Holiday!

Holiday technically started a week-ish ago, but because of results, it didn't feel much of a holiday. It's been quite a few days since results (yes I realize my exam and results post were fairly recent...but in reality my exams were like 2 weeks ago). I will be going back home to spend my short winter holiday and just make the most of my time with family and friends. Should be good so I'm really excited. Seems like I haven't had a break in ages, but technically just got off in August. This year has been extremely long.

Anyways I will be off for a few weeks. So happy holidays to everyone and congratulations to those who have already received offers (yay!) and those who have received interviews! For those who are still waiting, try your best to not think about it and have a nice holiday/break!

Close Call.

If you have read my previous post on exams...you would have noticed that this exam was very difficult and I was fairly convinced I had failed. From last day of exams to results...I had 7 days to ponder and scare myself/reassure myself. Easily the most anxious 7 days of my life. First day post exam - I swear I was brain dead. I couldn't do anything properly. At the same time - I was in a bit of a depressed state of mind. Also found it very difficult to sleep. Mind you, I'm not the type that worries about stuff. I literally am a happy-go-lucky/care-free person. I rarely worry about things.  Thank goodness I got to go to London for the weekend to watch a concert, which allowed me to get my mind off of exams and just to relax.

Results day - woke up at 8am...pretty much tossed around in bed for the next 4 hours as results aren't released until 2pm. Worst bit is that I have to go to the medical school to go see my results as for no reason the school does not post them online.

"Results are out...it ain't pretty." - the text message I received from my friend at 2:10pm. When I read the message, I felt my heart drop. As I got closer to the medical school, I could feel my heart racing. I then saw classmates standing outside the school. Some crying. Some cheering. Some looked in shock. I really didn't know what to expect. The short walk from the entrance to the notice board where our results are posted was probably the longest walk ever. Next comes the difficult bit. Finding your student number in a list of 280 other numbers. "Should I check the fail list first? Or just try to find my number in the pass list?" My gut went with looking through the pass list first. Thank goodness our numbers are in numerical order this year. Page after page....I finally found my number. I passed my exam! Then curiosity won me over and I took a look at the fail list. I was in shock. The phase director had failed 20% of the year (50+ students). Wow. She actually kept her word about it. I was disgusted by the number of students she had decided to fail. Ridiculous. As time passed, more of my friends came in to check their results as word had spread about results being out. One by one I saw students come through. Saw a couple people crying as they had failed their exams. Thinking about it - we were all top of the class students. Failure...is probably something we have never really experienced before, so for those who failed their medical exams it probably came as a shock. By the way - usually only 10-15 people fail their exams. In our last two years, my year had set the highest passing rate. The academic department was proud of our year. In 6 months, we went from the highest passing rate, to the highest failing rate. Obviously there is something wrong with the exam and not us.

Unfortunately a few of my close friends had failed their exams. I know a few people getting kicked out from the course from failing more than 3 times in the course. A couple of people had failed and had such a bad experience from these last 6 months, will be quitting medicine. It's really a shame that one phase director can put so many people off from medicine and possibly even change the future of so many students.  Lots of students had lost a lot of confidence because of these exams. These exams disgust me especially knowing the school had screwed up badly with these exams. Pass mark for our exams are usually at around 47-50%. This year our pass mark was around 40%. OBVIOUSLY something wrong with the exam if your pass mark is that low. I surely hope the school does something to resolve this as I think this is unacceptable. Yes I am angry at the school. Yes I am annoyed. Yes I know I passed, but knowing the pass mark was that low - I feel like I didn't pass my exam as it was not a fair exam and not a fair way to examine the knowledge I had gained in the last 6 months.

What I had experienced from these exams, I am a bit hesitant on even recommending the school to prospective students. It's really a shame how poorly this has been handled. Hopefully the school will regain my confidence in them in the new year.

Brain Torture.

As some of you know, I had exams about a week ago. Had 2 written papers and 1 practical (OSCE). It could easily be the hardest exam I have ever endured. I was mentally drained after each exam - I had never struggled so much in an exam. Our year had our exams re-written to a new format so we were going into the exam blind as we were told 3 days before our exam that the specimen papers that were put online are not representative of what we will be examined on. Instilling so much confidence into us (sarcasm). So pretty much we were all pooping ourselves prior to exams as we have no idea what to expect. We didn't even know what to study or how to study for this exam so the general consensus was "We are so screwed." It didn't help that we were told that the previous year 1 in 5 students had failed (20%). The scare tactics had been brutal and was pretty much messing with our confidence (quite unprofessional of the director to be honest). We were also told that the director was going to fail 20% of the year again so everyone was extremely scared. Horrible way to go into an exam.

Anyways the first paper I had was multiple choice and I swear once I finished the exam it felt like someone had continuously kicked my brain. I couldn't even think straight afterwards. The exam was 1.5 hours and the exam we took was definitely for a 2 hour time limit. I had BARELY just finished the exam. I was on my last question with only 10 minutes to spare. Didn't even get time to check. Mind you I'm not a slow exam taker...for the last 2 years I have finished my multiple choice papers in 30 minutes and the last two years my exam had 90 question and a 2 hour time limit. This year we had 60 questions with a 1.5 hour time limit. Each question was a massive paragraph to read. It was really frustrating as it takes just a minute to read the question. You seriously start to wonder if anyone had checked the exam paper and tried doing it to make sure it is possible to finish the paper in 1.5 hours. I had several friends who couldn't even finish this paper. Most people only did about 40ish questions out of 60. What a way to start the exam week.

Next day was the OSCE practical exam. 12 stations. 6 patient histories. 6 physical examinations. I was fairly confident going into this as I feel that I'm strong at doing practicals. Anyways the exam was 2 hours and it was so hectic and a lot more difficult than I had expected it to be. Should've known if I had based it on the previous day's exam. The instructions that were given in each station were long and very confusing. It would be like "Please do _____ examination on the patient BUT do not do _____, ______, _____, and _______; BUT remember to assess _______." Mind you the time you take to read the instructions is part of the time you're supposed to perform the physical examination so the longer you take to read, the less time you have to do the physical examination. You're already nervous and anxious, so when seeing such unclear instructions your brain gets all jumbled up. Personally I thought I did okay in the OSCE. Did however watch one examiner fail me in a patient history station for no reason. Everyone else in my circuit was complaining about the same examiner as he was giving everyone just half marks and was being very stingy/strict. Quit frustrating.

Final day was modified essay question paper. Obviously every one was petrified of this exam as based on how the last 2 days went - this exam will be ridiculously hard. Also because a lot of people couldn't finish the first paper, a lot of people were relying on this final paper to pull their mark up. This year we have to pass our written papers overall and pass the OSCE individually. For the first time in 2.5 years, people were studying prior to the exam. Usually we would all be standing around and being really relaxed. The air was so tense, it was ridiculous. My heart was thumping and I saw people being sick right before the exam. The nerves were through the roof. Got to the exam...and oh....my....goodness. We were asked really rare conditions which were probably mentioned in 1 slide of a random lecture. Again more people got up to be sick in the toilet. One girl passed out in the final 10 minutes of the exam. Some people threw the paper on the floor and just left in disgust. What an exam.

"Time is up. Can everyone please stop writing and close their papers."

I have never heard such a quiet exam hall after the exam. No one was celebrating as it was our last exam. No one was cheering. Every one looked shocked/disappointed/upset. People left the exam building in record time. The mood was quite solemn. No one was in the mood to do anything. Had lunch with friends and most of my friends had lost their appetite. To be honest, when I finished that last exam, it was the very first time I said to myself: "I am going to fail." I was already thinking how I was going to tell my parents. I was so convinced I had failed it was eating me up inside.

Medicine is not easy. Again confirming my belief you have to be mentally strong to study Medicine. It is mentally and physically grueling. You have to be determined. There will be several up and downs as I have faced in this new phase. Probably the worst 6 months of medical school I have ever endured. It was like going through Medicine Boot Camp. Medics certainly do have a crazy life. It is never a straight line. Never take it for granted you're in medicine - anything can happen.

5 More Days.

So yesterday it finally set in...the sense of impending doom - exam is just around the corner. It has been a very tough revision period. It was particularly hard to muster up some motivation as it is quite weird to have an exam so soon (as I just had an exam in May). I think I'm still recovering from May's exam - it was brutal/traumatizing. Horrible experience.

I've spent about 6 weeks revising now, and I feel like I haven't really learned anything, which is an unsettling feeling. Worst bit is that no matter how much I study/revise, I am not going to know everything. That's the thing with Medicine, it's just a bottomless pit of knowledge. Give me another month, I'd still find something to study. Went to look at specimen papers earlier today - had a semi-realization. No book will teach you how to pass a clinical year exam. It seriously is common sense. I mean I went through a whole paper and I was like "...nothing I've studied has been asked." Then I realized clinical questions is the application of knowledge. Take the basics and apply it to the question. No book will teach you how to diagnose. It is a matter of taking what you know and putting it together to form an answer...like a puzzle. After 2 years of medical sciences, you forget that Medicine isn't about 2+2 = 4. It's more abstract and requires critical thinking and pattern recognition. And then I kept flipping through the specimen and seriously some of the questions they ask really deserves a fat: "What...?" And then you look up the answer in a textbook and find the answer in tiny fonts as a footnote at the bottom of a page. Seriously think some questions are put into exams just so it's impossible to get 100%. If anyone ever gets 100% in our exams I will personally go to them and bow to them. Then again I forgot how disliked my year is in the medical school so I'm pretty sure there will be questions on the exam where you just want to pick up the paper and throw it at someone.

