Saturday, 21 December 2013

Year 2 results

We finished our year 2 exams early last week and we got our results yesterday - and I am extremely relieved to be able to say that I've managed to pass into the next phase of the course! After the pass list was published, we were sent our individual scores, and this was how mine looked:

Papers 1 and 2: 17/20 SAQ sets passed - pass mark: 13
OSCEs: 7/10 stations passed - pass mark: 7

We didn't get these scores until much later in the afternoon, so initially all I knew was that I had passed, but not by how much. For the first 20 minutes after checking the pass list at the med school, I couldn't even smile, all I could do was literally shake with relief. I think this was because on Wednesday I had to go to a meeting at the med school which you have to go to if you have mitigating circumstances (I've had some health and accommodation issues over the past few months) and if your score is judged to be a fail or borderline. As it happens, my OSCE score is borderline, so that's why I had to go to the meeting - but at the meeting they couldn't give away any details about what I might have failed, so I spent the next three days stressing about having to resit everything and I even started revising again, which was really stressful and not what I wanted to be doing at all.

I'm just so happy I can put that all behind me now...because this term has been really stressful in so many ways, but the most stressful thing has definitely been these exams and the prospect of doing resits. Now that that's over, I think I can concentrate on sorting out the other stuff in my life with much less difficulty, which makes me very happy indeed. This will also be the first Christmas holiday since 2008 which I won't be in work or studying - and I fully intend to take advantage of that and unwind a bit!

This result also means that I will be a clinical med student as of January, something that I am really looking forward to! We don't hit the wards right away; firstly we have an induction programme, then a community medicine project thing to complete, but as of late February I should be starting my first rotations, something which really, really excites me since this is the part of medical school which I have been most looking forward to since day 1!

Good luck to everyone else who's had exams and results and I hope you all have a nice holiday!

Thursday, 12 December 2013

Year 2 exams

It's pretty weird to have your end of year exams only 3 months after starting the new academic year, but that's just the way it worked out since this is an accelerated medical degree. A week before the written papers, we had our practical exams (OSCEs). Here's the breakdown:

OSCEs

Abdominal examination

This station was generally okay. I forgot to ballot the patient's kidneys but aside from that it was fine, and I managed to answer the examiner's questions okay.

History taking - respiratory

Again, another okay station, and with 10 minutes I managed to get through everything just fine. And thankfully, this time (unlike the summer) I remembered to ask the patient if they smoke!

History taking - male urinary

This history taking station was also 10 minutes long and involved asking the patient questions to do with the urinary system and then also taking a sexual history. Taking a sexual history is not something I've ever done before, not in an OSCE and never with a real patient on placement, but generally I think this station was fine too. The patient (really an actor) got a bit offended when I asked him if he'd ever had a male sexual partner, but I think that was just him being in character rather than me asking an inappropriate question!

Clinical anatomy - surface anatomy of the cardiovascular system

Right, this is something which really pisses me off about this medical school - how they enjoy testing theoretical knowledge in (supposedly) practical exams, and practical knowledge in written exams (see Paper 2 below). So this station was a bit of a shambles, but mostly because the question that the examiner asked me (to do with auscultating heart murmurs) was phrased really ambiguously. When I asked the examiner for a bit of clarification, they merely read the question to me again. So essentially, I interpreted the question incorrectly in my mind and gave an incorrect answer despite actually knowing the correct answer (which the examiner informed me of afterwards). This was really irritating, and I'm not particularly confident about passing this station in all honesty.

Clinical anatomy - the spinal column

Again, another theoretical station - this one involved looking at various models of vertebrae, the spinal column etc and picking out different features, and then looking at a couple of X-rays and again pointing out anatomical features. This station was generally fine, no complaints here.

Clinical anatomy - the hip and lower limb

The final theoretical station which didn't actually turn out to be all that theoretical! The station started off like the spinal column one before it, with the examiner asking me to point out different features on a model of the pelvis and the lower limb. And then...out of nowhere, he asked to perform a Trendelenburg test on a patient who was sat behind me. Well...I hadn't revised any clinical tests for this station, so needless to say, whilst I'm fairly certain I got all the theoretical anatomy questions right, I really screwed up the clinical examination. Not feeling very confident about this station either.

Cranial nerves II, III, IV and VI examination

So these are the cranial nerves which control the movements of the eye and the pupillary reflexes. This station generally went well (I quite enjoy the examining the cranial nerves because there's a lot to do and you get to use lots of different tools and equipment), but I don't think I answered the two follow-up questions very well.

History taking - knee pain

Right, this station should have been quite straightforward...but unfortunately it was a five minute station, which made things very difficult and I ran out of time when taking the patient's family history, which meant I didn't get to explore their social history or do a systems review. In clinical practice, I'm almost certain you're never only given 5 rushed minutes to take a history from someone, so I have no idea why we're examined as if we are, but it seems to be yet another quirk of the examination system. I suppose it depends on how much importance the examiners place on actually finishing the station...I ran out of time on the MMSE station last year and still managed to pass it, so maybe I'll get lucky this year too!

Thyroid gland examination

Hmm...it seems that with every OSCE I need to have one station where I just completely blank and screw everything up. In my very first OSCE it was using Medline, last summer it was conducting a breast examination, and this time it was the examination of the thyroid gland which let me down. I forgot to percuss for a retrosternal goitre and to auscultate for bruit and to top it all off, I didn't manage to answer one of examiner's questions correctly either. It was just a general fail all around.

Respiratory examination

Generally fine, nothing to comment on here. Forgot to check the JVP, but that's about it, other than that I felt this station went well.

Paper 1

The written examinations took place a week after the OSCEs over two consecutive days. Usual rules: 20 SAQs in total, usually need to pass 12 or 13 SAQs to pass the exam over all (each SAQ is marked out of 20, and the individual pass mark for each question is normally 10-13. Confusing? Try actually sitting the papers).

With previous exams (in January and May), I've found the first paper to be more difficult than the first. Somthing seemed different this time round - this paper didn't seem terrible. Yes, there many little details which I either couldn't recall or just didn't have a clue about, but on the whole, each SAQ was fairly reasonable. There weren't masses of intricate anatomy and physiology questions, and it was generally okay. I just felt a bit relieved really that there didn't seem to be any expectation to give a detailed account of the spinothalamic tract or the basal ganglia (yes neuro, I still hate you).

Paper 2

Before sitting this paper, I'd been naive enough to hope that the "second paper being easier than the first" rule would continue into year 2, and that therefore, since the first paper had been pretty okay, the second one would be even better. No such luck. This paper was really, really tricky. Lots and lots of random questions on social sciences, and what's more, they weren't even well distributed amongst the SAQs. For example, one SAQ (total: 20 marks) had 8 marks to do with a single lecture on carers and the problems which they might face. It wasn't even an easy question either!

The people who are in charge of giving us exam talks during each semester like to reassure us that our SAQs will be "integrated", i.e. the questions will be drawn from lots of different modules and consequently, we'll gain marks by having a broad range of knowledge about lots of different things. But when 8/20 marks in a single SAQ comes from one lecture, I find it hard to actually believe them. Instead I'm just left wondering if they've actually talked to the people who set the questions, because no reasonable person would consider the above to be an example of an "integrated" question.

Anyway, this general trend continued throughout the paper. There was lots of questions on social sciences which leaves me in two minds: if the examiners are looking for me to provide a reasonable answer which is justified well, then I think I've managed to (mostly) do that. If they're looking for me to provide some very concise and specific answers, then I don't think I've managed to do that...so I really really just hope they're looking for an answer that makes sense, rather than a direct quote from the lecture slides...

That was the social sciencey bit. The actual medical science side of things did not go much better. There was a question which involved drawing arrows on a diagram of the head and neck to demonstrate how you'd examine the lymph nodes in that area. Huh? Isn't that why we do OSCEs? No wait, I remember now, apparently OSCEs are where we demonstrate our knowledge of the anatomical features of a vertebra!

On the whole, I'd say that the papers are a bit crap in terms of the knowledge they're trying to test us on. Not a single question on commonly encountered conditions like asthma, pneumonia, Parkinson's disease or angina. But a fairly detailed question on thyroid cancer (total deaths worldwide: 36,000 in 2010). It's almost like they're just looking to catch us out...I was not a particularly happy bunny after sitting this paper.

In conclusion

Anyway, once the horror of paper 2 was over I headed straight to the pub and proceeded to have quite a few drinks on an empty stomach just after midday, something which left me feeling reasonably tipsy when I got back home a few hours later. I then went to the pub again later in the evening and got even more drunk. And I'm going out again tomorrow. It's pretty safe to say that I'm trying my best to forget about exams and results by attempting to improve my (rather poor) social life.

We get our results in just over a week. I really can't say with any degree of certainty how I think I've done, though in all honesty, I won't be very surprised if I haven't passed. I can think of a few things I think I've done okay on, and then I'm reminded of millions of other things I totally screwed up on, guessed or just plain made up. What's worse is that under our weird examination system, you don't pass or fail based on an overall percentage, but rather, how many SAQ sets you've managed to pass. And it's really, really difficult to gauge that with any degree of certainty.

But really, more than anything I just want to pass. I really, really love being on placements, taking histories and performing examinations on the wards, learning from consultants etc...it's all so close, it's actually within grasping range. I just really hope I've managed to pass these exams so I can have a break over Christmas and go back to uni in January feeling a bit more relaxed and ready to start the phase of the course which I've been most looking forward to since day 1...but I guess we'll see.


