Why medical students SHOULD get involved in extra-curricular activities

Many of you will know that a majority of us third years have been through an interview that will decide whether we can stay in college or not next year. Why are we going to these interviews in droves, you ask? Doesn't UPM medical students automatically get to stay in their hostels (K17) despite the level of extra-curricular involvement? A big reason this happened would be because we had previously thought there was no point in collecting merits as we had thought we would be staying in the KL Damai hostel next year when we have our postings in our 4th and 5th year. Because of politics and a lot of red tape, imagine the surprise, the slaps on our unsuspecting faces when we hear that there will be no KL Damai hostel and there might not even be a renewed contract with HKL as a teaching hospital for UPM anymore as of 2012. That's another story, and the issue is far more complex, but let's talk about the merits and staying in K17 part.

Medical students used to be priviliged enough to be able to stay in college without having to collect merits like other students, the cream of the cream syndrome if you ask me, so the few of us that do join these activities were seen as fools, and some were even advised by colleagues to quit medical school (with good intentions, of course) *ahem ahem*. Most of us won't even go out of the college to have a jog, preferring the creature comforts of our dorm rooms, let alone become chairperson of an event! So one wonders why should one get involved in these silly activities that nobody remembers in a few years time? I've heard of people saying medical students are so busy, they don't even go out to buy their own dinners! I've also read newsclippings relaying the opinion of some nerdy med student saying there is no enjoyment when studying medicine, only hard work and duty. Those "facts" are only true if you want it to be.

I have had the best time possible, and have learnt so much from being in UPM, and I've only gone through third year!  I never would've thought it would be possible since I honestly hadn't even known UPM existed before I searched it up to fill in my UPU form. I tell this to so many people, but it bears repeating: even if I could re-wind time, my first choice in the UPU form would still reflect that I want to be a medical student in UPM. Had I joined UM, UKM or USM I wouldn't have been able to join debate, I wouldn't have learnt the stuff I did, I wouldn't have been able to form the great relationships with the medical students, the staffs or the students from other courses. I would've never been able to gain working experience with my employers, some nasty, some nice. In short, I wouldn't be the person I am today .

Kem perkasa!

I think if I was to tell the kids about my time in UPM, the best thing would be about the fun I had joining the UPM debate team. (Of course, academically, clinical year was the best fun I've ever had learning.) It wasn't even hard to join debate because all you needed to be able to do was to speak "Yes" and "No" and you're in. Read the news and humanities journals? Learn economic/political/social theories? Um, yeah.. not really. I met with people I would've otherwise never did in K17, law students, fine art students, from Sabah, from Kyrgyztan, from other UPM colleges, previous medical graduates of UPM (hi Sooch!) Finally, it feels like I don't have to commit suicide by slitting my wrists with all my medical notes. I hadn't been able to join more tournaments since clinical year due to financial problems but I should hope that's about to change in 4th year.

Likewise, there are many seniors that's been vice president of the college MTM, MPP representatives, AIESEC members, thoose active in religious societies and so forth. Some can sing, dance, act, or all three and they do it well! Some have organized several big events and made it into the news! Some of them have their own side businesses and are able to afford cars on their part time jobs (hi Kak Ikin!). Some are married by their second, third, fourth year (hi, um.. nevermind). Don't think that a medical school limits you from having a life, because only you can decide that for yourself, not other folks propagating "truths" like to be a good doctor, one must study 24/7. Your life and how you balance it is up to you, so take control of it. People do ask, "How do you balance your studies?" I have no answer for this because I'm still not good at it even if I'm not active in extra-curricular activities, I make do with I have and I'm always improving my time-management.

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.

Doctor wannabe?

Assalamualaikum.

Ibubapa memainkan peranan penting untuk memupuk minat kanak-kanak, seperti sehelai kain putih yang perlu dicorakkan. Saya rasa, kebanyakan kanak-kanak disogok dengan impian menjadi seorang doktor, peguam atau cikgu. Ini pekerjaan yang biasa saya dengar dikalangan kawan-kawan sebaya sewaktu sekolah rendah. Tetapi tak dinafikan saya pernah bercita-cita mahu menjadi seorang posmen dahulu. Haha.

