Random Articles in the Internet: For Future Doctors: What if …?

For Future Doctors: What if …?

 First of all, I would like to wish everyone a very Happy New Year 2011. It has been a while since I last posted anything on my “For Future Doctors “series, the last being on “Housemanship Glut”. I have been observing all the comments and enquiries that were posted in my blog regarding my articles. I had many interesting questions by medical students as well as houseofficers regarding their future prospect in medicine. I thought of answering some of these queries’ in this posting.

 What if I quit Housemanship?

I had a couple of housemen who asked me what will happen to them if they quit housemanship and what the other options are. According to Medical Act 1971, a medical graduate has to complete 1 year housemanship in order for them to receive their full registration under the Malaysian Medical Council. This has been increased to 2 years since 2008 (officially). I am not sure whether it is legally binding as the Medical Act 1971 has yet to be amended.

What will happen if you quit housemanship? The answer: You will NEVER be able to practise as a doctor anymore. If you quit housemanship, you will not get your full registration which means you will never be able to practise legally. Thus, whatever you have studied over the last 5-6 years is just a waste. It would have been better if you had decided much earlier that medicine is not your field and switch course during your undergraduate period. There are 2 parties to blame here, yourself and your parents.

Basically, you need to find another job or undergo another undergraduate training in another course. One of the person who wanted to quit housemanship asked me whether she can do Master’s programme in preclinical studies such as Physiology (Master’s in Medical Sciences) or Anatomy and subsequently become a lecturer. The answer is yes and no. Of course you can but in order for you to get a place for Master’s programme in Malaysia, you must be in service. You must have undergone at least 3 years of service with full registration and need recommendations from Head of Department as well as good SKT marks before being able to apply for the programme. As such when you quit housemanship, this is NOT possible especially when our Master’s availability is very much limited with high demand. Probably you can try overseas universities but however, the degree offered must be recognised in Malaysia as a postgraduate degree.

 Can I join Pharmaceutical companies? Again it is a possibility. In fact, with oversupply of doctors in Malaysia in a few years’ time, we might be seeing a lot of medical graduates joining pharma companies to get a job. Sometimes, pharma companies also need you to have full MMC registration in order to join them.

 Can I become a Lecturer by just holding a MBBS? The answer is NO. As I have said before, medicine a very peculiar field. If you are an engineering graduate, can’t find a job, you can be made as a lecturer if the university wants to. Of course an engineering graduate without field work is going to be a useless teacher but who cares in this Bolehland. I have seen so many engineering graduates who have become lecturers the day after they passed out! No wonder we have so many buildings collapsing. I also have seen many engineering graduates becoming school teachers. But for medicine this is not possible. Only doctors with postgraduate degrees are allowed to become lecturers, internationally and of course you will never be accepted as school teachers. But, who knows………………… in Bolehland anything can happen.!

 Usually, my general advice to whoever decides not to continue as a doctor is to at least complete your housemanship, whether you like it or not!

What if doctors become jobless in the next 5 years?

Random Articles in the Internet: For Future Doctors: Housemanship, Medical Officer and Postgraduate Training

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 1)

I received more than 10 000 visitors to my blog posting on “The General Misconception of Doctors Part 1 & Part 2” since 08/09/2010. I also had many comments supporting my article. Surprisingly, most of the comments were from medical students and young doctors who just started housemanship or just completed. I also had some overseas doctors giving their comment, not sure whether they are Malaysians or ex-Malaysians?

Even though many supported my articles, I also had few asking me to tell them what is in store during housemanship and postgraduate training in detail. Thus I thought it is about time I give them the full detail, to my knowledge, about the current and future situation in Malaysia. There was a person who asked me to write some positive aspect of being a doctor. Well, I only have 1, a total satisfaction of treating a patient till recovery. But always remember, you can only cure sometimes. I have had a medical student who refused to go to the ward after seeing a young boy dying of Leukaemia. Well, this will be a daily affair once you set foot into the medical field. Be prepared to see people die no matter what you do. To comfort always but to cure sometimes should be your motto!

1)      Housemanship

I will divide this section into 3 subsections, explaining what has been happening since 1990s in housemanship training;

1a) Before 2000

Before 2000, the housemanship training use to have 4 monthly rotations in Obstetrics & Gynaecology, Medicine or Paediatric and Surgery or Orthopaedic. After the 1 year training, you will be transferred to rural or semirural areas to serve in district hospitals or Klinik Kesihatans (KK) (health clinics). Most of the time, these rural postings are a wonderful experience but a little bit scary due to lack of senior people to consult or assist you.

