GPA... GAMSAT... Interview...: What is your favorite clinical sign?

Sunday, July 14, 2013

What is your favorite clinical sign?

What is your favorite clinical sign? I got asked this question by someone last week at my clinical school.

It was something I had not thought about very much in fact. However, the first thing I shall say is that as medical students and doctors, we should be wary of referring to patients as their clinical sign instead of as a person with their clinical sign when there is a possibility of them hearing. It is understandable that doctors and medical students want to take shortcuts with their language amongst themselves to convey information quickly, but some patients take offense to referring to them as "the murmur in 1.1" for instance rather than "the person with a murmur in 1.1" or "Mr A with a murmur in 1.1".

The other thing to take note of is that pathological signs while "cool" to medical students and doctors may not be "cool" to those patients experiencing the pathological processes associated with them.

Now that all that is said, what is my favorite clinical sign? There are quite a few which I have found interesting, and a few others which I have heard of but have not seen myself.

Of those which I have personally seen, the first one is aortic stenosis. I have mentioned this one before in my blog, since this I have examined a few patients with this. The change in the loudness of the murmur with full expiration and sitting upright is quite remarkable!

Another one is the prominent v waves on the JVP of tricuspid regurgitation. It is quite fascinating to see the jugular vein pulsating up and down very prominently on the right side of the neck.

Another one is clubbing. Clubbing has many causes; some respiratory, some cardiovascular and some other causes. Very marked clubbing can be quite a sight to see when compared to normal fingers.

The other one is an upgoing plantar response. Usually the plantar reflex is down in adults, but it goes up in upper motor neuron pathology such as MS or with strokes. It was quite spectacular to see the first time around.

The last one I have personally seen which I will mention (which I find interesting but not as much as the other ones) is the "shifting dullness" of ascites.

Of those which I have not personally seen, Pemberton's sign sounds quite spectacular to see. I have heard that a medical student was particularly amazed when eliciting this for the first time during an exam that they had to be prompted by the assessor to continue the examination.

The last one I will put on my list is the flashlight test for hydrocele.

So that's my take. What's your favorite clinical sign?

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Definitions and context

Here are some definitions of terms, both official and unofficial, which I may use in my blog. Within the definitions, I've also provided some context which may be confusing if you first encounter my blog without reading right from the start.

You may also notice that I use some American spelling, even though I am based in Australia. This is quite deliberate, because American spelling is often shorter and more intuitive in terms of pronunciation. As an aside, I think that English spelling reform should be given good consideration by the authorities of the English speaking countries to facilitate learning, just like a lot of other languages have had reforms.

ACER: Australian Council for Educational Research. Runs the UMAT and GAMSAT among other things that the name suggests.

ATAR: Australian Tertiary Admissions Rank. Formerly called TER (Tertiary Entrance Rank), ENTER (Equivalent National TER) or UAI (Undergraduate Admissions Index). Roughly corresponds to a percentile rank (between 0 and 99.95, in increments of 0.05), but it takes into account dropouts, so an ATAR score is slightly higher than the percentile during year 12.

biomed: Biomedicine/Biomedical science

BMed: Bachelor of Medicine. Given by some universities as the first professional degree of medicine. Nowadays virtually identical to MBBS.

BMP: Bonded Medical Place. A type of CSP, but requires working in areas of workforce shortage equal to the length of the degree, although there is a "scaling bonus" for more isolated rural areas. There is no scholarship involved. BMPs can be "paid off" in that the breach of contract "only" requires paying a fine equal to the government contribution of your school fees while you were a medical student (adjusted for inflation) and no other registration issues unlike breaching an MRBS contract. BMPs are only for Australian Citizens and permanent residents.

CSP: Commonwealth Supported Place. An "unbonded" CSP place in Medicine is sometimes implied. For local students.

CSL: Case Supported Learning. The University of Melbourne uses it to refer to Problem Based Learning (PBL), as it involves cases, and they use it to complement lectures instead of completely replace them like some overseas universities.

dent: Dentistry/Dental Science/Dental Surgery/Dental Medicine

DDS/DMD: Doctor of Dental Surgery/Doctor of Dental Medicine. The names of the dental courses in UniMelb (starting 2011) and USyd (starting 2012) respectively. Classified as “masters degrees by coursework”. Originally the degrees were “Bachelor of Dental Science” or “Bachelor of Dentistry”.

EBM: Evidence Based Medicine.

ENTER: Equivalent National Tertiary Entrance Rank. The old name for ATAR used in Victoria.

ERC: Extended Rural Cohort. A group of 60 students (30 each) from UniMelb and undergraduate Monash who do their clinical years in northwest Victoria.

FBS: Foundations in Biomedical Science. The main subject in first year MD for UniMelb, containing mostly biomedical science as the name suggests, together with some social sciences and EBM.

FFP: Full Fee Place. Can be split into "Australian (local) Full Fee" or "International Full Fee"

international: international student. Not a local student.

GAMSAT: Graduate Australian Medical School Admission Test. It contains 3 sections scored out of 100: reasoning in humanities and social sciences (S1/humanities), written communication (S2/writing), and reasoning in physical and biological sciences (S3/science). Most universities use an "overall score" which gives double weighting to the science section, apart from Melbourne, which give each section equal weighting.

GEMSAS: Graduate Entry Medical Schools Application System. Only started in 2011 for 2012 entry, for local students applying to medicine. Designed to make the system fairer while keeping a preference list and avoid multiple interviews, but the UQ (lower preference) issue does not appear to be resolved.