Friday, 22 November 2013

End of pre-clinical medicine/Revision begins

There are two quite significant things which have been playing on my mind today:

The end of pre-clinical medicine

So today was our final day of pre-clinical teaching. As of today we have been taught all of the necessary basic sciences (anatomy, physiology, pathology, etc) which we will need during the clinical phase of the course and as foundation doctors. In a small way I'm feeling a minor sense of achievement - since last September we have covered A LOT of work and so far I've managed to keep up with most of it. In that way I'm quite happy with myself - before starting medical school I remember feeling very overwhelmed by my masters degree and being worried that I'd immediately fall behind with all the lectures and so on at med school (of which there are much more compared to any other undergraduate degree). But for the most part is has been largely okay (so far).

It's also pretty cool to think that now I've got a good basic understanding of every aspect of the human body - I know I spend a lot of time moaning and being stressed out by this degree, but deep down I really am interested in how the body works, what goes wrong with it and how to fix it. Reading about body facts, etc, was something I used to do quite a lot when I was little, so in a sense today is the satisfaction of a sense of curiosity which I developed early on in childhood, and that feels very good indeed. But I know it'll feel even better if I can pass these exams and actually get to put this stuff in practice during the clinical phase of the course!

I'm also very happy that I (hopefully, assuming I pass) will never have to go to any more crappy small group work sessions again. Seriously, I really like everyone in my group, but it's been such a waste of time really - I could have worked much better through things at my own pace!

Most of what we have learnt has been very interesting, including the non-sciencey stuff too (e.g. sociology, etc). The only problem is that due to the intensity of the course and lack of time for revision, stress has overshadowed the genuinely interesting aspects of the course. I try not to let that happen too often, but unfortunately over the past 15 months it has happened quite a bit. Honestly, it has been very, very stressful at times, though from what I gather, the way I feel is pretty normal amongst med students. But, all things considered, I know that doing medicine has definitely been the right decision for me, and I feel I've gained a lot of knowledge and fulfillment from doing this course - and that definitely makes me feel content with myself.

Exam stress

My attitude towards exams (with just over two weeks to go) has been alarmingly bipolar lately in that sometimes I feel completely on top of things, and like I have plenty of time left to do revision. I also try to make myself feel better by telling myself that since I did well last summer hopefully that means I can do okay this time round too. I usually feel like this when I've managed to make a good deal of progress in a single evening or managed to get my head around something which has been really stumping me (usually neuro).

Other times, I feel totally overwhelmed by it all and a sense of fatalistic resignation. It's all feels like it's too much because I only have just over two weeks to try and make the first two years of a normal medical degree stick in my head, and what's worse is that next month's exam will mostly concentrate on the modules which have been taught this term i.e. the ones which I don't feel particularly confident about anyway.

The really annoying thing is that I often alternate between the two opposites of "yeah I can do it!" and "I'm totally fucked" several times in one day. It is beyond exhausting and stressful. For example, today, I wrote up a number of neuro lectures including a rather tricky one on cranial nerves in the afternoon. I felt I'd made some real progress so I spent the afternoon and evening feeling genuinely okay about the exams next month. Then tonight...all of that confidence just ebbed away slowly as I realised just how much I still have left to do. About an hour ago I made a revision timetable for the next two weeks, and I've been feeling mildly panicked ever since - it just feels like there's way too much to do and not enough time!

There are times on this course when I've literally felt like a little child who's afraid of the dark or a spider or something. I can't describe why I'm afraid of it or what I want to do about it, I just want to hold onto something or someone - anything or anyone - for some comfort, and for it to just go away. Basically, I need to be told that it's going to be okay and that I can do it, and more importantly I really need to believe it myself. I'm not fishing for compliments here, but this is really one of the few places where I feel comfortable enough to vent and express these kind of deep feelings freely, so I guess I just need to get these worries off my chest because there's really nowhere else I can be this frank about just how scary it can be.

But ultimately I'm not a child and there's no security blanket out there for me, I need to try and get through my own issues - but it's going to be a horrible fortnight. That much I know.

Today has been beyond confusing - on the one hand I've felt a real sense of adult accomplishment at finishing something as demanding as the first phase of a medical degree...and on the other hand I've literally felt like a scared little kid. I just really, really, really hope that I can pull this off next month, god only knows I need to unwind a little over Christmas!

Thursday, 14 November 2013

Coming up for air

So it's been a while since I last updated this thing. It's pretty obvious from reading my last entry that about a month ago I was feeling really down and I was heading for a crash of one form or another. As it happens, that crash came a few days later in the form of a (normally dormant) health condition which reared its ugly head again and meant that I ended up going back home for a period to recover.

I'm fine now, and in a way the time off was useful because it helped me destress a bit and I returned to uni feeling more hopeful about things. I should also add that the condition is NOT stress related, so the fact that it happened at a really stressful time is just coincidence (or perhaps serendipity...).

Anyway I've been back at med school for about three weeks now and I'm feeling a bit more optimistic about my chances and prospects regarding next month's final pre-clinical exam. One of the biggest things which was stressing me out about a month ago was my renal module and how behind I felt with it and how tricky renal physiology is to understand. Thankfully, I've now largely caught up with it and, even better, the bastard loop of Henle is now starting to make a bit more sense so it's not as awful as it first seemed.

That said, I do still feel like there is an awful lot of content to revise before next month's exam and we still have another week of classes to go before we go on study leave. I think I've arrived at a vague conclusion that I simply won't be able to revise everything in equal depth with only two weeks dedicated revision time, so I am trying to focus more on nailing key topics rather than getting bogged down in the finer details of things which are less likely to come up.

For example, I could spend an entire evening trying to memorise all of the million and one respiratory gas laws which we were taught - something that's unlikely to come up and even if it did, would only count for a few marks - or I could make sure I understand the physiology of ventilation and gas exchange inside out. Or COPD or asthma or anything else which is more likely to come up. It's a slightly risky strategy and not one which I feel comfortable with since last summer I actually managed to revise everything, but I can't see any other way really - there's simply too much to cover and not enough time. I'm also trying my best to keep up with year 1 content because I feel that since I've already passed it once, it could potentially be easy to gain marks in again...especially since I would consider last year's modules to be my strengths.

Generally I'm just happy to be in a better place than I was last month. Yeah, I'm still pretty tired a lot of the time and I don't like the cycle of "wake up-uni-home-revise-sleep-repeat", but at least I get to sleep more easily nowadays and having finished writing up all of my anatomy and physiology notes, I now feel more confident as the clinical stuff is much easier for me to revise (and way more interesting). So really, I'm just hoping that if I keep plugging away at it, I'll get a decent result come December.

Thank you for all the reassuring and helpful comments which were left on my last post...they definitely helped cheer me up whilst I was recovering at home!

Wednesday, 2 October 2013

One month on

It's been a long time since I felt this pissed off, overwhelmed and really tired all at the same time. I have to apologise in advance, this is not going to be a happy post, but it's something I need to get off my chest because for the past few hours I have been feeling a level of anger and frustration which I haven't felt in ages. Unlike the majority of my posts on this blog, I don't even need to think about what I'm typing here, it's just flowing from my fingers effortlessly, which I assume is a big sign that I really need to vent.

To put things into context, I've been back at medical school for exactly a month, and am now halfway through the fifth week of a 12 week term which will be followed by a very important exam which, if I pass it, will allow me to progress to the clinical phase of the course. I'm glad to be back and to see my friends, but my god, there are certain aspects of this course which sometimes feel like I'm being pushed beyond belief and am totally powerless to push back. I'll try to break it down into a number of categories:

The pointlessness of small group work

How a typical morning/afternoon is structured on my course is as follows: lecture, small group work, lecture OR lecture, lecture, small group work. Then there's a lunch break or the day ends. The purpose of the small group work is to consolidate the concepts which have been taught in the immediately preceding lectures and I suppose, in some way, to encourage team work between group members i.e. by answering questions and completing exercises together.

This is an admirable aim, but it fails to take into account that different people learn in different ways. I find group work to be TOTALLY useless because it immediately follows the lecture and gives me no time to properly absorb the content, to go and look things up in a textbook, or to arrange my own notes - before throwing a load of questions at me.

Now, normally, I don't particularly mind having my time wasted because of someone's misguided notion of what learning "should" be like (er, as if I don't study in my own time anyway). However, when I have the most important exam of my life coming up in 8 weeks, this really throws into sharp relief just exactly how much of my limited time is being squandered each week to this rubbish. I could be spending the time working through things at my own pace and in a way which I understand, or you know, catching up on sleep (I'm not saying this to be lazy, see below).

Unfortunately attendance is monitored and compulsory, meaning that I have to sit through this utter pointlessness for up to 2 hours or more each day.

Lack of sleep

Once again, I'm finding myself becoming increasingly sleep deprived as the term drags on. In part, this is because, yes, deep down I'm nervous about these upcoming exams and the revision which I will need to recommence in two weeks or so (including year 1 content!) and this keeps me up at night.

HOWEVER a greater part is because a large amount of my day is wasted on pointless lectures or, even worse, group work - which means that I have to work much later into the night than I otherwise would. I would estimate that on a good night, I actually get into bed at 2 AM. When I fall asleep is anybody's guess, but I'd assume 3ish? I have to get up at 7:30 incidentally, so most nights I consider myself lucky if I get 5 hours sleep. I have had to go into uni on 3 hours sleep (or less) on more than one occasion this term, once again because group work is monitored.