Berbalik kepada tajuk asal, kenapa doktor? Masyarakat memandang tinggi pekerjaan yang satu ini, kerana pekerjaannya yang sangat mulia dan menuntut pengorbanan yang bukan sedikit. Memetik kata-kata Martin H. Fischer, "A doctor must work eighteen hours a day and seven days a week. If you cannot console yourself to this, get out of the profession."

Secara jujurnya, sewaktu minggu orientasi medic, soalan kenapa nak jadi doktor ni menghantui sewaktu buddy day yang sangat menakutkan. Haha. Dan satu jawapan yang terlintas, jawapan yang sangat biasa dan kerap didengari oleh pelajar perubatan, saya mahu bantu masyarakat-jawap saya seadanya.

Dan senior membalas- Banyak cara untuk membantu manusia lain, tak semestinya menjadi seorang doktor. Cikgu, peguam dan polis juga membantu masyarakat dalam cara mereka sendiri. Jawapan kamu terlalu umum.

Sedari itu saya terfikir, kenapa doktor?

Saya bertanyakan coursemate yang lain, setelah melalui kos ini selama 2 tahun, jawapan mereka adalah seperti:

-Ayah aku nak sangat aku jadi doktor, apa nak dikata?

-Minat aku dari kecik daa..aku keluar je dari perut mak tu, terus je aku jatuh hati kat doktor yang sambut aku tu. Sejak tu lah aku nak jadi doktor..haha.

- Oh, aku suka-suka je.

- Sebab dapat tengok cadaver.. Suke nyeeeee... Huhu

- ‎(Jawapan common) cita-cita dari zaman purbakala

- Ilmu perubatan tu tak semua orang boleh dapat dan apply... Maybe sume leh belajar tp tak sume boleh hargai ilmu tu... Sangat berharga... Jadi doc memang lain dari yang lain... sebab tu la kot... ade banyak sebab tapi yang lain tu common-common je laa... kang berjela-jela lak..huhu

- Aku jadi doc sebab doc best, perlukan ilmu dan seni, kalau jadi nerd je study dgn ilmu, tp takda seni seperti cara komunikasi, ketelusan dlm buat kerja, bijak urus stress tak jadi doc, doc boleh kawal keadaan walau ape sekali pn, dan doc ni kite boleh berkhidmat smpi mati, no limit utk buat kebaikan.

- Fardhu kifayah~

‎

- "Sampai masa tibanya waktu..redup hati kami berdua..bila dua jasad bersatu..hidup mati kita bersama."

Err..yang ni maybe masih mabuk Hikayat Merong Mahawangsa agaknya.

- Berkata Imam Shafie, "Tidak aku melihat ilmu yang paling afdhal selepas mana ilmu syariah seperti mana ilmu perubatan. Jika ingin berpindah ke suatu kawasan, pastikan ada dua golongan iaitu ulama dan doktor kerana kita sentiasa memerlukan mereka. Imam shafie belajar perubatan semasa hayatnya..."

- Pejam celik, pejam celik trus dapat perubatan~ mohon nak jado economist, tapi doktor pulak dia bagi~~ haiiihhh

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/

5th year: the UPM experience

Hi juniors and colleagues who might be reading this! Ok first things first, I’ve never written an article for a blog or whatever and I don’t even have a blog myself so I guess I can call this article my first ‘entry’? Haha. I was approached by Nazirah this past Friday (yesterday actually) to write about ‘experiences during 5th year’ to be shared with juniors so that you guys may have a basic idea of what’s it gonna be when u guys come to 5th year. Hmmmm 5th year? what about 5th year ey? I guess when you first come to 5th year you’re kinda gonna feel good about yourself (yelah dah senior kan, royal senior plak tu among all the UPM med students :b) and plus you get to ‘interrogate’ your juniors during senior day (which has been a tradition ever since UPM started its med program, but no offense juniors it’s just for entertainment we’re all good people at heart actually haha).

