Exams, again

We have our exams this week for O&G. They consist of a long T/F paper, and two OSCEs where we are given a fake patient (who can be male and is also the examiner and an O&G physician to boot!) in a structured assessment situation.

I'm mildly nervous, but much less than I would have been a year ago. We have been through so many exams in the past few years that it seems so mundane and normal.

The thing that is starting to weigh on my mind is internship. I have two lots of rotation exams (including this one), one elective rotation, one MSAT at the end of it all, and then I am technically a (junior) doctor.

In studying for these exams, I keep seeing myself actually being in these situations in a year or so. This is helpful for study, as it really makes it stick, but on the flip-side it is also scary.

Quite a lot of girls I went to highschool with are now experienced nurses in the system, with over ten years on the job. I have lost contact with them over time, but it would be very strange to interact with them in a work situation, particularly as a junior doctor. I actually think that most of them would be good to work with, and if things get uncivil, we can threaten to show the rest of the staff pictures of each other in dreadful 90's garb and fluffy hair. ;)

I'm also possibly going to be doing internship at the hospital where I have worked for years in my previous profession, which will also be odd. On the bright side, I have a good reputation there in my other role, so hopefully that will make the transition a bit smoother.

I have worked and studied in the same corner of the world for my whole uni and working life. As Mr TGWTBS has said, it will be a bit of an adventure if and when we get to go elsewhere, in the not-too-distant future.

Exams and Shoes and Empty Thoughts

The Exam went as well as was expected.

I'm not sure whether it was because I finished last year on Surgery rotation, which had notoriously difficult exams, or whether this exam was designed for everybody semi-competent to pass, but it was not bad at all.

Honestly, I think it was a bit of both. Some of the questions were so easy that it was shocking. Of course nobody is complaining. We have been through too much in the past few years to look a gift horse in the mouth.

My registrars questioned me a lot during this rotation (I didn't mind), and it REALLY paid off during the exam. I knew things about areas that I hadn't covered on this rotation because they asked me about things outside of the area that we were working in. I felt very lucky to land in such a helpful, proactive team.

I did not buy a pair of stomping shoes just yet. I'm contemplating buying a pair of Docs (then I can rename my blog Doc in Docs after I graduage - bwahahaha, that is awful!) but don't know if I can go that far into the realm of Stomping shoes. I love pretty shoes, but they keep falling apart, and Docs would be so much sturdier and comfortable.

What do you think? Perhaps I should buy a pair with flowers all over them - that would be more feminine, right? ;)

I also think that today will involve cooking. I haven't made a good old-fashioned spaghetti-bolognese in a while, but I have all of the ingredients in the fridge right now (apart from the mince, which isn't hard to procure). Tonight will be a little cool, so it will be a good evening for spag bog and a movie! Normally it would also involve a glass of wine, but I haven't touched a drop since FebFast, and am feeling great. The wine will have to go into the spag bog instead.

I would like to imagine that the lack of alcohol made this exam ridiculously easy for me, but then that would just be deluded. ;)

Stomper

One more hurdle and then I am finished with the first rotation of fourth year - The Exam.

If it weren't for the excitement over what this exam means in relation to my planned escape from medical school, it would not warrant the capital letters. You see, it is an exam that is about anything and everything, and thus it is almost impossible to "study" for. Thus, we are all experiencing Learned Helplessness and are suitably apathetic. I am more nervous about the drive in the morning traffic than the exam itself.

The learning has happened over the last three and a bit years (including all of the seemingly random cellular physiology from first year) and if it isn't in our heads now, then we won't know it.

My main aim on this rotation was to focus on the things that will make me a safe and competent intern. I think I have achieved this as much as possible given the circumstances. If I happen to pass the exam (which is fairly likely, unless they happen to base the whole thing around the fine details of the krebs cycle) I will be happy.

I have the afternoon off, which is something I am very excited about. The afternoon may involve shoe shopping. They will be Sensible shoes, particularly because I have managed to demolish three pairs on this rotation by wearing out and detaching the soles. The new shoes will be solid and suitable for stomping. Solid stomping shoes don't lose their soles after 8 weeks of walking.

