calls it - Talley's). Everything you need to know is here.
The thing about Internal medicine is that if you don't practise, the physicians will see that. If you haven't clerked a Respiratory patient, Prof Wong at Bara will go to town on your proverbial behind. Don't just use tutorials as clerking opportunities. After a long day when it seems oh so tempting to go home, go and see a patient.
If you are "lucky" like I was, you will be on call on your very first day. Yeah,that's right, not knowing much, you will be expected to be on intake. It sucks at first, but then you get better at it. Some doctors will expect you to see, diagnose, and start management on patients. It's the best. You actually feel like a doctor. Oh, and might I remind you that there is no shame in Googling stuff... Other doctors will be more passive. So calls become what you make of them. On your first day be sure to take a pair of scrubs and enough food for supper, just in case you're the lucky unit on call that evening. Call at Bara was until 21h00.
The block is essentially only five weeks long, as in the sixth week you write exams. During the block you will spend time in the wards in the morning during post intake ward rounds if you were on call the night before. These are usually just business rounds, so don't expect to learn too much. Ask questions though. Remember, there is no such thing as a stupid question, just a stupid answer (as I once told a doctor at CHSE who didn't answer my question). After that you will have a lot of tutorials. For the tutorials I would suggest that you give the doctor giving the tutorial a call and ask if they have a patient, if they prefer a certain system (CVS, Resp, etc.) or if you can choose any patient. Before each tutorial make sure everyone has seen, felt, heard or smelled the signs. Everyone doesn't have to do a full clerk. Use the tutorial as a chance to sharpen your skills. Rather look like a fool here than in the exam.
The physicians want your clerked case presented in a very specific way. In internal medicine, you always start your presentation with an overall assessment of the patient. No one told us that, and boy did we pay for it. Below is an example which can be used in any patient, regardless of the system or diagnosis. In brackets I will put the importance. Then I will give you a template for cardiology tutorials, which will differ greatly.
Mrs Jones (the name is very important!), a 46 year old accountant from Sandton (a personal touch which some physicians regard very highly), a known diabetic patient, well controlled on medication for ten years, (here you mention their chronic ailments) presented with a three day history (time period is important) with signs and symptoms suggestive of meningitis (don't list positive Brudzinsky and Kernig, with a fever!), with a differential including encephalitis and neoplasm (only include a differential if you are not 99.99% sure of the diagnosis), complicated by focal neurological signs, specifically seizures and weakness of the left lower limb (mention the complications, and grade it if possible, including presence/absence of any prognostic factors).
In cardiology they want to know the following cardinal things : What is the NYHA class of the patient (is the patient in heart failure?); does the patient have infective endocarditis (splenomegaly, Roth spots, proximal splinter haemorrhages); does the patient have a history of Rheumatic Fever (Ducket Jones criteria...); is there pulmonary hypertension; and if there are any murmurs (and grade them). The thing about murmurs and heart failure - they are not diagnoses, just signs of an underlying diseases. For example: Mrs Jones (she's very ill this Jones lady), a 46 year old accountant from Sandton, a known well controlled diabetic for ten years, now presents with signs and symptoms of heart failure, most likely a dilated cardiomyopathy, secondary to chronic ethanol abuse (we don't say she drinks like a fish in front of the patient, or professor); NYHA functional class III; no signs of infective endocarditis; no history of Rheumatic Fever; no murmurs; no signs of pulmonary hypertension. (and that, ladies and gents, is how you make a cardiologist very happy!)
The logbooks are pretty important. Make sure you fill in every single patient you see. Whether it's on intake (calls) or for tutorials. When you present it to a consultant, registrar or intern (in order of preference, intern being least) you must have them sign you off in your log book. For procedures that you observe or carry out, make sure you write it all in! Just not things like popping in a drip or doing an arterial blood gas. If you see an intern doing something, watch them. The next time you can do it! Make use of your time. Putting a huge needle into someone's spine and catching whatever fluid comes out is scary. For both you and the patient. After your second or third LP, though, you'll be fine.
Some general tips. GEMP I and II hasn't taught us well. Every clinical examination starts with the hand (apart from Neuro, which starts with gait). When is comes to cardiology you must know what you are going to hear before you place your stethoscope on the chest of your patient. For example, say you feel a collapsing pulse, a positive Corrigan's sign and hippus pupils, you must expect to hear an early diastolic murmur, as you should already know that it is aortic regurgitation.
