Request: Tips for Revising for Exams.

So I had a request to do a post on tips for revising for your year-end medical exam. To be honest, every person will have a different way of revising. The most ideal way to revise for exams is to start from day 1 of the course. After every lecture/day, gather all your notes together and make sure your notes have enough info for you. If not, look at your recommended reading and add info to your notes. Or after end of each day is to consolidate all the things you have learned and to go over it. Some people like to consolidate their knowledge on weekends as most lecture days go from 9-5pm and by the time you finish your day, your brain will be fried. If you stay on top of your notes, when it comes to exam time, you should know your material quite well and just need to commit things to memory and you will not be needing to learn anything "new".

What I just described is the ideal way...but realistically, the chances of that happening is quite slim, unless you're quire organized and on top of everything. For me, that method got tossed out 2 weeks into my course. What actually happens is that you take notes during your lectures/print out your lecture slides. If you're having a good week and have some spare time, your notes will go into a binder so your room stays relatively neat and that you will be able to find your notes. If your university only does 1 year-end exam, like mine, on average, medics begin studying between 4-6 weeks prior to exams. You would think that's ridiculously too far in advance, but the sheer amount of material you learn in one year...it just as ridiculous. I personally need 6 weeks to go through a whole year worth of material, but do keep in mind...I don't really look at my notes again until my 6 week revision period. So here I will list some tips on how to get on top of your revision period:

1) Make a revision schedule. Try and figure out how many days/weeks you will need to go over a topic (eg. 1 week for Paediatrics, 5 days for O&G). How much time to dedicate to each topic will depend on how well you know a topic/how confident you are with the topic. Always leave 1 week prior to exams for leeway/time to go over sample/past papers/revise stuff you don't know very well/last minute cram. I usually start thinking about making my revision schedule well in advance or else if you do one too late, you'll realize you have too little weeks left and too many topics. To avoid that, maybe think about your revision schedule when you come back from your last holiday before exams.

2) Find a study buddy! If you live with other medics, then that's sorted. If you don't, try finding a study buddy who has the same sort of revising method as you. It's a great way to make sure you don't miss out any topics and also a great way to test each  other's knowledge. Make sure this study buddy won't be a distraction though or else you won't accomplish much!

3) Rest! I cannot stress enough how important it is to get enough rest during your revision weeks. No point of pulling all-nighters when your brain can't even function anymore. Nothing will get absorbed. Your body will tell you when it is time to take a break (usually when you find yourself reading the same page over and over again and nothing is going in). Try and get a good nights sleep every day. Pretty basic stuff, but it is so easy to forget to just rest.

4) Use cue cards for memorizing things. Some people don't like cue cards, which is fair enough. In medicine we have to learn a lot of names that aren't even related to the condition such as drug names/some medical syndromes. Once you write it down, you can put it to the side. Also great for the last minute cram a day or two before exams.

5) Start early. At the same time I'm not saying start revising 10 weeks before exams. Obviously this is down to personal preference. I think I started too early for this year's exam, but it's not something I regret. It was extremely tiring and boring though. At the same time, last year I started too late and regretted it and it was extremely stressful. Because I started a bit too early (or maybe even perfect timing), I could sacrifice a day or two to take a break or to spend a few extra days on a topic such as Paediatrics. I originally allocated 10 days for Paediatrics, but actually ended up taking 2 weeks to go through all of Paediatrics, but because I started revising early, I was able to give up a few days and shift my other dates around for my other topics.

6) Use revision books to AID knowledge, not gain knowledge. There are some books called Crash Course or At a Glance, which are really good books which gives you a quick glance at a topic. These are good books to help you look up stuff quickly or to double check info, but these are books you should not base your revision around as it misses out fundamental/basic knowledge that you will get from a proper textbook/lectures.

To be honest, I think the key things for revision is to be organized, good time management, rest lots, and try not to stress out too much. Exams are extremely stressful and your anxiety levels go through the roof. Everyone will be feeling the same so don't think you're the odd one out. On top of revising, you might still have to go into placement as some unis only give you 1 week of revision (where nothing is timetabled), so you'll need to be able to balance going to placement and revising. If you aren't organized, your revision will get quite messy. At the same time, don't start skiving placements so you can revise because at the same time, you can learn/revise while on placement. Sometimes really useful tutorial sessions will be held and you can learn/revise during those sessions. To be honest, this whole revision business sounds a lot harder than it really is. You'll know what to do when it comes to revision.