One of the major faults in this system is the fact that if you do Medicine, you will miss Paediatric and if you do Surgery, you will miss Ortho. Only O&G was made compulsory. Thus, the government felt it was inadequate. Many will go to KK and District Hospitals without doing Paediatrics/Medicine and Orthopaedics/Surgery. A lot of the time, you need to depend on the senior nurses or Medical Assistants (MA). I must say that during that time, the nurses and MAs were excellent. They were second to doctors, not to be compared with the current generation of nurses and MAs.

BTW, just to mention, the HO’s take home salary before 2000 use to be RM 1648!! Pathetic isn’t it? You won’t even be able to buy a car/house. The car loan interest rate than was 6-8%! You will get RM 20 for each on-call that you do! This “On Call” allowance was only introduced in 1994. Prior to that, you are not paid a single cent for your “On-Calls”, free labour for the government mah……………..

1b)  After 2000

Around the year 2000-2002, a new posting known as junior medical officer postings was introduced after housemanship. This is also known as the 4^th and 5^th HO posting. It was 3 month posting in either medicine/paediatric or surgery/ortho depending on which that you did not do during the 1 year housmanship as above. After completing the 4^th and 5^th postings, you will be posted to rural or district as a Medical Officer.

1c)  Since 2008

Since 2008, housemanship training has been extended to 2 years. This means you will be completing all the major postings before being transferred out.

2)      Life as a Houseofficer (HO)

When I did my Housemanship in 1990s, there were only 2-3 HOs in each ward of 40-60 patients. It was a tough life.  You are the front liners who will see the patients for the first time upon admission. You’re supposed to take the medical history of the patient, do a physical examination, take blood investigations and come to a diagnosis. In fact, you’re supposed to start the initial treatment and management of the patients. There won’t be any medical officers or specialist in the ward. Most of them will come only in the afternoon to see the patients. This means, you’re the boss in the ward and the life of the patient is in your hands! It is a very stressful life, where on top of all the existing patients in the ward, you also need to see all the new admissions. The new admissions can be about 20-30 admissions/day, divided between each of the 2-3 houseofficers.

You start your work around 7.00am everyday especially if you are doing medical or O&G postings by taking the ward patient’s blood. Then, you will be doing the clinical rounds with the Medical Officers and Specialist of the ward. After finishing the rounds, you need to carry out all the orders by the specialist and at the same time, clerk all the new admissions! You also have to run down to radiology department to get urgent appointments, go to the blood bank to get urgent bloods, trace results urgently etc etc. Of course, you may not finish your work by 5pm. If you are “On Call” on that day, you need to con’t your work throughout the night till the next morning 8am. And now, don’t think you can go back to your room and rest! You are supposed to con’t with the work on the next day as usual! You are basically a professional coolie!

As a HO, you need to do at least 10 calls a month, which means once every 3 days. I have even done continuous day calls before, never saw sunlight for 2-3 days! For each calls, we were paid RM 20 then, now it has gone up to RM 100 since 2006 ( please read my MMA article on “Government doctors: Past, Present and Future”). I use to say that you can earn better by working in Mc Donald’s!

Whatever said and done, I enjoyed my Housemanship simply because I had good colleagues who helped each other very well. I also enjoyed learning all the skills and procedures during my housemanship. Housemanship is the only time where you can learn all the necessary skills in doing procedures like CVP line, Chest tube, Peritoneal Dialysis etc etc. Thus, as I said before, if you became a doctor for passion and to help people, then you will enjoy housemanship. But if you choose medicine for glory, good life and money, it is during this time that you will realise that medicine is not for you. That’s the reason why, many will get a mental breakdown during housemanship. They never expected their life to be like this! Many still think that being a doctor is sitting in a clinic and seeing “cough and cold” cases. Being a doctor is more than that.

Of course, the situation has changed recently. With the tremendous increase in the number of doctors produced, we have almost 6-8 HOs in each ward of 40 patients. In fact, surgical department with 2 wards, sometimes has more than 40 HOs!! The workload will definitely be lower but you will lose out in your training. How many procedures would you be able to learn with so many of you in a ward? I have even seen some HOs leaving the medical department without doing a single CVP line or Chest tube. Only those who are eager to learn will succeed. The rests are just given a license to kill… Sorry to say!

