That Time of the Year...Again.

So Freshers Week is literally right around the corner. You're sitting in front of your computer/packing/feeling excited and nervous/etc. A million questions race through your mind: What's medical school going to be like? Am I going to make any friends? What is Freshers like? Will I be able to cope? Will I get homesick?

I am probably considered an "oldie" at university now since I am now in 4th year. Most people who started university with me in the UK have all graduated now...most are working as well...and I'm still in school. I've been through 3 fresher weeks now - I think I can safely say that I'm fairly confident about what goes on in Freshers and what students are usually concerned about. Let's crack a few FAQs. 

What is medical school going to be like?

Medical school is going to be challenging, physically and mentally tough, tiring, and most importantly - FUN. At the end of the day - we are medics. We work hard and party hard, BUT it is essential to maintain a good balance between the two. Don't want to work too hard to the point you burn out within first year, but at the same time not party so hard you end up flunking the year. In the first few weeks of school, it will mainly be a lot of introductory lectures. Unfortunately, your first few weeks will probably be a bit of a shock. First 2 weeks - you'll still be either hungover or on cloud 9 as you are still coming to terms that you are in medical school. Then week 3 comes around and so on...you're in lectures from 9am-5pm. You want to be seeing patients and learning clinical things, etc. Here's the truth - everyone has to take baby steps first so you'll probably spend quite a bit of time learning the basics. The science of medicine more than anything. 

How do I make friends?

I cannot stress the importance of getting out there. Don't just stay in your accommodation. Go out and socialize! I do understand drinking/alcohol culture is not everyone's "cup of tea", but not all socials need to be at a pub/bar/club. In your first week (Freshers Week) there will be a lot of fairs. There will be a medical freshers fair, union freshers fair, sports fair, etc. Go to the fairs and join some societies! Remember all the freshers that attend these fairs will also be looking for friends. Thinking back, in the first few weeks of university was quite overwhelming. Every one seems a bit too friendly. You get so many numbers and emails from people you only say "Hi" to. Great place to start is at your first medical lecture. Go meet your classmates! You'll be stuck with them for the next 5-6ish years...so it's not a bad idea to start getting to know them. If you are a shy person, just think about it - everyone is looking to make friends. To be entirely honest - I used to be quite shy and the week before starting medical school - I was pretty nervous. I didn't know if I will be able to make friends. I'm not exactly the best person to initiate conversations. I can actually be quite quiet and can happily stand in the corner and watch the world pass by. Seeing how I'm in a new country, new school, etc - I knew I have to step out of my bubble and really try hard to make the first move and meet as many people as I can. Not sure what to say? Here's a start: "Hi! My name is _______. So where are you from? Liking *the university/city* so far? How are you finding it?" 

Do I have to party every single day to make friends?

No. I did not go party every night. I think I went out twice (?) during Freshers week. BUT a great way to get to know your flatmates is probably to hang out with them, but know your limits. Sometimes you feel really pressured to go out, but if you aren't comfortable going out - then don't go! Just tell your friends you're going to take it easy for the night and need to finish unpacking. It isn't a crime to take it easy and most people should understand. However, I do HIGHLY recommend going to the Medic Freshers Party. I've been to the union party and the medics party 3 years in a row during Freshers week. The Medics' Party is a lot better. Plus it gives you another chance to meet more of your classmates and probably upper years such as people like me who don't want to give up on Fresher parties! I still fondly remember my first year medics freshers party. The people who I met at the party are still my great friends 3 years later. All I can say about these parties is just to enjoy yourself. Let loose. You're a fresher only once - just go for it! You're away from home. You're officially a medical student! I think these are good enough reasons to celebrate!

I got the welcome pack and everything seems really confusing and overwhelming! What to do?!

Just relax. I have always found the welcome packs overwhelming and exciting. Things start to feel real when you read through the welcome pack. I still remember reading mine and going: "wow...I am going to university. I'm going to be a medical student in a few days. There is a lot of stuff to know...crap." Essentially what schools tend to do is try to cram as much info in a welcome pack as they possibly can. It isn't a bad idea to give it a read before you start university, but you don't have to know everything in it. Introductory lectures/induction will probably cover most of it. How I've always seen things is to just "go with the flow". Just remember if you are feeling scared/nervous - there will probably be quite a lot of other people feeling the same thing. You're not the only one on the boat. 