Ordinarily, I wouldn't give a toss about losing sleep for a mere couple of weeks - the human body can withstand far sterner stuff than this, however, what I have noticed is that my lack of sleep isn't exactly doing me any favours as a human being. On a bad day, imagine my usual grumpy self, multiplied by about, I don't know...20? Don't misunderstand - I don't act like a dickhead and take things out on my classmates, but on many occasions I think it's very obvious that I'm really not all there and I'm not really being as friendly or sociable as I should be. Usually when my eyes are sliding out of focus for the fifth time in 20 minutes or so.

Lack of effective stress relief

Clearly the above aren't unique complaints. All students feel tired (though admittedly I don't know anyone else who's keeping my sleep hours - one of my friends tells me I'm pretty alone in this regard), all students feel stressed out about exams, and all students eventually feel fucked off at their university's assumption that the university's way of doing things is the "best" way.

However, I think I've unfortunately also become deprived of effective means of stress relief. When I lived in London and was feeling the strain, I would take my iPod along on one of my favourite walking routes, enjoy the scenery and fresh air and spend a good 3 or 4 hours simply walking the stress out of my system. Or you know, I'd just get smashed a couple of times a week.

No such luck here: the town my med school is in is rather small and if you tried walking anywhere for more than an hour or so, you'd either end up in the middle of nowhere, or walking around in circles. What's more I don't even FEEL like I have 3 or 4 hours to sacrifice for this anyway. But yeah, okay, I feel homesick for London a lot. There's no point denying it: I am so happy to be training to be a doctor, but I also really miss what I've left behind too.

As for getting smashed a couple of times a week, well that's even more off limits - I don't have the time and my hangovers have become something awful since I entered this latest stage of my life i.e. my mid-20s. But my god, everytime I see or hear drunken freshers on campus or around town, I literally want to break down in front of them and plead with them most earnestly to PLEASE, PLEASE, PLEASE appreciate what you have right now i.e. the simply pleasure of being able to go out whenever you like, act like a fool, and not have to care about the consequences the next day. It will NOT last forever unfortunately - and that really, really makes me want to weep.

Being me

Of course...these problems are only problems because I am me. There are people on my course who deal with all of this crap and don't feel stressed out to the point of skipping sleep and getting grumpy. There are people who get much better grades than me, run long distant races for charity, have stable long term relationships and are just, well, let's face it, much more well rounded as people than me anyway, however much they do or do not sleep. I am not one of those people - I am me. All I know is that I want to be a doctor more than I've wanted to do anything in my life...and I am willing to make all the necessary sacrifices for this to happen...but sometimes I feel like I've abandoned so many other aspects of my personality in the pursuit of this one desire. And I do regret that somewhat.

No doubt, some people out there will be shaking their heads and will be saying "mate, you need to just give less of a toss" - yes, this is very true, but unfortunately I am not used to not giving a toss. After twentysomething years I'm not sure I'm really in a position to change this attitude either. I am - by my nature - intense, driven and determined. It's gotten me results, as my end of first year results showed. Unfortunately, it also leads to stress, personal neglect and mood swings. This is obviously something I need to work on as a person, and I hope very soon I can have the time to do that.

Do I feel better after this rant?

If you've gotten this far, then congrats and thank you. Yeah I feel a bit better but the fact that I'll probably be up until 2 AM tonight trying to figure out exactly what the bastard Loop of Henle does means that this isn't going to be an effective source of long term stress relief.

All I can do, I suppose, is plug away in the only way I know how to and hope that when I (hopefully, PLEASE) progress to clinical medicine, things will be less pressurised and I'll have more time to be return to being me. I can only hope it won't be too late by then and I won't have become irreversibly accustomed to feeling under pressure. Or maybe I'm just screwed for the forseeable future!


Saturday, 7 September 2013

First week back

It's Saturday afternoon and my head is still pounding. My fingers are shaking slightly and my mouth is dry - it's my first proper hangover in a long time and I'd forgotten just how badly I cope with them and how much of a relative lightweight I've become since a) getting older and b) starting med school. (a) is inevitable unfortunately but (b) is somewhat surprising considering that medical school is supposed to be about "working hard and playing hard"...but I'm not sure that phrase can be applied to the accelerated pre-clinical phase of a medical degree, at least, not for me.

In the run up to the summer exams I didn't really go out at all with the work, so my body has rather overestimated how much drink I can handle, so I'm paying for it now, and unfortunately I'm not yet qualified to administer the "Cadillac of all hangover cures" either. But since this was my first week back and exams are still three months away, it would have been stupid not to go out. It was a fitting end to a fun but intense first week back!

Over the summer I didn't really look at my books or notes at all. I told myself I would casually look through my notes for perhaps an hour a day but it never actually happened (we get examined on GEP Y1 content in December again so you can't just forget about it). But until I got my results back and my summer holiday properly began, I hadn't realised just how tired and drained I felt after the end of GEP Y1. I didn't feel it before then due to the adrenaline rush of having exams and so on, but as soon as all of these pressures were lifted I didn't really want to do anything apart from sleep, get up late, see friends, find new music, and not have to care about anything remotely academic. The mere thought of looking through my basic science revision notes again made me want to run or scream or something. That said, I did read through my clinical skills handbook during the final few weeks of August as I don't want to look totally incompetent when I start weekly ward placements in a few days. But I don't think that really counts as proper work, so consequently I felt pretty well rested by the end of August and ready to start GEP Y2.

First week back was good for several reasons. First and foremost, I was finally made aware of how it feels to be happy to be back at uni AND to happy to be continuing your course. On my previous degree, I was always very happy to move back to halls and see my friends and so on, but I was never really interested in the course or the new modules or anything like that. Thankfully here I'm happy with everything and I am looking forward to the new modules we're doing this term - and that feeling of contentment is very nice indeed. It's what I've been aiming for a long time now.

The new modules we're doing this term seem demanding but also very interesting. It's good to finally be able to piece together the final few body systems we have left to do and some other odds and ends, before hopefully starting clinical medicine in January. Even the dreaded neuro didn't seem so terrible following the first set of lectures. Admittedly, it will probably get harder as it goes on, so I'll reserve final judgement until a few weeks time, but what I'm trying to say is that it didn't seem totally awful from the off which was somewhat encouraging! Similarly, we were given a lot of anatomy to do with the respiratory system in the first session. That was quite overwhelming but after this the module becomes more concerned with physiology and different clinical conditions, both of which I find more manageable than lots of anatomy, so it should hopefully be alright. Basically, I'm hoping that by taking things one day at a time, I won't get excessively stressed out by it all.

The one slightly worrying thing is that our exam dates have been released and we only have 15 days dedicated study leave for revision. Considering this is the final pre-clinical exam which will test us on both year 1 and year 2 material, just over a fortnight doesn't seem like very much time at all. But at this point, I'm trying not to think about that in too much depth - I will merely try to stay on top of things as much as possible during this term so that those 15 days can be used for as much revision as possible. Then hopefully it'll be on to clinical medicine, which if our weekly ward placements are anything to go by, should be really, really good so that's definitely a decent source of motivation!

Monday, 24 June 2013

Year 1 results

So my written exams finished just over 3 weeks ago, and my OSCEs were over and done with about two weeks ago. Then came the part I hate the most about exams: the waiting. Mostly because for me that involves being much grumpier than usual, sleeplessness, feeling on edge a lot, etc. However, I'm very happy to report that I've managed to pass the first year of graduate entry medicine! My marks are as follows:

Paper 1: 9/10 SAQ sets passed
Paper 2: 10/10 SAQ sets passed
OSCEs: 9/10 stations passed

Because of the fact that at my medical school we pass or fail exams based on the number of individual SAQ sets we've passed (as opposed to raw percentage), it's often hard to tell after an exam how you've done, and whether you've passed enough SAQ sets to pass overall. That's mostly where all the anxiety and sleeplessness comes from! The pass mark this year was 13/20, so I'm really, really happy to have got 19/20 as it is a solid pass and has given me the confidence to go into the first term of year 2 (i.e. the final semester of pre-clinical medicine) knowing that my method of revising and studying seems to be working and yielding results. So if I keep at it next semester, hopefully I can continue to do well. My studying method was something I was unsure about during the last term of year 1, so to have that reassurance now is very comforting indeed!

Next term I will be doing (for me) the most difficult modules of all including the dreaded neuro (which I shied away from throughout my BSc), and the final pre-clinical exam is scheduled for early December and it will test us on everything taught throughout year 1 and year 2. To say that it will be a challenging term would be an understatement, but I am hopeful that after a restful summer holiday I can go back to med school and work hard for another term, hopefully pass exams, and finally be able to hit the wards and clinics in January 2014 as a clinical med student!

Thank you to everyone for all the supportive comments you've left throughout the year, and I hope you all receive the results you want over the coming weeks!

PS: In case you were wondering I failed the breast examination station in my OSCE.

Wednesday, 12 June 2013

Summer OSCEs

My first year of medical school finished with 10 OSCE stations of which we need to pass 7 to pass the OSCE component overall. Following written exams (which finished at the end of May), I took a few days off then began preparing for these clinical examinations which amongst other things involved me practising various examinations on my pillow over the course of several days!

