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.

Post #100 - A Look Back.

Post #100 for this blog. I obviously want to make a special post and let's take a trip back to the beginning of this blog.

August 6, 2009 - my first blog post. It was a big day for me as it was the day I received an unconditional offer from my university to study Medicine in the UK. Looking back, coming to study in the UK was a huge decision and definitely a path of a lot of unknowns. A new country. A new culture. A new chapter. Little did I know what a roller coaster ride it would be for the next 2.5 years. I faced many challenges (and still facing challenges) and have grown up a lot in the last 2.5 years. University was a new chapter to my life. Saw and learned so many new things. It has so far been the best few years of my life. I can easily say that Freshers week will always be a highlight as it was quite an experience getting to know so many new people in such a short amount of time. I've been in the same school for half my life so making new friends is something "new" and I was extremely nervous. Kind of laughing at myself now for being so nervous/scared as there was nothing to be scared about. Every one is on the same boat in terms of friends and people are just so friendly. A tip for those who will be starting this coming September: be EXCITED. There is nothing to be afraid of and don't let anything hold you back. Enjoy your time as a Fresher as it will blow by in a blink of an eye. 

When I first started this blog I was really unsure whether I will even be able to keep up with it. Slowly I've noticed that people are reading it and it really motivated me to keep posting. Whilst scrolling through my archives...I have noticed quite a change in frequency of posts. I think it's a fairly good representation of excitement through my years in medical school. Obviously if there is something exciting, I would post about it. Here's reality: the first 2 years of medical school is a bit of a shock. I think a lot of us come into medical school thinking like we would be like the TV show ER...or House and we would be immersed in doing clinical procedures and running around. WRONG. Well in my case I was stuck in a lecture theatre for 2 years learning about the basic sciences, which isn't the most exciting thing. It is obvious there were a lot of up and downs in the last 2 years. I lost sight of the final prize (becoming a doctor) several times throughout the last 2 years. You get to a certain point where you're like "get me on the wards!" and then there will be times where you ask yourself: "Why in the world am I studying Medicine?" Medical school is full of obstacles and it is emotionally, mentally, and physically tough. There are so many times where you're on the floor and you really need to dig deep to pick yourself back up. I realized this is a degree that you have to be committed to because there are times where you truly do question your desires of being a doctor. Then at last - I reached clinical years. 2 grueling years of being cooped up in a lecture theatre and finally I am able to do some practical things and talk to patients. But hold up...with my school we are quite lucky to have a bit of clinical experience in the first 2 years.

March 15, 2010 - first hospital attachment. It was a short clinical attachment and really just a taste test of what I'll be doing in the future. Only a few months ago I saw first year medical students starting with their first clinical attachment like I did back in 2010. Seeing these freshers really put things into perspective of how far you have come along. (And for once it was nice not being at the bottom of the ladder at the hospital). It really gave me a flashback to what it was like when I started my first clinical attachment. Patient histories were a struggle...I was not good at them at all. Hardly knew any medical sciences so I didn't really understand anything and tried my best to keep up. Couldn't do any clinical skills. Essentially just shadowed the doctors and tried to not get in the way. Went to observe a few surgeries and standing on a pedestal trying to peer over the consultant's shoulder. However, I do remember how much I enjoyed watching surgeries. It just clicked. Fast forward to 2012. Patient histories - easy. Interacting with patients - easy. Medical knowledge - growing every day. Clinical skills - taking bloods, inserting cannulas, inserting catheters...just the other day I put in an endotracheal tube on my own (supervised by the anaesthetist). Surgery - observe? Heck I'm scrubbing in now and even helping close up at the end! Medical school is a long and painful process...but when you take the time to stop and think back to when you started...you see how far you have come.

February 8, 2011 - immigration laws changing. I believe this is the first proper post where I've discussed in detail about being an international student and things we have to think about. From then on, I have dedicated 2 other posts (Tidbit for International Students and Life of an International Student) to give a bit more insight about the life of an INTERNATIONAL medical student. To be honest, being an international student isn't that much more different than a local British student. We go through the same course. We get treated the same. We learn the same things. We see the same things. The only difference is our accents, and our passports...and the fact we have to worry about Visas and immigration laws. But other than that, being an international student hasn't been that hard of a transition that I had initially thought. Before I started medical school, my biggest fear was the fact I was an international student and it might be a bit harder for me to make friends or get used to the culture. Again during Freshers week...everyone was just so friendly...I didn't feel different. I didn't feel that much of an outsider. There were a few times in the last 2.5 years where it was frustrating to be an international student due to the lack of support from the medical school, but you learn to manage. As an international student, you make a lot of sacrifice. You leave your family behind. You leave home behind (which can be thousands of miles away). You pay higher fees. But hey hopefully it will be worth it. Hopefully this is something I will not regret. At the end of the day...hopefully this will be all worth it. Homesickness is a huge thing for international students and a lot of my friends do struggle with this...including me. Every time this happens I just have to take a break and tell myself it will be worth it and think about all the obstacles I have already been through and how far I have come. What makes me wake up every morning is the end prospect from studying medicine. I am grateful to be in such a great field and the experiences I have had so far have been amazing. The future with immigration and working in the UK - not a straight path and one with many bumps, but the fact I have made so many sacrifices just gives me so much more motivation and determination to make it work. Work hard and hopefully have a bit of luck on my side when it comes to jobs.