When it comes to the other systems, be thorough as well. Use Talley's to guide you in what order to go. From day one you must have an idea of what systems you want to study when and then practice the skills it teaches you the next day. Prepare well for tutorials as well. If you clerk a patient today, go and read up on that system and make sure you've picked up all the signs. If you haven't, just go and do it the next morning.
The exams are straight forward. An impossible MCQ and then the clinical exam. It's all very well explained in the handbook they provide.
I hope this was helpful. It probably doesn't answer all your questions, so if you have any other, please just send me a message and I will answer as best I can.
Saturday 3 January 2015
Endocrine (Block 1) - Raging hormones and you
My favourite block of GEMP II. It's quite short, consisting of only five weeks. What I really enjoyed about the block is the logic behind everything. For the most part the hypothalamus, pituitary gland and then the target organs (thyroid gland, gonads, adrenal glands, etc.) are involved. What's nice about this is the feedback loops and axes. I'll give an example below. Oh, and the textbook I used and found super useful was Clinical chemistry by WJ Marshall & SK Bangert. Really great and not too much detail.
Week one is all about the thyroid. We all have a family member who ate just a little too much over Christmas and now suddenly has an "underactive thyroid". Usually not the case (yeah, we all saw the extra helpings, Aunty), but obviously you shouldn't say anything. It won't bode well, trust me. The thyroid axis is a great example of the feedback loops I spoke of. The hypothalamus detects that the body has low levels of thyroid hormone. It then produces thyrotropin releasing hormone (TRH) into what is called the portal circulation (the one in the brain, not the liver), which stimulates the pituitary gland to produce thyroid stimulating hormone (TSH). The TSH enters the systemic vasculature and reaches the thyroid gland (the target organ) and tells it to produce some more thyroid hormone. Once the thyroid hormone levels are replenished, it feeds back to the hypothalamus and says "K, thanks, bye." and the hypothalamus stops producing TRH. Week one doesn't have a course pack. So grab a textbook and make your own one. It won't take all that long.
Week two really should have been week one. The course pack gives the basic details you'll need for the block. Growth hormone is the name of the game. You'll learn of acromegaly and it is said to be relatively uncommon, but you might be lucky enough to see a patient with growth hormone secreting tumours. We did and I was taller than him. Oh, I'm two meters tall, by the way. So I'm easy to spot in the wards if you have any questions.
Ahh 'roid rage!! Week three covers steroids in the body. The biosynthetic pathway is very important and is, of course, not really well done in the course pack. I used Clinical chemistry and Harrison's and Google to get a comprehensive understanding of the entire pathway. Make sure you know this pathway really well. It's a favourite in the exams, both MCQs and written papers. Just a heads up - you'll notice different sources give certain enzymes different names. Try to use as many sources as possible, because you never know which one will pop up in the exam.
Week four and five are very much the same. It handles diabetes mellitus and metabolic syndrome. There are no real problems here with either week. The pharmacology here is really important. It's the bread and butter (low GI and low fat, of course) of endocrinology.
The work isn't all that bad, really. I would just advise you to try and commit the information into your long term memory. The next block was by far my biggest struggle. You will not have time to redo all of endocrine to study for the exams after block two. If you're a graduate who has never done anatomy (I know it was studied for the WAPT, but that was short term memory) I would advise you to make a point of being a boss in endocrine. It will take the pressure off.
Enjoy!
Week one is all about the thyroid. We all have a family member who ate just a little too much over Christmas and now suddenly has an "underactive thyroid". Usually not the case (yeah, we all saw the extra helpings, Aunty), but obviously you shouldn't say anything. It won't bode well, trust me. The thyroid axis is a great example of the feedback loops I spoke of. The hypothalamus detects that the body has low levels of thyroid hormone. It then produces thyrotropin releasing hormone (TRH) into what is called the portal circulation (the one in the brain, not the liver), which stimulates the pituitary gland to produce thyroid stimulating hormone (TSH). The TSH enters the systemic vasculature and reaches the thyroid gland (the target organ) and tells it to produce some more thyroid hormone. Once the thyroid hormone levels are replenished, it feeds back to the hypothalamus and says "K, thanks, bye." and the hypothalamus stops producing TRH. Week one doesn't have a course pack. So grab a textbook and make your own one. It won't take all that long.
Week two really should have been week one. The course pack gives the basic details you'll need for the block. Growth hormone is the name of the game. You'll learn of acromegaly and it is said to be relatively uncommon, but you might be lucky enough to see a patient with growth hormone secreting tumours. We did and I was taller than him. Oh, I'm two meters tall, by the way. So I'm easy to spot in the wards if you have any questions.