3)      Rules and Regulation during Housemanship

There are few rules and regulations that you need to know as a HO. You will be given a log book for each posting. This log book needs to be signed off at the end of each posting by the department. The Head of Department (HOD) has the right to extend the training if he/she feels that you are not competent enough to be released. The extension is for a minimum of 3 months but can go on as long as the HOD feels adequate. Unfortunately, many of the HOD take the easy way out. No matter how incompetent the HO is, they usually let them go as they feel that it will not make any difference in extending their postings and of course less problem to the department. To me, I think it is very selfish for some of the HOD to think like this. Remember, these doctors are the one who is going to be released to the community with a “license to kill”.

As a government servant, you will be given 25 days annual leave. As a HO, these 25 days will be divided equally between the 3 postings that you do in a year. Any extra leaves including MCs, maternity leave and emergency leaves are considered as an extension of housemanship training. For example, if you take 1 week MC during a medical posting, your medical posting will be extended by one week, unless you want to deduct your annual leave allocated for that particular posting. This is one of the reasons why I always advise doctors/soon to be doctors not to get married during housemanship. Pregnancy will not reduce your workload as you need to do the same number of calls with the rest and it will only extend your housemanship even longer.

Random Articles in the Internet: For Future Doctors: General Misconceptions of Being a Doctor

For Future Doctors: General Misconception of being a doctor (Part 1)

Over the last few months, many budding doctors have contacted me to ask about the future prospects of doing medicine. Of course I gave them a depressing night after informing them of the current and future prospects of doctors in Malaysia. During these discussions I realise that many of these people do not understand a lot of issues surrounding the field of medicine. Thus I was obliged to write this article to wake up these people from their dream of “guaranteed” life if you were to become a doctor!

1)      Guaranteed Job and Good salary/can make money

 Many parents still believe that being a doctor guarantee their children’s future. Well, it may be so before but not in another 5-10 years time. You can read about these issues in my MMA articles column. 20 years ago we only had 3 medical schools producing about 400 doctors a year but now we have almost 30 medical schools in the country (the highest per capita population in the world). Last year alone, almost 4000 new doctors started housemanship in Ministry of Health (MOH). The number will further increase in coming years when all the medical schools start to produce their graduates. I believe it will reach a figure of 6000/year by 2015.

This is where issues arise. Even now, the MOH is struggling to place these doctors in various hospitals in the country. We have almost 30-40 houseofficers in each department now not knowing what to do every day. Their training is compromised and they are being released after that without proper training with license to kill! I may sound negative but this is the reality. Even district hospitals are being used to train houseofficers now, starting 2010. As you would have read in the papers recently of parents complaining that their child has been transferred to East Malaysia after completing housemanship, it is a known fact that the shortage of doctors at this point of time is in East Malaysia. As our MOH Director General had said, most doctors will be sent to Sabah and Sarawak from this year on wards.

What’s going to happen in the next few years? Again, my prediction is, there will be surplus of doctors by 2015. There will more bodies than post in MOH by 2015. Doctors most likely will need to queue up to be posted in government service.  You will be sent to rural and East Malaysia to serve. Any appeal will not be entertained. If you think this would not happen, please look at the nurses! 5 years ago, the government began to approve numerous nursing colleges due to shortage of nurses. Now, we have surplus of nurses without any jobs. I know of nurses who are currently working in petrol stations! BTW, the MOH is currently considering introducing common entry exams for all medical graduates. Only those who pass this exam will be given housemanship post. This will happen soon.

Furthermore there may be a pay cut for doctors when all the post are filled. One of the allowance known as critical allowance of RM 750 will be removed once all the posts are filled. Critical allowance is never a fixed allowance and is usually reviewed every 3 years. As you know, the pharmacist’s critical allowance is going to be removed if not already. 

