[update] elective placement done!

Last week I completed the compulsory elective for my MD course. Although they have made it non-compulsory for people in MD1 this year, for us we were required to undertake at least a 4 week elective placement. The timing was not critical although it needed to be in our holidays.

I did my elective in ICU. Although I was hoping for a cardiology elective, overall I enjoyed my ICU experience. It was a great opportunity to revise a lot of medicine which I learned in second year and we didn't cover very much of in classes this year. The consultants were generally very willing to teach and it was also very interesting to learn about the ICU equipment and how to interpret the machines and etCO2 curves, which are also used in anesthetics. The consultants also did two rounds per day, with a longer morning round and shorter afternoon round, which was great for learning; in contrast to other non-ICU units where usually it is the registrar doing the ward rounds.

Although it was very nice to spend time in ICU and refreshing to learn about actual "medicine" after much of this year, it is very nice to finally have a break now until February.

[update] MD3 2014 results release

About two weeks ago, our overall results for PCP3 were released. I didn't do as well as I would have liked, although it seems like many people got worse this year than last year.

Ah well. I guess the main thing is that I did pass and didn't have to redo any assessments, so I will be going on to next year.

For some reason, they still haven't given back our mark breakdowns though. I would like to know where I actually did badly and where I did well.

No intake for new prospective students for GAMSAT or VCE

I regret to inform that I will not be taking any new students for the GAMSAT or VCE subjects these summer holidays and it is very unlikely that I will be taking any in the future. After these holidays, the next summer "holidays" will most likely be a very short one between medical school and internship, and I intend to make the most of those.

Although I enjoyed the last two rotations, this year has been a long year for me with this exam period, and I also have an elective coming up next week for another four weeks cutting into my holiday. For the rest of the holiday, I intend to spend most of the rest of it either resting, or looking at some biostatistics and reading more research articles online to get a handle around my research project for the first semester next year.

I apologize for any inconvenience caused. I wish the best for you all doing the GAMSAT and hope you can find an alternative tutor.

[update] 2014 MD3: all exams done!

Today I have finally finished all the exams for the 2014 year! This was such a marathon exam period, with 4 separate days for OSCEs and 2 separate written exams. It was quite an inconvenience having to go to different locations for the OSCEs for Children's and Women's compared to GP, mental health and aged care, with even those latter 3 having 2 separate days for those OSCEs. But I guess it is more convenient for the Children's and Women's staff. And finally, the exams are all over now.

As usual, I preferred the written exams over the OSCEs, although I feel that I may have done better on the OSCEs overall than last year. There seem to be quite a few "random" OSCE stations, although I guess they were reasonably fair overall.

Anyway, results should be out by 5 December.

[update] Women's rotation over. Children's rotation next

My rotation at the Royal Women's Hospital finished yesterday. So far, it has been the rotation I enjoyed most overall this year. Why? In both obstetrics and gynecology, many of the interventions make sense. I like things when they make sense. I also like all the technology they use nowadays. I still prefer cardiology though, and it was a bit sad to see that one of my favorite classes of drugs, the ACE inhibitors, could not be used on pregnant women.

Next week will be intersession, then I will be doing the children's health rotation. I am looking forward to that rotation too. But first there will be three days of "random" lectures.

[update] Birth week completed. Conference essay review correction

I had my birth week last week. Although there was excitement when the baby finally popped out all those times, there was also a lot of waiting. Apparently it was a quiet week. I once had one full morning shift when I did not witness a single birth!

We are expected to get at least seven births signed off, although they can include caesareans. I already had two births signed off from elective caesareans before the birth week and had the rest of the seven signed off during birth week. Since it was quiet, I was just relieved at the end of the week that I had all my required births signed off.


It seems like the faculty realized their error in the 500 word word count for the conference review essay. Now they are accepting 300 to 500 words. I had already written my 500 word version though with many unnecessary words with long-winded sentences, so hopefully two people can have fun reading it.

[update] Student conference essay review time. Birth week next week.