All in all - in a way Freshers week is overhyped. Keep your expectations low, and you won't be disappointed. How much you will enjoy Freshers Week is solely down to you. You control your life so you go out as much as you need to. But like I've said earlier: you're only a Fresher once so enjoy your time. Celebrate your week. You deserve it. You got into medical school - which was certainly not an easy task. Just think how far you have come to get here. It's also a fantastic time to get to know lots of people. Go join societies and get to know people from other courses. You are at university for 5-6 years so it is important to make the first good step. Relax and just go with the flow! Be excited. It will be a very fun 5+ years of university. It will go by quickly so enjoy it. 

Good luck and enjoy your Freshers week. Also congratulations for getting into medical school.  

Psychiatry - Slow Start.

I don't know why, but I'm quite prone to having slow starts on placements. So I've had my first week in psychiatry and to be honest...I've stepped onto the "wards" for about 5 minutes and then left. I don't know if I should be happy about the placement or a bit annoyed. We've got a lot of free time on the placement and seeing how exams are coming up - it gives us a great opportunity to revise. But at the same time...when I did go on the ward and ask if there's anyone I can see or anything I can do - the staff said that there's nothing to do here and told me to go get a cup of coffee. For the rest of the week - I spent my time in half-day clinics with my consultant. Luckily he is very chill and really good at teaching (if asked to teach). The nice bit is that there is a mutual understanding between the two of us. He has established that I do not want to do psychiatry and fairly indifferent about it. He said he will leave me alone BUT will teach if I have any questions or want any teaching. On top of that, he clearly listed out my learning objectives and what he does expect for me to have completed by the end of the attachment - which was pretty easy/fair. I know what my consultant expects and I don't see it being a struggle. He's also extremely nice which is a nice bonus.

I haven't really met any patients with full blown mental illness. All the patients I have seen were follow up patients who have their symptoms under control and doing fairly okay. Somehow due to my luck, I managed to miss the two new patients I was supposed to see in the week so I can see how patients present to the psychiatric team. For the first new patient, I only managed to stay for half the consultation as I had a doctor's appointment. Then in the next clinic, I ended up being 30 minutes late and missed the new patient as I got lost. Was really annoyed with it as apparently that patient was very interesting.

To be honest though, I don't mind this placement! I'm actually enjoying it as it is fairly easy and not very stressful. My schedule is very flexible and essentially to get good at psychiatry is to just speak to a lot of people (which I haven't exactly done as I'm having an extremely slow week). Despite having a slow week, I am learning a lot as everything is new so that's a bonus. So far all the consultants I've met are also very nice and chill, but they claim they should be chilled out as they know stress is a factor for suicide...

Hopefully next week will go a bit better and hopefully I'll be a bit more productive!

Penultimate Year.

"Hi, my name is - and I am a 4th year student doctor."

How time flies. I still remember when I first step foot onto the wards in first year and introduced myself as a first year medical student - it was almost like yesterday! Now, I unwillingly have to introduce myself as a 4th year. I quite liked introducing myself as a 3rd year to patients and to doctors/nurses. I feel like we get a bit more sympathy and leeway. As a 3rd year, we can always pull the: "Sorry it's my first year of clinical.", when we make a mistake. As a 4th year - expectations are higher and mistakes will be looked down on. I feel like 4th year is the "real deal". People expect you to know your place in the hospital and know what you are doing. Questions won't be as well appreciated and you will be much more independent. It's actually quite frightening! As a 4th year - people who know that your course is 5 years will know that as a 4th year, you'll be in your penultimate year and pull the: "You'll be graduating in a year or so - come on, you should know better!"