I had one budding doctor who said that the reason she wanted to do medicine is because it is the only field where you have a guaranteed job and a starting salary of RM 6000. Well, I have talked about guaranteed job issue above but she is definitely wrong in stating that the starting salary. The starting salary of HO has gone up over the last 5 years; no doubt about it (please read my MMA article). However, the starting salary of HO currently is about RM 3500 to about RM4000 after including the on-call allowance. Remember, your salary only increases about RM 70/year. You will only reach a salary of RM 6000 after 7 years of service as a medical officer, when you are promoted to U48 according to current promotional prospect in civil service introduced end of last year! BTW, other than the difference of critical allowance, a doctor’s salary is only RM 200 more than a pharmacist in civil service!

 2)      Medical degree recognition

 If I can’t work in Malaysia, I can go to Singapore or Australia to work, right?

Again, another misconception. Many do not know that medicine is a very peculiar field and cannot be compared to any other profession. In order for you to work in another country, your degree needs to be recognised by the Medical Council of the other country. If it is not recognised, you would not be able to work there. For your information, only UKM and UM degrees are recognised in Singapore.

Almost all medical degrees from Malaysia are NOT recognised elsewhere.Malaysia Boleh mah! Only Monash University Malaysia’s medical degree is recognised by Australian Medical Council and thus you would be able to work in Australia/New Zealand. Some of the private medical colleges do twinning programmes with external universities from Ireland/UK/India etc. These may be recognised depending on which degree and where you graduate from. 

3)      Housemanship & Compulsory service

I have mentioned a little about housemanship above. As you know the housemanship has been extended to 2 years since 2008. Even though it is good for your own training but it does prolong your future postgraduate training. After Housemanship you have to undergo another 2 years of compulsory service before you decide to resign for private practise or pursue your postgraduate degree. It is during this compulsory service that you will be posted to anywhere in the country.

 Furthermore, housemanship is not an easy posting. Even though the numbers of HOs have increased tremendously over the last 2 years, it is still a very exhausting job. Many have had a mental breakdown during housemanship. I just heard of a houseman who is on psychiatric MC for the last 2 months! It seems she thought that being a doctor is just like sitting in a clinic and seeing cold cases (probably she thought she can become a GP immediately!)

4)      Hard work and post graduate training

 20-30 years ago, being an MBBS holder itself is good enough. You can easily open a clinic and become a GP and well respected by the community. But things are changing. Even GP practise is a speciality by itself in many countries (Master in Family Medicine/FRACGP etc). Malaysia is also moving towards that. Many patients are demanding and would prefer to see a specialist directly nowadays.

 Thus it is important that when you join medicine undergraduate degree, please be prepared to continue your education for another 10 years after graduation! In order for you to complete your postgraduate education, it will easily take another 10 years, assuming you pass all your exams in one try! So, don’t assume your education is only 5 years! MBBS do not mean anything now, in fact it is only considered as a diploma!

 Getting into postgraduate training is also becoming increasing difficult. The number of places for Master’s programme is very much limited in local universities. The demand is greater than supply and of course don’ forget the quota system as well! Other than MRCP (UK) – internal medicine, MRCPCH (UK) – paediatric and MRCOG - Obstetric, you have to depend on local master’s programme for your speciality. Thus, you have a very limited option. With such a big number of doctors coming into the market now, I can assure you that getting a place for post graduate education is going to be a major problem in 2-3 years time! Be prepared.

Random Articles in the Internet: Clinical Electives

Medical Student Electives in Malaysia

Malaysia is a tropical country with beautiful beaches, islands, old rainforests, various muliracial delicous foods, and a multiracial country that will definitely make your elective experience a memorable and wonderful one.

The University Hospitals, Government Hospitals (under the Ministry of Health) and some private hospitals accept attachment and elective application by undergraduate medical students. They are as following:

University Hospitals:

1. Universiti Malaya Medical Centre (UMMC) - click here for application form

2. National University of Malaysia Hospital (HUKM) - http://www.hukm.ukm.my

3. Universiti Sains Malaysia Hospital (HUSM) - http://www.medic.usm.my/elective/ 

Government Hospitals (under Ministry of Health) 
Kuala Lumpur- Capital of Malaysia:
1. Hospital Kuala Lumpur (HKL) - http://www.hkl.gov.my/ (total bed no: 2331)
2. Hospital Putrajaya - http://www.hpj.gov.my/ (total bed no: 272)


Penang - Pearl of the Orient, the "Food Heaven of Malaysia"
3. Hospital Pulau Pinang (Penang General Hospital) - http://hpp.moh.gov.my/ (total bed no: 1090)
4. Hospital Seberang Jaya - http://hsbjy.moh.gov.my/ (total bed no: 314)