But along the way, as you go through all the postings during 5th year (Medicine, Surgery, Senior Psy, Dermatology, O&G, Paeds, Ortho, Anaes, A&E) you’ll realize that whats important during 5th year is for you to so called ‘connect the dots’ or ‘put the pieces of the puzzle together’. You see, when you come to 3rd year to start your clinical phase it’s about you learning how to take a history, and how to examine patients and talking to them. That’s about it. 

But when you come to 5th year, it’s a totally different story. When you’re a 5th year med student it’s all about you getting a thorough and good history (or as we like to write it ‘hx’) so as to sorta rule out all the possible differential diagnoses (or the short form ‘ddx’) and at the same time arranging and presenting the hx to hopefully impress the lecturers/examiners. The same goes to when you do a physical exam, it’s all about showmanship and how you interact with the patient in front of the examiners, and how thorough you have been examining the patient for the current problem (the so called chief complaint a.k.a c/c) and also complications (short form : cx) that may arise. 

Its different from 3rd yr in a sense that when u get e.g. a cardio case, you may have to do a cranial or peripheral nerve exam as well as fundoscopy to detect possible signs of complications, as may occur in a patient with longstanding diabetes, hypertension, and hypercholesterolemia. So again, it’s all about you being able to diagnose the current problem as well as considering possible complications that may arise (don’t worry guys I was not a good student myself during 3rd year as I spent most of my time just playing around but I started to see the ‘art’ if I may of hx taking and examining during 4^th year and from then on I kinda improved dramatically, but it all comes down to you're willing to put effort or not to achieve it). 

Plus it is during 5th year that you start to learn how to manage the patient’s disease and problems, and what are the things u need to do (referral etc) in order to achieve just that. And whats more important, with all the info you have managed to gather, you’d want to train yourself to be less nervous when presenting and be confident. Trust me guys, when you get nervous everything you may know before entering the room to present to the examiners/lecturers will somehow conveniently disappear, and you’ll only realize that you know the thing AFTER you get out of the room after you have finished presenting. Trust me I know. So please control your nervousness ‘cos it's gonna be a waste if you present badly when in actual fact you know for sure you can do better. Practice presenting to friends from now, so you’d get used to presenting and hopefully you’ll get less nervous when the time comes. 

And people have asked me, ‘Is it stressful being a med student, a final year some more when you need to know everything before going to the exams?’. Truthfully it is stressful, even more when we’re just 7 weeks away now from Professional 3 (ok today is 26th Feb 2011) but remember, other people have passed, so why can’t you, right? Whatever it is you can only put effort into revising and remembering all the things you have learnt for these past 5 years (and concentrate on the more common diseases encountered first) and hopefully you’ll do ok during the exams. 

Ok enough about exams lol (now I'm getting stressed out writing this ‘entry’ haha). Apart from the countless exams you’ll encounter during  5th yr (yes you do have exams at the end of each posting excluding senior Psy, Anaes, and A&E) what you need to do is enjoy your life more, huhu. ‘Cos when you're a student you have more time, and you get to socialize and meet friends more so you better make use of the time you have and just have fun ok? Loosen up, life is much more than just about exams and everything. ‘Cos it’s no use if you just dedicate your whole time to just reading and and studying, you’ll be what Malays say ‘Katak bawah tempurung’. Get to know whats happening in the world around you, make friends and have fun, and enjoy life more (I personally find that if I don’t do things other than studying my brain doesn’t get the creativity and fun it craves on a daily basis lol). Reward yourself after you have been putting a lot of effort studying. This is what keeps you going. If you just study and study and study, you’ll get fed up and you may lose interest altogether. 