My general thoughts are that the OSCEs went alright overall, however, similar to the written exams, I’m still wary of the fact that the pass mark is quite high and that I did make some silly mistakes along the way – i just hope these won’t prove to be fatal errors! Of the 10 stations, I feel borderline about two of them, and I’m pretty certain I’ve failed two of them. Most stations were 5 minutes long with two 10 minute history taking stations:

Male anatomy 

So this station involved quizzing me on various aspects of the male reproductive system (pointing to different organs/structures on a model), interpreting a histology slide, and finally a question about a clinical procedure (urinary catheterisation). I feel I’ve done well in this station and I’m pretty hopeful that I’ve passed as all of the questions were fairly simple and straightforward. Definitely a nice way to start the exam!

ECG 

A slightly trickier station came up next – I answered the first few questions about the principles of the ECG, how to measure heart rate etc well but became stumped when it came to actually interpreting the ECG readout – turns out it was a STEMI (a common exam ECG example which suggests a heart attack has occurred), but I totally blanked on this. Very annoying! However, I did manage to answer the follow up questions correctly i.e. which coronary artery and region of the heart are likely to be affected. The examiner looked pretty indifferent and impassive throughout the whole thing so that kept making me think I’d screwed something up, but on the whole I do hope I’ve managed to pass this station!

History taking – breathlessness 

Not a fun station at all – from the off my thoughts felt disorganised and I was acutely aware that I was taking the history in a fumbling kinda way. I really wish we had more opportunity to practice history taking during our weekly ward placements, since I really feel I’ve messed this station up, as proven by the fact that I totally forgot to ask the patient if they were a smoker – something very important to enquire about when someone comes in complaining of breathlessness!

Abdominal examination 

Next station was something practical – I’d had the chance to perform several abdominal examinations during my weekly ward placements and I passed my January abdominal exam OSCE fine, so this station was nice and straightforward. I remembered to wash my hands and I don’t feel I missed anything out. I’m pretty hopeful that I’ve passed this one.

Respiratory examination 

Again, another hands-on station: but unlike abdominal examination I did not have much experience of performing a respiratory exam on a patient. Luckily my brother had agreed to help me out so I was able to practice on him when I went home for a few days before the exam, so I didn’t feel unconfident during this OSCE station. I forgot to check for tracheal deviation, but aside from that I think I covered everything else on the list.

Cardiovascular examination 

As above, not something I had much experience of doing before, but luckily my brother was a great help during the past week of OSCE preparation. Again, I don’t feel I left out anything significant, I remembered to wash my hands, went through the sequence in a regular and orderly manner and it was over before I knew it. Really hope I’ve managed to pass this one too.

Mini-mental state examination 

Oops. This should definitely have been the most passable station since we were given a proforma with all the MMSE questions written on them, and our job was simply to ask the patient the questions and score their replies! Unfortunately I ran out of time and didn’t manage to ask the patient the final three questions. On reflection perhaps I spent too long introducing myself and explaining to the patient what I would be doing; maybe I should have just got on with it quicker. I’m not very hopeful of passing this station.

History taking – abdominal pain 

Well, this history taking station was much nicer than the respiratory history station – I felt rather more confident and my thoughts were better organised, but I still feel like I could definitely do with more history taking practice as it still didn’t seem like I was being slick enough. This is really something I hope to improve on in second year (if I’ve passed that is!). A few follow up questions from the examiner, but I feel I managed to answer them reasonably well.

Infection control 

Easy station – demonstrating how to wash your hands with alcohol gel using the 8 step technique, and then some follow up questions about proper waste disposal and infection control in a hospital setting. No problems here.

Breast examination 

The final OSCE station involved performing a breast examination on a manikin – I have mixed feelings about this station: since it’s a manikin (with no limbs) it’s easy to forget to ask it to raise its arms, place its hands on its hips etc – luckily I did do this eventually, but only after some prompting from the examiner. Palpating the breast and lymph nodes went well enough I think, but unlike the earlier respiratory/cardiovascular/abdominal examination stations, I don’t think I came across as confident enough in this station.

Summary 

I think I’ve probably failed the respiratory history station and the MMSE, and I feel ambivalent about the breast examination station and the abdominal history station. But I think I made a reasonable attempt at the other stations, and speaking with some of the other students afterwards, I took some comfort in the fact that it seemed like most people had made a few silly mistakes or left something out; the examiners clearly aren’t looking for perfection here, so I do hope that the good things I did will outweigh the things I forgot/missed out, so I can pass overall. The rest now lies in the hands of the OSCE examiners and whoever’s marking my written papers, but I really, really hope I can make a post on here in a few weeks time saying that I’m ¼ of the way to being a doctor. Here come the sleepless nights in preparation for results day!

Hope that everyone else’s exams/revision are going well!

Friday, 31 May 2013

End of year exams

End of year written exams took place yesterday and today and represented the culmination of year 1 of graduate entry medicine and sought to test us on everything taught since September (so 2/3rds of the pre-clinical basic sciences curriculum). To say that these exams were causing massive amounts of stress for everyone in the year would be the understatement of the century; up til now we'd only had formative exams in January which were shorter and tested us only on the modules taught during semester 1 (mostly fuzzy stuff like medical sociology and public health) but end of year exams are an entirely different kettle of fish however and would test us extensively on the anatomy, physiology, pathology, biochemistry etc of the different body systems we've studied so far this year. And even more scarily, they actually count and failing comes with pretty terrible consequences which I don't even want to think about (though I know they'll continue to rob me of my sleep until results day).

There were 20 sets of short answer questions spread across two papers - unlike the January exams we don't yet know how many questions you need to pass to pass the year overall (yes, I'm aware our examination system is unnecessarily convoluted), but usually it's 12/20 questions. On the whole I'm not sure how I feel about how I've done. This mainly stems from the fact that the two papers seemed to be trying to test us in completely different ways and I have no idea if the marks I've gained have been evenly distributed across enough questions to merit an overall pass:

Paper 1

Not fun. I didn't like this paper one bit. Throughout the year we've been taught in a very "here are the facts, now go away and memorise them" sort of way. This is a pretty common method of teaching at medical schools from what I know and unlike with biomedical sciences, there's no expectation to do extra reading or to be able to link two distinct aspects of science and to theorise about different things. For example, in our reproductive system module we've learnt about dysmenorrhea (painful periods) and the contraceptive pill, BUT, we've never been specifically taught how the Pill can be used to treat dysmenorrhea (i.e. the "linking" of the two principles). But in the exam yesterday there was a question on this very matter.

Well, I did the best I could and attempted to apply my knowledge of how the Pill works to the underlying causes of dysmenorrhea but since this was never explicitly stated in a lecture, I have no idea if what I'm saying is right or if I'm just "inventing" science.

This paper was on general very scattered and did not correlate well with the lectures we were given - questions were thrown in haphazardly and one set of questions i.e. worth 10% of the paper, was on the brain and neuroscience (we don't get taught neuro til next year) which resulted in a desperate attempt by me to scavenge some marks by a combination of guesswork and scribbling some likely sounding stuff I'd heard on Casualty the other week. This was a pretty disappointing experience if I'm perfectly honest with you - I'm almost certainly going to fail that question and it's not a fair representation of my talents (or my classmates' talents for that matter) since we were being examined on something which wasn't even taught.

Paper 2

Right, today's paper was much better which was a huge relief. It wasn't perfect and I definitely think I've screwed up some of the more minor questions on the musculoskeletal system, but on the whole, it was far more in line with our lectures and coursework and there weren't many questions which required "linking" of two distinct aspects of science. Frustratingly, I'm doing that thing I always do when I've done an exam i.e. obsess for hours about stupid little mistakes I've made and wonder if the examiner will be kind enough to turn a blind eye to them - it's mostly one mark and two mark questions, but they all add up!


Now what?

So now it's all over and the sun is out, so I'm going to take the weekend off and try and relax. I've been free of exam stress for about 6 hours now, and it's a very weird feeling - this huge cloud of stress has been hanging over my head for the past two months and now it's just...gone. I keep feeling guilty for not revising then I remember there's nothing to revise. I have OSCEs in under two weeks so I'll start preparing for those in a few days and after that I'm sure that my neuroticism will get the better of me and I'll start going through my written notes so I can be prepared just in case I need to do resits. But I really, really, really hope it doesn't have to come to that, I don't think there are any words which can describe just how much I want to not have to go through this whole rigmarole again in a few weeks!

Monday, 13 May 2013

End of first year

So as predicted in my last post, a few days ago I hit a low point, then started going up again. So currently I'm in a reasonably positive mood and I've been making some reasonable progress with revision (even with the dreaded immunology). Anyway, first year teaching finally came to and end last Friday and today we had to give patient case presentations for the SSM we've been doing this term (an SSM is like an optional module: everyone has to do one, but you get to pick which area you want to do it in).

If truth be told, I was rather annoyed at the medical school for landing this presentation on us so close to the end of year exams. Clearly everyone is likely to be very stressed out by revision at this time of the year and whilst the presentation itself is short, it still requires preparation, practice and effort - all of which dig into precious revision time. Like, couldn't it have been scheduled for after written exams? I'm almost certain the whole year would have been happy to stay on for a few extra days. Still, never mind, it's all over now.

