Easter

AMC exam
***********
17th march
Went to AMC clinical exam last sat to become SP (simulated pt)
AMC exam is the entrance exam for foreign docs who wanna work in OZ, be it you are a lowly intern or a highly consultant overseas.
actually the exam consists of a MCQ and the clinical exam. how far infront of the Q for clinical exam will depend on how will u do in MCQ.
it's really interesting to be at another end of table
the scenarios were mostly based on GP setting. so beware consultant.....cuz they can be easily outta touch of the community needs :P

i was SP as a mother with a kid with septic arthritis (paeds) (morning session)and also a young lady with psychotic disorder >_< (psych) (afternoon session). These 2 are basically quite straight forward and hard to fail. heard that there are other killer stations such as secondary post partum hemorrhage and oso the infective endocarditis. there are 16 stn altogether and doc has to pass 12. and oso pass at least 1 paeds and 1 ONG . most docs are very knowledgeable, the diff lies in their approach to the patients. in order words, it's like customer servicing. cuz everytime the doc leave the room, the examiner will ask me how do i feel. it's so interesting to see different doctors with different approach.

Mom & kid with septic arthritis

1. a doc who act like he's a big doc..... he is physically big as well. can see the sweat mark on his armpit. he's the kind who sit heavily on the chair and then merge with the chair and qiao his leg ( cross his leg) and start his conversation" OK, today i'm goin to...." he told me wat to do most of the time. This is a classic example of doc that don't give me a chance to talk. well if they cover all areas then it's good. if they don't, too bad....but they definitely get mark down on the pt approach part.as SP, we were told wat to answer and what to ask if the doc hasn't address the issue yet.
some of the doc i wanna help them oso cannot cuz they juz keep talking. i juz find it hard to input some questions to them as a concerning patient

2. a lost doc
he looked lost, i didn't know why i got lost with him too..... mayb he's cute(part of the reason) LOL. anyways, he was not very focussed and didn't seem to know what's goin on. so i'm lost in the sense that i don't know when can i find the right chance to input my question to help him to score his content point.

3.shy doc
a middle age lady who look all nice, smily, slow and shy. and not too confident and oso not too sure as well.

4. a super prim and proper doc
a thin small size russian looking guy, with long and stern face. put both of this hands on the table and straighten his back when he ask u qn with a monotonous tone.....
oh my....i so feel like laughing....but i ctrl myself lah.

5. of course there were those good one,
even the good ones they will miss out some points. each good one managed to cover some points that other good ones didn't managed to.

in this stn, to be perfectly good, some minor points to cover like remember to take a brief full overall hx even u already know its septic arthritis fr the presenting complaint. try to ask whether they can go to ED if not, arrange some kind of tpt for them (ambulance). there are lot more details to cover.juz one trick, even if you know wat will their concern be...there is no harm asking.

i wonder whether is it becuz of the exam setting that render the above doc half of wat they normally are.

for the morning session: it was all nice. as i can be a nice pt and try to prompt them with my questions. and my answers were mostly repetitive...
most docs were great that the examiner ( the Albury clinical school incharged) had a strong urge to give them his name card & ask them to work for him.

Critical Error for this stn (critical error is the error that will fail u str away no matter how well u did) : did not admit the kid immediately to hospital

Pscyho patient who has strong paranoia

in the afternoon, as i was reading thru the instruction sheet to be a psycho, i was confused as well. no clear hx given, hahha that's the point right !!!!
well, we are not encouraged to be aggressive psycho cuz it can be very tiring after acting over and over again for 16 times!!!

i wasn't very familiar with what i should do initially so i was a pretty reserved psycho but i slowly warmed up. basically i was a calm psycho. i'm supposed to have some self harm intention too...
i find it hard to help the doc in this stn as compared to the previous one. but later i found something such as kept telling them that i'm worried about my work so i can't sleep....which most of them fail to address anyway ..... (waste my effort)

1. the anxious doc (stuttering)
i guess everyone is anxious.(including me, cuz i have to be really concentrated in listening to the doc and try to ask them necessary qn to bring them back to the point). but this one is so hilarious. he stuttered every 2 words. but luckily he still managed to cover the content points before the buzzer rang. this one i actually pity him and be nicer abit to him :D