As part of our pass/fail assessment for the student conference, we were required to do two critiques of MD2 essays. This year, for some reason it was decided that we were supposed to do 500 word critiques instead of 300 words like last year! I mean, personally I thought 300 words was sufficient enough, but someone decided that that wasn't enough.

Well, honestly I don't think most of us would be giving that much more information with our 60% longer essays that we had to write for critique this year. Naturally, it goes something like this:

Needless to say, after an initial essay which was around 300 words (last year's word count), I proceeded to add many needless words. Some of the sentence constructs I used must have made me sound like I was a completely different person!


Anyway, regarding my current women's health rotation, my week at the birthing center is next week. Should be something different from what I've been seeing so far.

[update] Halfway through women's rotation

I'm about halfway through women's rotation now. So far, it is probably one of the best I have had this year, if not the best rotation.

This rotation is about obstetrics (birth giving) and gynecology (more about the pathological things to do with the gynecological system). Right now, I enjoy the obstetrics part of it more, although the gynecology part is still OK. It is really amazing when you find the fetus's pulse with the doppler ultrasound probe, or visualize the fetus using the ultrasound imaging!

We also had the opportunity to scrub up into theater at times, for gynecological or caesarean operations. I got to see the surgeon do a hysterectomy and then follow the specimen straight to pathology and watch as it was cut up and analyzed right there. It is a lot more interesting when you can relate the pathological specimen and slides under the microscope to the patient whom it was taken from.

The caesarean sections were also very interesting, with the incisions and closing up, together with the birth of the baby. It is quite an interesting feeling to see the obstetricians make an incision in the uterus and break the membranes, knowing that the fetus is right there inside.

Apart from caesareans though, I haven't had my birth week yet, so I haven't seen the natural births. That should come later.

[update] 2014 MD student conference over. Semester 2 about to begin. SS1 and Women's Health.

This week we had the MD student conference for the University of Melbourne. It was the first time that we had a student conference encompassing all the years of the MD course during the conference.

Overall, I think this conference has been the best one I have been to so far. We were able to listen to the research which had been done by the MD4 students, some of which was very intriguing. We also had more "optional" sessions this year, where in the past conferences there were more sessions which were compulsory for everyone.

I also felt that the food was better than last year, although not as good as at the MCG. However, others disagreed, saying that the muffins were better last year. Perhaps it is because I don't particularly enjoy muffins anyway, or eat the dessert, so I had that off my radar for "evaluating" the food.

Anyway, I somehow managed to finish my 1500 word essay reflection already, so I won't have to worry about the conference again for a while, when I will need to peer-review two MD2 reflections or e-portfolios.


Meanwhile, over the next few weeks, I will be trying to organize in greater detail my research project to get ready for next year, and writing a literature review. This should be interesting, as we don't have time off for this. As I had hoped for though, I did get a project at St Vincent's cardiology, so I am happy about that.

My next rotation will be Women's Health at the Royal Women's Hospital, then my final rotation will be Children's Health. I think this should be a better semester than the last, although we will be required to spend a few nights at the hospital seeing babies being delivered. Let the semester two proper begin!

[update] MD3 semester 1 over!

The GP rotation is over, and semester 1 this year is now over! For reasons inside and outside of medicine, this semester was more dramatic than I hoped it would be. But I have made it through, and it is now done.

The GP rotation was my favorite rotation this year so far. Right now, although GP is not my top preference as a future specialty, I think it is a viable option for me. Apart from the coughs and colds, most of the other things in GP land are varied and interesting. GPs are at the front line of cost-effective preventative medicine in Australia. It is also a better lifestyle choice compared to other specialties.

However, the main thing making GP a less attractive option is that it is not as well supported financially compared to other specialties. Furthermore, even now the federal government is trying to cut money to Medicare and charge the GPs a co-payment for "bulk-billing". Unfortunately, this will serve to make it an even less attractive option!


Meanwhile, I am happy with the results of the MCQ progress testing for this semester so far. I have not done as well as towards the end of last year, but I still have one more semester left. I am more concerned about how my OSCEs will go compared to written exams.

We should be getting our scholarly selective (research) supervisor details on Monday. I am hoping to get a cardiology project. Why? I believe that "if you are not interested in cardiology, you have no heart". Well, not exactly, but I do think that cardiology is interesting.