So I'm starting psychiatry and will on the specialty for 6 weeks. We just had a week of lectures on psychiatry and it seems pretty interesting. It's also nice to learn something completely new as well. The past lectures we've had were more of a refresher and a bit more clinical, but wasn't completely new. We have never learned about psych so it was good.

Had my induction at the psychiatric hospital and it seems promising. It seems really organized and we've got a binder full of info. We've also got schedules for our next 6 weeks. Something so simple is well appreciated as that means I can plan my life. It's a shame other placements can't give our schedules that far in advance. Got a fairly easy week - mainly at clinics. Bit nervous as psych is so unfamiliar and new. Also scared about being quizzed. Yikes. Got to do some reading asap!

What to do during summer holiday...

I tend to see a lot of prospective medical students and current medical students wondering what they should be doing during holidays. For most people they see it as a bit of a dilemma...I personally don't...but some people feel the need to be doing something during the summer.

The most common question I see from prospective medical students is what should you read during summer holiday to prepare for medical school. To be completely honest: you don't need to do any pre-reading unless the medical school specifically told you so (which is unlikely).  If you are a gap year student and haven't studied in a long time - then just quickly look over your biology notes. I don't think looking over your notes will really get you ready for medical school. I don't think it is that big of a jump from school to medical school. I guess it varies from university to university, but for me - there was a gradual introduction to medicine. What did I do the summer before I started medical school? I traveled with parents as I know once I get to university, I won't see them as much - so I spent quality time with them. I did a lot of sleeping. Played social basketball and hockey. Chilled with friends before we all split up across the world for university.  Essentially I did a lot of relaxing..I don't think I did anything related to medicine or prepared for medical school. The most preparing I did was probably reading the intro/welcome guide that the university sent.

Another common question from prospective medical students: What books will I need to buy for medical school? I personally won't buy any books until a few months into medical school. Most medical schools will give you a recommended reading list. Go to the library and take a look at all the textbooks and see which one suits you. Textbooks are expensive so choose wisely. I made the mistake of buying books too early and ended up only using a few of them. Some of my textbooks are still sitting on my shelf looking brand new untouched. If I had to recommend ONE textbook - it would probably be Vander's Human Physiology. It is probably the only textbook I have that is quite beat up and well-used. I found it to be the perfect textbook for the first two years. Again, go to the library and check it out before buying! Kumar and Clarke Clinical Medicine is also another great textbook, but I never really used mine. Medical students from other universities say that it's really useful. I've only used it for certain topics that weren't covered well in lectures. The few chapters that I looked at - I really liked the layout and how things were explained. The only problem I had was that I found that there was a lot of assumed knowledge and some descriptions of certain conditions were too brief.  My friends say that it is either a hit or miss. Some students swear by it. Others like me, don't really care for it. Another textbook you should check out in the library before buying.

So you're a medical student and you're sitting around at home feeling that you should be doing something productive and medically related. If you're in 1st or 2nd year and you've still got a long summer holiday - go enjoy your holiday. As the years progress - your summer holiday will get shorter and shorter. This year, my summer holiday is only 3 weeks. Stupidly short. In first year my summer holiday was 3.5 months! Most of the doctors that I have talked to all told me to not work during my summer holiday as I'm currently doing an audit project. I was quite stressed about it before holiday started trying to get it done so I don't have to worry about it, and I'm glad I did get it done before holiday. Now, I can relax and just sleep as much as I want. Actually might be taking the whole sleeping in to a whole other level. Thinking about it, it's nice to sleep in. Before holiday, I was getting about 4-5 hours of sleep per night. Now I'm well rested as I'm getting about 10-12 hours of sleep...doing some major catch-up. Knowing that my holiday is only 3 weeks, I'm glad I didn't bring any work with me as I'm spending as much time as I can relaxing and doing the things I love to do. Hanging out with friends. Eating good food. Sitting around. Just doing absolutely nothing. Need to get the brain rested as exam season is coming up. So my biggest tip to current medics: RELAX when you can! Enjoy your holidays while they last! Take a break as you'll just end up burning out. Medicine is mentally and physically demanding - give yourself the needed break!