August 7, 2009 - first tip post. Not exactly one of my best tip post, but hey we all got to start somewhere. Obviously this blog was to keep a track of my crazy life of being a medical student, but also to give some tips to future medical applicants. I try my best and over the last 2 years I have posted quite a few tip posts here and there. Applying to medical school is no easy process and I wished I got some tips. My school back in Canada was not very good with helping out students with applying abroad as they are not very familiar with the process. It was a difficult process as I had to do a lot of stuff myself and call up universities in the middle of the night (my time due to the time difference) to get some more information. Hopefully with my tip posts I am able to help future applicants with the process. Obviously I applied 3ish years ago so UKCAT info and tips are a bit off, but I'm sure the interview process is still the same. Now I'm trying to focus on giving tips on surviving medical school. Little tricks I have learned here and there. I remember my very first medical school lecture, one of my professors told all of us: "Life is not fair." And it is so true and particularly true with medical school. So here is a tip to all of you: Life is not fair. You cannot have your way with everything...unfortunately, BUT what you can do is make the best of every experience no matter how undesirable it is. There is always something to learn. Stay humble and treat those around you with the same respect you would expect in return. You will meet a lot of people throughout medical school and treat everyone well as you never know, you might see he or she again in the future. Consultants on placements - treat them with as much respect as you can as who knows, he or she may just be your future employer in a few years. Don't do anything you will regret, even outside of school hours as things can come back and bite you on the ass. Unfortunately as a medical student - we got to grow up very fast. We start medical school at around 18 or 19 years old...you will see patients of all ages and they expect professional behaviour despite your age. Also grow some thick skin - consultants can be very unforgiving. Do your best to not take it personal. At the end of the day their criticisms are for your own good.

June 2, 2012 - post #100. It has been quite a journey and I expect more ups and downs in the next 2 years. Being a doctor is starting to get real. Now going through my specialty placements, I'm starting to do more and more on placements. This post has made me look back and realize how much I have grown emotionally and mentally. Thank you to all you readers out there and keeping me going on this blog. I really appreciate it. Happy reading!

Planning Ahead.

I would like to think I am fairly good at planning ahead. I am quite a simple person and fairly straight forward, but few know that I actually think quite a bit about the future. Being an international student, you have to think about the future.  We try our best to not think about the future as anything can happen, but we also have to be ready for anything unexpected. My biggest advice to international students (no matter how confident you are about staying in the UK) is to have a backup plan. What happens if the UK government decide to throw us a curve ball and change the immigration/Visa rules? What happen if you suddenly have to return home due to family issues? And if you're not planning on staying in the UK, you really got to plan when to take the registry exams such as USMLE. It pains me when I see international students not having a single clue what they'll be doing in a few years time. Unfortunately it isn't a straight path for international students, let it be staying in the UK or going back home. Either way it won't be easy and you will have to make sacrifices. Anyways enough with the grim outlook for international students. It isn't all that bad to be honest. It's just that you have to constantly remind yourself you are an international student and it isn't a simple straight path. There will be many obstacles to cross and many walls to climb. It isn't easy, but hopefully it'll be all worth it in the end.

Anyways enough with the weird banter paragraph above. Maybe I should put the beer away. Haha. If you guys read my last post carefully, I did not talk about Friday. No I didn't have lectures...and no I did not go into placement. Then you must assume I was skiving. No I wasn't skiving either...well I wouldn't consider it skiving because I was actually doing something productive. I had a meeting with an Orthopaedic consultant at the central hospital to discuss about my Student Selected Component (SSC) project for this coming May.  The last time I met the consultant, I fell asleep in the chair and he had to wake me up...great first impression. Luckily it didn't really affect him as he was willing to see me again. He was actually quite keen to be my supervisor for my SSC and to mentor me. This time prior to meeting him, I made sure I was not going to fall asleep. I heard him come out from his office so I made sure I didn't look like I was dozing off...to be honest I was zoning out as all I did was stare at the wall. I had to wait for awhile as I was 30 minutes early for the meeting as I messed up on my travel timing so I was quite tired. Went into the office to discuss what I will be doing for my 6 week SSC project. We did a lot of brainstorming and came up with quite a few ideas.  Either this consultant is smart or was prepared to discuss about my SSC as he was rapid firing ideas at me. Unfortunately, I kept zoning out as to be fair...I did not understand half the things he mentioned. He was talking about the different type of implants used in Orthopaedics, and obviously I have never heard of the brands. He talked to me like I knew all the brands so you could imagine I was very lost. When I get lost...I zone out. It's a horrible trait I have. As he went on, he realized he should write down what I will be doing. He set out a bunch of aims and wanted me to expand on it and give it a think. He filled up half a page with notes on the aims of my project (looking at implants). I quickly put the paper away in my bag without looking at the paper.