Anyways...looking forward to end of exams and at the same time I am scared out of my mind for this year's exam. Ugh. ALMOST THERE!

Practice Makes Perfect.

I was signed off from placement on Monday so I haven't been doing anything particularly interesting other than revising for exams. Met up with a friend on Thursday to do some physical examination practice on patients at the hospital. As you may recall in my first attachment back in the summer (doesn't seem that long ago...time flies) I was drilling Cardio an Respiratory Examinations. Well exams are in 2.5 weeks so I got to get drilling on the rest of the examinations.

So we went and practised Abdominal, Shoulder, and Knee exams. Got that down pretty quickly. Never really had trouble with those examinations to be honest. Then we practised Cranial Nerves, peripheral neuro, and hand examinations. We did these with each other as these exams have quite a lot of steps. Before practising, I was hopeless at Cranial Nerve exams. I was not slick at all and obviously needed some serious practice. After a few attempts, I have finally gotten it down and was starting to get slicker at it. Did the same with the other examinations and I could definitely see an improvement. I was starting to feel much more confident with my examination skills and a bit more confident for my OSCE exam. Have arranged another physical examination practice session for Monday so hopefully I'll continue to improve and get better at these things.

Today I finally reached the last system to revise (Gastrointestinal). It surely doesn't feel like the last unit as my binder is still full of notes and it just doesn't seem real that exams are so soon. It's really weird. Most of my friends and I agree that exams don't seem near and the panic still hasn't set in. Generally been feeling quite unmotivated so I constantly have to remind myself how close exams are which results in mini panic attacks/a kick up the ass. I guess it kind of works as I've been revising furiously for these last few days and really pushing to get ahead of my revision schedule to give myself an extra half week of revision for anything I'm unsure of. At the moment I have scheduled in 1 extra week prior to exams for random revision/going over sample questions. Hopefully if I work hard enough I can make it 1.5 weeks of extra revision time to actually properly learn Microbiology. I swear Microbiology is my new nemesis. It used to be histology, but because we don't do that as much anymore...Microbiology has quickly taken Histology's crown of being my nemesis. There are so many things to remember! And all the stains for the different bacteria. Mental.

Pharmacology comes close behind. Drug treatments for Cardiovascular disease and respiratory are fairly straight forward. The minute you get to Dermatology...oh wow. You start feeling like a walking BNF (British National Formulary - it is a book of drugs)...but more like a BNF written with fading ink. Put some new drugs into my brain...the old drugs fall out. Dermatology...endless amount of drugs. So many names as well! Half of them I can't really spell! I can picture myself writing drug names in my exam and writing the first few-ish letters and then squiggling the rest and making sure it looks like the drug I'm thinking of. Thank goodness spelling doesn't count in our exams! As long as the word is recognizable they will take it.

My Oxford Handbook of Clinical Medicine is also finally getting beat up. It had been in mint condition for 2 years and FINALLY it is getting used...and I am seriously using it to death. Also random note - think I might be getting tennis elbow as my desk isn't great to write on as it is fairly deep. That means my elbow is constantly resting on the hard surface and sometimes I can feel my hand go tingly and numb. Also my elbow is sore from resting on the hard surface. The things you sacrifice for exams. Sacrifice sleep, good food (yay for quick microwave food), social life, going out, sanity, blah blah blah, and now sacrificing joints! Prospective future for my body. YES!

I hate revision. I miss lounging around and being lazy.

Exam Preparation.

To be honest...I haven't really done anything in placement, hence, the lack of updates. As you probably noticed from previous posts, my exams are coming up which involves 2 written papers and 1 OSCE. It's my first year of taking OSCE and doing more clinical based papers, so I'm quite nervous as I don't know what to expect. Yesterday, I finally got an idea what the OSCE will be like though as the school held a mock OSCE session for the students.

Essentially, our OSCE will be 6 stations of patient histories, and 6 stations of physical examinations. Each station will be7-8 minutes long. Before going into the mock, I had an impression that it will be really difficult. To my delight, the mock turned out a lot easier than I thought. Obviously could have done better as I didn't study for it (haven't had time to) or really practice for it. All in all, it wasn't too bad. I do have to work on making my examinations more slick and quicker as I take too long examining the peripheries. For example in Cardiovascular examination, I spend too much time looking at the hands and face. I think I need to just quickly glance over the hands and really just scan it instead of really looking at every single detail. Obviously the most important part of the exam is to examine the chest and I felt that I spent less time on the chest than the peripheries. Again, I think this is down to practising more.

It was really nice getting feedback from people on how I did in the mock OSCE and I now know what to focus on. Prior to the mock, I wasn't too sure what I needed to work on so I will be making a trip to the hospital tomorrow with one goal in mind: get slick at examinations. It should be good and I'm quite determined to get this down as the OSCE is worth 70% of our mark. In terms of history taking, it has always been my "strong point" as I do enjoy talking and I feel that I have a really good logical system of asking questions. In a patient history you would ask Presenting Complaint, History of Presenting Complaint, Drug History, Family History, Social History. Once I get that in my head, I find that asking questions and getting info from the patients quite easy. During mock, I was also helping out and was a patient for a station. Some people don't have a system at all and you can tell as their questions are all over the place. It's nice to see the level of history taking other students are at as it gives me a good idea of how much I need to work on my history taking skills.

Other than that.....3.5 weeks until exams. Eep.

Late Again!

I left my flat really early today to make sure I would show up on time to meet my new consultant. Obviously turning up on time is going to be my new enemy for this placement. Despite leaving my flat much earlier, I still ended up being 5 minutes late and the new consultant started his ward round right at 9am. I can't wait until the roads are reopened so I don't have to deal with the nightmare traffic I had to endure for these 2 days. However, I was quite lucky as this new consultant is really nice. He assumed I was late because I had some teaching earlier and was running a bit late. He greeted me and introduced himself and made sure I felt part of the team. It was definitely a nice thing for him to do and I do admit I felt bad for being late.

Anyways saw a new patient today who was moved from another ward. Found myself sympathizing with this patient as he had a metastatic tumour in his brain. He had undergone chemotherapy and radiotherapy, but is now placed for palliative care as it is an advanced tumour. Met the family today and you see the family trying to be strong and keep their chin up, but in the end the wife broke down. Felt quite useless as a student as no matter what you say - it isn't going to change the situation.

What confuses me the most about this placement is that I am placed in Endocrinology but majority of the patients don't have an endocrine related illness. Most of the patients I've seen have chest infections/pneumonia. It's quite weird. I only saw 1 patient today who had an endocrine related illness (Cushing's). I guess endocrinology is quite flexible? Will definitely have to ask one of the SHOs or FY1/2 doctors about this.

Final Placement of the Year!

So today was Day 1 of my final placement of 2011. I'm only on this placement for 3 weeks so yay, but that also means...EXAMS are coming up. Been revising for the last 2 weeks and it's bringing good ol' memories of how much I hate revising. It's tedious, tiring, and stressful. Oh and I have to juggle it with placements as well. Luckily I've been placed in a fairly slack placement (Endocrinology) so hopefully I won't have to be too committed.

Met my consultant today and I always believe in first impressions. If you want to impress:

1. Dress well
2. Show up early
3. Be keen
4. Read up on the specialty

Today, I was 15 minutes late due to road closures and traffic, I ran to the ward so my shirt was all over the place, haven't read up on the specialty as I have been revising the respiratory system, and I was groggy from 3 hours of sleep. Nice one. The consultant wasn't very impressed as I bumped into him as he was leaving the ward to start his ward round. If I was perhaps a few minutes later I would've been able to follow the other consultant on the ward who is on another team as he was late himself, and I wouldn't have looked as bad. Lucky me. Anyways embarked on a ward round which spanned across the whole hospital (literally). My partners and I were out of breath by the time we reached our first port-of-call: Medical Assessment Unit (MAU), as it was quite a long walk and my consultant walks extremely fast.  From time to time we had to jog to catch up with him!

Saw quite a lot of patients - all seemed pretty ill. I also noticed a trend that most of the patients are quite confused. We had one patient who told us that her husband had passed away 30 minutes earlier, and seemed quite depressed. However, when asked what date it is she thought it was the 10th of October, 2009! She didn't know where she was either and didn't know what our consultant was (expected answer = doctor, she had no clue!). She is a new patient and the consultant wasn't sure whether the news of her husband's passing was whether she was confused or it really did happen. At this point my partner and I left the patient and stepped to one side as our consultant talked to a nurse about the patient's story. Unfortunately it was quite noisy and we couldn't hear what the nurse had told our consultant. I guess it is now just a mystery to us. Anyways our ward round lasted 2.5 hours (which isn't too bad as I've been on 4 hour ward rounds).  At the end we were told that today was our consultant's last day and another consultant will be taking over for the month. But because our consultant isn't actually leaving the hospital he now has more time to teach so he offered to teach us this week on anything we would like. It was great news as endocrinology is quite complex and it would be great revision for exams. However, that also means I will have to go in tomorrow morning to meet the new consultant as he will be the one to sign us off for the placement. I wasn't planning to go in so I could stay home to revise - guess that won't be happening. Who knows, this consultant might be really nice and good at teaching, so I guess there is something to look forward to! Cross my fingers that this new consultant won't be stern/serious/intimidating. Some of the doctors on the ward knows of this consultant and they say he is quite nice. Hopefully they were being honest. Bring on tomorrow!

End of Placement 3.

