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...
Monday 12 January 2015
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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