Melaka- Historical City of Malaysia: 
5. Hospital Melaka (Melaka General Hospital) - http://hmelaka.moh.gov.my/ (total bed no: 901)


Selangor: 
6. Hospital Tengku Ampuan Rahimah, Klang - http://htar.moh.gov.my/ (total bed no: 893)
7. Hospital Selayang - http://hselayang.moh.gov.my/ (total bed no: 852)
8. Hospital Kajang - http://hkjg.moh.gov.my/ (total bed no: 306)
9. Hospital Serdang - http://hserdang.moh.gov.my/ (total bed no: 630)
10. Hospital Ampang - http://hampg.moh.gov.my/ (total bed no: 562)
11. Hospital Sungai Buloh - http://hsgbuloh.moh.gov.my/ (total bed no: 620)


Perak:
12. Hospital Taiping - http://htaiping.moh.gov.my/ (total bed no: 608)
13. Hospital Raja Permaisuri Bainun, Ipoh - http://hipoh.moh.gov.my/ (total bed no: 990)
14. Hospital Teluk Intan - http://htintan.moh.gov.my/ (total bed no: 548)
15. Hospital Seri Manjung-Lumut - http://hsmanjung.moh.gov.my/ (total bed no: 270)

Random Articles in the Internet: Tips for Surviving Medical School

Remember when you were a premedical student in college? It seems like a century ago for many of us who have just completed the first year of medical school. It feels that way because our lives have changed dramatically. Normal life seems to have vanished, and suddenly, 24 hours in a day are not enough to get through the enormous volumes of information that we are expected to learn for every exam. It seems virtually impossible. We barely have time to eat or sleep.

Medical school is not the end of the world. Take it from us, 2 students who have been there, when we say that medical school is what you make of it. Do not let medicine define you; instead, you should tailor medicine to your lifestyle. Otherwise, you might become overwhelmed by the demands of your new life and lose the sense of why you chose medicine in the first place.

How do you survive medical school? From the beginning, time management must be a major priority. If you can manage your time successfully, you can still enjoy your life to a certain extent. Studying in med school is not the same as it was in college; this is a new world where you have to explore different techniques and find what works best for you. In medical school, it is all about studying smart, not studying hard. If you don't know this at the beginning, you will learn it the hard way.

Studying medicine is a long process and demands a great amount of discipline and sacrifice. But the reward is priceless. We hope that you chose medicine for the amazing field it is: the rich opportunities it provides for helping humans and the avenues it opens for making a difference in the world. The following are some of the most common pieces of advice we have collected:

1. Take care of yourself. You may face long-term negative consequences to your health if you adopt negative behaviors. Do not deprive yourself of healthy, fresh food. Do not ruin your health by eating fast food and avoiding exercise. Do not pull all-nighters and deprive your body and brain of sleep; the consequences are too severe for what may be only 15 minutes of productive studying. Your brain needs fresh food, water, fruits, and vegetables. Your body needs exercise and sleep.
2. Do not compete with your classmates or compare your grades with others. We all had to be competitive to get into medical school. But once you are accepted, it becomes a level playing field. Although many students still compete with their classmates, it will not make them better physicians. Getting a 95% on your pathology exam does not mean you will be a great pathologist or clinician. As soon as you walk out of your first exam, look around, and you will see people obsessing about what the right answer was for Question 13. It is easy to spot them. They will come to you and ask you if you put "C" for Question 84. Seriously! Avoid everyone after the exam, and make friends with those who share your philosophy.
3. Answer practice questions while you study. "Studying my notes 10 times is probably the best way to prepare for exams." Wrong! The only way to test your learning is to do practice questions. For example, after studying your Board Review Series physiology textbook, make sure you complete the questions at the end of each chapter. This will help solidify the concepts you just read. Studying the same thing repeatedly does not make you smarter, but getting a question wrong will teach you quite a bit. Professional educators will tell you that it is statistically proven that students who do more questions perform better on boards, and that the only time you should go back to the big books is when you consistently miss questions on a certain topic and the answer explanations are insufficient.
4. Learn the big picture. You will likely start your first day in school delving into biochemistry, anatomy, physiology, or histology. From the start, instructors talk about columnar cells, impulse transmission, and glycolysis in fine detail. The next day, you are learning about brachial plexus and cardiac output. This is an enormous amount of information overload and students are often not prepared. As you memorize, learn the big picture
5. Study with groups. "I am going to study on my own because I don't need anyone's help." Wrong! Medicine is all about teamwork and sharing information. You have to be able to cooperate with others. Even when you apply for residency, it is important to keep this concept in mind. The moment the residency directors feel you will not be a good team player or that you might have "issues" with your colleagues, your application goes in the shredder. Find a small group of people who share the same healthy habits as you, meaning they like to exercise, they do not like to discuss grades, and they have a positive attitude. Once you find the right group, arrange to meet weekly for several hours to ask each other questions about concepts you do not understand. Even better, ask each other questions on little details you think your friends might have understood. Arrange for a review session the night before the exam for last-minute tweaking of your knowledge.
6. Take time to engage in stress-relieving activities. Everyone in your class is facing the same amount of stress, some people more than others. You might notice some students walk around with a frown, whereas others wear huge smiles. How is that possible if they are all facing the same pressure? Again, it is time management. If you have extra time, you are able to reduce stress. Spend time with friends, or do something on your own that makes you feel better. Activities like exercise, yoga, listening to calm music, talking to your parents or praying -- there is something out there that makes you feel better. Find it and do it. Do not let the stress affect your studies, relationships and, most importantly, health.