It didn't go too badly I think. Admittedly, I'm comparing the experience to the last time I gave a presentation to a panel of examiners - this was in December 2011 and very early on during the Q&A session I realised I did NOT know as much about apoptosis as I thought I did. When I was asked a question to which I genuinely had no clue about, I did something which I'm sometimes prone to do in awkward scenarios, something which has very rarely (if ever) actually paid off: I decided to inject some humour into the proceedings. Cue a rather cringey joke on my part involving the band Deep Purple and haematoxylin & eosin staining (ha bloody ha ha). To say that the examiners were not amused would be an understatement, it was really rather reminiscent of the audition scene in Back to the Future:


Anyway, fast forward to May 2013 and thankfully I had slightly more of a clue about this presentation and actually managed to answer the follow-up questions without a) being caught like a deer in the headlights or b) resorting to telling rubbish jokes. I'm not saying I aced it, but I don't feel it went terribly either.

So with that, the final bit of year 1 coursework was done and I've been released into a two-and-a-half week void before the start of written exams and OSCEs. I just can't believe how quickly the year has gone, especially the second term (since January) - I feel like it should only just be the beginning of March now, but nope, here we are, almost halfway through the calendar year and with exams around the corner. Exams which aim to test me on two-thirds of the pre-clinical curriculum. Exams which are seeing most people in the year walk around either with a deadened look in their eyes or with the grim manic zeal which comes from too much caffeine and a subconscious realisation that time is fast running out. Exams which are technically passable (the existence of the second years proves this) but which don't feel passable a lot of the time.

Still, despite the horribleness of exams, I've really enjoyed my first year of medical school. I feel like I've learned a lot. About my own body, what can go wrong with it, and about how to interact with patients, the latter being something I'm really looking foward to learning much more about if/when I make it to the clinical phase of the course. I've been taken far out of my comfort zone, away from a city I call home, away from friends and family, but I feel that it's been worth it, because despite the horribleness of exams, I really do enjoy medicine and training to be a doctor. For the first time in my adult life, I've finished a year of education which I've genuinely wanted to do as an end in itself, and not as a stepping stone to some other course. That feeling of comfort and peacefulness has certainly been the best thing about this year. I just hope I can continue experiencing these positive feelings by passing into second year!

Tuesday, 7 May 2013

Fluctuating mood

Hey


Lately my mood has been fluctuating in terms of how I view revision and my chances of passing into second year. There are some days when I get up, feel positive, revise, get through my list of objectives for that day and go to bed feeling reasonably alright about my chances. I tell myself that every year the vast majority of people in GEP Y1 pass exams and progress to year 2. What's more, most of them pass on the first attempt. This is quite a comforting statistic. I tell myself that even if I'm not the smartest person on the course, I am at least of average ability (hopefully), and that if that's true, then if I put in the work I too should be able to pass along with all the other average people. Those days are good. I can look through a past paper without feeling panicky or like I don't have a clue about what I'm looking at. I can think up some reasonable answers, and when I check my notes a lot of the time I'm right too. It's an amazing feeling when you think you're progressing in the face of something as monolithic and massive as the content of the first year of an accelerated medical course.

Other days are just crappy from the off. I get up and from the outset I feel totally thick. Like someone's poured sand into my head overnight. I can't think straight and when I sit down to work I just feel really woolly and spaced out, like I've had too much to drink or like it's the first time I'm ever looking at this content (even though it isn't). It takes a long time for the content to sink in and when it does, it doesn't seem to stick around for long. I'll review the notes a few hours later and realise I've forgotten lots of details. Just in the space of a few hours. I'm not expecting perfect recall or anything, but a lot of the time it feels like I might as well have not bothered revising at all. If I look through a past paper on those days, none of it makes sense. I'll think of totally irrelevant or half-baked answers and most irritatingly of all, when I look through the answers afterwards, I actually realise that deep down I did know the answer to the question and that if I'd thought about it a bit harder I would have got it right. But for some reason, I just can't seem to make the connections in my mind at the time.

Today has been a day when I've felt pretty thick. I've been revising immunology and it's been really tough because there are so many different nitty-gritty little details to remember, and it doesn't seem to have been sticking. The only plus side is that after a crappy day like today, the only way is back up so I usually end up feeling a bit better for the next few days. It's an annoying cycle, but I can't really see a way out of it.

There are just over three weeks remaining til my first exam which means that in theory I should have enough time to be able to revise everything in order to make a decent attempt at passing the exam on the first go. But that's really dependent on having fewer crappy days like today and more of the efficient, feeling positive kinda days. In all fairness, I do mostly have positive days, but persevering through the negative ones can feel very tough at times.

It just feels like I'm stuck in the UCAS cycle again hoping against hope that I won't be rejected from medicine. Except now I'm actually here and I'm hoping against hope that I won't fail exams and have to leave medicine. The uncertainty and constantly feeling on edge really does sap all energy and life force out of you on some days.

Sunday, 14 April 2013

Next teaching block

I made my previous post the week before we broke up for Easter. And here I am a month later, back in my university town and about to embark the next block of classes. Certainly this is very different to how I'm used to doing things; on my previous degree Easter meant four weeks of cramming then a single month called the "exam semester" over which eight exams would be spaced out (or not, depending on how sadistic the course organisers were feeling that year). There was certainly no teaching or new material to absorb after the end of March.

Here, however, we have another four weeks of teaching for all of our second semester modules, then another three weeks off, then exams at the end of May. And unlike a non-medical degree, the exams aren't split into modules, there are only two papers which integrate all of the material taught since September. So I'm having to revise both what's been taught in semester 1 and semester 2. Luckily I've already been examined on the semester 1 material and I spent all of December revising it, so it's moderately fresh in my mind, but semester 2 is a lot more content heavy, and juggling both is something of a challenge.

I'm viewing this new set up of "teaching-holiday-teaching-study leave-exams" with a combination of academic curiosity, bemusement and borderline fatalistic resignation: frankly, the amount of work which was taught in the first eight weeks of the second semester was immense and I didn't manage to revise as much of it as I wanted to during the Easter holidays. In part, this was because I had something of a backlog of lectures to catch up on, so it took me a week to get fully up to date with my lecture notes. Then there were some family commitments and I went out to see friends and so on, so in practice I had about 2.5 weeks for pure revision. During this time, I managed to revise approximately the first four weeks of semester 2...so what this means is I still have another four weeks of material to revise, and come the middle of May another four weeks of new content (from the coming teaching block).

Basically, it's going to be very tight indeed. Some of the classes which will be taught over the next four weeks will be revision lectures (i.e. no new content) which will be good, and one of our modules is actually finishing this week, so that means an extra half-day per week for revision/study...so theoretically if I can keep my head above water and stay on top of things, I might not be totally screwed for exams at the end of May. But there is just SO much information to remember, on more than one occasion I've genuinely felt my brain can't absorb anymore...and I'm not even halfway done yet!

Friday, 8 March 2013

Spare parts

I use(d) my blogs (both past and present) for different reasons. Sometimes to grumble, sometimes to express worry, sometimes to celebrate, sometimes to ask for advice, and so on. Sometimes however I like to think of this blog like a couch in a posh psychiatrist's office. By that, I don't mean that I secretly feel the need to see a shrink, but rather that it's occasionally nice to have a blank, neutral space to express thoughts which I wouldn't share with other people. Other people tend to fall into specific categories whom I can't, or don't, necessarily want to speak to about certain things. More on this in a minute.

Since I'm still a pre-clinical student, I haven't yet been exposed to much of the emotional side of medicine: the dead/dying patients, the sorrowful relatives, the aftermath of a failed resuscitation attempt, etc. These are largely things I've read about, heard about or watched on TV. I've also never seen a fresh dead body before. I've seen prosections (professionally dissected and preserved body parts) before in my previous degree, but never the body of a recently deceased person. I'm not afraid of the notion of death or mortality, like many I consider death to (paradoxically) be just another part of life, and since I don't believe in an afterlife I also think it's more important to enjoy life whilst I'm living, rather than constantly worry about the inevitable. So this post isn't about fear of death or anything like that.

Normally our anatomy sessions make use of prosections. The thing with prosections is that they're very professionally prepared and preserved. So much so that in my opinion, they no longer resemble a human body part. They look more like a really realistic model. They don't feel very lifelike and they're not easily manipulated (the fingers feel stiff, etc) That makes learning from them easier and also means there's no emotional involvement. After all, you can't get contemplative over what only looks like a very hi-tech model.

This week however, there was a slight change to our anatomy schedule: we would not be using the professional, preserved models, but rather fresh specimens from a cadaver. This was a pretty educational experience for me in many ways. For a start, it made me immediately realise how little anatomy teaching has evolved over the centuries at its basics:



Aside from some very obvious and positive differences between the 17th and 21st centuries (female students/demonstrators, no longer abusing the bodies of dead convicts, no ruffs, etc), Rembrandt's painting is remarkably similar to what I experienced in the anatomy lab this week, right down to the dissection of the upper limb and the pulling of various tendons to cause flexion of dead fingers. In some ways, the continuity of medicine and human anatomy is comforting, in that hundreds of thousands of students before me have gone through it all and will know what I'm talking about, but I do think it's still a very unique experience and each student will have different thoughts at the time. Some students treated the session like a museum exhibition, some treated it like a science experiment, others seemed in deeper thought. Some were just too tired out after a very long week and the shadow of revision looming in the distance to particularly care either way. I don't think there are any rights or wrongs, I'm just here to talk about my own thoughts.