Ahh 'roid rage!! Week three covers steroids in the body. The biosynthetic pathway is very important and is, of course, not really well done in the course pack. I used Clinical chemistry and Harrison's and Google to get a comprehensive understanding of the entire pathway. Make sure you know this pathway really well. It's a favourite in the exams, both MCQs and written papers. Just a heads up - you'll notice different sources give certain enzymes different names. Try to use as many sources as possible, because you never know which one will pop up in the exam.
Week four and five are very much the same. It handles diabetes mellitus and metabolic syndrome. There are no real problems here with either week. The pharmacology here is really important. It's the bread and butter (low GI and low fat, of course) of endocrinology.
The work isn't all that bad, really. I would just advise you to try and commit the information into your long term memory. The next block was by far my biggest struggle. You will not have time to redo all of endocrine to study for the exams after block two. If you're a graduate who has never done anatomy (I know it was studied for the WAPT, but that was short term memory) I would advise you to make a point of being a boss in endocrine. It will take the pressure off.
Enjoy!
Friday 2 January 2015
Telephones and testicles
What is to follow is just as romantic as the title. I promise. We were in our Emergency Medicine rotation at Tambo Memorial Hospital, in GEMP III. It was a regular day, really. Some acute coronary syndromes, an asthma attack here and there and a few lacerations on people who clearly upset other people who owned knives. That's when Mr Chutney (get it? Like in Mrs Balls chutney? Balls being a euphemism here... Anyway.) came walking through the doors.
A wonderful elderly chap who came with a common problem - unilateral testicular swelling. Claudia (my fiancée) saw him, took his history and subsequently examined him. The thing about testicular swellings is that you must ascertain whether it is composed of solid tissue or a fluid substance. The best way to determine this is to shine a light onto the swelling and see if it transilluminates (that is, if the light shines through or not). Problems arose when Claudia realised that she did not own a small torch to do this with.
Being the resourceful medical student that she is she overcame this obstacle by using her smartphone's light. "Careful," she thought, "do not make contact with the scrotum." and had it not been for Mr Chutney's urge to move, she would have achieved her goal. Alas...
Claudia walked up to me and handed her phone to me whilst she washed her hands. She the politely proceeded to tell me what her phone just went through. There I was, all willy nilly with her phone in my ungloved hand. Sure, sounds pretty benign (as it were), but trust me when I say it wasn't.
"Where is he going with this story?", you might be asking yourself. Not only am I looking for moral support here, I would like to give you some advice. Firstly, be prepared. Seriously. Make sure you have the basics with you at all times - your stethoscope, your ophthalmoscope, your torch (ahem, Claudia), gloves, tongue depressors, etc.
When you go through your various rotations, especially in GEMP III and IV, you'll notice that some wards are better stocked than others and you will often have to make use of this fact. When you're in the Surgical pit (the wonderful name given to the Surgical Emergency department at Bara) you will notice a severe shortage in something. It's always different, you see. Today it will be black needles (which you'll soon learn is the most useful size needle with which to poke holes in people), tomorrow gauze. These commodities vary in availability. Now, I'm not saying you should steal supplies from well stocked wards around the corner to use on patients who are in dire need of it where you are working, I'm merely saying that people do it... Ahem...
Be resourceful, no matter where you are. Make use of what you have. Just clean it afterwards before handing it to you fiancé... Just saying.
Happy hunting!
A wonderful elderly chap who came with a common problem - unilateral testicular swelling. Claudia (my fiancée) saw him, took his history and subsequently examined him. The thing about testicular swellings is that you must ascertain whether it is composed of solid tissue or a fluid substance. The best way to determine this is to shine a light onto the swelling and see if it transilluminates (that is, if the light shines through or not). Problems arose when Claudia realised that she did not own a small torch to do this with.
Being the resourceful medical student that she is she overcame this obstacle by using her smartphone's light. "Careful," she thought, "do not make contact with the scrotum." and had it not been for Mr Chutney's urge to move, she would have achieved her goal. Alas...
Claudia walked up to me and handed her phone to me whilst she washed her hands. She the politely proceeded to tell me what her phone just went through. There I was, all willy nilly with her phone in my ungloved hand. Sure, sounds pretty benign (as it were), but trust me when I say it wasn't.
"Where is he going with this story?", you might be asking yourself. Not only am I looking for moral support here, I would like to give you some advice. Firstly, be prepared. Seriously. Make sure you have the basics with you at all times - your stethoscope, your ophthalmoscope, your torch (ahem, Claudia), gloves, tongue depressors, etc.
