Another Step Forward.

I think a bit back I said I was working on an Orthopaedic project (since May). Today I had the chance to present my project in front of a group of orthopaedic surgeons across the region. It's nice to finally present something that you've been working so hard on, but I would be lying if I said I wasn't nervous. I was fairly confident a week ago when I was preparing my powerpoint though. My run-through with my supervisor went really well, but this was presenting in front of someone who I know. Presenting in front of a group of orthopaedic consultants is a whole other ball game. What I was most worried about were the questions at the end.

One thing about me is that I don't like over-rehearsing/practising my presentations as I like to improvise. I like to give relaxed presentations that can go any direction depending on how I feel as it shows confidence in your presentation/project. I know my project very...very well so this was a route I know I wanted to take, but a risky one as I haven't presented in over 2 years and certainly not in front of a group of consultants. But because I didn't want to make a fool out of myself, I thought it was a good idea to practice a bit more than usual so I rehearsed once a day starting on Monday. The one rule I have for myself is to never use cue cards or notes and this was definitely not going to change for this presentation. When I showed up at the meeting, I think the lead was a bit surprised by the fact all I had was my powerpoint and no notes/cue cards to run through while I wait for my turn. To be fair, I wanted to look like I was confident and at ease about my presentation, but actually I was completely bricking it inside. The night before I was "choking". Was confident until the night before and everything just fell apart. I was stuttering when I was running through and forgetting to talk about certain things as my slides contain very little info as I like to expand on my points.

Anyways it got to my turn and I told myself that one of my strong points are doing presentations and this is not anything different. I introduced my powerpoint and I went through my powerpoint like it was second nature. It was almost like I wasn't even consciously doing it. It felt really good! Then the dreaded part: question time. Surprisingly, the first question wasn't even a question. A consultant took the time to complement me so I was really chuffed about it. It definitely made me feel proud of myself and especially when I was the only medical student presenting amongst a bunch of registrars. At least it was some sort of confirmation that I didn't make myself look like a complete idiot, but the bail out sentence was always ready: "Sorry I am just only a medical student." The questions asked weren't too bad and it actually started a discussion amongst the audience about the thing I studied.

After doing this presentation it gave me an idea to make a post of tips for making presentations:

• Keep your powerpoint short and simple - maximum 4-5 points per slide - use these as cues for yourself and expand on these points
• Use images to make your slides/presentation look more interesting 
• My personal rule is about 30-60 seconds per slide. 10 minute presentations = 10-15 slides. Any more slides, you could potentially end up speaking too quickly
• Practice your powerpoint without any cue cards or notes from day 1 - if you don't get into the habit of using cue cards...then you'll never need to rely on them
• If you're really unsure about your presentation, find a friend to practice in front of and ask he/she to give you feedback
• If you're nervous at the time of your presentation, pause for a second at the end of each slide to allow yourself to gather your thoughts for the next slide. The audience will think you're giving them time to read your slide so use the opportunity to calm yourself and gather yourself.
• Introduction is key - also an easy way to calm yourself as you'll never forget your own name! 
• Always end your presentation with a summary slide as it's a nice way to round off the presentation
• Body language! Be aware of how you stand and what you're doing with your hands. If sitting, don't fidget/swivel in your chair. Standing and don't know what to do with your hands? Clasp them in front of you or try to use your hands to point to relevant images on your slide. Practice makes perfect for this. Avoid closed body positions such as crossing your arms across your chest and leaning against the wall. Don't want to look bored of your own presentation!
• Look around the room when talking. Don't have to make eye contact, but remember there's more than one person there so involve the room by looking around.
• And SMILE! Don't want to look grumpy about your own presentation!

So these are my quick few tips about presentations. Everyone has their own unique style so these are tips from my own personal experience. Do what you're most comfortable with. As a medical student, you are BOUND to have to do a presentation...even more likely once you become a doctor so while you can start practising in less serious meetings/conferences so when you do have to go to a proper formal meeting to present - it will be a piece of cake!

Theatre Etiquette.