And then I perked up as the consultant mentioned that during my project he wants to do some clinical things with me. I told him that I got to observe a few trauma surgeries and paeds orthopaedic surgeries over the last few weeks. He ended up throwing a curve-ball at me and told me that it is good that I'm making the effort and be keen to go see these things, BUT the difference is that when I follow him I will be scrubbing in and actually assisting. Oh man, I got so excited it was ridiculous. I immediately sat up straight and couldn't stop smiling. Scrubbing in and assisting = music to my ears. Finally I get the chance to get my hands in and do something that I am interested in. He also went on how I will be able to do some stitching (heart sank a bit as the last time I learned stitching was a year ago). Now, I was very excited about my SSC and the consultant surely knows how to make a student happy.

After the meeting I quickly went home and took out the paper that he wrote on. To my demise, I could not make out half the things he wrote. I regretted zoning out and I should've remembered doctors do not write legibly.  Took me ages to decipher what the consultant wrote. In the end, I figured out most of the things he wrote as I vaguely remembered the stuff he was talking about and managed to crack on with expanding on his notes. Note to self: Do NOT zone out while a consultant is talking to you. You'll regret it as you won't be able to read half the things he wrote down. Imagine if I couldn't decipher what he wrote...the embarrassment I would have to go through as I would have to email him and tell him I can't read what he wrote when I should have been paying attention during the meeting.

Anyways I'm super stoked about my SSC in May! One more meeting and a bit of paperwork before my SSC will be official. Cannot wait.

Life of an International Student.

Winter holiday is coming to an end and it literally blew by. First came Christmas. Next thing you know it was New Year's eve. Then we welcomed a new year - 2012. I celebrated these festivities with my family and knowing that this is probably the last Christmas/New Year I will spend back at home before I graduate really gave us the urgency to do as much as we could this winter holiday. Ate lots of good food and did quite a bit of shopping. Really tried my best to take in as much of home as much as I could. Also tried my best to spend as much time as I could with my family. I really don't know when is the next time I'm coming back home. It is a really sad thought. School is getting busier and I am getting shorter holidays.

In a blink of an eye I will be heading to the airport to fly back to England. I hate going to the airport and saying "goodbye". Tears my heart every time.  It will never get easy. It is really hard to see your parents sad to see you leave. Sometimes I wonder if going to study thousands of miles away from home a good choice. Unlike local students, I can't just spontaneously decide to go home for the weekend. Home is in a different country thousands of miles away. Thinking about it, international students make huge sacrifices to come to England to study. So food for thought: when parents of international students come to visit, don't tease them.  Sometimes flying back home isn't an option so the next best thing is for parents to come visit. Think about the sacrifices we make for a better education and the opportunity to study things that may not be available in our home countries.

Life of an international student is not easy.

Tidbit for International Students.

Today I received my Student BMJ in the mail and while reading the front page articles on the newspaper - I managed to walk into a door. You may ask: "What's so interesting?"

Well there is an article called: "BMA rejects 'unjust' limits on training for non-EEA medics". A summary of this article is literally about the unfair treatment towards international students especially those studying medicine. I was shocked to see that us international students' tuition fee contribute £100m annually! WHAT! That's a HUGE number. Technically we should get equal rights on getting specialty training and with the new immigration rule of removing the Tier 1 Visa it will essentially be impossible to get specialty training in England. So in the last post I said that recruiters don't care if you are international and they are happy to accept them. THE annoying part is the VISA and that Tier 1 visas is our post-study work route for specialty training, which they want to junk.

It was shown in studies that International graduates are not stealing away jobs from local students so they don't see why they should make an international student's life so difficult. I don't know if you guys have been around the hospitals a lot but I have noticed a lot of consultants aren't actually local British people. I've talked to a few consultants who are from India and we have had a few internationals who lectured us - and they appear to be quite skilled (well they are consultants). Unfortunately with the junking of Tier 1 and if these consultants have not declared citizenship...wouldn't they be in danger of being kicked out from the country?! That to me sounds quite shocking that the UK would want to kick out highly skilled people...especially extremely skilled consultants. It was also mentioned that it is unfair towards those medical students who are currently studying medicine and suddenly changing the immigration rule on us midway through our degree. If some of us knew about these immigration restrictions and not being able to do a specialty...some of us may have not chosen to come to study in England as essentially it appears to be a flipping dead end after foundation year 2.