What a placement. It actually went by a lot faster than I thought it would as I hated my first week of placements. In the end, it wasn't too bad. Definitely found out colorectal surgery is not for me. I can never seem to orientate myself in theatre especially during laparoscopic procedures. Everything looks the same! Just bowels here and there. Clinics were alright - completely understand why consultants hate it though. It's usually the same old things - over and over again. Only been to 2.5 clinics - and to be fair - it was starting to get repetitive and boring. I must admit, I am a bit embarrassed by the fact that I only turned up to ward rounds ONCE in the entire 4 weeks of placement. Oops. 7:30am ward rounds are too early - Note to self: don't get admitted as a patient to a hospital with 7:30am ward rounds - no wonder most of the patients we saw on ward round were cranky. You're ill/in pain and you're tired - 7:30 am a team of 5+ doctors (have seen teams of 10) crowd around your bed - doctor takes a feel/ask a few questions and then disappear. As a patient, that would really tick me off, but then again I'm not the most cheerful person in the morning.

What else have I learned on this placement? As previously mentioned in an earlier post - common sense takes you a long way. Oh and some consultants are actually human and love to talk about other stuff other than medicine. And again especially at busy hospitals - medical students are probably the least important things in the hospital - be prepared to get ignored/no one caring about you. That's reality and you just have to be proactive and be responsible for your own learning.

Next placement will be in endocrinology. Don't know what to expect; however, I don't even think I will have time to go into placement as exams are around the corner (December). Need to really study and start focusing. Can't tell you how stressed I am - it's mental. Like most students - I hate revising. The only thing that keeps me going is the future. I keep telling myself that once these exams are over I can slack off again and it'll be a year before my next exam. Can't wait as we just had our year-end exams in May - so it's only been 6ish months. The thought of 2nd year exams/revision still scares me - it was tough/a nightmare. At least this year's December exam will be more clinical (what I like) and not as science based. Still a bit lost as to what to study. Just hoping the best and hoping that I'm studying the right material as this year - we've hardly had any guidance. Eep.

In Memory of...

Sorry everyone, but this is going to be a solemn post so if you're not into reading something depressing please read another post - will be making another post either tonight or later in the week which will be a bit more cheerful.

Anyways...I've been a medical student for almost three years now - been around the hospitals a fair bit. Have seen happy things, have seen sad things. Have seen births, have seen deaths. Can one environment contain any more contrasting emotions? One family is in tears of joy; another family is in tears of sorrow as they have lost someone close. I myself have witnessed these events as a medical student. I smile with those who celebrate/are in joy; and I try to comfort those who are in a tough time. To be fair, deaths in the hospital has yet to make me lose any sleep or never really bothered me as I know everyone on the healthcare team has tried their best to save a person's life or at least have tried to make it as comfortable as possible.

When I first came to university - we were told in our first week that we will experience many personal obstacles. We are at the age where drastic things happen in our lives - some good, some bad. One of these "bad" things is death. Me being the typical fresher who didn't really pay attention in the lecture just brushed it off. Most of us tend to think: "Meh this won't happen to us."

October 24, 2011, I received the news that a friend of mine had passed away. I have never met this friend face to face, but we had shared many life stories and experiences. He was a guy I could talk to and have a nice laugh with, but because he lived in another country - I never had the chance to meet him. In terms of how I met this person? Well 4 years ago I purchased a custom item from him that required a lot of communication as we were in different countries - so I couldn't just walk into his factory and tell him what I want done. Anyways we would have periods where we would talk every single day - like loads, and then go through weeks where we wouldn't talk at all as this man was very busy with his business. Few weeks later - he would contact me again and we would talk about random things/he would check up on the product he made for me and whether I'm still happy with it. When I heard the tragic news - I was shocked. To be honest - I didn't know what to feel. It was mixed. Shocked, sad, empty...essentially confused. It was weird because I never met this man face to face, but yet cared about him. He was a very kind man. I still remember just last year he sent me a surprise Christmas present and I was planning to surprise him this year with a Christmas present. I had not been in contact with him for the whole summer as I did not want to bother him as he said he was very busy. Thinking back, I wish I had checked up on him.

Unfortunately this made me realize that death can occur in anyone's life. Like it or not, it's a fact. You can brush it off as much as you want, but it is something we will all have to face in our life. Take care of your friends, keep in touch with love ones, and if you know you don't talk to a friend that much - make sure you make every sentence count. You don't want to regret not telling someone something as anything can happen in this world. I wish I had told my friend how great of a friend he was to me and how much I enjoy his product. Hopefully he could decipher that from our conversations but I just wish I had told him plain and simple and thank him for his advice and lovely chats. If I could have done anything differently, I wish I had just contacted my friend despite knowing he was busy - just to make sure everything is alright.

But to those who are still reading - seriously, cherish your friends and loved ones. Death is a topic we all want to avoid and never want to think about, but it can happen to anyone. Because once you're in university and especially when we are all travelling away from home/friends, make an effort to keep in touch. Check up on your friends once in awhile. Be there for them. Support them. Don't hide things away and make sure they know you're there for them.

RIP buddy, you know who you are. Thank you for the great memories and the fantastic product. I will miss you. 

Common Sense.

On tuesday at clinic my consultant looked me in the eyes and told me: "No matter how smart you are, in order to be a successful doctor, you must have common sense." Since then, I can't stop thinking about what he said.

So I've started revision for my December exams and as I'm studying up on management and treatments of conditions, "common sense" suddenly pops up. I realized I can know nothing about the disease, but if I know the symptoms from a history and use common sense - I can figure out how to manage a patient and treat. What my consultant told me on tuesday was really starting to click.

Clinical years of medicine is all about logic and common sense. A person can study all they want and flip through every textbook and know everything, but without common sense: they won't know how to apply their knowledge. It's all about going back to basics. Picking out key bits in a patient history and focusing on it. Unfortunately, in pre-clinical years of medical school - students tend to forget what is common sense. 2 years of pre-clinical almost trains your brain to just retain information and splurge at exams. Because questions in exams are structured in such a detailed manner such as where cells of something is asked - common sense can't really be used. It's either you know the answer or you don't. It's that straight forward. Now in clinical years, you can work your way through a history and physical examination. It's really difficult to describe but in high pressure situations, you got to stop, relax, and think. Think basic and work through all the clues and start piecing the puzzle. Lots of people have the tendency to just jump to the most ridiculous diagnosis as they panic and don't think how one symptom can lead to a sign.

It sounds easy, but as a medical student it is difficult to remember to just use common sense. 2 years of pre-clinical medical sciences in our brains - we can't help but panic and just dig/try to remember information/answers that we crammed for exams. There were times where I would get put on the spot with a question and I would panic. My consultant had told me off a few times for blanking out as all I need to do is just stop trying to dig for an answer but instead work it out. I guess the closest thing I can relate it to is that in maths we learned 2 + 2 = 4. By now we've all memorized it - don't put any thought into it whatsoever. It's kinda like that in medicine. We see 2 + 2 = 4 (symptom + symptom = disease x) - easy. Sometimes we don't know the answer so when we get 1238 + 236, we will panic. Our brains will go "I haven't memorized this!". Instead break it down and try and link them together to come to your answer.

Anyways I hope that made sense. But only now, after 2.5 years - it has clicked. Medicine is all about common sense. We can't memorize everything. At the end of the day we'll need to use our brain to solve/work out things. It won't all be 2 + 2. But as we encounter more problems, we learn more. The beauty of medicine - never ending knowledge.

The Key is to be Proactive

Have been in placements for about 10 weeks now and I have had many ups and downs as you have read in my previous posts. After looking back at my placements, I've realized that my best experiences had been when I am being proactive. Being active in learning and stepping out from my consultant's shadow. In my first placement in the summer, I put a lot of effort into taking patient histories and doing loads of physical examinations (cardio, resp, and abdo). 2nd placement...did a lot of ward rounds - definitely seen a lot. For comparison sake - first placement I took about 10 patient histories and have done 4 cardiac exams, 3 respiratory exams, and 3 abdo exams. 2nd placement: 1 patient history, 1 shortened peripheral nerve exam. Poor showing in the 2nd placement. Yesterday, I did a group revision session on cardiac, resp, and abdo examinations. I knew how to do those examinations quite well and knew what I was looking for and can easily explain positive findings. The minute we got into neuro and musculoskeletal (MSK) exams...I died a little inside. I didn't know what was going on. Okay well MSK was easy to follow as I'm quite familiar with joints and those tests...but neuro was painful. I obviously didn't know how to do these exams as well as the cardio, resp, and abdo exams and it just felt horrible how lopsided my learning has been. Thinking back - it was because I was really proactive in my first placement. I had put a lot of effort into seeing patients and doing examinations. These last 2 placements - I've been...how should we put it...lazy.

You might ask: why suddenly the realization? Yesterday I was in clinic in the afternoon and my consultant told me to go take patient histories of the new patients in clinic and to come back and present the histories to him. While presenting, my consultant would ask questions dealing with the presenting complaint and about the differential diagnosis. It really made me think and be on the ball. When I didn't know something - he would teach me what to look for in a history and I realized: "I'm actually learning and remembering this." Once clinic was over - I actually had a good time. I felt independent and a lot more confident in my history taking skills as I got to present my histories and then got quizzed on it. I also realized that I was quite rough with my history taking with my first patient but by the time I saw my 3rd patient - it was easy and straight forward. It was a great feeling and a great confidence boost.