Personally, I was just surprised at how lifelike the dead specimen still looked. Right down to the hairs (still very long and visible) on the arm, the tattoos, and the softness of the skin (even through gloves this was obvious). Sure there were blemishes and discolourations, but on the whole there was no confusing this for a hi-tech model. It was very much a human specimen, right down to the still very present fingernails (the fingernails on preserved prosections tend to wither to a hard yellow plate at tip of each finger - hardly realistic). The finger nails, and indeed, remnants of fingerprints on this dissected arm were unmistakeable however. There is a train of thought which can follow on from these observations. Fingerprints are unique to each person, so noticing them almost immediately makes you conclude that this specimen is definitely real and not just a "thing". Once you consider that this is real, you also consider that it had a life too. Putting the rest of the pieces of this puzzle together isn't particularly difficult.

This is what I meant by things I "can't or don't want to" speak with other people about. Many non-medics (so my siblings, parents, non-medic friends, etc) are pretty squeamish. Talking at length about my thoughts before and after seeing dead human tissue is not something I feel is fair on them. There are friends in my class and other medics I could talk to I guess and, but for some reason something is stopping me doing this too - I'm not sure what either, since I normally have no problems talking about different things to do with the course. But at any rate, that's why I've ended up on here.

Long story short, these realisations made it somewhat harder to concentrate purely on the anatomical science. Sure, I listened to what the demonstrator had to say, I pulled on the tendons, inserted my fingers into various anatomical points of interest, and yes, I learned a lot too - viewing forearm pronation/supination and how the radius pivots about the ulna was much more easily appreciated in this specimen rather than a hard immobilised specimen. I saw that a much greater quantity of fat is located under the skin than I previously thought and how much thicker the nerves are. On the whole however, I think I was more contemplative during the session than I normally would have been. I didn't feel sick, faint or like passing out...but I didn't feel like I was just taking part in a purely academic exercise either, which is normally how I feel when in the anatomy lab, with the usual specimens. I'm sure some of Dr Tulp's students might have felt this way too. Or maybe not, who knows? I personally don't feel like I'm the only one who must be thinking this though.

At some point over the next few weeks, I also have to observe a post-mortem examination as part of my pathology module. Now that I've had (some) experience of fresh cadavers, I think I know what to expect...but much like today's experience, I don't think it'll be a purely academic experience for me. Maybe this sort of thing becomes less remarkable with time as you become desensitised to it, but for now, I felt like it was an important part of my medical training which I should reflect on.

Oh, and another thought which randomly occurred to me today - exactly a year has passed since I got into medical school. Today's post really sums up, I think, just how far I've come since then, in so many different ways. But one thing's for certain, re-reading my acceptance letter earlier today, I'm extremely happy to be on this path. Wonder what I'll be doing this time next year!

Wednesday, 27 February 2013

Results

January seems like ages ago, but in reality only two months ago I was frantically cramming for the exams which would test our knowledge of everything which had been covered in term 1. The basic sciences would be tested in the written papers and the clinical skills we had learned would be examined in six OSCE stations. We were meant to be getting the results at the end of January, but there had been a few errors in the marking of my paper (something I've been assured won't happen in the summative exam in the summer), so I only got my results fully confirmed yesterday. Quick recap: eight questions in total across two papers (each question worth 20 marks), you need to pass 5 to pass overall:

Paper 1: Passed 3 questions, failed 1.

Paper 2: Passed 3 questions, failed 1.

Total: 6/8 - pass

I was pretty happy with this score, as it shows that I'm currently working to a reasonable standard and am largely keeping up with the rest of the year group. I was right in my post-exam assessment in that I'd done very well in the medical sociology and biochemistry/endocrinology questions. One surprising thing was that I'd managed to pass the neuroscience question on paper 1, the one I was certain I'd failed. So far, so good.

However, looking back over my answers, I do think that there are definitely some very specific areas I need to work on. Anatomy is the big one, I lost a lot of marks by not knowing specific anatomical details. In part, this was because during term 1 I was still working like a biomed: barely using the lecture slides, mostly going off and finding out random details from textbooks etc. In actual fact, I should have predominantly stuck to the lecture slides and learning objectives, because that's what the exam questions seem to be heavily based on: this is something I'm trying to do this term! I'm also allocating more of my time to anatomy learning: I don't particularly enjoy it, but I can't avoid it so I might as well try and get good at it.

I'm also trying to keep on top of things more this term so that when the Easter holidays begin, I can get down to revision as soon as possible, instead of spending the first few weeks catching up with the previous term's lectures (something which happened in December). This is very important since the summer exams in a few months time are not formative, and I really, really do not want to fail them and have to go through the stress of a resit. I hate the phrase "hit the ground running" as it sounds very management-y and corporate to me, but I guess that's what I'm looking for here.

But overall I feel that 6/8 was a fair mark: it tells me that if I carry on working hard, hopefully I'll be able to pass in the summer, but that I'm definitely not supposed to get complacent in the meantime and rest on my laurels. As such, it's given me an incentive to try and work harder and more effectively this term.

So onto the practical exams, six OSCE stations, needed four to pass overall:

Medline: Fail
Blood pressure and BMI: Pass
Taking a history: Fail
CPR: Pass
General examination: Pass
Abdominal examination: Pass

Total: 4/6 - pass

A few weeks after the OSCE we were informed that there had been some discrepancies in the marking of the taking a history station on a particular day: I was one of the students affected by this. The med school have said that if this was a summative OSCE, that station would have been removed from the results. My personal feeling is that I probably did do well enough to pass this station, but I guess I won't ever know for certain. The doctors who have observed me taking a history during clinical skills sessions and on the wards have never told me that my history taking is substandard and neither did the OSCE examiner's feedback on the day indicate that. It's a slightly annoying result to have, but it's all formative at the end of the day so it doesn't really make a difference. Medline was a deserved fail, so I was neither surprised nor upset to get that result.

So that's it then. Overall I'm quite happy with these results, though there's definite room for improvement. And considering the summer exams are more difficult than the January ones, I'm trying to improve as fast as I can. It's going to be a very nerve-wracking couple of months!

Thursday, 14 February 2013

First patients

This time exactly a year ago I'd just come out of my first medical school interview, not feeling particularly happy with what I felt had been a rather intense grilling. Happily, the next day I had another interview which went much better, and which was followed by an unconditional offer three weeks later. Six months after that I started medical school, and here I am, five and a half months later and having seen my first patients during the past week. Things have certainly changed in the last 12 months, that's for sure.

If I'm perfectly honest with you, pre-clinical medicine hasn't felt totally unlike my previous degrees in the medical sciences. What I mean by this is that so far our the way we learn and are taught hasn't been all that different to any other undergraduate's (except in terms of the volume, which is a lot more now) but generally we still work out of textbooks, fall asleep in lectures, do exercises to consolidate our knowledge, that kinda thing. In short, it doesn't feel radically different to a normal science degree.

Of course, there are differences, for example, this is the first year since primary school where I haven't set foot in a lab, even once. That's something which I'm very thankful for. And also, whilst pre-clinical medicine may be theoretical and sometimes rather dry, it's still a lot more relevant and applicable than the stuff we were taught in biomed. Learning about the individual muscles of the upper limb isn't particularly fun (I'm a physiology/pathology kinda guy, anatomy is definitely not my scene) but at least you can see why it's relevant, even if it also feels so overwhelmingly detailed that it makes you want to run screaming from the lecture theatre. But at any rate it feels a lot more personally relevant than learning how to manipulate a fruitfly's genome. There are also lectures on the social and psychological aspects of medicine, rather than a heavy emphasis just on scientific theories. So there are definite differences even if, on the whole, pre-clinical medicine is still very theoretical.

However, as medical education has become more integrated over the past few years, even during pre-clinical medicine some basic clinical skills are taught and patient contact is gradually introduced. So last term we learnt how to take a history, different systems examinations, etc so that this term we can actually put them in practice when meeting patients, which is what happened this week.

First patient

The first patient was recovering on a surgical ward after an operation to fix a hernia. The task for this week was to practice history taking and any relevant systems examinations. A quick briefing at first in the hospital lecture theatre to remind us of what we should be saying and asking, and then we split up into smaller groups to shadow the doctors who would be observing us as we took our histories. Interestingly enough, though this was a real patient, I felt I actually managed to take a better history than during my OSCE with a simulated patient. Maybe it was because it was in a ward setting, maybe because there wasn't an examiner scribbling away furiously whilst I was at it, but at any rate I took the history and performed an abdominal examination (though carefully avoiding the site of the operation). The patient was very nice and happy to help out, which was very kind of them and definitely put me at ease too! The junior doctor who was observing me said that I'd done well with both the history and the examination, so I left feeling pretty happy about it all. Learning about hernias in the lecture theatre is interesting enough, but it feels a lot more real when you actually hear about it in the context of someone's personal experiences: both when they describe the initial pain it caused them and then their feelings of relief after it had been fixed.

I'm glad that of all the patients I'll see throughout my professional career, this first one left such a positive and good impression on me. It could have been very different I guess: patients are often tired, stressed out or simply not in the mood to be quizzed by med students. The fact that this patient put me at ease is something I'm very grateful for.