2. the consultant looking doc
he looked like he has a certain age and calibre with his white hair, consultant body shape ( not very slim >_<) and also his coat but he didn't do really well. i think partly becuz this stn requires knowledge of OZ psych system (something as " Mental Health Act") 3. the very happy doc a china guy.... oh my...he look so happy & relac. keep smiling when asking me qn. haha i'm supposed to be depressed but .... i'm not that depressed in his case. i actually smile and shake his hand on his way. usually i don't cuz i'm supposed to be Acting !!! i'm such a dedicated actress 4. the fierce looking doc i'm not very happy with this one personally, she gave me a fierce look. COME ON, I'M SUPPOSED TO BE PSYCHO.... YOU CANNOT BLAME ME. after i refused to be admitted, she ignored me straight away and turn to the examiner ..... -_- as compared to this, another doc handled my unreasonability pretty well when i ask her not to be sucha busybody when she ask me how i hurt my hand. she is the best candidate for this stn.

5. The good ones
address my concern : which is my work issues. bonus: offer a solution: counseling (instead of juz hospital admission) but it's abit unfair as well cuz the instructions already contain most of my hx so most pple didn't go back to it again but went straight in telling me about my prob and that i need to be admitted.

6. Doc who gave me a label !!!
most of the doc said" Ms Lina, i think you have psychosis based on your hx and clinical examination". Even i'm SP, i felt damn OFFENDED wuay!!!. i would be either like " huh? what's that" or " i know wat's hallucination but i 'm pretty sure that i don't have that". but there this one doc i can see he is trying very hard to not to call me psychotic. only went i kept kacauing him then he tell me nicely that i have psychosis and explain it pretty well to me.

Critical Error: didn't admit me straight away or let me go home and take my stuff....

most doc will juz kept repeating that i need hospitalisation but none of them actually convinced me......
as a bad pt i will try ways to buy some time & trick them in not hospitalised me immediatly
1. simply just refused to be hospitalised
2. said that i can't skipped work cuz it's goin to make my workplace problem worse
3. said that i need to feed my cat first
4. said that i need to go home to take some stuff first
5. said that i will admit myself and ask for hosptial address

but luckily none of them fall for that. so becuz of the way the marking scheme is drawn out....it is actually very hard for the candidate to fail this stn as long as they don't fall for the critical error and manage to explain mental health act and management well..... the pt approach is not a major component under this marking scheme. according to the examiner, this qn was not drawn out suitably cuz knowledge on mental health act and psycho mx could well be tested in MCQ, not in clinical exam.

lilian was doing the same stn as me at another stream. her examiner focussed more on the scientific part such as mental health act blah blah blah. while mine is more towards pt approach: have they addressed my absence from work (MC), do i need company to go hospital, is my cat being fed at home while i'm away....

heard that they r goin to abolish the exam for those coming from UK and NZ

most doc look Arabish or South Americanish. but language wise so far so good....haha they can understand my asianish english :D

Bondi Hurricanes
*******************
Tuesday
try out free wifi in uni
and then met up juniors at bondi Hurricanes for dinner.

Phase II over and over

To my dismay, right after 1 - 2 weeks when my school started, i found out that i failed my portfolio....(one of the Phase II assessment). thus i was given around 1 month+ time to redo that with an additional assignment. Totally potong steam (kill my enthusiasm) for the surgical term.

During that period
i can't concentrate on both of my attendance of my surgical term and the portfolio thing
as often when back home fr hospital, i would be too tired to do anything but to shower, cook, eat, watch some tv, surf, stone and try to do some work on computer and fall asleep in front of computer with only 10% of work done by the time i got to bed it's 1-2am. have to reach hospital to go for ward round next morning at 730am, sacrificing my most efficient time of the day. it's like a bad cycle everyday....

and i have not been exercising for the whole 2 months as opposed to my everyday exercise routine during the hols. i lose all the muscles and gain subcutaneous fat. i can't justify myself to exercise when i have so much work yet to be done. i'm totally inefficient.

therefore i decided to take one week off to do my work slowly....
seriously i dont know how can i cope when in the future similar situation arises. i can't possibly juz take one week off work to deal with personal crisis right?!!!!

anyways, i juz wish that i can pass and wanna thank those who help me in one way or another

1. My friends: people who offer me their portfolio ( kitty, katherine, lilian, sarah, karli.etc)
as Terence would say, not many pple would offer their portfolio.... that's how the way it's like in this competitive aselfless world.