Now I'm sitting about - pondering - actually no...stressing about exams (OSCE + 2 written papers in December). There's no way I can pull off taking good histories and performing examinations without practice. I need to be proactive and do what I did in my first placement. Make a schedule and follow it. Be involved and just take a step away from my consultant and tell him that I need to practice. There isn't much point following him - I've got a good idea what the specialty is about already. I need to see more physical signs and conditions to start seeing patterns and recognizing things quicker. 4 more weeks of placements - I need to get back on the wards and talk to patients!

Placement 3 - Week 2

Pretty straight forward week...well except for Wednesday. I had to wake up early to attend a whole day of theatre. Saw a TEMS procedure to remove an early cancer in the rectum. Also got to do my first PR on a patient...which I was trying to avoid like no tomorrow. It isn't exactly the most pleasant thing to do. I mean I got to feel the cancer which was quite small. But yeah...really didn't enjoy doing the PR. At least the patient was asleep though (as it was right before the start of the operation). Finished the TEMS procedure quite quickly and then we found out that the next patient will be late coming down to theatre. So I had a bit of a dilemma because I had a meeting to go to at 12pm to meet another consultant. Essentially when it was time to do the next operation, I had to leave for my meeting. Grreatt...I was kinda excited for it as it was an APER procedure to remove a late rectal cancer.

If I remember correctly, this involves the removal of the sigmoid colon and the entire rectum.  The surgery is done in two parts - first part is to do key hole surgery in the abdomen to separate the sigmoid colon from the rest of the colon.  The second part is to turn the patient over into a prone position to remove the sigmoid colon and rectum. Sounds pretty interesting right...so I was pretty bummed out that I had to miss a bit of it.

Anyways rushed to meet another consultant only to find out he was late. I sat outside his office and ended up falling asleep in the chair. Next thing I know, the consultant comes out to meet me and I was snoozing with my phone in one hand. Awkward. He said my name and the first thing that went through my mind was the synonym of crap. Opened my eyes and saw a really confused consultant. Mind you I have never met this consultant before..so great first impression. Had a really great chat though and it was really relaxed. I was pooping myself (before I fell asleep) as I wasn't sure if this consultant was going to be mean or super serious. By the end of the meeting I didn't even know why I was so nervous. It turned out fine and I managed to sort some things out for next year (that's for another blog entry later in the year). I was really happy with how the meeting went and quickly went back to theatre to watch the APER.

Apparently I didn't miss too much of the APER but I did miss the chance to scrub-in. I also realized my consultant has some pretty dodgy camera skills as the abdomen bit of the procedure was laparoscopic. There were times where he would shake the camera so much, everyone would start feeling a bit sick. Oh well. After the first part, we took a 5ish minute break and then went on to the second bit. I must say...this bit was a lot more gruesome than I imagined it to be. Incisions were made around the anus and you would keep cutting in to access the rectum.  Because the colon has been separated, all the surgeons had to do was remove the sigmoid colon and rectum and close up the anus. One of the incisions went too deep and there was quite a lot of blood. At one point blood spurted out and luckily I dodged just in time as I was right in its path. My consultant was really on the ball though and quickly stopped the bleed and we continued on with the procedure. Removed the sigmoid colon and rectum (which was quite a large specimen). Unfortunately, I had to leave early from the surgery so I missed the part where they closed everything up. Either way it was a really interesting operation to watch and I enjoyed it quite a bit.

Thursday - day-case surgery. Not going ever again. It was pretty boring as we just did a bunch of procedures to fix anal fissures/fistulas/etc. I didn't really enjoy it and my consultant did pretty much no teaching either. I was pretty excited to just go home and get ready for the epic Medics Fancy Dress Pub Crawl. Obviously that meant I couldn't go into placement on Friday. The registrar told me to go to clinic on Friday morning and I told her "I don't think I'll make it." She gave me a really confused face and I just smiled and laughed nervously. My consultant picked up on my nervous laugh and he was really cool about it and was like "Yeah....clinic will be boring so just sleep in and I'll see you next week *wink*" The registrar was pretty clueless. Pretty sure everyone else got the gist of what I was saying, except for her. I guess she would find out if she ventured out to city centre that night. Haha.

Anyways pretty slack and uneventful week. Wednesday was definitely the highlight of my week though.

Placement 3 - Week 1

Can't believe it's already my third placement. Time flies. Actually I lied...this week was pretty slow.  So I'm back in the local teaching hospital so I don't have to drive like 40-50 minutes to the peripheral hospital anymore. But day 1 of my placement was probably the worst experience I have had on placement...ever. First I found out I was placed in General Surgery....AGAIN.  Found out I was in colorectal surgery...joy. I mean general surgery is interesting, but I'm a bit tired of it as I want to see other specialties. First year I had 2 surgical placements both in General Surgery. First placement of this year was General Surgery. Now...general surgery...again. I feel like I know loads about the GI system...and nothing about other systems.

Met my consultant in the afternoon...and only to be told I couldn't join him in endoscopy as I was in a group of 3 and only 2 people can stay in the room. My two other partners are quite keen...and jumped on the opportunity before I even started moving my slow Canadian mouth. I was a bit bummed out as it is our first time meeting the consultant and I kinda missed out on the first meeting. But then again I got to go home early as there wasn't anything else for me to do in the hospital. Also got to suck in the last of the amazing heatwave/get some colour back into me. Got home and hoped that the next day will be MUCH better as I felt like I accomplished nothing. Also felt that the nurses and doctors weren't as nice as the ones in the peripheral hospitals. Everyone seemed busy and us medical students just blended into the background/environment. It was a weird feeling. It was a bit unsettling. Kind of like: this is reality. I must've had too high of expectations as I did have a great time in the peripheral hospital as I got loads of teaching and everyone was so friendly (and the hospital wasn't as busy). It finally struck - us medical students are no one. We are of no importance as there are more important things for doctors and nurses to care about. It is a big hospital and it is very very busy. Depressing start to be honest.

Tuesday - I was determined to make my placement better as I will be on this placement for 4 weeks. I have a strong interest in Orthopaedics so I decided to go to theatre with my friend who is placed in Orthopaedics. Went in really early and I was quite content. I definitely felt less anxious and tense about the placement. I started to relax and was enjoying being in theatre. We were quizzed on the ankle and I knew how to answer the question as I know my MSK anatomy quite well. I got a sudden boost of confidence and my day was looking to be a good day. In the afternoon I went to meet my consultant to go to a really busy clinic...I think we had about 20+ patients. It was also my first time properly meeting my consultant. Managed to see a lot of PRs and unfortunately a lot of patients who have/had colorectal cancer. It seems like the surgery for colorectal cancer is quite effective especially if the cancer is a T1 cancer (early cancer).  Also learned about the different surgical procedures for colorectal cancer such as the TAEMS procedure which is apparently quite new and the major surgery which is an anterior resection.  After 4 hours...and getting the impression that our consultant doesn't particularly find his job that interesting...my partner and I finally got dismissed from clinic as our consultant noticed that we were quite bored and it was also getting late. I mean my consultant seems like a really great guy. Very chill and relaxed and doesn't really care about us. Not caring about us is sometimes good...sometimes bad. He does teach a bit, but he wouldn't breathe down your neck about going to placement from 7:30am to 5pm (I do have friends who are forced to go in every day 7:30am to 5pm).

Took a day-off on Wednesday as my other 2 partner wanted to go to theatre. Thursday...can't really remember what I did....hmmm. What did I do on Thursday?! I know I went in...so I assume I was on the wards talking to patients...I guess Thursday is my new mystery. Old age...can't even remember what I did 2 days ago. Friday....first time I went in for ward round, which was at 7:30am. I think a little bit of me died when I woke up at 6:00am to get ready. It was pitch black outside. Got to the ward to meet up with the team and was trying to stay awake. My consultant came in...did probably the fastest ward round I have experienced. It took less than an hour. Met the new registrar and he did some teaching with us and watched us do patient histories and abdominal examinations. Examined a patient with an incisional hernia. It was really interesting and I really enjoyed the teaching. It was a nice change. So I guess I ended the week on a high note. Oh and I think my consultant has came to a conclusion I'm a lazy bugger. Apparently he was on ward rounds which I didn't go to on Wednesday morning. Maybe that's why I got a surprised look from him on Friday morning. Anyways bring on a really busy next week.

End of Placement 2.

...where did my 3 weeks go?!

Seriously. These last 3 weeks actually blew by. Crazy. Couldn't believe that today was my last day on my placement in the peripheral hospital. Next week I will be back in the local teaching hospitals so I guess YAY no more 45-50 minute drives! Thinking back - I quite enjoyed my placement in the peripheral hospital. There were only 20 medical students at the hospital so the doctors were all really keen to teach and the staff were all very friendly. If only the hospital wasn't so far away. I've been hearing stories how the local teaching hospitals are absolutely packed with students; hence, patients are pretty annoyed with us and the consultants don't have time to teach.

Anyways this week has been really good. Did the standard ward rounds and finished up my first essay assignment that I handed in today. Got loads of teaching from Dr Y so that was really good. Saw some pretty interesting physical signs this week. Saw really marked dyskinesia in a patient with Parkinsons Disease. Today we saw a really interesting case. Patient presented to hospital with left sided weakness as well as facial weakness. This patient had a previous history of stroke. On examination, it was found that the patient had heminiopia and reduced corneal reflex in both eyes. Patient could not show her teeth/smile and could not open her mouth very wide. Arms and legs were not that weak. Both limbs seemed fairly normal and there were no changes in sensation except in the face. So what do you think she has?