Hope this helps!

Request: The Future.

There was a request from one of the readers here asking:

"What are you planning to do after medical school? It would be great to get some insight to what Canadian medics plan to do after their studies in the UK."

To be honest, the future can always change directions and I know I will have to be prepared for anything that life throws at me. My first choice is to stay in the UK and do my specialty training here as I know the system,   and I have gotten to know quite a lot of doctors who can give me advice for the future. I will try my hardest to stay in the UK, but laws do change. Hopefully the law won't change to prevent international students who study in a UK medical school from practising in the UK. In my eyes, I have spent 5 years in the UK. Moving isn't easy. The last thing I want to do is moving back and forth between countries. When I set my mind to something, I like to stay on that track and I am a very determined and ambitious person. In a way some people see it as stubborn, but I set goals for a reason - it is something for me to look forward to and to work towards to. I used to be quite a high level athlete and giving up is not an option. I do not like to stray away from the goal and when I do, I do get disappointed. I set high standards for myself and yes I know staying in the UK will not be easy, but I have set my mind to it. I have moved my life over to the UK and I personally don't see much of a future for me in Canada.

Now I may be determined and ambitious, but I'm not going to shoot myself in the foot. Always have a back-up plan. Things can go wrong. Life can throw a curve-ball at you. Rules can change. Who knows. The future is unknown and the most you can do is to be ready. Yes I have my mind set to stay in the UK, but I am still planning to take the Canadian MCCEE so if push comes to shove and I have to go back to Canada, I can. Nothing worse than ending up jobless and stuck in that awkward grey area.

I know quite a few international students wondering about taking the USMLE. (Note: I am not trying to start an argument/debate with this topic - just a personal opinion. Sorry in advance if anyone takes this persona/finds it offensive...) Who doesn't want to live the "American Dream". So why am I not taking it? Because I am not seeking for the "American Dream". To be very blunt - I do not care for working in the US. Some people see it as a great opportunity to make some good money. Some people just like the environment more. How I see it - if you are looking for the "American Dream", I'm sorry to break it to you, but in today's economy - there isn't much of an "American Dream" anymore unless you become a very famous doctor. The US is a very competitive place. Remember not only do you have to take a sickeningly hard exam, but you also have to score well in it. There's no point in just scraping a pass - you have to have a competitive score to get a desirable job in the US. I personally have my mind set on a specialty and it is a very competitive specialty. If I wanted to go the US, I would actually have to ace the USMLE. I don't want to end up working in some small southern town in the states in the middle of nowhere. The UK schools aren't geared to take the USMLE. UK medical students are geared to become practising doctors...not to take a US registry exam. That means students who want to take the USMLE, have to spend a lot of extra time to study for the USMLE alongside with their UK course work/exams. It is a very tough thing to juggle and you really have to be determined to go to the US and be committed to do well. So do your research.

Having said that, those who are determined to go to the US and have their eyes set on the prize - will probably do well in the USMLE. These people would probably take the exam seriously and study hard for it. Some might not really care what specialty they want to go into. These people will probably get a job in a desirable location. I'm sure I wrote a post about priorities before. Personal preferences and priorities - what is important to you, may not be as important to the person sat next to you. To make your priorities work, you will have to make sacrifices. At the moment, my #1 priority is to get into my desired specialty. This will probably require me to make quite a few sacrifices as it is a competitive field. The most likely thing I will have to sacrifice is: location. Someone else who wants to do the same specialty may see location as a huge priority. He or she may rather stay in London than do specialty X or he/she may not mind doing specialty Y in order to stay in London. It is all down to you.

All in all, the future is a personal thing. Everyone has his/her own path. No one path is the same. Know your priorities and stick with them. Don't let someone else alter your priorities or talk you out or into things. It is your life at the end of the day.

Just Need to Ask.

As you have all realized, I am not enjoying my GP placement as I haven't really gotten to do anything hands-on. Learning is minimal and I essentially just sit the day away. Last week, I requested to sit in with a GP who has a special interest in MSK. Finally got a schedule I could smile about. I was placed in a surgery where majority of the patients came in with MSK complaints. Then my next day was placed in the hospital (oh how much I miss the hospital environment) to shadow a physiotherapist.

