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.

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!