Well she was just admitted so investigations have to be done, but it is suspected that she has bilateral facial palsy which is apparently quite difficult to make out. In general her face was emotionless which lead us to think that she may have bilateral facial palsy, and both corneal reflexes were reduced. The team didn't think this is a stroke but probably a pathology in the brain.

I personally thought this case was quite fascinating. It was different and it definitely makes you think. Thought I would share this case with you all.

Found out my next placement will be in General Surgery..........................AGAIN. General Surgery is great, but I have had enough. I'm so sick of it. I've done general surgery in my 2 weeks of placements in first year and then general surgery for my first placement this year. I want to see something else NOT GI related...PLEASE. I'm really interested in surgery and it's just so frustrating to be constantly placed in the same specialty. I really want to see the other surgical specialties and it's annoying how the medical school doesn't take into consideration your previous placements and what specialties you have been on. Pretty sure the school will come up with something like "Life isn't fair." But come on.

But yeah all in all - great placement out in a peripheral hospital. Definitely the complete opposite to my initial impression and have learned not to listen to other students as these students said that the hospital I was just placed in was hostile and unfriendly. Complete opposite and my experience has been fantastic. Really enjoyed it and have learned so much. Hopefully this continues in my next placement.

Placement 2 - End of Week 2

Holy smokes what a crazy week. To be honest though there isn't much to talk about placement as I only went in 3 out of the 5 days. Well actually more like 2/5. On Monday I had my clinical skills assessment so I spent the whole day pooping myself and practising before my assessment. I was so nervous it was kind of ridiculous. I was nervous because I felt that I haven't had enough practice yet and there's just so much to think about whilst doing a clinical skill.

So it was finally my turn to do the assessment and thank goodness the assessors were REALLY nice. It was really informal and they told me that they don't expect me to be a pro at it and will guide me through each skill. Essentially I was tested on hand washing (easy), vital signs (BP, temperature, pulse, SpO2), venepuncture, cannulation, drug mixing, and finally setting up an IV drug. I didn't mind doing any of those EXCEPT for drug mixing and setting up an IV. I haven't done either of those skills since last year and I didn't get a chance to practice either of those skills prior to my assessment. I nearly started sweating bullets while doing those two skills but thankfully everything came back to me and I managed to pass all my clinical skills. That means I can officially do all of these clinical skills on real patients in the hospital as long as I am supervised.

Tuesday - standard - ward round and clinic. Clinic was really interesting. Saw 2 patients which some interesting case histories. Ward round...was a pain. Dr B was doing ward rounds which meant another grilling session. Also what I have realized is that he is PAINFULLY slow at doing ward rounds. Dr Y takes 3 hours to do a ward round....Dr B takes 4.5 hours and has the same amount of patients to go through. Anyways while Dr B was finishing writing notes in the patient's notes, my partner and I talked about the patient and the physical signs that we saw. Out of no where, Dr B turns around and snaps at us. He told us off for talking and said that if we keep getting distracted/aren't interested we can go to the library and do something else. My partner and I were like "....what?" We were confused because we were talking about the patient and what we saw, so we weren't distracted and obviously we are interested; hence why we were talking about the patient. Obviously Dr B was a bit grumpy today. The way he snapped at us really bugged us as it was uncalled for. So my partner and I had two choices: a) Piss him off more and just leave and go follow Dr Y or b) Bombard Dr B with loads of questions to show him we are interested and obviously to annoy him as much as possible. We chose to go with plan B and cue the waterfall of questions. We literally asked him about EVERYTHING. We looked at a patient's drug chart and asked Dr B about why he would prescribe these medications and why not alternatives. We started asking about the mechanisms of different drugs. I'm pretty sure Dr B got the idea that my partner and I were doing this on purpose and Dr B blazed through the rest of ward round. I guess that's one way of getting things done fast.

Wednesday - I didn't go to placement as I was helping out at the Medic's Fresher's Fair, which was quite tiring. Started setting up quite early and then had to wait for the fair to finish as I also have to help put away stuff. It was really nice meeting the new medics. Then I had an age crisis as some of these freshers look really young. I mean I saw some who barely even look 16 years old! It was crazy. We also got to showcase the Fresher's Video that we made. It turned out quite well and I think (hope) that the freshers enjoyed it.

Thursday was the usual, BUT Thursday night was the night of Medic's Fresher's Fever! I was really excited for it as there was going to be a hot tub and sand at the venue. In the end - I must say this was the best Fresher's Fever I have experienced. It had a really good vibe and for once all the Fresher's stayed til the end! The last two Fresher Fevers I went to, people left 2 hours into the party and essentially used the event as a pre-drink before going to another club. This time - people stayed all the way until the venue closed. I was so glad I got Friday off as there was no way I would've been able to go to placement. I got to get Friday off as there was another freshers event that I had to help out at: Buddy Scheme. That didn't start until 3pm....and I thought I would definitely be able to wake up for that. I ended up waking up at like 2:15pm and was literally running around my flat trying to get ready to get my butt out of the door. But yeah this week has been quite interesting. Highlight of the week must be Fresher's Fever. Yeah yeah I know I'm getting too old for it, but seriously it was amazing. Definitely a memorable night.

Placement 2 - End of 1st Week

What a quick change. From sitting in lectures from 9am-5pm to being on my feet from 9am-5pm. Hands down: placement > lectures. There is just so much to learn and see on placements.

For my 2nd placement, I've been placed in the Stroke Unit. On the first day I realized that this is the first time I've been placed on a medical ward. For the last few hospital placements - they have ALL been in surgery. I was definitely preparing myself for the worst as I really do enjoy surgical attachments and I wasn't sure what to expect from a medicine attachment.  Also the fact that I was placed in the Stroke Unit was quite intimidating. In my mind Stroke = Neuro = intense. I was scared as heck on the first day and quite nervous, but also excited for the unknown.

The minute I stepped onto the ward, I was greeted by a really friendly receptionist who assured my partner and I that the doctors on this ward are really nice. We asked to see consultant X, but was then told that he no longer works at the hospital. What a great start to the day. We then muttered out another consultant name, Dr Y, and immediately the receptionist became very reassuring as she guaranteed us that we will be just fine with this consultant. Apparently he is very friendly and is a great teacher. I was starting to get excited. Right before going to the Dr Y's office we bumped into another consultant, Dr B. I must admit, I was surprised to learn that he was a consultant as he is quite young. He seemed really friendly...and perhaps a bit quite awkward. Then we met Dr Y. My first impression of him was: "What a boss." I know that sounded a bit weird but Dr Y seems to be a very confident/leader-like person. Very calm, and very approachable. He definitely looks serious, but we came to find out that he is a very patient man. Oddly enough, Dr Y quickly set out a schedule and several goals that he would like us to accomplish and what he aims to do with us. I believe this has been the first time where I've been sat down with a consultant and made goals and aims. I actually quite liked that as we are only 3rd year medics (1st year of clinical), so a little bit of guidance is quite nice as we don't really know what we should be doing in the hospital. He also arranged for some time to teach us about neurology/stroke. I was definitely liking the sound of this.

Anyways we then joined Dr B on ward rounds and pretty much got grilled to death by questions. I guess that's his way of teaching. Not exactly the method I would prefer to learn from as I do get quite nervous when put under pressure with a question, but Dr B is a really nice guy so I'm not too scared about answering a question wrong. He wouldn't put you down or look disappointed, he would simply acknowledge and explain the answer to his question. With this method of teaching, I guess things stick in my head for longer as you remember being grilled on that topic and stuff stands out a bit more.

Impressions of the ward? I'm really surprised at the range of ages on the ward. You would expect the whole ward to be elderly people, but to my surprise - there were quite a lot of middle aged patients. Made me realize that stroke isn't an elderly person's problem, but it can be a risk to anyone of any age.  The ward is also extremely friendly and relaxed. You don't feel pressured or watched on the ward. It's also nice that the nurses and junior doctors have welcomed us and do acknowledge our presence. Quite a difference from my last placement where I felt like an ignored object standing in the middle of a corridor looking really awkward and lost. Here, I feel a part of the ward.

I got to admit I have learned loads. I mean LOADS. Information overload. I have learned so much from both Dr B and Dr Y. They are really amazing at teaching. And it's really nice that they show us physical signs and teach us how to classify the signs as we do the ward rounds. I'm definitely looking forward to next week where we will learn more about stroke/neuro. From time to time, I do miss watching surgeries though, but it's good to finally experience a medicine attachment. Not a bad start I guess!

Reality.

So I've been back for just over a week now and have started lectures. These lectures have literally made me question why I am studying Medicine. It has been a horrible week. 9am - 5pm lectures. I can fly back to Canada in that time period! I do not know what is going on with my medical school...but 9-5 lectures do not work. No one can concentrate for that long. I really have to admit it was tough. Not only was it tough, but I was dealing with jet lag so my days felt like weeks. I actually thought time had stopped as my days were going by so slowly.

All these lectures actually made me lose focus of my ultimate goal: to be a doctor. I was struggling to find my footing and was not motivated at all. I mean I have definitely found my footing again after having a good rest during the weekend. Yesterday I had Diabetes Teaching which was more interactive and practical. Definitely lifted my spirits and gave me a bit of motivation. I'm sure once placements come around again I will be inspired and motivated again.

After talking to a few good friends, I feel a bit better. One of my friends pointed out that I never give up in anything I do and giving up Medicine is not an option. And you know what, she is right. I never give up and I am not prepared to give up now. I'm halfway through my degree and it can only get better. Just need to put my head down and power through these lectures and assignments. I had a passion for medicine and when I really think about it - I still have a passion for it. There were some sparkles of hope today during our practical session and tomorrow I will be seeing diabetic patients. I am actually excited so I know my passion for medicine is still with me. Just need to get through 3 more days of lectures and I'll be back on the wards. I will be examined on my clinical skills soon so I'll be able to do some clinical skills on the wards. I just need to be patient and keep going.