Second and third patients

The second and third patients I saw were seen a few days later in an outpatient clinic and again I was here to practice history taking, this time for a case report. Both patients were HIV positive, and this was my first encounter with an HIV positive patient. The thing I like most about clinical medicine with real patients is that it makes you learn from the moment you enter the room. My first recollections relating to HIV/AIDS are of seeing Princess Diana on the news visiting AIDS patients in a hospital in England in the 1990s, and those patients definitely didn't look well at all. So, in my mind I imagined that the patients I would be seeing today would probably be very poorly too.

Things couldn't have been more different actually. The first patient was in his third decade of living with HIV/AIDS, was in his 80s, and was (according to the notes and history) perfectly healthy otherwise. I quickly realised that what I had read about anti-retroviral drugs being able to effectively control HIV wasn't only true for the young or for the recently diagnosed, but that HIV patients who have access to the appropriate medications can have a near-normal life expectancy (or in some cases, wholly normal), something which the consultant reiterated to me after I took the history. You can read about this stuff in a book, or you can actually see it up close and personal, and I definitely know which has made a bigger impression on me!

The second patient was a few years younger than the first and again, otherwise healthy and very proud of it. I had a bit more time with this patient and we managed to talk about things other than the medicine whilst waiting for the consultant to return. During this time the patient informed me that the number of countries they had visited over the years was nearly in triple figures, and due to carry on rising over the coming months - something I found very impressive, considering mine is still in single figures. I suppose, deep down, I'm a bit nosy. Actually nosy is the wrong word; more like perennially curious. I'm curious to hear about what other people do with their lives, where they live, where they grew up, where they went to school, where they go on holiday etc. Maybe this stems from the fact that I feel my own life is pretty standard, so I like hearing about how different life is for other people. It's definitely one of the most interesting aspects of medicine for me.

Anyway, I probably won't be updating this thing every time I see a new patient, but since these were my first three and since they each made an impression on me for different reasons, I felt the need to reflect a bit. I'm glad that medical schools now include patient contact before the clinical years, as it can be educational, motivational and pretty fun too. Next time I'm grappling with how best to commit a list of muscles to memory, I'll definitely feel a lot more motivated knowing that if I can get through pre-clinical medicine, there will be many more interesting patients to see in the clinical years and beyond!

Also, I know it's been a while since I updated - there's been a slight administrative hold-up with my Semester 1 exam results, hence why I haven't posted on here to gloat/moan as per usual. As soon as I hear back I'll update. Hope you're all doing well and enjoying the new term!

Tuesday, 15 January 2013

Good med students pass exams?

A few days back I was speaking with a relative of mine who I get on with very well. This relative is roughly the same age as me and is also an undergraduate student, though a non-medic. Whilst catching up and exchanging stories of the latest goings on at uni, they asked me how my latest set of exams (see previous entries) had gone and how I think I'd done. The conversation went like this:

Relative: So your exams are all done now eh?
Grumpy: Yep, thankfully, maybe I can start getting some sleep now.
Relative: When do you find out how you've done?
Grumpy: Should be within a few weeks or so I think.
Relative: How do you think you've done?
Grumpy: Erm, not sure really. I mean, I really hope I've passed, I spent a fair old while revising over Christmas so I feel like I put the work in, but you know, it's always difficult to tell...
Relative: Yes, I suppose so...I mean what happens if you don't pass?
Grumpy: Oh, nothing awful, these exams are formative, so you just have to have a meeting with some med school bigwigs who'll tell you to get your act together a bit more.
Relative: Oh, so you don't get kicked out or anything?
Grumpy: No. If you fail the summer exams and the resit, then you get told to leave.
Relative: Do you think that would ever happen to you?
Grumpy: I'm not sure really, I mean, I really, really hope it won't, but I haven't a clue what the summer exams will be like and they're supposed to be more difficult than the January ones...so I wouldn't like to say I'm going to pass with 100% certainty...
Relative: Oh I see. Well I suppose if you did fail it would be better if you get told to leave as you'd end up being a bad doctor...

Anyway, this conversation got me thinking about some things. Firstly, how exactly does one define a "bad doctor"? There's an old joke which goes: "what do you call a med student who graduates bottom of their year?" with the reply being "doctor" (ho ho ho). Is a doctor who scrapes a pass in finals automatically a "good doctor" whilst a med student who marginally failed finals did so deservedly because they would have become a "bad doctor"? I'm not sure it's that simple really. Looking at things from another angle, is a grumpy*, rude surgeon with top marks in med school and membership exams automatically "better" than a more academically average colleague who nevertheless genuinely makes their patients feel well looked after and cared for? Doc Martin is a great TV show, but would you really like Dr Ellingham to be your GP, despite his excellent academic credentials?

I sincerely hope there's more to being a "good" med student or doctor than doing well in exams, but unfortunately many members of the public don't see it that way. It's not that I have a massive thing with exams, but I don't like the assumption that "good" med students or doctors are those who pass exams and don't fuck up along the way. In a sense, the public can't be blamed for having these high expectations: in their minds a med student who fail an exam = more likely to be a rubbish doctor = more likely to make a mistake on the job. In most lines of work fucking up isn't really that much of a big deal (if you're a politican fuck ups are practically expected, nay encouraged, on a weekly basis), but in the collective mind of the public "medical mistakes" immediately evoke memories of news stories on botched operations and lethal prescribing errors. Medical mistakes can clearly be much more serious. However, it's also worth bearing in mind that many of the doctors involved in these incidents were actually perfectly competent students and junior doctors, which again makes me wonder just how much of one's performance ought to be judged by exam results.

Let me put it another way: this relative of mine knows that I failed two modules during my BSc. They know that I failed them, not because I was stupid or lazy, but because a few years ago I just didn't know how to revise and work efficiently. They also know that I later resat those exams and passed. And that ultimately that I did well in my degree. At no point was it suggested that I was a "bad BSc student" for failing those exams, because failing exams is a normal and common occurence for many BSc students, and everyone knows this. But there seems to be a whole other level of expectation for medical students: even if, like me, they're just as inexperienced as a first year BSc student is with their BSc. My relative didn't actually say I've been a bad med student (I haven't even done summer exams yet), but I'm just trying to examine a train of thought here. It was actually a very laid back conversation which we had if you want to know the truth, despite how seriously I'm taking it all here.

But at the same time, it seems that some non-medics think that if you're smart enough to get into medical school that therefore you're smart enough to be able to cope with anything which gets thrown at you and still pass with flying colours. Never mind if it's all totally new and unfamiliar to you, that there's a lot to learn and not that much time to learn it in. All of these grittier details aren't known by them; they assume that since their GP is confident and smart, that therefore they were like that right from their first day at med school and anyone who isn't like that clearly doesn't have a decent future ahead of them anyway. In actual fact however, for all they know, their GP (like lots of other medics) might have screwed up an exam here or there along the way. And in my opinion, it's still perfectly possible to mess up exams and go on to be a good or even great doctor.

In my opinion medical school (and the formative stages of a doctor's career) are all a massive learning experience, both from an academic and a personal perspective, and whilst exams are, to an extent, a useful method of assessing someone's understanding of a subject, they shouldn't be seen as some sort of yardstick against which medics are measured. Becoming confident in learning and applying medical knowledge and practical skills is something which takes time, and not everyone adapts to learning these new skills straightaway. I don't think that makes someone necessarily a "worse" medical student, I think it means that they need to reflect on what they're going to do to address the problem and then fix it, and there's nothing wrong with that in my opinion. But ultimately it's hard to try and explain this all to people who have never experienced medical school.

*Yes, I know I'm grumpy on here and often sometimes in my personal life too, but I won't be grumpy with patients. Mainly because I've had a few doctors who were irritable at me in the past, and I know just how "not cool" it is.

Thursday, 10 January 2013

Paper Two

Okay, so, this was in the same format as paper one - the final four questions which continued to test us on the different areas we'd covered in semester one. Five questions need to be passed overall from the eight we've done since Tuesday. On the whole, I felt this paper was much nicer than Tuesday's, but because I've never done medicine exams before, I'm not sure if I'd like to say with any degree of certainty if I think I've passed or not - these kind of exams are something totally new for me, so I'm not sure if I did amazingly, but I guess I'll find out over the next few weeks.

Question 5

A mixture of public health and anatomy. Generally alright, no massive problems but realised I may have screwed up a couple of the finer anatomical details. Don't ever expect to see me doing the MRCS is all I can say!

Question 6

A mixture of medical sociology and public health questions. No real problems here, but the thing with medical sociology is that on the surface it just appears to be a load of waffle - but in actual fact you need to mention some very specific phrases and concepts to get the marks. I hope I've managed to do this, but I guess we'll see.

Question 7

Best question in the entire exam, from both papers. Pure biochemistry. The good thing about biochemistry is that it's either right or wrong. You either know the pathways and reactions involved or you don't. This is pretty much the only question I can say I think I've passed with any degree of certainty and without feeling like I'm being a cocky bastard.

Question 8

A mixture of questions on physiology and medical sociology. Once again, with the physiology you either know if you've got it right or wrong, there aren't tonnes of isolated, random details to memorise like with anatomy. So I think I did alright on this question but again, we'll see. After exams I always get this feeling in the back of my mind that even though I think I gave the right answers, in reality I was barking up the wrong tree and wrote down totally irrelevant stuff. It's pretty crazy.