Finally, and we cannot emphasize this enough, remember that we are joining a great profession. Be passionate about what you are learning! Medicine is a treasure and an art. As Henri Amiel said, "To me, the ideal doctor would be a man endowed with profound knowledge of life and of the soul, intuitively divining any suffering or disorder of whatever kind, and restoring peace by his mere presence."

Note: This was adapted from a book manuscript in the publication process, How to Prepare for the Medical Boards – Secrets for Success on USMLE Step 1 & COMLEX Level 1, by Adeleke T. Adesina and Farook W. Taha.

Article taken at 11/03/11 from http://www.medscape.com/viewarticle/736773

Random Articles in the Internet: How Should I Deal With Gunners?

Question:

How do you deal with a classmate who is a gunner? Is it something that I even need to worry about?

Response from Sara Cohen, MD Fellow, Department of Physical Medicine and Rehabilitation, Harvard University, Boston, Massachusetts; Fellow, Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, Massachusetts

During one of the first anatomy labs in medical school, I was approached by the professor. After he examined our dissection of the abdominal cavity, he reached his gloved hand deep into the cadaver and spoke to me for the very first time as he pointed at a blood vessel. "Sara," he said, "can you tell me the name of this artery?"

I was pleased because I knew this one. I opened my mouth to answer the question, but before I could get a word out, my lab partner piped up, "The gastroepiploic artery."

I was shocked. The professor had clearly addressed the question to me. He used my name and he was looking right at me. There was no way that could have been misunderstood. Why would my lab partner yell out the answer to a question that was obviously not directed at her before I even had a chance to speak up?
It turned out that this was my first experience with a "gunner."

The definition of "gunner" varies depending on who you talk to, but it generally refers to an especially competitive medical student. Every medical school class has at least 1 gunner, and usually many more than that. Some people use the term to refer to students who study much more than average and are especially concerned with grades. However, the term may also be used to refer to medical students who exhibit behavior that is either borderline unethical or even blatant cheating.

Gunner behavior in the preclinical years that is borderline unethical includes (to name a few) hoarding study materials, making comments in front of professors that are meant to make the gunner look smarter and other classmates look unprepared, and dominating small group discussions. More malignant gunner behavior includes ripping pages out of textbooks in the library, sending out erroneous study materials to the class, or even cheating on examinations.

As a medical student, you will almost certainly encounter a gunner classmate at some point. (If you don't, the gunner might be you!) Many specialties have become very competitive, which puts pressure on students who want to match in these specialties to be at the top of the class. If a gunner is making you feel unprepared or making it difficult for you to learn, the easiest approach is to avoid him or her in an academic setting. If you have a study group, make sure it only includes classmates who are conducive to your learning, rather than people who are trying to top you or make you feel insecure. Just because a classmate is your friend, that doesn't obligate you to study with that person as well.