Well, now I have a week break, and then we will have the MD student conference. I'm looking forward to the food, and to the research presentations that this year's MD4s will be giving about their research.

Petition: Stop the co-pay cuts: GPs make the difference

Australian Doctor has started a campaign to hold a petition to oppose the proposed $7 copayment for bulk billing GP visits. Please sign the petition to support primary healthcare in Australia.

http://gpsmakethedifference.com.au/sign-our-petition/

#StopTheCoP

In the Federal Budget announced just over two weeks ago, the Abbott government has announced cuts in funding to hospitals and GPs, with an inclusion of $7 copayments for GP visits starting from next year.

GPs are the gatekeeper of the medical system in Australia. They are in the front line of preventative healthcare, and the forefront of prevention, intervention and screening. They do pap smear tests, blood pressure checks and screening for diabetes and high cholesterol, smoking, and excessive alcohol use, where cost effective lifestyle and pharmacological interventions are used to prevent morbidity and mortality.

However, it is known that people from a lower socioeconomic status are more likely to have poor health. The effect of this copayment will be fewer visits to the GP from people of lower socioeconomic backgrounds, which are likely to lead in an increase in the overall disease burden. Furthermore, there will be likely an increase in presentations to the emergency department for trivial matters, wasting the resources of the hospital where GPs could have provided appropriate care.

As such, the copayment is opposed by the peak bodies representing doctors in Australia. See what the AMA has to say, or the #StopTheCoP posts on twitter.

GAMSAT 2014 results released!

The GAMSAT results for 2014 have been released today! Congratulations if you have done well, and commiserations if you have not done as well as you would have liked.

If I have tutored you this year, I would like to know how you went. Send me an email if you wish to let me know.

[update] Aged care rotation over. GP rotation starting next week.

Yesterday on Friday was the last day of our aged care rotation. In total, there were three weeks of geriatric medicine, two weeks of palliative care, and one week of psychiatry of old age. I found geriatric medicine reasonably good and palliative care OK. However, as per the adult psychiatry rotation in last rotation, I was not very keen on psychiatry of old age.

The next rotation will be the GP rotation. I am looking forward it.

The ECG song - Song and lyrics

S1 Q3 T3 From: Life in the Fast Lane http://lifeinthefastlane.com/ecg-library/pe/

<<Intro/Chorus

It’s ECGs,

Everybody reads ECGs,

GPs read ECGs,

Physicians read ECGs.

Rate, rhythm, axis,

LV hypertrophy.

First start at P,

Then QRST.

End Intro/Chorus*>>

The rate is easy,

Take 100 times 3,

then divide by large squares,

between two R-Rs you see.

The Rs from the rhythm strip,

Alternatively,

Can be multiplied by 6,

More time but more easy.

The next one is rhythm,

See if there’s a P

Then a QRS,

It’s sinus rhythm you see.

If it isn’t regular,

And there is no P

Then chances are

It’s AF you see.

*Chorus

If there’s a sawtooth,

or a pace of 150,

Then I would suggest

atrial flutter it be,

If the PR lengthens,

before each QRS,

drops one complex before resuming,

Then it’s Wenckebach.

If there’s one QRS,

after every 2 or 3 P,

Then it’s Mobitz II,

Heart block of 2^nd degree.

If PR is more than 200 ms,

heart block first degree,

If P and Q are dissociated,

Then it’s CHB.

*Chorus

Leads I and II usually,

Should both point up you see,

Otherwise see if the pattern is

LAD or RAD.

S in V1 or V2

Plus R in V5 or V6

Greater than 7 large squares,

LV hypertrophy.

Look for Q waves

Quarter of the QRS,

Two in the same territory

Could be an infarction past.

Less than 100 ms

QRS length should be

Otherwise a ventricular rate

or bad ventricular conduction it be.

*Chorus

If the QRS is long,

look for two rhythms you see,

MaRRow for right bundle

WiLLiaM LBBB.

Things are more complex

with a LBBB,

Hard to assess ST

Or LV hypertrophy.