Because I am so sick of sitting around, I finally opened my mouth and asked if I could do joint examinations.  The GP was more than happy to allow me to examine and started introducing me as the "Student doctor with a special interest in muscles and bones." Clinic for once actually went by quickly and was fairly enjoyable. Then I decided to ask the physio on my next day if I could participate and get involved. She was also more than happy to allow me. The physio had a special interest in upper limbs while I am interested in lower limbs. It was good for me as I am obviously missing quite a bit of knowledge about upper limbs. I learned loads about the common injuries and presentations you see in upper limbs. I also got to work on my upper limb examination skills which involved a bit of neuro; therefore, it was a really good refresher.  It was also fun to talk to someone who knows the orthopaedic consultants in the hospital and just learn more about the other sub-specialties in orthopaedics.  I got to know about the spinal unit and the shoulder consultants and what they would usually see.

It was also cool to see what would count as an urgent referral as we had one patient who we believe to have cauda equina syndrome. Cauda Equina is essentially where your spinal cord goes further down your spinal column than most people. Most people's spinal cord terminate at L1/L2; therefore, when you do a lumbar puncture, you make sure you go below that to avoid the risk of paralysis. The patient presented with urinary retention symptoms and decreased anal tone.  He also complained of changed sensation in his genitalia region.  It was evident that he also had bi-lateral leg weakness. His symptoms fit cauda equina syndrome so we had to urgently refer him to get an MRI scan. It was also interesting because the patient was claustrophobic and he made it very clear he does not want an MRI scan. We told him that the hospital has a wider scanner so it won't be as tight, but the patient was still adamant that he doesn't want to go through a closed scanner. He allowed us to refer, but he told us that he will refuse to go in on the day. We told him there is medication that he can take before he goes in to keep him calm that he can get from his GP. I don't know why but I felt like he is still adamant that he isn't going to get the scan done and will not go get the medication from his GP. Cauda Equina Syndrome can be quite serious and need to be treated so it was a bit frustrating to see someone refusing a simple scan which can rule out cauda equina.

Then I got a bit of a reality check near the end of physio clinic. I have suffered from a shoulder injury for 5 years now, and never really bothered to take myself to see a doctor. It's a thing about medics: "Medics either go see a doctor too early, or go too late." In my case: I just never go. A shoulder patient came in who obviously needs a shoulder replacement due to OA in the shoulder. The patient had very limited range of movement and you could hear his shoulder grinding as he was abducting his arm. He explained to us that it has completely hindered his lifestyle as he can't even reach up to get things from the cupboard and it is quite painful. He then mentioned that when he was young (my age) he had a few shoulder injuries and reckons that due to those injuries - he now has pretty bad OA of his shoulder. Once the patient left, I told the physio about my shoulder and she sternly told me to go see a GP and get a referral to either physio or orthopaedics as  I am susceptible to early OA if I don't get it sorted out. Even worse, it could hinder my ability to do orthopaedics in the future as it requires a lot of strength and lifting.

To be honest, the physio is right. I've left my shoulder long enough and it is obviously not getting better. Hate being on the other side of the table as the patient.

Difficulty of Going Backwards.

So I've had a week of lectures...which to be fair weren't too intense. They weren't 9-5 lectures so I can't really complain. Ever since January, I feel like I have made leaps and bounds in terms of progression in clinical experience. In paediatrics, I hardly did any clinical skills and was in a small group for my placement. I had a partner with me for all clinics and was never really on my own. Didn't really even see patients on my own either. Then we get to Obs and Gynae...slowly venturing out a bit and being a bit more independent. Still in a small group on my placement, BUT I didn't have a partner to go with to clinic/theatre. I was actually scared to be on my own as I have never really been to clinic on my own and you get all these thoughts of: "Ahh no one to bail me out when the consultant asks me a question." I actually really enjoyed going to clinics on my own as you get to chat with the consultant more and it isn't as daunting for patients to have two students watching/sitting in. I definitely started becoming more independent on placements and started being more proactive in guiding my learning.