So here is to finishing the first rotation of year four, and new Stomping shoes!

Surgery Rotation - End of Week 4

Surgery rotation is going well. We are being involved and learning things.

I'm glad that I already have skills like cannulation and phlebotomy under my belt from earlier in the year, as it is one less thing to be concerned about learning.

We are also at a slightly smaller hospital, so we get to scrub in and assist the registrar from time to time. I can actually enjoy a little bit of scrubbing in and assisting. After a while it wears thin, but I think I'll be alright with a bit of it in the next few weeks, and then maybe again when I'm an intern and need to help out.

There is nothing much new to add. I'm still trying to learn a lot (well, enough to get through) and work hard, because we have a lot to do during the week.

Today I helped out in preparing some second years for their MSAT exams (Multi-Station Assessment Task) and took part in a mock exam. It was quite fun and it really sank in just how far we have all come in the space of a year.

The students weren't bad (a few of them were lacking in confidence) but you can see that they REALLY need personal attention and teaching from people who actually know what they are doing. It is one thing to learn a technique from a list on a piece of paper, and another to actually see that technique demonstrated by an expert.

This is just the way medical school works. You spend the first two years learning the theory behind things, and then you get to see it in action and try to understand how it REALLY works in the following two years.

I always think that it is unfair when people expect you to know something that you haven't actually been taught, specifically when these things are practical skills that you can only learn when somebody who knows what they are doing passes these skills on.

One of the problems with the massive increase in class size in medical schools in this country is that we aren't getting the personal attention that we could have received in previous years. It just isn't logistically possible.

This isn't so bad when it is in the first couple of years of medical school, but the potential for there to be so many interns, residents and registrars that we don't get proper teaching is there and it is a horrifying thought.

My fingers are firmly crossed that it doesn't come to that, but you can't have a huge leap in graduate numbers in such a short space of time without the system failing at some point. I still think I'm ahead of the biggest increase in the next couple of years. Fingers crossed.

Medicine Rotation Exam: The Aftermath

Hmm, that was an . . . interesting experience.

My long case went okay, and I am pretty sure that I passed it with a clear margin. I really like interviewing people and can get a bit out of them because I try to listen actively, and repeat what they have said so that we are clear on their details.

The short cases are a little harder to predict. One was an upper limb neuro exam, I picked that there was something going on with his co-ordination so asked to jump straight to that because we only have a short amount of time, and they said that was fine. I worked out that it was a cerebellar lesion, but didn't pick the cause in this fellow. (It was MS. I hadn't seen MS in a patient before, so it makes it difficult.) I guessed alcoholism or trauma. (I have seen Wernicke's in a 29-year-old before, so it isn't out of the picture completely.)

The second case was an abdominal examination, which I would normally be happy with, but this fellow's abdomen was so incredibly distended with something (possibly shit or fat) and he had guarding and tenderness, so it was hard to really feel anything. I faffed around a bit, managed to mistake some fat/poop for the liver edge until I percussed, found an abdominal wall hernia, found splenomegaly, faffed around a bit when they asked how to tell the difference between the spleen and the kidney, but got the causes of splenomegaly and this specific cause in this patient.

I feel like I didn't do the examinations as smoothly as I could (when under stress . . .) and that I ummed and awed a lot. They were not the easiest exams (particularly the abdominal exam). Another one of the students saw the same patients as I did and is convinced that he failed, too.

On the bright side, if we all do badly, then they will review our results if we failed. :( The third student on the rotation is quite talented at this area, so he will do better, I think. (He is a really bright spark who specifically wants to be a physician, and will be really good.)

Unfortunately I don't find out whether or not I passed until a few weeks time, when I will be far, far away (7 hours drive) on my rural rotation. On the bright side, if I have to repeat any part of the exam, I am at a hospital so there will be plenty of opportunities to short case practise.

Fingers crossed!

Edited to add: the word is that we all passed. Hooray for holidays!