And remember this, great doctors are not the most knowledgeable people, but those who know how to talk to patients and have good rapport with their pts. This is just basic human to human interaction. Most of the time the patient feels ‘cured’ and relieved just by getting reassurance from time to time from his/her doctor. What I'm trying to say is you can memorize a whole textbook, you can be a so called ‘gold medal’ student or whatever but when it comes to real life what counts is how good you interact with the patient and his/her family, and how well you show to the patient that you care like hell about his/her problems. Medicine is a life-long learning process, and even when you start to work you’ll still be learning. More so ‘cos that’s the time when you’re actually practicing.

So I guess the take home message that I want you to have is continue to learn and learn, and develop that sense of empathy and giving a damn about the patient’s problems, ‘cos when you're able to do all that you’ll be just fine. Trust me. Have a good day guys and good luck!

Syafeeq Faeez, 5thyr 2010/2011

Memory and Instinct

(Picture taken from Google Image)

I should probably write the first article to encourage more to come along.

I'll be the first to admit it. I feel I don't deserve to pass my professional exam. Not that I'm not grateful to lecturers or God, without them no way I would've been able to pass. No, rather, I feel like I lack the knowledge and thinking ability that I've always imagined a third year should have.

When I was a first year, I used to look at the third years as if they're the most amazing people ever and wonder how they ever passed their exams because I was struggling and had convinced myself that coming from Physics stream, I was more handicapped than most since I hardly studied in my years as a student. I remember every time we had a Problem Based Learning (PBL) class, a chief complaint was given, and we're supposed to give a rundown of differentials. And I remember saying to a mate of mine, "I can't wait until I'm a second year and we've gone through all these systems. Then, we can do this PBL thing properly. Time tu dah tau semua, baru boleh diagnose semua benda." Kononnya lah.

Now that I'm a third year, every day is PBL day, and every person in hospital is a PBL patient. And I'm still no better off than that first year girl who feels like she has no clue as to where to start diagnosing her patient. Now I think, "I can't wait until I'm a specialist. Then I can diagnose the patient intelligently." And then I'd wonder about how lost I'd feel like when I actually am a specialist...

Now and again, I have first years coming up to me, asking me, "How do you memorise all this stuff?!"

I wish I knew then memorising is a basic skill, and not even the most important skill, whereby the most important, the crux of a doctor's neurological software is the ability to think. Bak kata Mr. Gee, "Common sense is not so common."

How we used to memorise time tables from two to twelve to be able to do complex calculations properly until the ability to calculate 1897 x 789 becomes a basic function in us as a human being is exactly how we should treat medical knowledge. After being exposed to a certain problem, a brain's structure changes in a certain way so that the next couple of times we try to solve the problem again, the thought process that occurs in our brain is faster, almost automatic, as if by instinct. For example, monkeys solve true-false problems faster when they are taught the concept of one and zero!

Just like how log, calculus, etc is the next step in maths after learning how to multiply and divide, thinking and diagnosing is the next step after knowing all that medical jargon and information. Interpretation of signs and symptoms, prognosticating, treating, referring is the next step after knowing all your values, your facts, your texts. After all, you don't want to examine a sick patient infront of you and still be thinking mainly about whether you're doing the steps correct! It should be a given, and what you should be doing already is collecting clues.

It doesn't matter if you're from the Physics stream, if you're a monkey, you can learn medicine, anyone can. Don't think you're a better human being than most just because you're taking the medical course. (Yes, there are people who act like it!) It just takes unfailing will to continue to memorise and learn until it becomes instinctual on top of a powerful internal drive to be able to think, not just for your sake to pass exams, but for the patients you're facing in the future.

I hope first years remember that. That exams are just exams. That if you pass exams, viva, repeat papers, whatever it is, well done, no-one cares, no-one's looking at your pointer. I hope they know the things they're learning aren't for exams, but for that Holy Grail of a medical career: the development of a professional medical instinct. Here's to hoping that we all reach that point some day in our lives.

Nazirah, 3rdyr 2010/2011