Wednesday, December 7, 2016

The hectic third year

Surviving Third Year in MDUKM

In UKM, third year consists of  3 major postings which are Internal Medicine, Surgery, Obstetrics & Gynecology, and a minor posting Public Health.

We'll have to go through 2 of the postings in 1 semester. Then the other two postings in the next semester. After each of the semester, there will be the final exams which consist of the theory paper and OSCE.

I was very fortunate because I got the posting that I was most looking forward to first. SURGERY! So I went into third year veryyy excited. Despite not having any of my closest friends in the same posting, I am determined to make the most out of it.

so Surgery, around 70 people in a posting were divided into several teams (hepatobiliary, colorectal, upper gastrointestinal, breast&endocrine, vascular). and in that team, we were divided further into our respective supervisors. I was put under the hepatobiliary team throughout 7 weeks of surgeryyyy.

UKM syllabus is ever so changing. I was third year in 2015. and I think currently, the schedule has changed. During my surgery posting, we were basically really free. Few days, we would have lectures & seminars. but that would only be 1-2 hours in the morning or maybe 1-2 hours in the afternoon. Other than that, we are basically on our own.

Hepatobiliary team has morning ward rounds every day. and I once counted if i go to the ward at 7 am. I would go through ward rounds three times. (one with HO&registrar, 2nd registrar with specialist, 3rd would be when the consultants come) *means same patient 3 times* tapi tak semua patient la.. hahaha.. hepatobiliary team has a lotttt of patients. and usually these cases are the *must know* topics in surgery. for example : jaundice, gall stones, cholescystitis, hepatocellular carcinoma etc. a.k,a usual short case & long case. But during my time, it wasnt really "mandatory" to follow the rounds. "means the doctors doesnt really care if you are there or not" . But you are student and you know nothing so, its better you do follow the rounds. ask questions. cover bed. and clerk the cases before ward rounds.

Basically the main point you need to know in clinical year is that everything is your own initiative. No, the doctors will no tell you to do this and that anymore (certain), to read this or that. Teach you step by step. If you want teaching, you have to ask for it. When you do come for teaching, you must be prepared. Dah clerk patient. Case dah ada . dah tau investigation and managment. (usually teaching would pretty much be a long case presentation or a bed side teaching) . If its a bedside teaching, you have to search for the patients before hand (minta izin dulu okay), you are already prepared to volunteer to do the examination. Our lecturers/Doctors will be there to correct what is wrong and and add in some information. It is our responsibility to read up the topic first and come with knowledge.

Its not like PBL anymore - tau topic tu. start first session baru nak search kat medscape, wiki, dan sebagainya. NOPE.

Clinical year macam ni  - "okay esok buat abdomen" - so before teaching you'd have to study about the liver, the stomach, the colon, hernia, what ever causes masses in the abdomen, causes of acute abdomen. and you need to know everything. examination, clinical feature, investigation, management. semua tu dah tau dah. tunggu nak present je kat doctor je. haaaaaa.

So my suggestion for the clinical year.

1) Spend loads loads and loads of time in the wards. Practice history taking, physical examinations. So you can gain confidence, you'd be comfortable. tak takut. Dah clerk case kat ward, balik pergi baca investigation and management dia pulak. Dont think that you are in third year you don't need to know the treatment/management. You call yourself a future doctor kot. YOU NEED TO KNOW! (its better if you do though. tak rugi apa2)

2) Get guidance from your senior. this is applicable as well for internal medicine and o&g. I myself was close to my seniors during surgery and O&G and the amount of knowledge they gave me.....I cant thank them enough. I followed them everywhere, I ask them too many questions. They tell me a lot of things without me asking. And because of them... I survived the hectic third year!

but everything depends in what team you're in what supervisor you got. ada juga team yang ada "hala tuju". I unfortunately was not in it HAHA.

Next, I went into O&G. I got yellow ward. This is another posting that I had no "hala tuju" . and everything was on my own initiative. especially when my supervisor would only see us on the 4th week of posting. that means we had to learning everything about O&G before we had teaching. (HMMM....) yeah thats clinical year... O&G -WAJIB ikut ward round everyday. tak rugi apa2 pun. WAJIB cover bed. tak rugi apa2 pun juga. its all for our own good.

O&G was fun because there were a lot of procedures and labour to assist(yeke?)/observe.

IM- set your aim 2 short cases a day. 1 short case a day. go back home and read! simple. In this posting I had a more "hala tuju" . I'd follow my supervisor's ward round everyday. We'd have long case presentation everyday of different cases and systems. we'd have short case bed side teaching twice a week. and sometimes even just a group discussion. I was fortunate to have some guidance compared to my other posting mates. but with that, I had to find my own extra time to search for the cases. which was quite difficult as well because most of the time we were with our supervisor. So for IM, theres alot of "your own initiative" kinda thing. cari case. clerk. physical examination. present. REPEAT. balik baca investigation, management. REPEAT

1) Case Write Up
2) Long Case (from history, physical examination, investigation, management)

3)Short case (physical examination, investigation, and maybe management)