You know while writing this post, it made me think. This is what medicine is about. Fighting adversity. Overcoming challenges. Pick yourself up and keep moving. On the wards - you will face challenges. You will have to make difficult decisions. There will always be ups and downs throughout your career and you have to learn how to deal with them. These days have been long and will only get longer when I become a doctor. Time to get used to it. This is reality.

Which Medical School?

Well it's a new cycle for 2012 medical applicants. I have a received a few messages about which medical schools to apply to. I can't remember if I have done a post on how to pick your unis so I'll just do another one just in case.

1. Get your priorities straight.

What do I mean by priorities? Each person has a different priority. If you're an international student like me: usually location is a huge point. So ask yourself: "what do I care about?" Location? Course structure? Teaching standards? Size of the university? Union? Night life? And so on...

2. Research. Research. Research.

Do as much research as you can to learn about the course structure for each university. Research about the city. Research cost of living. Some cities will cost more to live in than others. London for example is a very expensive place to live in. Finance is a huge thing especially for international students. This is something you should discuss with parents if they are going to be your main sponsors. If you will be on loan, again you need to make sure you spend your money wisely and try to be economic. You don't want to end up in money trouble after your first few years of uni. Also research the location of the university. Is it a campus university (e.g. Nottingham) or is it a uni within the city (e.g. Manchester)?

3. Course Structure.

For medicine, some universities have a PBL system, Traditional, or Integrated (Lectures with PBL). So how do you learn best? Do you like to have small tutoring sessions and learn best from those? Do you like to sit in a large lecture hall with hundreds of other students? Do you want to sit in a lecture hall and then apply your knowledge in a small group? Again, every person is different. By figuring out your learning style - you can already narrow down your universities.

3.1. Course Structure - Dissection.

Also some universities still have full body cadaver dissections and some have gone to prosection where you only get a section of the cadaver to dissect. What would you prefer? Some people don't care and some do. It's all down to personal choice. If you definitely want full body dissection that will literally shoot you down to a handful of universities. If you don't mind well you still got loads of unis to pick from.

3.2. Clinical Exposure.

Now some people see early clinical exposure as a very important aspect to their learning. Some people may not want such early clinical exposure. Some unis throw you out into the medical world in first year and integrate a lot of clinical experience into the course. Some universities keep it traditional and mainly keep you to the learning aspects and keep you away from patients until after 2nd/3rd year. This is something where you will have to do a lot of research on if this is important to you. Some prospectus/websites for the uni will not mention this so speaking to students from the uni of interest will be helpful.

4. Location.

Do you want to study in a big city like London? Or do you prefer to study in a smaller city such as St Andrews? Personally I chose against studying in London or big cities in general because of the distractions. Big cities = more distractions. I get distracted easily and will find excuses to not do my work. At the same time I don't want to be in an isolated area with nothing to do as I would lose my mind. I wanted to find a place with just enough distractions to keep me sane but not too many distractions that I won't get my work done. Best for you to go visit the universities to get a first hand experience of the city and university. I was quite fortunate to be able to travel the UK to visit all the unis I was interested in. Before I went I already had a rough idea which 4 schools I was going to apply to, but after visiting - my list was COMPLETELY different. You will know when you find the right school for you. You get a weird feeling and sense belonging. You gotta be able to picture yourself in that city for 5+ years. 5 years is a LONG time so you must make sure you will enjoy yourself there.

5. Entrance Requirement.

Some universities require higher grades than others. Your grades is something you can't really change or influence. You will probably have a ballpark idea on what grades you will achieve by the end of the year so look for reasonable unis that you know you will be a competitive applicant. It's nice to dream to go to certain universities but if you don't have the grades for it, you could end up wasting 1 of your 4 choices. Marks isn't everything to get into medicine. Everyone applying will be smart. They use marks as a cut-off and if you don't make the cut-off...well they won't even look at your extra curricular activities that make you seem unique. Also now with the UKCAT, more and more unis are putting more importance on it and using it to cut out applicants as medicine is such a popular course. Admissions need a way to cut down the number so they will use the UKCAT. So look up what are the cut-off marks for each university. Again like your grades, no point in applying to a uni where your UKCAT score is well below what is stated as they will cut you out without looking at your application. If UKCAT didn't go so well, there are still unis that do not look at UKCAT. I believe Birmingham and Liverpool don't use the UKCAT. Some schools need the BMAT so they will not look at UKCAT. Please do your research and look at the entrance requirements.

So this is a pretty rough list of what you should definitely keep in mind when choosing your universities. It takes a lot of research and priority setting. Location and Course Structure will probably be your best two filters to narrow down your list. If you're an international applicant, make sure you check if the university is international friendly. Some universities may not accept your high school diploma/standards. Remember choosing which uni to go to should be YOUR choice and YOUR decision. Yes of course if your parents are helping you out with money, they have a bit of say, but again you have to make sure you will be happy at the university and will enjoy the teaching. So select your unis carefully and take your time with it. Think it through and try and get some opinions as well. By the way I quite enjoyed this website: UnionView. It's a website which has a review of almost all the unis in the UK. So take a look at it if you don't get the chance to visit the uni.

Good luck with your application and I truly hope this has helped.

Congratulations!

To those who got their A-level results today and gotten into medicine - congratulations! Now you all can relax and prepare yourselves for freshers. It is going to be amazing. Even I'm excited for Freshers and I'm in 3rd year! Few more weeks and you will officially be medical students. When you start your first lecture - it will suddenly hit you: "I am in medical school." It is a feeling you can't describe... or you can be insanely hungover...which isn't a pleasant feeling. Either way it will hit you at some point so do enjoy it. To be able to study medicine is a rare opportunity so make the most of it. Should be a fun filled 5-6 years to become a doctor.

Anyways congratulations again and enjoy your next few weeks of holiday and get ready for freshers!

End of Week 3.

Sorry for the late update. Literally left for Canada the day after the end of my first placement, so I haven't had time to update.

Anyways. This was my final week on my first placement. I realized that the patient I was originally going to use for my SSC project/essay does not fit the criteria for the essay. Therefore, I was out hunting for another SSC patient. Decided to take a stroll to the Coronary Care Unit to see if there are any straight forward patients. We met a patient who was quite talkative and in general well enough to talk to us. He had an MI and was waiting for a bypass surgery. This time I made sure we got every single bit of info we need for this essay and all in all it was a really straight forward patient history. Did cardio, respiratory, and abdominal physical examinations. The patient was really friendly and actually didn't want us to leave because he was so bored. Kinda feel bad for some of the patients as they really do look like they are bored out of their mind. Some of them don't even get patients so you really do sympathize.

Actually before we went SSC patient hunting (on Monday) we went to theatre to look for our consultant. We literally stood there for 1.5 hour as our consultant was late and we didn't want to risk missing him so we turned up quite early. Finally caught our consultant racing through the corridor and asked to meet him on Wednesday so we could get our proformas signed off. I swear those 1.5 hours were horrendous as nurses kept asking if we were alright and if we needed anything. Swear we nearly blended into the background.

So come Wednesday, our consultant had clinic so we went to meet him at his clinic...only to find out he isn't there yet and will be an hour late. Great. I decided to talk to the SHO and nurses about bariatric surgery as I was thinking of writing up about it for my 2nd SSC essay on ethics and law. Had a really really good conversation going and I learned quite a lot. It's all down to personal opinion and it is definitely an interesting topic. So an hour later, consultant turns up...only to be in a bad-ish mood and completely ignored my partner and I. We waited til the end of his clinic to talk to him. So we gave him our proformas for him to assess how we did in placement. He took our sheets, quickly glimpse and it, and just circled "Satisfactory" for each section. My partner and I were panicking and our consultant returned the sheets to us without leaving feedback. In general it is expected for us to get an overall mark of "Good" in placement or else the medical school may think we didn't show up to placement. So out of desperation we asked if we can show him what we have been doing on placement as he hasn't watched us therefore couldn't really mark us properly. We were hoping after showing him our work he would raise our grade. He told us to meet him in between surgery on Thursday at 12:30pm.

We get there at 12pm...he apparently finished his first surgery early and had an early lunch break so he could get on with his second surgery. So we stood in for one of his surgeries which was expected to be only 2 hours. Not bad right? Wrong...midway through surgery we had a complication and the surgery ended up taking 4.5 hours. My legs were not happy with me. I think at one point I lost feeling in my quads. After surgery, our consultant was obviously annoyed, but still managed to meet us. We gave him a new proforma and he was like "Didn't I sign something like this yesterday?". We pretty much told him it's a different sheet and it requires written feedback. Somehow he fell for it and before marking us we showed him all our patient histories we took over the 3 weeks. Despite all the effort...he still gave us "Satisfactory" but in the feedback he put down that it was difficult to mark us and was sure we were "good/excellent" students but he didn't get the opportunity to watch us in the wards. At least we got some sort of reason. But to be honest, we now understand why he gave us a "Satisfactory".