As promised I will discuss about surgical theatre etiquette. Theatre is a really good way to see anatomy and learn more about the management of certain conditions.  Again like the wards it's a really daunting place to be in. I actually found theatre a bit of a scary place as there's so much equipment in there, but once you have experienced it...it really isn't that bad. Your consultant finally invites you to go to theatre with him next day so here are some tips: Find the theatre list for the day you'll be going into theatre so you can get an idea what you'll be seeing - best place to go is the consultant's secretary. This will allow you to do a bit of reading up on relevant anatomy for the surgery. Also a great chance to read up on the condition that the surgery is treating. Most consultants like to ask questions during surgery so make sure you're ready. Nothing worse than being the student that seems like he/she didn't do any preparation whatsoever. Also theatre starts at different times so it is something you'll have to find out from the consultant/registrar/theatre staff/secretary. Make sure you turn up for the very beginning as this is when everyone introduces each other and go through a team briefing. So you get to the hospital - what do you do next?

Head on to theatre and sign in. Go get changed into scrubs and put on a theatre cap. Make sure you also change into theatre shoes which are usually clogs/the super fashionable crocs. Hopefully your hospital have some theatre shoes for you to borrow so make sure you ask at reception first. Take off all jewelery. At all times make sure your ID is visible. In general for theatre changing rooms it is best to bring your valuables with you or simply don't bring valuables to a theatre day. I always bring my money and my phone with me and depending on the hospital I also bring my bag with me to theatre as it's just a small messenger bag. Make sure you leave the bag in the prep room or ask theatre staff where you can put your bag.

So you get to the theatre and hopefully you'll know who is the consultant. Go introduce yourself or say "Hi". You'll be surprised how often they don't notice you even though you think they saw you. I guess sometimes they can't recognize you as you are in scrubs and have a theatre cap on. Get in on the team briefing and pay attention to the theatre list for the day. Also find out who is the anaesthetist. Ask the anaesthetist if you can observe the patient being put to sleep. It's quite interesting to watch.

Simple rules of theatre:

• Don't touch anything green/blue in the operating room especially on tables/trolleys
• If you're going to faint - don't faint on the patient - so go sit down - it happens to everyone
• When the surgeons are gowned up - don't make any contact with them as they are now sterile so that means good dodging skills and just stay out of their way until they have gotten to their place at the table

Usually there will be 3 people scrubbed in and working on the patient. It will usually be 1 consultant surgeon, 1 registrar, and 1 scrub nurse. It'll be fairly obvious who is who. Scrub nurse is the one who will be passing all the equipment to the surgeons. If it is open surgery (not laparoscopic) you'll probably need to get a pedestal to see over the shoulders of the surgeons but make sure you ask them first/let them know you're standing behind them so they don't bump into you...but obviously don't be right up behind them - give them some space to breathe and move around. If you wear a lanyard for your ID badge - then this would be a good time to tuck it into your shirt so it doesn't swing around.

If it is a laparoscopic surgery - there will be a tv screen for you to watch so you don't need to be standing as close to the surgeons. Just find a good spot to stand and for me, I never sit down as I think the theatre staff are more deserving of a chair than I am. 

The problem with surgeries is that it can range from 30 minutes to 8 hours. You'll find that your back and feet will be hating you during long surgeries. Also make sure when you're standing for a long time just to keep your legs moving so you don't faint. Sometimes with long procedures I will go take a walk around the operating room just to get my legs moving again and give my back a stretch. No matter how much you love surgery (and take it from me - I really do LOVE surgery) - it will get boring especially when you're not scrubbed in and just observing. If nothing interesting is happening go talk to the anaesthetist. Ask he/she about the machines and what they are doing. The thing with surgeries as well is finding the right time to ask questions. There will be times where the room goes dead quiet as the surgeons are concentrating - obviously horrible time to ask a question. You'll be able to tell when they don't need to focus as much as usually they'll start talking about really random things like plans for the weekend...you'll be surprised what sort of things surgeons talk about during surgery. Some surgeons even have music playing in the background so don't be shocked when you walk in and there is music playing. I think the best one was when I was waiting outside a day surgery theatre and the doors to the operating room opened and all you can hear was music blasting out...almost seemed like a night club in there!

