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!
Showing posts with label GEMP III. Show all posts
Showing posts with label GEMP III. Show all posts
Monday, 16 February 2015
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.
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