Then my last placement in orthopaedics. It was the first time I ever attended a placement on my own. I have always been in a small group. Funny enough my first concern was: "Who the heck is going to eat lunch with me?!" I am definitely not a fan of eating on my own as it is painfully boring. I like to talk during my lunch as I eat quite quickly so talking helps me slow down. I can easily scoff down lunch in 5-10 minutes and I end up taking extremely short lunch breaks. Luckily, due to my half-days I was able to go home to eat so I didn't have to sit in a cafeteria eating on my own and staring off into space. When I did have to eat lunch at the hospital I was usually with my consultant/registrar so we all ate together. But yeah my independence was really tested in this placement as everything I did was all "me". No one to fall back on. No one to rely on. No one to catch your mistakes...other than the consultant. Went to see new patients on my own and do full examinations on my own..then presented to my supervisor. If you had asked me to do that in my paeds placement...I wouldn't be confident enough to do it. I guess that's one thing with being dropped in the deep end. Got to learn quick and deal with it quickly. To be honest it did help that my supervisor is probably one of the nicest people I have ever met so I knew if I made a mistake I wouldn't get a full blown telling off/humiliation. It was also nice that I actually got to do things during my placement such as see patients, do examinations, assist in surgery, etc.


Now...sitting in lectures on a very hard plastic seat (even the clinic chairs are more comfy) in a small tutorial room...painful. I was talking to my friends and they kept saying it was nice to have a relaxed week of just sitting around and doing nothing but listen. I actually struggled this week. I may not be the hardest working medical student...but I hate sitting around. Especially with my last 2 placements where I was actually being productive and learning loads on placement...I am actually a bit sick of sitting in lectures and listening to one person talk about the same subject for 2-3 hours. Also got my induction pack for my next placement (GP) and the first thing I read: "Patients should not be seen by medical students who are on their own. Medical students will be supervised at ALL times." I'm totally looking forward to GP now...so excited that I'm bouncing off the walls (sarcasm). I really really hope that the package is a bit outdated and my GP will let me go see patients on my own and do some examinations. It's weird getting so much independence and responsibilities...and suddenly being stripped from all of it and back to holding hands. If this is the case...wow this is going to be a shock to the system.

The End of Another Placement.

Seriously cannot believe it has been 6 weeks. It literally blew by. I didn't think it would as I wasn't particularly busy and I had quite a few day offs as well (bank holidays, etc). My friends said that you cannot find a happier medical student on placement than me. I will admit, the placement started off quite slow...but once it got going...I truly truly truly did not want it to end. It's the first specialty where I could see myself work in as a career. Before starting, I was a bit hesitant as ever since I knew I wanted to do medicine, I wanted to do orthopaedics. I had very high hopes for it. Obviously I was very excited to start the placement, but there was a bit of doubt in the back of my mind. These 6 weeks could either make or break this specialty for me. I was actually scared that I will end up not liking orthopaedics...and actually hating it.

Luckily, orthopaedic surgery is just like how I imagined it to be. I was genuinely happy. It's the first placement where I enjoyed everything about the specialty. I enjoyed the surgeries. I enjoyed being on the ward (which was minimal to be fair). And I can't believe I am saying this but I enjoyed clinic. Everything clicked for me. I never struggled waking up to go to this placement. I had 8am meetings to go to (where I had to wake up at 6am) and I never struggled. If this was any other specialty and was told to go to an 8am meeting...I can guarantee you I would struggle and would probably turn up late or maybe even miss it. I was actually motivated to work hard in this placement. I didn't work hard because my supervisor was strict/I was scared of him...I actually worked hard because I enjoyed the specialty. I felt no pressure to work hard...actually my supervisor kept telling me to take it easy and made it very free. It was all down to me. There were times where I wished I was in more.

This was probably the most flexible and easy going placement I have had this year, but this is easily the one placement where I have learned the most. I had lots of fun, but also learned a lot of useful things. I am so lucky to have a supervisor who is really good with teaching and letting me progress. You all probably remember me having great praises for my last O&G placement and that it has set a very high bar. This orthopaedic placement just blew through that bar. I mean I knew it was going to be hard to have more fun and more responsibilities than my last placement, but wow this placement was fantastic. I have nothing but good things to say. I got to scrub in. I assisted in surgery. I learned how to suture and help close up. I saw patients in clinic on my own and got to examine them. I got to start and finish an audit project. I really could not ask for more. I don't even think I could do much more.