Hopefully your consultant will be good at teaching and he'll show you the relevant anatomy IF it is easy to see. Not all the time the anatomy is easy to see, but don't be disappointed if you don't really see much. Most surgeries that I have observed - I usually don't see very much so don't think this is your fault. Especially now, surgeons are trying to make incisions smaller to reduce the recovery time...but again as long as your consultant knows he/she has a student around - most are quite good at moving over and letting you do a quick lean in to take a closer look - again make sure you don't touch the patient/surgeons.

When the surgery is done - go make yourself useful and help the theatre staff with moving the patient. Put on a pair of non-sterile gloves and grab hold of one side of the bed sheets (other than the head as the anaesthetist will be there). It'll be made clear which way the patient will be going and usually the clue is probably the empty bed right next to the operating bed with a slide board underneath. The anaesthetist will always count you down to moving so some will say "On 3" or "Ready Steady *Move/Shift*" - either way it'll be obvious.

If the previous surgery was long - you might want to stick yourself onto the consultant/registrar as they usually will disappear to the coffee room. Go make yourself a drink or get some water - staying hydrated is key for surgery. Sometimes it is quite frustrating as you could wait for an hour before the next surgery. I always hate coffee room breaks - not because I hate waiting around...it's because sometimes the consultant needs to quickly pop up to the ward and you're left alone in the coffee room. Just keep your eye on someone who is from your theatre as they tend to leave without telling you. Well based on personal experience - I always get left behind so I always got to stay near the registrar/consultant/theatre staff just so I wont miss the next surgery. Another way is before breaking off to the coffee room - ask a theatre staff how long a break do you have or what time does the next surgery start - then at least if you lose everyone - you'll still know what time to get back.

Hopefully this gives you a better idea what to expect when going to theatre for the first time. Hey maybe you'll be lucky and get to scrub in. But don't be disheartened if you don't scrub in as I didn't get to scrub in til this year (3rd year of medical school - been on surgical placements ever since 1st year). So just enjoy your time in theatre and hopefully you'll see lots of cool things. Also a great place to witness some good teamwork and communication skills as well. If you're unsure about anything just ask a theatre staff.

Highlight of my Placement.

It is now the end of week 4 of my placement. 3 more weeks to go. To be honest...these last few weeks have been going by quite quickly. Even the doctors on the ward agree that these last few weeks have blown by. Now 4 weeks in....I'm really feeling a part of the team. We are all starting to get to know each other better so there's a lot more banter going on and joking around, which I really enjoy.  Despite this, there are still a lot of up and downs during this placement. There are days where there's a lot going on, and then there are days where you start asking yourself why did you even come in.

Wednesday could have been easily the highlight day of my entire placement. This day also came at a perfect time as it's halfway into the placement and it really gave me a good boost. Every one noticed that I was in a very good mood on Wednesday and actually had a bit of spark in me. Found out that there was some paediatric surgery going on in the morning and I decided I needed a change of scenery. Heard the consultant surgeon apparently looks fairly stern (cue heart sinking) and no one could pronounce his name. Got changed into greens (oh I missed them soooooo much) and heard that surgery is delayed as the patient hasn't arrived yet. Sat in the coffee room and there was only one doctor in there (who looked kind of stern) and I figured he was the surgeon I will be following in the morning. It was fairly awkward in the room as we just sat in silence and watched a tv show. Few minutes later he got up and I shortly followed behind him and hope it didn't seem like I was stalking him. Saw the surgical list before going in and to my delight I found out he is a Paediatric Orthopaedic Surgeon.  Pretty sure I was smiling like an idiot at the list. Walked into the anaesthetic room and we did introductions and after the consultant introduced himself, I knew immediately he's a really nice guy. He asked me to help him out with setting up equipment and he seemed really keen to get me involved. Slowly my mood was picking up and I was really getting excited. He then allowed me to scrub in for one his surgeries (in grown toe nail). It was a really quick surgery but when a consultant asks you to scrub in, it makes you feel involved and you start to feel more included/less useless. You feel like you're actually helping. It's a hard feeling to describe.  Like during placement, especially early on, you feel unwanted and useless so when a doctor asks you to help even in a tiny little task, you get this good feeling/sense of satisfaction.