2. Assignment advisor-Dr S. Wong for guiding me through and reviewing my assignment despite his busy surgeon schedule.He gave me so much confidence in completing my assignment when i know the things i have written were on track, even when his reply is juz one sentence. when he saw me he would ask how's everything and am i ok. obviously he can see the gloominess and grumpiness looming on my face. Often I can't resist his always smiley face so i have to give back a forced smile and replied i'm OK.(I figure that's how the way it works in angmo country). The reassurance from his smiling face is priceless and luckily it's not the 笑里藏刀 type (dagger in the smile). 笑里藏刀is the type that will send chills down my spine.... u always see them in examiners........
i embarrassed myself by being too absent minded and forgot to attach my assignment in one of the emails.

i was fortunate to have one separate assignment advisor as compared to my other fellow colleagues. Dr Wong is one of the rare JEWELs in the hospital ( i shall explain the term jewel later)

3. Dr P.Harris for being my portfolio advisor. luckily i have 2 face to face sessions with him as i don't get what he meant in his first email review of my portfolio. meetin up with him where he guided me through step by step on each content point, probing me to think and giving me some constructive ideas really helps alot. i officially concluded that reviewing thru email where you have that special column on the side don't really help me much. this is becuz i always don't get wat they want from that 3 sentences remark. that was what happened during my first submission to Prof P. J. i should have arranged a personal meeting instead. I think Dr P Harris is the overall portfolio coordinator as i will see lecturers pop in to collect their share of portfolio to mark every now and then from his office.
Dr P Harris is incharged of medical education where he was in melbourne presenting to the rest of the world about this new system of assessment last week.
According to him, there are only the Brown's uni, USA; Calgary uni, Canada; Eastern ....Uni in UK that have the same system where Calgary is still pretty much still a traditional system.

4. Learning center language advisor, Helen. I had 3 meetings with her. again, she's like a confidence builder as well. though she's not the super frenly type but her help and patience are invaluable. but pity she was abit confused initially on how the assignment n portfolio work.

5. Sebastian the acute surgical team registrar- my supervisor for acute care attachment.
thanks for his kindness for letting me off. oso his encouragement on asking me not to give up. obviously he misunderstood lah, i m not goin to give up on medicine. but he meant well. he is another piece of JEWEL in this hospital. i always feel that these pple from overseas can relate to our situation better. He is from india. He is this layback and sleepy looking guy, can be grumpy sometimes but man his clinical judgement is good and confident (lotsa overseas doc though older and more experience but hold lower position then the OZ pple as they have to retrain from bottom again)

6. Joan for being my IT support when my connection was so shitty last minute. She helped me hand in my portfolio all da way from Melbourne :D my portfolio file went detour leh >_< She oso pop in once in a while to chat with me,l scold me for watching tv, listen to me complain and complain to me in return.

7. LAST BUT NOT LEAST, my fellow comrades who offer encouragement and advice every now and then :D we shall have a celebration after all these k? Malaysian BOLEH!!!! and juz a random note, hopefully malaysia system will improve after this election. if not for all these people, i will be

as lost as a dandelion 蒲公英 in the middle of Sahara Dessert.
"You are strong but you have no idea where to go........."
Now the lost dandelion has the help from different elements,
oasis is not far from sight anymorei believe i can pass as far as i can remember i haven gotten any weird dream that i fail as last year i dreamt that i fail which actually came true. some of my dreams are like premonition of my future - be it significant or insignificant. i always experience the phenomenon of DeJaVu

SURGICAL TERM
******************

Now in year 5, i finally feel that i'm doing real clinical stuff. and why only now??!!!!!!!!!!!!!
my surgical term is coming to an end soon. this coming week is the last to go.