So on Friday, we actually had nothing to do and it was our last day. Went in at like 10pm and my partner and I decided to get assessed on our history and examination skills. I think I did alright in it, but was told that my smiling was unprofessional. Still confused about it because if I was a patient I wouldn't want to be greeted by a doctor looking like he/she doesn't give a crap and is in a bad mood. Anyways everyone has their own opinions but it was one feedback point that I will keep in the back of my mind but definitely won't change the way I greet patients. It's not like I excessively smile and laugh/be inappropriate with my facial expression. Just want to treat the patients like a person. It was a weird one to get my head around, and still kinda bothers me. Oh well. After the assessment, we managed to leave at like 12pm and returned our lockers and bleeps. Only if I could relax the minute I got home. It was more like "need to pack. need to pack. need to pack." I don't think I sat down at all for the rest of the day as I was running all over the place trying to get things done and running some final errands before I left.

All in all my first placement as a student doctor has been enjoyable and I definitely learned loads. When I return to placements at the end of September, I will be able to take bloods and do injections/perform invasive procedures, so I'm really looking forward to that. Shame I have 2 weeks of 9-5 lectures prior to my 2nd placements. Yuck.

But finally a week into holiday I've had my chance to sleep in and relax. Now getting to writing up my first SSC essay. The brain hardly wants to work though.

Anyways sorry again for the late update. Hope everyone is enjoying their holiday! Freshers week is getting closer! :D

End of Week 2.

Wow this week went by really quickly. One more week and then summer holiday!

So last week wasn't the most productive, so this week I wanted to make sure I get lots of patient histories and examinations done, as well as find a patient for my SSC project. This week I have managed to do about five patient histories and managed to do at least two physical examinations on 3 of the 5 patients. Again today (Friday), was my most productive day. Started bright and early and went to go see a patient my partner and I had taken a history from yesterday. The patient was going to be discharged today so we quickly did all the physical examinations we needed to do for our SSC project. Our SSC project requires us to find a patient where we do a full case history and all physical examinations (Cardio, Respiratory, GI, GALS, and CNS). This patient was extremely nice. I mean he was not feeling well and was quite frail. My partner and I expected him to say "no" when we asked for permission to take a history and examine him, but to our surprise he quickly said "yes" with a big smile on his face!

We first asked why he was admitted into hospital and listening to his history made me feel quite sad. This patient lives on his own and is almost at the grand age of 90 and he had collapsed on his floor at night. Because no one lived with him, no one knew he had collapsed and unfortunately he could not get up off the floor. He spent the entire night on the cold floor and because he had not answered his phone, his son had gotten worried about him and went to see if he was alright. The way the patient described his ordeal made it sound painful and you just feel really bad for the patient. He looked very upset and distressed about collapsing and told us that the pain he had from falling was immense. Whilst talking to the patient, we realized he was quite short of breath and had a constant and productive cough; therefore, we thought we should give the patient a break and would come back and examine him the next day (Friday).

So today we went to see the patient and the nurses told us not to bother the patient because they had just finished ward rounds and had prodded him quite a bit. He also looked quite tired as well and did not look very comfortable. We were then told he was going to be discharged later in the afternoon, so after popping to another ward to join a ward round we went back to the patient and asked if it was alright to do a quick full examination on him. Again, we were expecting to hear a "no" and a "leave me alone!" as he did look quite annoyed; however, he looked at us and promptly smiled and told us that he'll be more than happy to let us examine him. Because the patient looked quite tired, we tried to do our examination as quick as possible to minimize the amount of "prodding" we had to do. At the end we thanked our patient again and he gave us a firm handshake and wished us good luck with our career. He said it with so much sincerity and kindness it definitely brightened up my day. If I was in the patient's position I definitely would not let two medical students poke around and bother me if I was not feeling well. What a kind man and I got to say, my partner and I had learned a lot from this patient as he had an extensive history and was an immense pleasure to talk to.

Also now being my 2nd week of venturing the hospital, I realized that the staff in the ward I am placed in are starting to recognize me and it was nice to see them saying "Hi" to me. Makes me feel like I am not invisible and that the staff do remember there's a medical student wandering around. I even had a lovely chat with one of the nurses as well and finally felt welcomed. Worst part is that next week is my last week and I feel like I am starting to get the hang of being in my ward and getting to know people. The turnover is so quick as each placement only lasts 3 weeks for us (total of 4 placements). Can't believe that next week is my last week! I feel like I've still got lots of stuff to do. I still have to be assessed on doing a patient history and a physical examination by a doctor. As well, I need to find another patient for my second SSC project with some sort of ethics and law background to it, such as discussing patient confidentiality, DNR forms, etc. Not only do we have to do that, but also we need to find our consultant. We haven't seen him since Monday in theatre as he is away for the rest of this week. He said he'll be back next Monday and my partner and I will have to chain him down (as he can vanish into thin air in a blink of an eye) and hopefully arrange a meeting with him on Wednesday morning as he will be free. I will definitely make the most of my final week and I still haven't been in clinic so I'm going to try really hard to go to one next week. It should be good. And then...I'll be HOME! Haven't been back since winter holiday and I'm starting to get really homesick.

Anyways sorry for the long post. Will update next week if I have time!

End of the Week.

What a week.

Driving to the peripheral hospital for 40 minutes each way every day does take a toll. Since Monday, I have been going in at about 9 or 10 am, which is considered a late start when compared to others. My consultant is fairly "slack" and told us not to come in too early because we do have to travel a long way and for safety sake not to tire us out too badly. Last few days my partner and I have been going around to different wards to take patient histories and do physical examinations. I swear we have not been that lucky this week. We have been given two patients on our ward who we should definitely speak to as they are quite interesting to talk to and one patient in particular is extremely fun to talk to. Every time we wanted to go speak to this one patient, he is asleep in his chair. We were told by the nurses and junior doctors to not wake him up as he gets tired quite easily (plus he is quite old). Finally, when my partner and I walked by his room he was awake so we went in to ask for permission to speak to him about his condition.

I am not kidding but I think the entire ward (nurses and junior doctors) were playing a mighty good prank on us. Here's the catch: this patient is almost completely deaf. We literally spoke right into his ear and he still could not hear us. My partner and I were absolutely baffled. We could not believe that the staff had been recommending us a patient who is deaf. The main point of patient histories is to ask questions and it does not exactly work if the patient cannot hear you. Now we feel like we are the joke of the ward. However I am VERY determined to get a patient history from this patient as I had a read through his notes and he is definitely an interesting patient. I think I will opt for the writing on a whiteboard to ask my questions.

After being absolutely baffled by this patient, my partner and I decided to abandon our ward and move to other wards to get patient histories. We went to the Cardiology ward and we managed to get a really good patient history. This particular patient was very kind and VERY patient with us. We visited him again today to do a Cardiovascular physical examination on him and again he was very cooperative and seemed really keen on helping us learn.

Today we also went to the respiratory ward and managed to get another patient history and do a respiratory physical examination. Despite being a Friday, I thought today was one of our most productive days. Last few days we were leaving early (e.g. 1:30pm-2:00pm) as we felt redundant. Today, we left feeling like we've done a lot and actually had some fun. Definitely a good way to end the week of placements.

Next week - hopefully we'll start off where we left off and continue to be productive. On Monday we will be doing a theatre list with our consultant so we'll finally see him again and hopefully get some teaching from him as well as he is amazing at teaching and very patient. I was also hoping to ask to be able to scrub in and maybe be a bit more interactive and try and help out as I think that is the best way to learn. Much better than standing in the corner of the room and trying not to be in the way.

Sorry for the long post. Will update hopefully soon. Have a good weekend!

First Day as a Student Doctor.

So today was my very first day as a proper student doctor (clinical year medical student). I must admit that I was fairly nervous about my placement and at the same time excited. I really didn't know what to expect and my biggest worry was not being welcomed.

Anyways I am placed in Upper GI surgery which I had done for 2 weeks before in first year. Technically I should be an expert on it. Obviously I am not. Today was induction day at the hospital and we got a hospital tour. The hospital is fairly large and because it is a teaching hospital, most of the doctors/nurses there are really helpful. I heard a few bad things about the hospital I am placed at such as consultants completely ignoring you and being rude. I literally have nothing to complain about today. When I was standing around with my partner on our ward trying to look for our consultant, we were approached by several nurses asking if we needed help looking for someone or something with a smile and genuinely wanted to help. It really made me relax as it seems like I am welcomed and that people are willing to help.

After induction/introducing ourselves to our ward, the search for our consultants still continues. After lunch, we decided to go down to theatre to look for our consultant as he is a surgeon. Bingo! He was in theatre all day. During the surgery, our consultant did a great job at showing us stuff and letting us take a look and he took the time to explain things. However, we were quizzed, but our consultant was really nice especially when we did not know the answer. After surgery, our consultant went over the surgery that was just done with us and I mean our consultant has been in theatre all day and he took the time to sit us down in a room and draw us a diagram of the operation. He took the time to run through the basic anatomy involved and took the time to explain each step of the surgery. It really showed us that our consultant is committed in helping us learn and I have a feeling it will be a good attachment with great learning opportunities.

As well our consultant told us his schedule and told us to join him whenever we feel it is necessary. I like how we have the freedom to plan our own schedule and I guess quite self-directed. Really gives us the opportunity to prioritize things and get some of our compulsory assignments done instead of being our consultant's shadow.

By the end of the day I got to admit my back was quite sore after standing for so long. Can't wait to get a really good sleep tonight as I didn't get much sleep yesterday.

Hopefully I'll update you with more things if I encounter anything interesting.

Hectic.