Another strategy is to set a good example. If you share your study materials with the class, it will encourage others to do the same. This is a subtle way to let gunners know that information should not be hoarded, and it is best for everyone to learn the material.

If a gunner is making class very unpleasant by dominating the lecturers' time, and the subtle hints aren't working, the only option might be to approach him or her and explain your concerns. Most students don't want to be perceived as gunners, so pointing this out to the student might make him or her change. When you speak to your classmate, be nice and respectful when you address this issue -- after all, this is someone you're going to be working with for the next several years and you don't want to make an enemy.

Finally, if the gunner is outright cheating, it is your responsibility to report this to the appropriate authorities.
Unfortunately, during the clinical years, gunner behavior often escalates, because grades are largely based on evaluations from the attending physicians who are observing you. A gunner may try to be the first person at work every day and the last to leave. He or she may try to leap in and do every available procedure or surgery, even on a patient who belongs to another student. I've heard of students who looked up the laboratory results on their co-student's patients to be ready if the other student dropped the ball.

The best thing you can do in that situation is try to ignore the gunner's behavior and do the best job you can on your own patients. If you are very diligent and knowledgeable, that will be apparent to your attendings and residents. However, if the gunner's behavior is very disruptive, the best recourse may be to confront him or her.

Keep in mind that all attendings and residents were once medical students, and they're often able to recognize gunner behavior. Although the gunner may impress some attendings, others will be turned off by attempts at showing off. You may be gratified to discover that your attending dislikes your gunner co-student as much as you do.

Although gunners are a common occurrence in medical school, there's no reason for them to make your life miserable unless you let them. Work hard and learn as much as you can and take gunners for what they are: harmless distractions.

Article taken at 10/03/11 from http://www.medscape.com/viewarticle/732051

Random Articles in the Internet: Saifuddin bincang dengan dua kumpulan mahasiswa UPM

Most of us at the clinical posting stuck wherever in Malaysia might not know this has happened although it happened some while ago. Just updating. For the details of the politics behind this incident, this site shall refrain from commenting. But I will admit I have tons of respect for him.

Nazirah, 3rdyr 2010/2011

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February 24, 2011 PETALING JAYA: Timbalan Menteri Pengajian Tinggi Datuk Saifuddin Abdullah telah mengadakan pertemuan dengan dua kumpulan mahasiswa dari Universiti Putra Malaysia (UPM) bagi membincangkan mengenai pilihan raya kampus (PRK).

Kedua-dua kumpulan mahasiswa yang ditemui beliau secara berasingan itu ialah Kumpulan Pro-Aspirasi dan Persatuan Mahasiswa Islam universiti itu.

Menurut Saifuddin, berhubung PRK, Kementerian Pengajian Tinggi (KPT) bersikap berkecuali dan tidak memihak kepada mana-mana kumpulan mahasiswa mahupun individu yang bertanding.
“KPT juga mahu PRK menjadi gelanggang politik yang sihat dan menyuburkan idealisme mahasiswa, dijalankan dengan licin, telus dan adil serta meningkatkan penyertaan mahasiswa dalam proses tersebut.
“Saya ingin tekankan bahawa PRK ini seharusnya dijadikan medan terbaik memberikan pendidikan politik dan demokrasi kepada mahasiswa,” katanya dalam satu kenyataan media hari ini.

Alasan tidak munasabah

Merujuk kepada isu pilihan raya UPM, beliau menghubungi Naib Canselor, Prof Datuk Ir Dr Radin Umar Radin Sohadi pagi semalam dan dimaklumkan bahawa kemenangan sekumpulan mahasiswa pada 22 Februari lalu dibatalkan oleh pihak universiti atas alasan yang tidak munasabah.
Menurut Saifuddin, beliau “tidak mengarahkan” Naib Canselor, sebaliknya “memberi pandangan” kepada pihak universiti tentang cara terbaik mengatasi isu tersebut.

Beliau berpendapat pembatalan kemenangan itu tidak wajar atas alasan kumpulan terbabit berkempen secara berkumpulan.

“Saya anggap alasan ini tidak munasabah kerana umum tahu bahawa pihak yang membuat bantahan itu sendiri adalah sebuah kumpulan juga. Ini diakui sendiri oleh seorang daripada mereka dalam perbincangan dengan saya hari ini.

“Pembatalan itu dibuat tanpa memberi peluang kepada pihak yang dibatalkan itu untuk membela diri,” katanya.