Today started out like any other day. Early meeting and then to morning clinic. Usual banter in the meeting...lots of good laughs and teasing. I took up my usual spot at the back of the room against the cabinet. Then off to clinic. Busy clinic as usual. Saw new patients on my own. Did the usual. I'm sure no one knew it was my last day because everything was going like it was just another day of my placement. Patient by patient...the note pile got smaller and smaller. Clinic was coming to an end. Next thing I knew my supervisor was signing my feedback form off. Had a bit of a chat about the placement and then a solid handshake. To be honest it was tough to leave. I wasn't sick of the placement yet. Just wasn't ready for it to end already. Every day when we finish and before I leave, I always crack a: "When am I seeing you next?" It was weird not to say that as I was heading for the door. I didn't even know what to say as I left. I think all I kept saying was "thank you" as I dragged my feet out the door. Even now...I'm absolutely gutted this placement is over. Feels like someone shot me out from cloud 9. Next week is going to be tough. Back to lectures. Back to reality. Then on to GP and being cooped up in a clinic from 9-5. No surgeries. Not in a hospital environment. Going to be out of my element. Hurts just to think about it. Should be a crime to enjoy a placement so much.  Genuinely loved this placement. Entered placement as one of the happiest medical student you can find to probably the most gutted one at the moment. What a contrast. Just shows you how much I enjoyed this placement.

O&G Ward Week.

You can hardly call this my "Ward Week" as I probably spent more time in clinics than on the ward. This week also marks my last timetabled week of my placement and I have been seriously trying my best to enjoy every day of it as there is a bit more flexibility with my week.

Spent Monday morning in Gynae clinic. I managed to see a lot of prolapses such as cystoceles (proplapse of the bladder). Luckily the consultant has gotten to know me as I've been in a few of his clinics with him so I got to do a vaginal examination on almost every patient. It was interesting to feel a prolapse as it is definitely very different and then feel the difference when a shelf/pessary is inserted as a temporary treatment for the prolapse. Patients with cystoceles tend to classically present with a "dragging" feeling down below which becomes quite uncomfortable as the day progresses. There is also a "heavy" feeling, which again gets worse as the day progresses especially when stood up for a long time. Some of these patients also present with urinary symptoms such as urinary frequency and hesitancy. I think by coincidence these patients also present with some form of urinary incontinence as well. Usually elderly women would not be offered a surgical repair where stitches will be placed to reinforce the anterior wall of the vagina (where the bladder prolapses through) as these patients are usually unsuitable to go under anaesthesia.  By the looks of it, most of the women are fine with the pessary and it seems to sort out their problems quite well.

Then I wandered onto the wards with one main goal in my mind: Take as many gynae patient histories as possible. Why so keen? This is because my assessment is taking place the following day. Essentially we are required to take a full patient history with an assessor sitting alongside. This assessment either makes or breaks me. If I fail, I would obviously have to resit the assessment which would go down on my records that I had 1 failed attempt. If I fail the second time, then I will have to repeat the entire 7 week placement all over again. I mean I'm having a good time on this placement, but if you asked me to do another 7 weeks, it might be a bit of an overkill. Anyways I took about 4 patient histories in the afternoon and had a good time talking to patients. It's nice to see patients enjoying talking to me as I guess for them it is better than sitting in silence and day dreaming as the hospital is pretty boring in general.

So I had my assessment...and oddly enough...I wasn't too nervous for it. Actually I was so calm it was worrying. I was struggling to take the assessment seriously as before I went in to take the patient history I was chatting away with my colleagues (well I did the talking...they just listened as they all looked very nervous). I kept telling myself to take this assessment seriously but I struggled. I was fairly annoyed with myself, but at the same time - if I'm in a good mood I tend to take better patient histories and form much better rapport with the patients, which is key for the assessment. Luckily, my patient wasn't too complicated (vaginal hysterectomy and anterior wall repair). I finished my history quite quickly and  I thought I did quite well. Didn't have any difficulties whatsoever. Huge contrast from my last placement (paediatrics) assessment. In my last placement I was properly pooping myself prior to my assessment and I was dead scared. I was much more confident for this gynae assessment - night and day in terms of confidence between my last placement assessment and this one. My assessor had no difficulties in passing me and even gave me an "above average" mark which I was quite chuffed about. I was quite proud of myself as I was only expecting a "meets expectation" as my supervisor is known to be quite strict with marking.