GMAC: Graduate Medical Admission Centre. In the process of being phased out and replaced by GEMSAS.

GMP/GEMP: Graduate-entry Medical Program. GMP may also mean guanosine monophosphate depending on context.

GPA: Grade Point Average. In the context of medicine admission, this is different to a percentage average (WAM). GPA can be either weighted progressively (most unis) in later years or not (some unis like USyd, UQ).

LMS: Learning Management System. Known as "blackboard" in some other unis, this is the online resource for UniMelb students for online tests and lecture notes etc for the subjects they do.

local: local student. Australian citizen, permanent resident, NZ citizen, or someone on a permanent humanitarian visa.

MBBS/BMBS/MBChB: Bachelor of Medicine/Bachelor of Surgery. The first professional degree of medicine in a lot of Commonwealth nations.

MCAT: Medical College Admission Test. Predominantly a North American test, although a lot of graduate entry universities worldwide accept it for international students. However, University of Melbourne applicants need to sit GAMSAT if they are based in Australia during the time of the GAMSAT.

MD: Doctor of Medicine. In Australia, traditionally it is a research degree. However, in North America, and in the usage that some Australian universities are now adopting (controversial because of possible ambiguity), it is the first professional (practicing) degree of medicine; almost identical to the MBBS.

med: Medicine

medsci: Medical Science

Melbourne GAMSAT/Melbourne score (unofficial term): The University of Melbourne weights all GAMSAT sections equally, unlike all the other ones which weight science double. The Melbourne score is defined as (S1+S2+S3)/3.

midsem: mid-semester. May refer to a mid-semester test.

MMI: Multiple mini interview. Interview with a lot of stations with different questions and interviewers, designed to minimize the effects of interviewer bias. Roughly based on the OSCE

MRBS: Medical Rural Bonded Scholarship. A type of CSP requiring a six year commitment to rural medicine after attaining fellowship (before scaling for degree of isolation). There is significant money given while studying, although the penalties for breaching the contract are severe. Only for Australian citizens and permanent residents.

OMS: Oral and Maxillofacial Surgery. A dental specialization requiring both dental and medical degrees.

OSCE: Objective Structured Clinical Examination. Exam designed to test a set of clinical skills with multiple stations.

PBL: Problem Based Learning. Involves group work discussing problems. Slight variations in structure exist between universities.

PCP: Principles of Clinical Practice. This subject is a small part of first year (preclinical), but worth a larger part of clinical years 2 and 3. The year number may be specified after PCP.

RMH: Royal Melbourne Hospital

sci: science. May or may not refer to GAMSAT section 3.

sem: semester. May also refer to "standard error of the mean"

sub: subject. May also refer to substituting.

S1/S2/S3: GAMSAT (or rarely in this blog, UMAT) section I, section II, or section III. See GAMSAT or UMAT for more information.

UMAT: Undergraduate Medical school and health sciences Admission Test. Aptitude test sat predominantly for undergraduate entry medicine in Australia (except James Cook University). Contains Logical Reasoning and Problem Solving, Understanding People, and Non-verbal Reasoning sections. Recently found by UQ to be a very poor predictor of medical school performance (section 1 was slightly predicitive, but sections 2 and 3 were not statistically significant in predictive ability).

unbonded CSP/unbonded place: a CSP place with no commitment attached upon graduation; not BMP or MRBS or some other state's own bonded scholarship.

UniMelb/UMelb/UoM/Melb/Melbourne (note: read the term “Melb/Melbourne” in context; it can also refer to city of Melbourne): University of Melbourne. As of now, the only university in Australia which has an “MD” masters-level medicine program instead of a bachelor degree level. However, the University of Western Australia is set to follow starting 2014 and UQ is expected to switch in 2014 too.

UQ: University of Queensland. In 2008, for 2009 entry, they discontinued the use of the interview. They are the only graduate entry medical school in Australia with no interview. They also expect to switch to an “MD” medical course in 2014.

UQ (lower preference) issue: Since UQ doesn’t interview, they give their place offers at the same time that other GEMSAS unis give out their interview offers (and 2-3 months before the other GEMSAS unis give out their final med school place offers). As a result, people putting UQ below their first preference may miss out on a place even if they would have gotten in if they put UQ first, if they happen to do badly in their interview for their higher preference university.

USyd: University of Sydney. In 2011, for 2012 entry, they pulled out of the GEMSAS consortium and local students are required to apply directly. They also had local student interviews during early July instead of late September like the GEMSAS universities.

VCE: Victorian Certificate of Education. Equivalent to HSC, WACE, SACE, TCE etc. Roughly equivalent to A-levels.

WAM: Weighted Average Mark (percentage average). “Weighted” refers to weighting subject marks according to credit points, so that for example subjects like Integrated Human Structure and Function (25 credit points) in University of Melbourne’s Biomedicine course would be weighted double compared to say Pharmacology: How Drugs Work (12.5 credit points).

UWA: University of Western Australia. UWA has the last intake for a 4 year, 8 month MBBS graduate entry course for 2012 entry (running alongside a 6 year undergraduate course), and is set to switch to a 4 year MD program for 2014 entry.

WEHI: Walter and Eliza Hall Institute.

wrt: with respect to

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Sunday, July 14, 2013

What is your favorite clinical sign?

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