Final thoughts

Well that concludes my first experience of pre-clinical medicine exams. Luckily these exams are formative so it's supposed to be a good learning experience rather than something to worry about getting kicked out over. That said, I still hope I've passed. I'd really, really like that, it would show that the work I've been putting in over the past few months has been on the right lines and it would be a nice little confidence boost at the start of the new term, but if I haven't I guess the only thing I can do is try and figure out what went wrong so I don't repeat the same mistakes next time. It's weird to think that there are two more sets of pre-clinical exams this year, and that if I pass them, this time next year I'll be doing clinical medicine. It seems much closer now than it did in September. Anyway, now I get to relax for a few days before starting semester 2, something I fully intend to do!

Tuesday, 8 January 2013

Paper One

OSCEs done and dusted, it was on to the written exams today. Two papers, eight questions, all formative, so no big consequences for failing. Today's was the first paper which had four questions each with several parts to them (a, b, c, d, etc). Thing is, these kinda short answer questions are different to the questions I had before during undergrad. During undergrad, each module would have its own exam paper. Let's pretend it was a biochemistry paper. You'd cram everything you knew about biochemistry in the days running up to the exam. You'd do the exam, then promptly forget everything about biochemistry within hours of putting your pen down. Then you'd start cramming for genetics or whatever was your next exam.

No such thing here. The questions here are all drawn from the different modules studied during the course of this term, so it's all jumbled up. For example, part a could be about biochemistry, part b could be on anatomy, and so on. This is presumably to stop people selectively learning, which I suppose is necessary (you don't want a doctor who doesn't know any anatomy), but it does tend to put a bit of pressure on you. Each question is worth 20 marks and usually you need to get 10-12 marks to pass a question. Five out of eight questions need to be passed overall. So here's how I found the questions:

Question 1

Really liked this question, no problems really. Lots of medical sociology. No complaints here.

Question 2

Whoops! From the fluffiness of medical sociology to some serious anatomical theory and then some public health. I think I did alright here, but there was a particularly nasty anatomy question which threw me a bit.

Question 3

Totally FUBAR, to use military parlance. This question was split between anatomy of the nervous system (which we had a single introductory lecture on - and are due to have an entire module on next year), and questions on cancer. The questions on cancer were alright, but the ones on neuro anatomy were a total write off, and unfortunately these parts carried the most marks in this question. I didn't have a clue, and frankly you'd hope that instead of testing you on a single introductory lecture they'd test you on stuff you'd actually been taught in a comprehensive kinda way.  I think a lot of people came out of the exam feeling rather pissed off and genuinely disappointed at this question:
















Question 4

Nice question here, lots of biochemistry, lots of public health. No complaints again. Certainly no need for an outraged gif at any rate.

Final thoughts

Well, Qs 1 and 4 went well enough, I think I've managed to pass them. Question 2 might have been a pass, I hope so anyway, but I won't hold my breath on Question 3. Whilst there's no guarantee that the same topics won't come up again in the next paper, the chances are that they won't. So I'll be putting slightly more effort into revising those things which didn't come up today. Really hope the second paper is nice, I don't think I can explain just how much I want to pass these exams, it'd definitely make me feel more confident in my abilities and learning techniques!

Thursday, 3 January 2013

OSCEs

Barely 48 hours after my New Year's Eve moan about how much I hate the run up to exams and all that it entails (insomnia, more insomnia and even more insomnia - and the occasional feeling of total stupidity and utter ignorance) I was launched into what will be the first of many examinations throughout my medical career. That is, assuming I still have a medical career to look forward to - lately I have to keep reassuring myself during moments of uncertainty that "people pass, so I will too if I work hard enough because I am a person too". That sometimes works, but occasionally I still have these blind moments of panic where it feels like it's all going to be a total write off.

So, OSCEs. For the non-medics these are exams which test your practical skills. The bread and butter of being a doctor, as it were. This ranges from relatively simple things like taking a blood pressure to more lengthy processes like examining a "patient's" abdomen or whatever else. The inverted commas are there because the people were examining were actors who were hired to pretend to be ill or to generally be poked and prodded by us. There were six stations to go through, and like the two written exams I will sit next week, it's all formative, but damn it all, I still want to do well. I hate feeling like an idiot, and I do (on the whole) try and work quite hard...so I'd like to see some pay off. But I've long since realised that it's not all about working hard, it's also about working smart - and that's something which comes with experience, and experience of medicine and med school is something I'm severely lacking at the moment, but unfortunately I don't have all that much time to gain experience either on an accelerated course. You need to be pretty good from the outset. Anyway, here are the stations I went through today:

Station 1: Medline

Medline is a database with medical journals and such. Searching this thing is a pain and I do wonder whether it's something which doctors and med students need to use everyday. I prefer Pubmed anyway. So I walk in and there's a computer terminal and an examiner and a task i.e. you wish to find out more about this particular subject, find the relevant article. Well...to cut a long story short, I just couldn't find the damn article. When my time was up I had managed to find some articles on the general subject we were looking for but not the specific one we needed. The examiner noted that I did manage to identify the key search terms and so on well, but I needed to refine my search technique. On the other hand, I did manage to answer her follow up questions well, so hopefully I may have scraped a pass in this. But obviously I didn't find the sodding article, which was the whole point of the exercise, so it's all a bit hit and miss really.

Station 2: Blood pressure and BMI

Right, so, not the best first station, but never mind, we persevere. Or not. I'm still feeling nervous and slightly disappointed after a rubbish first station. Anyway, I enter the room and there's a patient and an examiner. Smile, introduce self, ask patient to stand next to wall to be measured. Ask her to take a seat. Remember that I haven't taken her weight. That's kind of crucial to do a BMI. Apologise and ask her to step on the scales. Work out BMI. Fix bp cuff on too low. Realise this after a second and re-adjust it. Much better. Take blood pressure. Answer the examiner's questions. Get told that I didn't remember to wash my hands. Fuck! Definitely not feeling happy with myself after this.

Station 3: Taking a history

So, I move on to the next room feeling like a prize idiot. How the hell could I have forgotten to wash my hands? Really hope I won't be hung out to dry for that. So in this room there's a patient with chest pain. I take a history and keep things friendly, the patient's nice and so it all seems good. Go through the SOCRATES mnemonic, make sure to ask her for her own ideas, concerns and expectations. Finish up and thank the patient. Comments from the examiner: generally good but too many closed questions in some places. Also seemed to jump around a bit from topic to topic. Feel marginally less awful after this station but still wish I could simply get something right for once.

Station 4: CPR

Pretty simple really, the only station where you don't have to introduce yourself to the patient or bother with the social niceties. Mainly because the patient is a plastic dummy and supposed to be in cardiac arrest. They're probably not too fussed with giving consent at this point, they just want to be resuscitated. I'm able to do that, reasonably well I think, and I time my chest compressions to the tempo of Another One Bites the Dust. How appropriate. Answer the examiner's questions well for the most part. I didn't know what should be done with C-spine patients i.e. the "jaw thrust", but I did know about shockable rhythms, how deep you should compress, when you should stop CPR, etc. Hopefully passed this one.

Station 5: General examination

Feeling slightly better as this weird experience trundles on. Go in, introduce self, get patient to lie at 45 degrees on the examination table. Take her pulse. Realise that I've forgotten to rub hands with alcohol gel, so do that, and the examiner smirks - hopefully this will still count, but I'm not optimistic. Is it better to do it later than never? Get back into it and do the general exam. Examiner's feedback is that it was generally okay, but he gives a few points for improvement.

Station 6: Abdominal examination

Feeling slightly heartened by the not totally awful experience of the previous station, I go in for the last one. I remember to wash my hands with the alcohol gel (first thing I do, whilst I'm introducing myself to the patient) - congratulate self on finally beginning to remember to do this at the right time. Decide to go out drinking later to celebrate. Remember that I still have revision to do for the written exams. Crap. Carry on with the exam. Inspection, palpation, percussion, auscultation. All over within a few minutes. Examiner seems happy and remarks that I "percuss and palpate better than most, most students are very timid". Surely something to be happy about? Hey, I might have given you some awful germs when I was taking your blood pressure, but at least I can tap on your belly like a boss, that surely counts for something! He asks a few questions...they're alright but I flounder when he asks what else I would do after the abdominal examination. The answer is hernial, genital and rectal examinations. I actually DID know this and had revised this particular bit multiple times, but for some reason I drew a blank and started rambling about cardiovascular examinations instead. Slightly disappointed that it wasn't as amazing as it could have been, but otherwise this is the only station I'm genuinely reasonably happy with.

Final thoughts

I have no idea when we're getting the result from all of this, but I imagine it will be in a few weeks or so. We need to pass 4/6 to "pass" overall, but since it's a formative there are no penalties for failing. However, if I have failed, I think I'd be very disappointed with myself. I've wanted to be a doctor for so long and if I stumble at the first hurdle that's not exactly promising is it? I've looked over my notes and (Medline aside which was totally FUBAR) I've managed to remember to do most things the way they should be done, so I hope I've passed. Though even with Medline I still managed to get the follow up questions right, I think. That might count, mightn't it?

However, I'm rather worried that little (but important) things like forgetting to wash my hands with the gel at station 2 will see me being failed despite managing to get the blood pressure to what the examiner said he expected was the correct value. I feel this way because he stressed that handwashing is important and "could be the difference between a pass and a fail". I'm not feeling particularly encouraged by that, was that a subtle hint that I've screwed up and that's the reason why? Or simply good advice for the future? Never mind, it's all a learning experience I suppose. Anyway, now I need to revise for the two written exams which will be next week. Over and out.