If there is ischemia,

there can be depressed ST.

But if it is elevated,

It may be a STEMI.

Pericarditis has globally

elevated ST;

Ischemia or old infarcts

cause an inverted T

*Chorus

It is a massive pain

To assess prolonged QT

But it is important

To prevent polymorphic VT.

QT on root RR

Will give you QTc

Less than .45 for males

and .46 females see.

*Chorus

It’s S1 Q3 T3

a huge PE

and leads aVF, II and III

an inferior STEMI

If there’s a LBBB

Look at a prior ECG,

If it’s VF or VT,

Get the defib ready.

*Chorus

<END>

nucleophilic addition-elimination, 2014

Disclaimer: No responsibility will be taken for any harm as a result of following this song. This song should not be used for entire preparation of ECG training. Also learn about the different regions of the ECG, spotting SVT, VF, VT, right sided infarcts, and differentiating atrial and ventricular ectopics just to name a few other things. Or other things like ECG signs of hyper/hypokalemia and hypothermia, and the various more common signs of PE on ECG.

Edit to add: Youtube link to ECG song.

[update] Aged care rotation and research project selections

I am now two weeks into the aged care rotation. So far, I am enjoying this rotation a lot more than mental health. I have heard several others say that they enjoyed mental health a lot more than aged care, but I found the opposite.

For me, it was very refreshing to go around in the ward round and see the patients being asked history questions and being examined, with medications being reviewed. Due to the holiday at the end of the year and the mental health rotation, it had been very long since I had seen patients having their chest listened to or their JVP checked. It was as if I had almost forgotten that these things could actually be done!

It was also refreshing that we didn't need to spend too long with each patient. For me, mental health was very draining, spending such a long time with each patient during a ward round.

In this rotation, apart from general medicine, there is more emphasis on learning on things such as falls, incontinence, reduced mobility, delirium and dementia. It was interesting to see some of the more functional tests in action too, such as the functional reach test and three minute walk test, while the standard neurological exams and eye exams were also performed to examine for potential causes of a fall.

I will have one more week in the geriatric medicine ward, then I will have a few weeks of palliative care, before my GP rotation.


There have also been sessions recently at the various hospitals advertising about scholarly selective projects that they want us to do. The scholarly selective is a research project during the first semester of fourth year MD at Melbourne. I am personally trying to look for some cardiology related projects and contacted a few supervisors, looking forward to meeting them. Some of them are in Austin though, which requires traveling by me from St Vincent's, which takes up considerable time. I haven't conducted any research before myself, so I am looking forward to this research semester next year.

GAMSAT 2014 Australia over. No new student intake until after end of year exams.

Today was the date for GAMSAT 2014. If you sat the GAMSAT this year, I hope you have done well. The results will be out in approximately mid-May, in 8 weeks.

I am planning to concentrate more on my studies, so I will not be taking on any new students for the GAMSAT or VCE until after my end of year exams this year. I'll also be required to do a medical student elective during the upcoming summer break, so my availability will be restricted on some days more than usual on holidays. I apologize for any inconvenience caused.

GAMSAT 2014 in two weeks!

The GAMSAT Australia 2014 is in two weeks time! If you were one of my tuition students, I have sent an email on some tips. If I have tutored you and you haven't received this, feel free to send me an email and I will send it to you.

Not too long to go now! Keep up with your studies and good luck for the test!

[update] two more weeks in mental health rotation

I have spent four weeks in the mental health rotation so far, with two more to go. Many of the doctors I have observed in the psychiatry rotation are very nice and seem to do a good job. However, I don't feel like this is the specialty for me.

In this rotation, we need to get a list of tasks signed off. This is proving to be quite annoying indeed. Many of these patient encounters are touch and go. However, I can understand the thinking of those making this list in wanting us to get a minimum amount of exposure to tasks.

Anyway, it seems like I have a mini-CEX next week and one the week after. I hope they go well. I'll probably give another update when this rotation finishes.

[update] MD3 2014: first day back. Mental health rotation.

