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!
Friday, 2 January 2015
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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