[update] end of Surgery block

Last Friday was the end of my Surgery block in the MD degree. In some aspects, surgery is very interesting and technical. I have not ruled it out as a career, but so far I think some other specialties are more likely. I have some interest in anaesthetics, and I was exposed a bit to it during this surgery term.

As per the other terms beforehand, I needed to write another hurdle EP (ethical/empathic practice) reflective piece essay. These essays are widely detested throughout the medical school student cohort. As with the conference essays, I imagine that there would be a lot of superfluous word usage in many essays to make up word counts.

There will also be another formative test next week to see how we are going. It will be interesting to see how I go. This term I have been using the BMJ onExamination app a lot to revise and reading the pathology and clinical examination texts, but I haven't been keeping up with the lecture revision very well.

2014 entry: GEMSAS medicine interview offers and UQ offers released

The GEMSAS medicine interview offers and UQ medicine offers were mostly released yesterday and today, with the GEMSAS unsuccessful application notice also coming out two days ago. To all my students and readers of this blog, congratulations if you have received an interview or offer at UQ. Good luck for your interviews!

Also, commiserations to all of you who may not have received an interview or offer at UQ.

[update] Finished review of MD1 conference reflective pieces

As part of the student conference assessment in the MD course at UniMelb, in second year, apart from writing our own reflective piece, we were required to also review and provide feedback on the reflective pieces of two students from MD1 (pass/fail). I managed to get both of the reviews done this morning, so that is the end of my assessment for the conference for this year.

For next year's student conference there will be four cohorts doing the MD program, so we should be able to see the MD4s present their research results during the conference. That might be interesting to see.

Context is everything - in the economy and in medicine

During the past week, there was the usual bickering of politicians about interest rates policies, with the RBA dropping the overnight cash rate target from 2.75% to 2.5%. As expected, Labor seized the opportunity to announce that the interest rates are lower, which makes it better for working families with home loans; directly contradicting the former coalition government's advertising campaign that interest rates "will always be lower under the coalition". To counter this, the coalition opposition mentions that "context is everything", and the only reason why the interest rates are low is because the "economy is struggling", which is a bad thing.

Now, both these arguments have some element of truth behind them. That said, if the government was to support the economy further, perhaps the only way to do this would be to increase the budget deficit even further, which is not desirable. Now, even for budget debt and deficit is context very important. The coalition talk of debt and deficit as if it is the "be all and end all". However, while it is very true that debt should not be ever increasing, and there should not be continual deficits, it is also true that temporary deficits are justified to support the economy in bad times; to be made up with surpluses when the economy is strong. As such, the government was quite justified in spending in the stimulus package at the peak of the financial crisis in order to support jobs and growth, even though this resulted in a larger deficit for the budget.


One thing I have realized though is that "context is everything" also applies to medicine. I recall an interaction with my CSC (clinical skills coach) tutor, who was quizzing the group about the effects and side effects of certain medications. The interaction was as follows:

CSC: What does aspirin do?

(At this stage, my pharmacology major instincts kicked in)

Me: Aspirin is a non-selective, irreversible cyclooxygenase inhibitor. It inhibits both COX-1 and COX-2, by irreversible acetylation of the active site. This reduces the amount of prostaglandin production. In this case, for this patient, the wanted effect is a decrease in TXA2 to decrease platelet activation, and we want an irreversible inhibitor because platelets don't synthesize new COX and other tissues can...

CSC: What you said was all true, but if you can summarize this in three words, what would you say?

Me: Stops blood clotting?

CSC: Close. "Thins the blood"

Now I was actually quite surprised that we were allowed to use this terminology, because aspirin doesn't actually decrease the viscosity of blood; it just stops the platelets from aggregating. But it seems like it was OK in this circumstance.


Another interaction was with a cardiologist in cardiology outpatients.

Cardiologist: How would you tell the difference between someone with fluid retention due to kidney failure and heart failure?

Me: Heart failure might have displaced apex beat, additional heart sounds, valvular regurgitation, murmur...

(seems like he was after investigations, rather than examination findings)

Me: BNP level...

Cardiologist: The BNP level might give you some idea. But what else?

Me: Echo

Cardiologist: Yes. An echo!


In contrast, there was a question of some similarity but also considerable differences asked in a tutorial I had later in ICU.

Intensivist: How would you assess if his heart and circulation is working well?

(I had the cardiologist experience in my mind)

Me: An echo

Intensivist: Get out. You won't have an echo everywhere you go.


Now it seems like the answer to the same question depends on the context in which it is asked. In pharmacology class, the molecular mechanism is important, but in the clinic, the CSC tutor is after the end broader effect. And in cardiology, the echo is very useful in determining heart failure, but not practical for immediate measurement of cardiac function. So as it is the case in many other things, context is everything in medicine too.

2013 Student Appeal: Students with a cause

In 2011 and 2012, I was part of the University of Melbourne Student Appeal, part of the team raising money for students who were finding it hard to meet with living expenses. This year I will be unable to continue doing so since my clinical school is not right next to the university and we don't have very long breaks usually. However, the Student Appeal is a very good cause, so I recommend supporting it if you have some spare time or money.

If you want to become a volunteer or donate, see the official website or their Facebook page. Donations of $5 or more are matched by the university.

$2000 CPD cap deferred for 12 months

The government has decided to defer the $2000 CPD cap for at least 12 months pending further discussion as to the best way to continue to support education without allowing the perceived abuse of the system from using the money for holidays etc too. This is a good move from the Labor government, which is discussed on the Australian Doctor and Medical Observer sites. Now we should hope for a more common sense approach to this matter. Ideally we should see the new policy before the election because as it stands it is not out of the equation for Labor to return to this $2000 cap. But without too much rushing, so that it can be a good policy.

USyd 2014 entry local applicant interview offers out.

It seems like today the USyd 2014 entry local interview offers are out. It seems like the cutoff was 68 this year. If you have an interview, good luck with it.