Now with the NHS reform and the ridiculous suggestions...I do not know what is the UK government trying to accomplish. I feel that the UK heavily relies on immigrants for jobs and it is a shame that they believe that internationals are getting in the way of locals. While providing £100m annually from tuition fees in total and the NHS is spending a couple hundred thousand pounds to train each medical student (including internationals) I reckon the smart thing to do is to not shoo us away. If the UK is going to make working in the UK as a doctor and an international so difficult and almost impossible, just simply stop international students from applying to universities! With every article I read about the immigration rules and how it'll affect us, the less UK appears to be welcoming. Hopefully by the time I graduate the UK government gets their heads checked and really take a deep thought about the consequences of these immigration rules will do the economy and the work force. I feel that internationals play a vital role in the UK as a whole. Really is a shame if these immigration rules completely bar off internationals. Multiculturism is good to have and especially coming from one of the more successful multicultural countries (Canada) - I truly feel that immigrants are not as welcomed anymore in the UK.

Local students may argue with me on this, but really what a shame.

International vs. Local Debate.

So the other day I had quite an interesting debate with my fellow medical friends. Mind you this debate involved a mix of international and local medical students. With immigration laws changing and making an international student's life even harder, it leads to the question of how are international students studying at a UK medical school affected? Let me give you a quick overview as to what is the proposed change that COULD affect international medics. The government is planning to scrap the Post Study Work Scheme (Tier 1 visas). This apparently does not affect Foundation Year jobs, but apparently does affect international medics wanting to pursue a specialty in the NHS.

Not sure how true is this but someone please do correct me if this is not correct: all posts for specialties will be first filled by local students. Any postings with room left behind will be then filled with international students. In my eyes that sounds a bit unfair but my local friends have made a valid point that us "internationals" are stealing jobs away from the locals. However, what I do not understand is that it is such a shame that an international student who got an equal education to the local students at a UK university still has to be classified as an international. Obviously a bit biased here, but I would think it would be a lot more fair that when ALL medical students graduate (including internationals), everyone should be placed on an equal playing field. Received the same education, hence, should receive equal opportunity for specialty placements? Either way, quite a few internationals do end up leaving UK and return back home to work, but I feel that those who are left behind should be regarded equally and just as suitable for specialty postings. Again I'm not sure how true this is about locals getting more priority than internationals when competing for specialty posts, but I do get both sides of the story.

Next point which could be a bit controversial. Some locals I have spoken to are quite against universities accepting international students in general! Obviously baffled by this comment I do admit I did take it a bit personal even though I know I should not as it is just a fun debate. Anyways again I see why locals find internationals a bit of a nuisance. However, I feel that international students bring a lot of diversity to the UK. I know recently David Cameron said that "Multiculturism [in the UK] has failed", and with these changing immigration laws, studying in the UK doesn't seem as welcoming for international students as it is quite the challenge to get a job after your studies. I think without international students UK would lose its diversity and possibly higher education being less renowned. A major factor for me to come to the UK was for its renowned education system and that its top notch. Who knows down the line immigration is cut down so much that internationals just don't want to go to the UK as there are no job prospects, I think it could put a bit of a dent in the UK higher education's reputation. As well there was this whole other point about international fees vs. local fees which turned out quite heated but not really worth mentioning on the blog. I guess I may have poked a few too many buttons when I said that I like the system in the US where both local and international students pay the SAME fees. I think again it puts people on a more leveled playing field. Then another debate of being able to afford higher education, etc etc.

Where I stand is in the middle. International students bring a lot to the universities and certainly to the medical schools, however, it does threaten local students as we can take up posts that should be for local students. But I don't think it is fair to make it so difficult for a competent graduate (especially a medical student) to stay in the UK. As well, if international students are placed on a leveled playing field with local students when fighting for posts, I think it would create really good competition. Medical school shouldn't be a cruise along the river. It should be like back in school where you compete and do your absolute best to get into the universities you want to go to and study medicine! I feel that now there is hardly any competition and I think we need just a bit more. Competition can create more competent/excellent doctors as everyone will feel the need to work hard, take on extracurricular activities, etc.

What do you guys think about the changing immigration laws which could possibly put off possibly amazing future medical students? How do you think it will affect the UK/NHS? What is your view on the whole International vs. Local Student? Should there be more competition at medical school? Please post your comments below. :)