Anyways during a break in between surgeries, the consultant and I had a chat and he noticed that I seemed quite keen about surgery. It was cool having a casual chat with the surgeon and I told him I'm interested in orthopaedics. We had a really good talk about the specialty and then he told me to go to the Trauma list in the afternoon. Saw a fracture reduction + internal fixation and it was easily the bloodiest surgery I have ever seen, yet oddly enough, the one I enjoyed the most...ever. Even a few times I questioned myself as I caught myself smiling during surgery. I was really interested and I found the surgery pretty cool. There was a surgical trainee who was observing and he talked me through the surgery. The surgery was fairly complicated, but I was genuinely absorbing everything the trainee was saying. I was following along without difficulty and I just had this good feeling inside me. I think the hardest part about the surgery was wearing the lead aprons for 2.5 hours as there was a mobile xray machine in the room. Xrays were periodically taken to make sure the plate was in the right position and if the screws were placed properly. My back was killing me by the end of surgery (as I've been in surgery all day and almost all the procedures I had to wear a lead apron). But the aching legs and back was totally worth it. I could easily say it has been the best time I've had in surgery. The morning procedures were fairly simple, yet I still really enjoyed my time. It's quite weird.

"Be back by 4pm" said the registrar when I stopped by the ward to grab my bag for lunch. It was now 5:30pm and I was still in surgery watching the surgeon close up. He made stitching seem so effortless and simple, but I guess if you've been doing it for 20 something years, it'll become second nature.  I was in no hurry to leave theatre. To be honest, I didn't want to leave. My bleep went off twice and I knew I should get going. The consultant and I had a chat after surgery and he said throughout the surgery he noticed me looking very interested/keen. I don't think I have ever really heard any doctor tell me I look keen. To be honest, most of the time I probably look like I'm not even there. The consultant also said he was fairly impressed that I didn't get sick as he agreed it was a very bloody/gruesome surgery.  He asked when will I join him again in theatre or pop by his clinic as he said he wouldn't mind me around, especially if I'm interested in the specialty. Again I got this weird feeling of actually being wanted. Usually consultants don't want to deal with students, but this consultant seemed interested/keen to teach me.

Dragged my feet back to the ward and everyone was commenting how I look alive for once and happy. To be fair, I was very happy. I was definitely motivated. I can't wait to go back to theatre next week/hopefully I'll be able to escape to theatre. What a great day. Will never forget the last surgery of the day.

First Day as a Student Doctor.

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

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

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

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

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

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

Unnecessary Stress?

Lately I have been getting a bit stressed. And I do not know if I am giving myself unnecessary stress. I've been having a lot on my mind. As some of you know, I am a Canadian and an international student studying in the UK. Just for good back-up should I take the Canadian registry exam so if things go bad or for some reason I have to return home to work I can. I have done some research and some people say take the exam after 2nd year because all the sciences stuff will be fresh in your mind. Some say do it after 3rd year so you have a bit more knowledge about the clinical side of medicine. Then there are some who say after 5th year (aka after graduating from medical school) because I would be more mature to take the exam. There are pros and cons for each year but you know if I am considering taking the exam after 2nd year or 3rd year I should really get thinking. I really do not know what to do. I'm stuck. In a way I am a bit hesitant about taking the exam after 5th year as I am worried I'll forget all the sciences stuff. But on the other hand, 2nd year could be too soon as I need time to study and it is now November...well in a few days it will be November and I also have to study for my final exam in the summer. Might be giving myself too much work! So in a way 3rd year seems like a good time but is it really too early to be taking the exam?