Since my next assessment isn't until next week, I knew I can relax for a bit and return to enjoying my placement. Oddly enough I thought I was going to be quite bored on the wards as there isn't much a medical student can do on the wards, but I was actually quite productive on the wards. The doctors were all really welcoming and actually allowed me to write in the medical notes and sign off on them (of course the doctors reviewed and counter-signed my notes). I also got to clerk in a few patients, which is always interesting. It's weird seeing how seriously some of the patients treat me. I mean at the end of the day I'm just a medical student, but these patients really take everything I say seriously and show a lot of respect. It's quite nice to not be treated as a joke and it definitely makes me feel much more responsible.

Because my next assessment is on obstetrics and I haven't had much exposure to it on the wards, I decided to spend my day on the obstetrics ward and practice my obstetrics examination skills. And jeez....I suck at obstetrics examination. I swear I cannot feel a thing. In our assessment I'm supposed to be able to tell the position of the baby, the engagement of the head, the lie, etc. I feel like my hands are dead stubborn as I swear the bum of the baby feels the same as the head! Yes I know one side is flat and the other is round like a ball, but at the same time I'm too scared to palpate deeply in fear of hurting the mother. I definitely need to get more confident in doing this examination or else I will fail my final assessment. Not looking good. I thought I could get away with just a full day of practice, but I definitely need to go back to the obstetrics ward next week to examine more pregnant women. I think I did leave a good impression with the midwives as they seemed keen to have me around and that I am welcomed to come back next week to practice some more.

1 more week until holiday...well not even. Technically only 2.5 more days of placement left as I have a half day next Thursday (and Monday is a bank holiday and I get Friday off).  Can't believe it's already been 7 weeks. I can still remember my very first lecture for O&G like it was just yesterday. This placement seriously went by way too fast...and I'm having such a good time. Argh.

Progress.

I was watching Junior Doctors earlier on and listened to the FY1 doctors saying how they feel more like a real doctor as they have responsibilities and they get to do procedures. I sat on my couch thinking about my last placement on paediatrics. Thinking about it...comparing to my placements just only half a year ago when I first stepped onto the wards as a student doctor, I have seen myself progress. My last placement in paediatrics, I was clerking in patients and presenting the patient history and examination findings to senior doctors. I am probably one of the first "medical" person on the ward to properly sit down and ask them about what has brought them to hospital. I get the honour of seeing these patients prior to the doctors on the ward. While on my placement, I guess I didn't really appreciate this properly as I just took on the responsibility to clerk the patients in, but never realized that I could be one of the first people to see the patient on the ward. I also have to make sure my patient histories are accurate and that my examination is accurate as when I present the history to a senior doctor, it is now expected for me to have a differential diagnosis, possible investigations, and management. Only half a year ago, I was stepping on the consultant's heels going around on ward rounds and just watching. I didn't really get to do very much. If there is something interesting on physical examination that the consultant sees/hears, then he/she would let us take a look/listen. Now...I am the one telling the senior doctor about hearing something and I have to be confident about it. It is actually quite frightening. There were times where I heard crackles at the base of the chest, but I would sometimes doubt myself as they are fairly faint crackles. However, when I present the patient to a senior doctor I have to be sure about these crackles and now I get to write into the patient's notes about any examination findings. It's pretty crazy how much I have progressed from half a year ago.

Also 2 weeks ago the first year medical students got their quick taster of hospital placements and for once I wasn't the most newbie medical student around. There were people more "new"/fresh than me. It was a weird feeling. Then you start noticing that they really don't have a clue how to take patient histories.  And then you think to yourself...about 2 years ago...I was just as clueless. It's weird thinking how much you learn in such a short period of time. Now the structure of patient histories come naturally and you don't really have to think about it. You just ask the questions and go with the flow. I still remember in first year constantly trying to remember what questions to ask...what is important to ask...what the structure is to take a patient history. In first year before I saw a patient, I always wrote on my paper:

PC (presenting complaint)

HPC (history of presenting complaint)

PMH (past medical history)

DH (drug history) - ALLERGIES?