As i have mentioned previously, i was a bit lost with cardiothoracic. i am obliged to stand in cardiothoracic surgeries as only right after 3rd week into the attachment i realised that there isn't much ward stuff goin and the only way to let my supervisor know my existence is to be in the theatres. there is not much i can do in the theatre but juz STAND and WATCH which eats up lots of time and energy too. by right, i can try stitching up the leg. but there are the eager training surgical registrar and resident hogging the place and refuse to juz let me to have one chance of touching the forceps. :( . i promised that i wldn't be like that in the future. just one chance will be enough to make a medical student's day. same thing happen to my fren in colorectal, there is simply no space for her to even watch when the pt has 3 pple: fellow, reg and intern peering over in his abdomen. anyway, i do learnt something by observing the surgeries.

in cardiothoracic, i have found another piece of Jewel - Sub (a cardiothoracic fellow from India) . he is this humble guy who is helpful and willing to teach.
when into the acute care, i try to keep track of the pt under the care of the team. it's way too ambitious to take a hx from all of them. but at least i know what's goin on with their conditions and management. the 2nd week is the time i took off. i came back on 3rd week, feeling more energised and directed. i managed to assist in an appendicectomy when sebastian offered me to.
luckily in the team there is only one reg, one senior resident. i hope that my colleague who is doin the same attachment wldn't think i'm depriving her of her chance...

you see.....that's wat is happening around. competition everywhere for a chance of exposure and training.

JEWELS
*********

there are the existence of nasty/not so frenly/welcoming pple but the nice people that I met once in a while is what keeps my hopes up that is why i call them the "JEWEL" in my medical encounter dictionary. mayb i shld get some medical terms to describe the rare jewel instead eg. phaeochromocytoma >_<

1. Dr Wong who is not hesistant to flash his megawatt smile to even students like me

2. Sebastian- who let me tag along him even during his worst time when his resident FFK him during low activity day

3. Sub- who is a rare Jewel amongst the overeagerness of other people. he is willing to teach even my knowledge is like shit.

4. Sam- the cardiothoracic ward assistant who always say hi to me and offer me biscuit and milk juz when i was hypoglycemic. she is one of the rare few who actually respond to me when i smile to her. some pple juz sorta ignore you mayb becuz they r shy or they think you are too insignificant.

5. Kevin - a resident who patiently taught me ABG and cannulation which i found very comprehensive (when my own resident MIA).the ultimate time is when he took 3 med students thru ABG (ABG + students = multiple tries = time consuming). he also told me how to deal with distress patient. He has this stereotypical outlook of a doctor: tall, confident, guy.

i juz hope that this world is not too judgemental in terms of appearance. Else it will be to my disadvantage: i am a girl, i'm a asian, i'm short ....... so do i look like a doctor? >_<

GREETINGS
*************

one thing i found interesting in angmo country is that their
"how are you" = "hi"
actually, i dont' see the point of asking "how are you" this way when everyone is juz answering" fine, thanks" without even looking at you. you might as well juz say hello, hi, elo, yo or even wassup!!!
that is when i was glad when i asked "how are you" to one of the jewels, he actually indicated that his day is not too good....tt's the way mah... not good means not good lah, why answer the standard "fine thank you...." total fakeness.

unfortunately, i 'm part of that fakeness as well as i answered "i'm good. thank you" to dr wong as i don't want him to worry. *grinz sheepishly*

CRITICISM
************

one of the unpleasant things was during the my oral presentation with dr H. He kept interrupting and didn't even let me finish my presentation cuz i was too lousy. it is a total demoraliser. i know i'm not good but please at least let me finish mah.... : ( in the end he ended up presenting for me. i know he meant good but i juz don't like this approach. Anyway, i guess the seremban folks have many more such unpleasant encounters than me. mayb one year being angmo country has sorta blunted my toughness to this kind of criticism. cuz angmo country always give mild comments. For eg. fellow colleagues who did something badly even i as a medical student oso don't think warrant the standard but then the doctors will comment oh " not bad not bad" -_- this kind of cocoon has its pros and cons. i think that you need to strike a balance to let the students to know what's wrong yet not to be too demoralised.....

Gambate for my last week of surg!!! Gonna miss it.