Okay...I may have lied in my last post about updating my blog sooner. Oddly enough, I did not expect to be this busy. No I am not on summer holiday. I had a 4 week holiday...well 2 weeks after results. Started back on June 6. It has been non-stop 9am-5pm lectures. I have never really had 9-5 days. Usually I would be in lecture for the morning and get the afternoon off. There will be a day here and there where we would get the odd lecture from 3-5 after 2 hours in the morning from 9-11. But I have never had 9-5...non stop. We're talking about 1 hour lunch breaks. Most of you reading this will be like "...9-5 is nothing. What are you talking about?" I find it quite difficult to sit for so long, so by the time I get to the afternoon lectures I am mentally drained and can't really focus. On top of that all my friends feel the need to cram a million events into these next few weeks as we'll be splitting up for placements and all of us are in different hospitals so we will not be seeing each other very much. Can't handle so many dinners and outings!

Anyways my lectures have been mostly about clinical examination sessions, such as how to examine a patient with a vascular disease. Or how to examine a thyroid patient, or how to do a breast examination, etc. Also I finally got to use my stethoscope. Really started feeling like I am studying to become a doctor. It was really weird. The feeling will only get greater when I start placements in 2.5 weeks. Quite nervous and excited at the same time about placements.

We have also been learning clinical skills such as catheters, injections, etc. Crazy jump from sitting around in lecture theatres learning about medical science to suddenly learning how to do stuff that you do on the wards. Finally get the feeling of doing something practical and I feel that I can finally call myself a student doctor.

On a side note the weather has been something. Been roasting this weekend and today. Sitting in a lecture theatre with over 250 students with no air conditioning, and attempting to concentrate for 4 hours of microbiology is almost impossible. It was quite annoying that during the winter the air conditioning would be on and you would be freezing to death, but during a mini heatwave they decide to not turn on the air conditioning. Hopefully they'll turn it on tomorrow, but I don't think it will be as warm.

Anyways these last few weeks have been quite dull so I won't bore you with the details. Hopefully in a few weeks I will be updating you on my first time on the wards as a clinical year student...or as a "student doctor". Hopefully I'll be placed with a good consultant who is enthusiastic to have medical students around.

Start of Clinical Years.

Finally got some free time to make a post. First want to thank those who are still following me on my blog as I really do appreciate it.

So I finished my 3 exams (MEQ, Multi-Station, and EMQ) on May 5. 3 torturous days as predicted. To be honest - The MEQ and EMQ exams weren't too bad as I adapted a new way of studying which is better suited for those two exams; however, I neglected the method needed for Multi-Station exam. Consequently, I did suffer a bit in my Multi-Station exam. It was horrible. I didn't exactly start at a great station either. I knew how to do the questions in my first station but the next 4 stations shattered my confidence. I did not study the things asked and it was a horrible feeling. With every station I lost more and more confidence and was starting to think pretty negatively. At one point I even asked myself if it was possible to get 0% on the exam. It was grim. After 2 hours of absolute shattered confidence and the horrible sinking feeling - I was hoping like no tomorrow that the EMQ would be much better. Thankfully - EMQ was quite okay and I didn't have too many difficulties with it.

Fast forward to May 19. Results day. My university requires us to go into the medical school to get our results so the journey to the school was long and nerve-racking. I don't think I have been so nervous before. To my relief I had passed and cue celebration. We still haven't received the breakdown marks of our 3 papers, and I'm looking forward to see how I did in the multi-station paper. Last year it was my best paper of the 3...I don't think that is the case this year. Who knows - maybe I've got some pretty amazing guessing skills.

Just the other day I got my first clinical year schedule and it looks really crammed and hectic but after looking at it again - it isn't too bad. The major downside of starting clinical years...is the lack of holidays. I guess they're trying to prepare us for the future? From what I've heard from upper years - this is the time when it hits you - you'll be a doctor in 3 years and it is quite a frightening thought. I swear the last 2 years FLEW by. Freshers week felt like it was only a few months ago.

Anyways just wanted to do a quick update and hopefully my next post will be soon. :)

5 days.

5 more days until my year end exam. I must admit - I have never worked so hard before - even my friends agree. In return, the level of stress is immense. There are days of ups and downs. Days where my confidence is sky high and days where I start doubting myself. With every low point I have faced and on the verge of giving up - I refuse. I have never given up on anything and I am certainly not going to give up now. 5 more days. It is almost over. I can't wait as I know it'll be all worth it in the end. I found a great speech from a commercial titled: "You vs. Them" It definitely keeps me going. The video is below if you want to listen to it.

Whether or not you win this thing, you’ve got to decide how you’re gonna walk out of here when it’s all said & done because the game is going to go on. And there’s only one rule you’re going to need to know about:

There are no second chances.

There is only this moment and the next moment. Every one of those moments is a test that you get to take one time – and only one time.

So, if you see an opening – tear into it! If you get a shot at victory, make damn sure you take it! Seize that moment. That moment is a crossroad where everything you want will collide with everything standing in your way.

You’ve got momentum at your back. Fear and doubt are thundering like a freight train straight at you. And all you’ve got, the only difference between making history and being history, the only thing – THE ONLY THING – you can count on at any given moment is YOU.

It’s You versus Them.
You versus No.
You versus Can’t.
It’s You versus Next Year. Last Year. Statistics. Excuses.
You versus History.
You versus The Odds.
You versus 2nd Place.

The clock is ticking – let’s see what you’ve got.

5 Weeks.

Well okay not exactly 5 weeks but close enough. Anyone care to take a guess 5 weeks until what?

If you said exams...you are CORRECT! It has come to that time of the year that every medical student dreads - EXAMS. Well for my university...not sure about others...passing the year 100% relies on 3 exam papers which are done 3 days in a row. Stressful much?! I dread it so much. It can easily be the 3 worst days in my life. No matter how much you study you will not know everything on the paper. Unlike back in school - you study...you go to the exam...you know everything - easy. Medicine? Study like no end...think you've covered everything...get to exam day and first page of the exam - BAM - you have no bleeping clue about the question. It is BOUND to happen. Now as a 2nd year medical student we have to also know last year's material so technically we will be examined on 2 years worth of knowledge. Not like one year isn't hard enough eh?

I have started studying since end of February...now I am about 3/4 way through the material. Now thinking back...I don't think I remember really anything from what I studied in February (which was all of last year's material). Great. Oh and NEVER look at a specimen paper in the middle of revision just because you got curious or whatever. With no doubt you will most likely scare the crap out of yourself as you'll see questions in there that you have no clue about and then cue panic attack/major stress. I made that mistake a few days ago...and I nearly cracked, but I haven't actually studied the section that the question was aimed for, but still - it was not a pleasant feeling.

The only nice thing about only having 3 papers is that we can get it all done with in 3 days. Nice and short - just extremely torturous. At least now having already taken an exam last year, I know now what to expect in this year's exam and will be more prepared. Last year, I had absolutely no clue what the exam would be like. Armed with experience I think I am a bit more confident this year than I was last year. One major difference is that I started studying MUCH earlier than I did last year so I won't be rushing through revision and causing unnecessary stress.

5 weeks...jeez. I'm really scared. Haha. Instead of losing an hour sleep can we possibly increase the days to about 30 hours just until exam time? It would be very useful. Oh and to make matters worse, the SSC attachment I have been talking about...well my final report (2500 words) is due in a few days. Great...time to wave goodbye to good quality sleep and hello long hours of studying through the night!

That's It?

After some good banter after our critical analysis presentation for our SSC research attachment, we were told by our supervisor that we essentially will not go back in/see him until the LAST day of our attachment which is in 2.5 weeks. In the meantime we are supposed to do our final task: data analysis. I am absolutely ____ing my pants about this as I do not know anything about stats. Doh! This is definitely going to be a REALLY tough task and thank goodness we have 2.5 weeks to figure it out. At the same time when I found out we will not be going in for 2.5 weeks you would assume that I would be doing a victory dance the minute I left the building. Wrong. I was actually really bummed out. I hate to admit it, but I have THOROUGHLY enjoyed this attachment and I am having a really good time! I think it is because I have an amazing supervisor coupled with amazing group members as we get along extremely well. Once you get into med school and make medic friends you tend to talk about medicine with each other, but with my group members - we all play sports and we are quite athletic and to be honest - we NEVER talk about medicine when we are around each other. We actually have something interesting to talk about and it is quite nice. Such small things can make quite a big difference.

As well, we were promised at the beginning...okay not promised...more like notified that we will probably get to go to the gait lab to try out the equipment and test out what the volunteers will be going through in the trial. Because our supervisor has to leave for conferences and stuff, we apparently will not be going in. I was really excited about going to the gait lab and now seeing that we won't go in until the last day - we obviously will not be getting the opportunity to try out the machines. Boooooo. Super bummed.

So essentially our last day of attachment is 2.5 weeks away and that means we have already been at this attachment for 3 weeks now. It definitely does not feel like 3 weeks and I know earlier I was whining about doing a research attachment, but I loved it. I think the main reason is because of the tiny little things like a great supervisor and a great group really made things a lot more enjoyable. On top of that, my attachment is very clinical based and it was nice not being in a lab all day (actually we never went to the lab) and the hours were quite "slack". Definitely a good balance. Go in just enough to get a feel for the attachment, but at the same time we get enough free time to get some revision done for exams. When I looked at my calendar and looked at the last day of our attachment I said: "That's it?" Before embarking on this attachment I would NEVER think I would be saying this as I thought by the end of this I would be sick of the attachment and hate the attachment. I am soooooooooooooo wrong and I am happy to admit that it was wrong of me to have such a close-minded view of this attachment prior. Can't believe that this is it. Today was my last proper day of being at the attachment. The final session will be a quick presentation and then getting feedback. Wow. Time flies. Scary stuff.