SH (social history)

FMH (family medical history)

This structure is now engraved into my head...and it's only been 2 years! I also taught these freshers how to take a pain history. It's weird that they don't know SOCRATES. SOCRATES is my saving grace. You can never go wrong with it!

Site (where is the pain exactly?)

Onset (when did the pain first come on?)

Character (what does the pain feel like? can you describe it to me?)

Radiation (does this pain go elsewhere?)

Associations (are there any other symptoms that you noticed?)

Timing (does this pain come on at certain times? does it come and go? is it constant?)

Exacerbating/Alleviation (what makes the pain better? what makes it worse?)

Severity (on a scale from 1 to 10 - 1 being not very painful and 10 being the worst pain you have ever felt, what score would you give your pain?)

I found it very confusing to actually see these medical students taking me seriously and genuinely absorbing what I was saying. I'm not much older than them...one of my students was actually older than me! Also when I walked by a few of the first year students and quickly said "Hi!" to them as I walked by, I heard them whispering: "Whoa an older medical student said hi!" I still remembered when an older medical student said "Hi" to me while I was in the hospital...I felt quite happy as I felt like I was noticed and not ignored....more like I actually existed!

Crazy how 2 years make such a big difference, yet thinking about it...it hasn't been too long ago. Speaking of which...this month actually marked the halfway point of my career! Halfway to being a doctor! Scary!

Sh!t Hitting the Fan.

Oh wow...it is quite rare for me to leave work to the last minute. I should be panicking, but I'm not...well not just yet. I have 2 essays and 1 reflective writing to hand in on Monday. One of my essays is a case report, which I have finished...but it is still pretty rough. The other essay is an evidence based medicine essay, which requires me digging through a bunch of literature...haven't started that whatsoever. Reflective writing...I hope it doesn't take long as I haven't done that either, but I usually only take 10-15 minutes to do up reflective pieces. As you can tell...I'm not too shabby at reflecting (which I do believe is a very important part of the degree - can't improve if you can't reflect on your performance/day). It doesn't end there - I've got a summative assessment on Monday where I will be watched by a consultant in taking a full patient history and perform two systems examination (could be either Cardiovascular, Respiratory, GI, Peripheral Nervous System, Cranial Nerves, or Developmental examination). Afterwards I will be asked a few questions about the patient history such as differential diagnosis, management, investigations, pathophysiology, etc. Anything goes as long as it is relevant to the patient's condition. Will also be asked to present my findings on physical examinations. Ack. I mean taking a patient history and doing examinations is just a matter of practising which I think I've done enough of. I'm just worried about the questions my consultant will ask me.

This week has been fairly uneventful. I was only in for 3 days as I had a lot of meetings to attend. Because of all my meetings, I haven't been able to do an "on-call" from 9am-9pm, which means I have to do 2 on-calls in my final week of Paediatrics. Fun. Essentially I spent this week completing my log book in terms of getting my clinical skills signed off and getting a registrar to do my formative assessment for 3 systems examinations in preparation for my summative assessment for next Monday.  I also found this week incredibly hard to wake up. Every morning I was struggling to wake up. Thank goodness 1 more week of Paediatrics and travelling a long way to the peripheral hospital. Next placement is Obs+Gynaecology and the drive there is about 15 minutes so I won't have to wake up as early. PHEW. To be honest I'm quite sick of my placement now. 7 weeks is too long and I haven't really been having a great time either so that doesn't help with my experience. I'm usually bored and I generally feel quite unproductive. To be fair though, I still learned a lot especially on how to interact with children. Still something I'm struggling with, but if I compared myself to the first week of placement, I have definitely grown as a person and have learned some new skills. It'd be unfair for me to write this placement off as it has been very useful. Just not my "cup of tea". Can't love every placement. There will always be up and downs, but medical school is all about exploring specialties and learning about everything. As a medical student, you need to learn how to adapt and essentially "just get on with it". My basketball coach from high school always told me: "If you don't like it, too bad. Make the most of it. If not, just suck it up and keep going."

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!