Second, I have a strong passion for surgery. Ever since I had the opportunity to learn/discover about surgery I have been non-stop thinking "I want to be a surgeon". Also for my 2 week hospital placements to shadow surgeons/doctors, I was fortunate enough to be paired with a general surgeon and a paediatric surgeon. Compared to others I found surgery really interesting. Can't believe some people say it is boring and actually would do anything to avoid going to watch surgery. I have been criticized by people that I am thinking too early, but to be honest, it is never too early. I want to prepare myself and really try to find as early as possible what I want to specialize in and whether or not surgery is genuinely right for me. About three years ago I was first exposed to Orthopaedic surgery. I was hooked. I thought it was interesting and I really enjoy sports medicine. When I reached medical school, I have seen a lot of surgeons/doctors teasing orthopaedic surgeons which essentially put me right off. "The carpenter of the hospital." "Oh you hear the hammering and drilling sounds? Ah must be the orthopaedic surgeons working." It seems to be that orthopaedic surgeons don't get enough respect. I personally feel that they should get a lot more respect than they really do as they do help a lot of people's lives feel better. Yeah they might not always be saving a life like a neurosurgeon or a trauma surgeon, but they have their part in changing someone's life for the better. Anyways so after being put off from orthopaedics, I found that I had a huge interest in learning about the heart. So I thought about cardiothoracic surgery. Sounds great. Love the anatomy of the heart, get to save lots of lives, prevent people from dying, and great pathology. Oh wait....it is at risk of getting phased out by them interventional radiologists. Plus the other day I went to attend a talk by an Orthopaedic - Spinal surgeon who discussed about thinking about the future. Need to think if the specialty you want to go in will still be here in 10 years time. He listed cardiothoracic and vascular surgery will be at risk. Great. Hmm. I obviously want to do something that has a lot of potential and has plenty of time to develop and not be at risk of disappearing. I did pay a lot of money and study really hard to get into a UK university and I definitely don't want to spend a lot of hard work at training into a specialty which could diminish in a few years time. I like to be on my feet, and excited about the future. The new technologies for surgeons and a field that is developing.

So the other day after attending the spinal surgeon's careers talk, I gave orthopaedics another look. Like it is a field that is developing and we have an aging population. There will be higher demands for hip replacements, knee surgeries, etc. So yeah I'm now jumping back and forth. Deep inside me I feel like I will end up in orthopaedic surgery as I always tend to go back to my first choices. Orthopaedics clicked with me early on and yes pathology isn't huge...but I could do a sub specialty into something that may involve interesting pathology.

Some others I have thought about are surgical oncology and ...well that's as far I have gotten to for now. My mentor is a surgical oncologist and specializes in breast cancer and after having a brutal four hour lecture from him, it actually seems quite interesting. Cancer will be out there for a long time and I don't see it disappearing anytime soon. It is constantly developing. Huge research goes into it. LOTS of people are affected by it. Very interesting pathology. Quite enjoyed it last year when we had lectures on it.

So you're probably thinking:

1. Are you done ranting?
2. Ok so what's the big deal? It isn't like you're graduating next year.
3. ZzzZzzZzz

On top of what I mentioned earlier, to become a surgeon you need a CV that stands out from the rest. What did I do last summer? Relax aka did absolutely nothing. My classmates? Oh well they volunteered and worked at their GP surgeries, went to the hospital to shadow surgeons and doctors. Great....my CV is already looking real unique now...more like in a bad way. So now I'm on full blown motivated mode. To be honest I need to speak to someone about my future. At the moment we are in the midst of changing our mentoring program and we still do not have our new mentors. I don't know how much longer will I have to wait to get my new mentor and I don't know how much longer I can wait with so much in my head. I don't know who else to ask other than my mentor from last year as he seems quite knowledgeable. Maybe I should have a chat with him, but he is soooo busy I feel bad wasting his time when I am no longer his "mentee". Hopefully he'll have the answers. If not, time to search for someone to ask.

Sorry for the long post. Hope everyone is having a great time at uni still and enjoying medicine!