“Jika berlaku pembatalan atas alasan yang tidak munasabah ini, saya bimbang kita akan dilabelkan sama seperti Myanmar yang tidak mengiktiraf kemenangan Parti Liga Demokrasi Kebangsaan pimpinan Aun San Su Kyi dalam pilihan raya pada 1990.

“Atau Amerika Syarikat, Kesatuan Eropah dan Israel yang tidak mengiktiraf kemenangan Hamas dalam pilihan raya Palestin pada 2006,” katanya.

Beliau turut memuji sikap keterbukaan Naib Canselor UPM yang bertemu dan mendengar aduan kumpulan mahasiswa itu.

“Sikap keterbukaan beliau telah berjaya menyelesaikan isu tersebut dengan baik. Namun, saya kesal kerana terdapat juga sesuatu permintaan daripada sekumpulan mahasiswa tidak dilayan oleh pegawai tertentu sehingga menyebabkan insiden yang tidak diingini berlaku.

“Saya bukan menyokong permintaan mahasiswa itu, saya cuma kesal ia tidak dilayan. Saya juga kesal dan tidak bersetuju dengan tindakan sekumpulan mahasiswa yang menyebabkan kerosakan harta benda awam.
“Pun begitu, saya percaya jika permintaan kumpulan tersebut dilayan, maka insiden tersebut mungkin tidak akan berlaku,” katanya.

Article taken at 8/3/11 from http://www.freemalaysiatoday.com/2011/02/24/saifuddin-bincang-dengan-dua-kumpulan-mahasiswa-upm/

Random Things in the Internet: "Bad" Medical Students

by Kendra Campbell, MD, Psychiatry/Mental Health, 07:57PM Feb 24, 2011 from http://blogs.medscape.com/kendracampbell

Taken from Google Image

I've written some posts in the past about how to shine during your clinical rotations. But an experience today inspired me to write about "bad" medical students. We were having a resident lecture by one of our psychiatry attendings, and he invited his medical students to join us. I couldn't help but stare in disbelief at one of the med students, in particular (and keep in mind that this was a small room with less than 20 people in it). One of the students clearly had his phone in his hand, although he was attempting to cover it up (but doing a rather dreadful job). For about 95% of the lecture, he stared at his phone, occasionally typing things or apparently reading stuff from the screen. He looked away from his phone only once that I observed, and never looked at the lecturer. It was really quite incredible, actually.

During my psychiatry program, we had an entire course on "how to teach medical students." We were taught tips and tricks on providing quality education to our students. In addition, we had lectures on how to deal with "bad students." We were introduced to various situations that we might encounter, and were taught ways to handle them. For some reason, psychiatry seems to be one of those fields that some future doctors believe that they'll "never need in the future," and as such, it can bring out the worst in students. 

I thought I would list examples of some of the "bad" medical students, whom I encountered as a resident, as a "don't do" list for med students:

1. The disinterested medical student. See above example. As an aside, let me say that although you may think that you will NEVER need to know psychiatry as a surgeon, you are wrong. Trust me on this one. So, even if you could care less about a particular specialty, it's really important to "fake it 'til you make it." It really doesn't take that much extra energy to act interested. And yes, residents and attendings DO notice when you take absolutely no interest in learning.

2. The "no" medical student. I was actually quite shocked the first time I asked a medical student to take a history from a patient when she responded "no." While it's entirely reasonable to refuse to do something you are uncomfortable with, refusing to perform required duties is certainly not a good way to get a good evaluation (or learn!).

3. The late medical student. While there are always excusable reasons to be late on occasion, chronic tardiness is very unprofessional, and is definitely noticed by your resident and attending.

4. The medical student without a clue. No one expects med students to know everything, or to be able to answer all questions. But when a student is obviously not taking the time to learn about a particular specialty or topic, it really shows. We all understand that you don't have the luxury of studying all day long, but reading for even 20 minutes a day will show that you at least have the motivation to learn.

5. The distracted medical student. We all have lives outside of med school and residency, and emergencies arise. But constantly texting or being pre-occupied with things other than the rotation looks unprofessional, and does not go unnoticed.

I hope this list is helpful to some of you out there. Please do provide examples from your own experience or add to the list!

Kendra Campbell, of http://www.doctorpsychobabble.com/