When you go through your various rotations, especially in GEMP III and IV, you'll notice that some wards are better stocked than others and you will often have to make use of this fact. When you're in the Surgical pit (the wonderful name given to the Surgical Emergency department at Bara) you will notice a severe shortage in something. It's always different, you see. Today it will be black needles (which you'll soon learn is the most useful size needle with which to poke holes in people), tomorrow gauze. These commodities vary in availability. Now, I'm not saying you should steal supplies from well stocked wards around the corner to use on patients who are in dire need of it where you are working, I'm merely saying that people do it... Ahem...
Be resourceful, no matter where you are. Make use of what you have. Just clean it afterwards before handing it to you fiancé... Just saying.
Happy hunting!
Thursday 1 January 2015
GEMP I & GEMP II: Exams, Negative marking and other horrors
I trust that I am not alone when I say that exams suck. They are supposedly the only way we can be tested. (If you're reading this in the year 2134 and civilisation has developed a way to gauge knowledge using computers and soy sauce, please ignore the last sentence.)
Exams in GEMP I and II follow the same dreadful pattern. At the end of, say, Block one you will write a Multiple Choice Question (MCQ) paper covering that block's work. At the end of Block two you will again write an MCQ (on Block two's work) in addition to two Written papers (one on Block one's work and one on Block two's work). Block three and four and then five and six will follow the same pattern. I've approached the brains behind the scene before and questioned why on Earth this is the way we get examined and I was not expecting the answer: Students have requested this manner of examination in years gone by. Alrighty then...
The MCQs are particularly evil and very random. There are three kinds of MCQs - X-types, A-types and R-types. Let's chat about X-types first. Negative marking applies. Sigh. This is to discourage us from guessing the answers. This is probably for the best, considering we can't just guess when it comes to real live patients. If you haven't been exposed to negative marking before, here's a brief rundown for you: A question will be asked: Which of the following statements are True?, after which five options will be given (of which at least one will be true and one will be false):
A. 1 + 1 = 2.
B. There is no such thing as a bad time for cake.
C. Grey's Anatomy is always based on real life.
D. Food is never the answer.
E. All of the above are true.
Let's assume that this question is out of a possible two marks (so marking each option as either True or False correctly would give you 0.4 marks, each). The correct answers are A and B are true, and C, D and E are false. If your MCQ card reads that, you would receive two marks. If, however, you selected A, B and C (Let's say you guessed option C. ) as being true, and the others false, you would receive 0.4 for the correct answers (A and B as True and D and E as False = 1.6 = 80%) but would have 0.4 deducted from the total for marking C incorrectly as True (1.6 - 0.4 = 1.2 = 60%). If you didn't guess C and chose to select "Don't know" or leave it blank, you would have received 1.6 (80%) for that question.
If that didn't make sense the first time you read it please don't stress. It's quite a mouth full. Some tips: Never guess! Getting just one option wrong brings the mark down drastically. The only time you should guess if when you read a question and you have never even heard of what it's asking about (it happens). A pitfall is seen in options C and D. The words always and never should be assumed to be false, because somewhere, somehow something does what's not expected of it. Oh yes, and if it's ever true, then the answer is true. Like if the statement read "Grey's Anatomy is based on real life" (which it sometimes is) the answer would have been True. So read the question twice and ask yourself - Is this ever true?. And lastly, if you disagree with option B we need to talk.
A-types are better, I think. They're similar to X-types in that you get a question with five options, but only one is true. It does happen that two seem right and, if the one isn't obviously more right than the other, flip a coin and guess. No negative marking. Phew.
R-types are weird. You get a list of options (from, say, A to J) and are asked to apply the correct one to the scenario or question that follows. No negative marking. Yay. Be alert though - sometimes you can use an answer more than once.
Now on to the Written papers. You will hear a bunch of acronyms like MEQ, SAQ, SACS, etc. being applied to the Written papers. I have no idea what these things mean and I don't really care. It doesn't matter. Point is you get a paper with various scenarios followed by a series of questions surrounding a patient in the scenario. Some questions are worth one or two marks, and some worth ten or twenty marks. Read the questions carefully.
To prepare for these exams obviously you need to study, but it's also very useful to go over the past papers as you do. Past papers are available on the GEMP websites. The very long questions on random things, like Ethics and Family Medicine, are very often repeated and rotated. Also, don't spot. It's not the best idea and don't rely on the past papers alone.