Okay so you're not convinced and you HAVE to do something during summer holiday. Try to avoid doing something medically related. Go volunteer for summer camps. Go volunteer for an activity that you enjoy doing. Do the things that you love to do. For medics: I really advise against shadowing a consultant during your holiday at your local hospital. You'll get to spend all the time you want in the hospital in the near future. For some, your next 30+ years will be working in the hospital. You can follow/observe as many consultants you want when you get back to medical school.

Anyways that kind of gives you an idea what I'm usually up to during holidays and what I think is the best way to enjoy your holiday.

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.

Any Requests?

So it is summer holiday and that means I'll have a bit of free time and I'm bound to get bored at some point. If you have any requests for a post you'd like to see - please leave a comment! I'll try my best to write something up for you as soon as I can.

End of GP Placement.

Oh how much I looked forward to typing the title to this post. It could have easily been the least brain stimulating placement I have yet to have. Not only that, I couldn't go make myself useful elsewhere unlike being in the hospital. Looking back on the last 6 weeks, it was definitely a struggle and a challenge. It was mentally draining as it was just so much harder to get the motivation to work. After throwing my arms in the air when stepping out the door of the practice...I realized I have another GP placement next year. Joy. BUT, I know it'll be more useful as I'll have my own surgery and get to see my own patients. This placement literally has redefined work experience. It was 20 days, 10 hours/day of work experience.

Also in other news - crisis averted with all the deadlines as you would remember from my "Walls Closing In" post.

1 report - completed and submitted.
1 audit report - completed awaiting for submission.
1 audit poster - 90% complete.
1 audit abstract - completed and awaiting for submission.

Cannot feel any more satisfied and proud of myself managing to get everything done in time. I think it has been a long time since I was really sure I was not going to make the deadlines.  Miracles do happen. Actually it's more like: Efficient...and very late and long nights...

Oddly enough, in my final week of GP placement, I saw the most interesting case. It was a case of a man with an end-stage disease and the GP needed to start the palliative care pathway with him. This man is quite young (40 years old). Initially when I heard about his medical history, I did not know how old is he. In my mind I imagined him to be an elderly man. Surprisingly when I went to go meet the patient, he looked frail and skinny, but young. What really struck me was that he also has two very young children (ages 8 and 3). Unfortunately, the patient has not really told his children what is wrong with him. They are aware that their father is ill, but do not know the extent of his illness. With his condition, no one really knows how many more years he will live. His condition has been progressively getting worse and the GP told the patient and his wife that there would be one day where he does a nose dive and his health severely deteriorates. We discussed the various options for support and care. In my mind I knew the GP was trying to find the right moment to bring up the "Do Not Attempt to Resuscitate" (DNAR). Eventually we had to talk about it and only until you come onto the topic you then come to realize that the patient is still in denial. To be fair, he has a young family and he himself is quite young. Worst bit is that there is no cause for his condition - as what doctors like to call it: "Idiopathic". He was adamant that he wants to be resuscitated when it comes to the end of the line despite the GP fully informing him about the benefits and harm of resuscitation. As we were talking about his palliative care plan, his children were happily running outside - no clue what is going on in the room. It was definitely a very "grim" consultation. Before leaving, the GP advised the patient to find some support for his end-stage disease and to have someone help him to explain his condition to his children as they will have to know at some point. The GP was right that it is better for him to talk to his children while he is still well and still able to versus down the road he might not be well enough to explain - leaving his children a bit puzzled.

In all fairness - my experience in GP has not been the best, but the GPs who I have worked with are all really nice people and some are great at teaching. Guess it just wasn't my "cup of tea". Had a good feedback session with my supervisor though and I suggested giving students a bit more responsibilities and letting us see our own patients. Hopefully they'll take my feedback on board as I really think it'll improve the student's experience. All in all though, 7 weeks...that was painful.

Psychiatry up next...don't really know what to expect...actually I have no clue what to expect. At least it is hospital based (in a more familiar environment). I'm sure it'll be interesting seeing these sort of patients. Hopefully it'll be better than my GP placement and get back to the happy-go-lucky medical student.