Today was the first day back in medicine this year for MD3. My first rotation is mental health, and I was at the Austin today. I'm not sure exactly why that was the case, because I don't think I need to go back to Austin for the rest of this mental health rotating term, but I was required to go today.

It was the first time I drove from my home to the Austin Hospital. I was a bit nervous leading up to it because I never drove completely this way before, although a large portion of the trip was familiar from other travels. Nevertheless, I managed to find out where to go without major hassle. So that was good.

Since I was there, there were a few people I met who were not from my home clinical school, so it was a good experience to catch up with them all. I also enjoyed playing table tennis on the Austin clinical school table tennis table. It nice getting back into playing table tennis after this holiday break again, and I didn't feel too out of touch.

Needless to say, being the first day in the mental health (psychiatry) rotation, there were some psychiatry lectures. This is not one of my favorite topics, but I guess I'll just have to get through it. Other rotations this year seem more exciting, so I guess that's something to look forward to.

Back for another year of medicine study!


By the way, all of you who are intending to study for the GAMSAT, there's less than six weeks left until the exam. Go and prepare for it!

The role of common sense

I do some voluntary tutoring almost every weekend during the school term. It has opened up my eyes to how much the national Australian mathematics curriculum lacks rigor in primary school years, but that is not the topic I will be discussing about today. Recently, as the school year has just started in Victoria, there was a training session for voluntary tutors in the tutoring program I am in.

As part of the training session, we were discussing a few cases of imaginary students who had real or potential difficulties in their learning due to their backgrounds. In my case, the "student" I was required to discuss about on our table was in late primary school, and had trouble at school and in tutoring. Even though they willing to learn, they were easily distracted and seemed to lose concentration.

At discussing the case, I first listed the more specific things related to this student's background - namely that there could be deficiencies in their English ability and mathematical ability present, particularly if they did not come from a country using English and if their country did not have strong mathematics standards in their school. To counter this, the steps would be to explain clearly any mathematical terminology they did not understand, starting from the basics if necessary.

After this, I also listed a few other potential causes. I felt that it may have been a possibility that they did not have breakfast in the morning, or they did not have enough sleep during the night. So I suggested that if this was an ongoing issue, I should ask the student whether they had breakfast in the morning and how much sleep they got. I felt that if there was a simple solution to this problem, then it should rightly be solved.

Finally, I raised the unlikely possibility of a medical condition causing the lack of concentration, and said that if all the rest failed, the student may be advised to go to the doctor. This was a bit ill advised on my part. I now recognize that the action I suggested may have been reasonable for talking to an adult, but it is different because the student in question would not have been an adult. One of the other tutors on the table criticized my recommended intervention, and I accepted the criticism - perhaps I should not tell the student directly and it should go through the course coordinator.

However, after this, he also opined it is not the tutor's role to inquire on issues of breakfast and sleeping patterns - that some topics should be off-limits. While I did agree that some topics should be off-limits, particularly if they have nothing to do with learning, I definitely did not agree that issues of breakfast and sleeping patterns should be off-limits.

Yes. We are at the tutoring program primarily to tutor the students in the subject matter. However, the end result of this is for the students to perform well and gain confidence in their studies. Issues of breakfast and sleeping patterns are not what we need to teach, but if a student is lacking breakfast or good sleeping patterns, then addressing these issues has the potential of having a greater benefit than the supplementary teaching of school content done in the tutoring program. That is why I feel that these questions are relevant for students who cannot concentrate very well.

In some way, I could see where he was coming from. It is definitely "safer" to stick with what the tutor is "supposed" to do. Any deviations from the common practice is liable to be controversial. This is particularly the case in the litigious society of today.

On the other hand, I do think that common sense should prevail. Anything that can help with the outcome we want without too many side effects should be considered, whether or not it follows the usual "process". We should not be biased in what strategies to implement. The leader of China during the crucial "opening up and reform" period, Deng Xiaoping, once said: "do not care if the cat is black or white, what matters is it catches mice". This pragmatism is an excellent attitude to have even today.

EDIT to add: it seems like now the policy is to inform the coordinator. Perhaps this is the best approach. That way, the coordinator can advise the parents directly.