Lastly just remember one thing: you're not studying for an exam. You're studying to eventually save a life. The exams are merely there to show Faculty that you've been there and read through some stuff. It shouldn't be the focus. In addition, don't be defined by the mark you get. It's not a test of how good a doctor you'll be. I've only come to realise this at the end of GEMP III. If I didn't get the mark I was hoping for I would be so bleak. At the end of the day the reward of studying hard isn't a good mark like in MBBCh II or other degrees - the reward is having a patient coming into the ER in a Diabetic Ketoacidosis and you not giving the patient 5% Dextrose water IVI at one litre an hour.
Good luck!
PS. I will discuss the practical exams and integrated exams in other posts.
Exams in GEMP I and II follow the same dreadful pattern. At the end of, say, Block one you will write a Multiple Choice Question (MCQ) paper covering that block's work. At the end of Block two you will again write an MCQ (on Block two's work) in addition to two Written papers (one on Block one's work and one on Block two's work). Block three and four and then five and six will follow the same pattern. I've approached the brains behind the scene before and questioned why on Earth this is the way we get examined and I was not expecting the answer: Students have requested this manner of examination in years gone by. Alrighty then...
The MCQs are particularly evil and very random. There are three kinds of MCQs - X-types, A-types and R-types. Let's chat about X-types first. Negative marking applies. Sigh. This is to discourage us from guessing the answers. This is probably for the best, considering we can't just guess when it comes to real live patients. If you haven't been exposed to negative marking before, here's a brief rundown for you: A question will be asked: Which of the following statements are True?, after which five options will be given (of which at least one will be true and one will be false):
A. 1 + 1 = 2.
B. There is no such thing as a bad time for cake.
C. Grey's Anatomy is always based on real life.
D. Food is never the answer.
E. All of the above are true.
Let's assume that this question is out of a possible two marks (so marking each option as either True or False correctly would give you 0.4 marks, each). The correct answers are A and B are true, and C, D and E are false. If your MCQ card reads that, you would receive two marks. If, however, you selected A, B and C (Let's say you guessed option C. ) as being true, and the others false, you would receive 0.4 for the correct answers (A and B as True and D and E as False = 1.6 = 80%) but would have 0.4 deducted from the total for marking C incorrectly as True (1.6 - 0.4 = 1.2 = 60%). If you didn't guess C and chose to select "Don't know" or leave it blank, you would have received 1.6 (80%) for that question.
If that didn't make sense the first time you read it please don't stress. It's quite a mouth full. Some tips: Never guess! Getting just one option wrong brings the mark down drastically. The only time you should guess if when you read a question and you have never even heard of what it's asking about (it happens). A pitfall is seen in options C and D. The words always and never should be assumed to be false, because somewhere, somehow something does what's not expected of it. Oh yes, and if it's ever true, then the answer is true. Like if the statement read "Grey's Anatomy is based on real life" (which it sometimes is) the answer would have been True. So read the question twice and ask yourself - Is this ever true?. And lastly, if you disagree with option B we need to talk.
A-types are better, I think. They're similar to X-types in that you get a question with five options, but only one is true. It does happen that two seem right and, if the one isn't obviously more right than the other, flip a coin and guess. No negative marking. Phew.
R-types are weird. You get a list of options (from, say, A to J) and are asked to apply the correct one to the scenario or question that follows. No negative marking. Yay. Be alert though - sometimes you can use an answer more than once.
Now on to the Written papers. You will hear a bunch of acronyms like MEQ, SAQ, SACS, etc. being applied to the Written papers. I have no idea what these things mean and I don't really care. It doesn't matter. Point is you get a paper with various scenarios followed by a series of questions surrounding a patient in the scenario. Some questions are worth one or two marks, and some worth ten or twenty marks. Read the questions carefully.
To prepare for these exams obviously you need to study, but it's also very useful to go over the past papers as you do. Past papers are available on the GEMP websites. The very long questions on random things, like Ethics and Family Medicine, are very often repeated and rotated. Also, don't spot. It's not the best idea and don't rely on the past papers alone.
Lastly just remember one thing: you're not studying for an exam. You're studying to eventually save a life. The exams are merely there to show Faculty that you've been there and read through some stuff. It shouldn't be the focus. In addition, don't be defined by the mark you get. It's not a test of how good a doctor you'll be. I've only come to realise this at the end of GEMP III. If I didn't get the mark I was hoping for I would be so bleak. At the end of the day the reward of studying hard isn't a good mark like in MBBCh II or other degrees - the reward is having a patient coming into the ER in a Diabetic Ketoacidosis and you not giving the patient 5% Dextrose water IVI at one litre an hour.
Good luck!
PS. I will discuss the practical exams and integrated exams in other posts.
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